Care Home: The Boyne Residential Care Home

What has improved since the last inspection? This was the new Registered Providers` first inspection. What the care home could do better: The rota needs to be reviewed to ensure there are sufficient numbers of staff in the team to promote health and safety. Staff must not work excessive hours or days in a row. The home must ensure it is a safe place for people to live in. Water temperatures must be monitored on a regular basis, especially if there has been issues noted. Medication systems must be robust to ensure errors do not occur. Key inspection report CARE HOMES FOR OLDER PEOPLE The Boyne Residential Care Home 38 Park Way Ruislip Manor Middlesex HA4 8NU Lead Inspector Sarah Middleton Key Unannounced Inspection 26th May 2009 10:00 DS0000072314.V375600.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Boyne Residential Care Home Address 38 Park Way Ruislip Manor Middlesex HA4 8NU Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01895 621732 01895 678559 Hannah Cader Javed Zulficar Ali Cader Hannah Cader Care Home 25 Category(ies) of Dementia (25), Old age, not falling within any registration, with number other category (25) of places The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories Old Age, not falling within any other category - Code OP 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 25 First key Inspection under new Providers. Date of last inspection Brief Description of the Service: The Boyne is a large detached property that offers residential care for up to 25 older people. It is now registered to accommodate people with dementia. The accommodation is on two floors, with 7 single rooms on the ground floor and 18 rooms on the first floor (12 single rooms and 3 double rooms). The home now has 13 rooms with en suite facilities and has four assisted bathrooms and five toilets. There is a passenger lift connecting the two floors and the home offers facilities to people who are wheelchair dependent. The communal accommodation on the ground floor consists of a large open plan area with two lounges, one smaller and one larger with doors leading to the patio area of the garden. There is also a large dining area with separate tables. There is a large reception area and a separate telephone area. The rear garden has been grassed with paths and a patio area with seating. The front of the building offers parking for several vehicles. This is currently looking to be expanded. The property is situated on a main road close to Ruislip Manor shopping centre, buses and underground railway link. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 5 The home is owned and managed by the same person. The Manager’s husband is also the Registered Provider. The staff team consists of the Registered Manager, five senior carers, eight carers, one domestic staff, assistant cook and a cook. There is also an activities-co-ordinator. The care staff team work both days and night shifts. Fees range from £460-£650 per person per week. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection carried out on 26th May 2009 from 10am-5pm. Two Inspectors were present during this inspection visit. The Registered Manager (who will be referred to in this report as the Manager) and the Registered Provider, her husband, assisted with the inspection process. The Manager had completed an Annual Quality Assurance Assessment, (known as the AQAA). This document asks the Registered Provider and Manager to comment on how well the home is meeting the needs of the people living in the home and how well outcomes are being met. We received fourteen surveys from the people living in the home; some of these were completed with the help from either care staff or relatives. Two health professionals and eight members of staff also completed surveys. Samples of comments have been included into this report. During the inspection we spoke with five people who live in the home, four members of staff and four visitors. Not all of the people living in the home are to express their opinions but we were able to speak to five people who told us what it is like to live in the home. One person said that the staff were “marvellous” and that they had settled well into the home. They said the meals were very good; there was choice and more than enough to eat. Other people we spoke to were positive about the home and the support they received. As this was the Registered Providers first inspection the previous requirements, star rating and report were not taken into consideration at this inspection visit. We would like to thank all those who participated and contributed to this inspection. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 7 What the service does well: The staff team have worked hard to make significant improvements to the home. The Manager is aware of the need to ensure the home meets the needs of the people living in the home. Currently there is a mix of people, some with dementia and others who do not have dementia. The staff team are committed to working to support all the people in the home. There is good documentation in place in the home. This includes information about each person living in the home. The staff team are providing various activities and these are being developed further to ensure people are stimulated and occupied. The meal provision has improved with the Manager looking to make further changes to ensure people have choice and variety. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 & 3 were assessed. Standard 6 is N/A. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is provided for people who are thinking of living at the Boyne so that they are able to decide if they want to move into the home. Assessments are carried out before and after admission to ensure peoples’ needs can be planned and met at the service. EVIDENCE: We viewed the Service Users Guide and Statement of Purpose. The information was very detailed and lengthy and the Manager might want to consider how accessible it is for people to read and understand. However it was informative and gave a detailed insight into what to expect from living at the Boyne. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 10 We saw from the six files we examined that assessments had been received from the Local Authorities who refer people to the home. The home also has its own assessment procedure which includes a pre-assessment form. This form did not include questions about whether the person would have a preference in how they received personal care support, for example receiving care from a member of staff who is a different gender. This was raised with the Manager as it should be assessed and recorded in assessments and care plans. The Manager said that people’s families usually visited the home in the first instance, often unannounced, and said that people were encouraged to visit prior to admission so that they could see the home and meet other people and the staff team. We recommended to the Manager that Regulation 14 (1) (d) should be completed. This is relating to the home confirming to people that the home can meet their needs and clarifying the support that can be provided, should this be necessary. The majority of the people who returned a survey said that they had received information about the home prior to the move into the home. One visitor confirmed they were happy to have a relative living in the home. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 & 10 were assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and social care needs of people were recorded in detail and were being met. Arrangements for the recording of medication carried over each month could be improved to ensure the health and welfare of people is promoted. People are treated with respect and their privacy is upheld. EVIDENCE: We examined a sample of six care plans which all had comprehensive information about the people’s abilities and support needs. There was information on all areas of support, such as personal care, mobility, rest and sleep, nutrition and mental state. In addition, we saw a variety of risk assessments for manual handling, fire risk and bathing. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 12 The risk assessments viewed considered various aspects of the person’s life, such as, if they spent time in their rooms, then staff knew to keep a check on people to ensure they were safe. Body charts had been used to record any areas of bruising or other skin problems. Each file also had a Deprivation of Liberty assessment completed for both the Local Authority and for the home’s records. Each person has a key worker and the files contained a key worker report. The care planning files also contained signed copies to show that people had been given information about the home and had information about having keys to their rooms and lockable spaces. We found the care planning files to be very detailed and almost all areas of the person’s support needs had been considered. We recommended to the Manager that, in time, the care plans would benefit from being typed, both for ease of reading, and making them easier to review and amend. The Manager showed us a “life book” which she hopes to introduce for every person living in the home. This contained photographs and information about the person’s life, family and interests. The book was very well produced and families have been asked to provide photographs and details for them to be compiled. We thought that these would provide an excellent tool for staff to use to get to know the people in the home and for reminiscence. We found that people’s health needs were being met by community services. The records showed when referrals have been made for chiropody, dentist and opticians and other professionals as required. The Manager said she has referred people for NHS chiropody but the services are only generally provided to people with diabetes. Private chiropody is available. The home keeps separate records of medical visits, such as those from the district nurse, as well as all significant events. We found this to be useful and easy to follow and provided a comprehensive record to ensure that people’s needs were recorded and were being followed up as required. The home carries out a variety of assessments, including nutritional and dependency levels. They undertake regular weight checks and were seen to make referrals to health professionals and alert Social Services when a person’s health needs have changed. There were no specialist medical needs at the time of this inspection. General health needs were recorded on people’s individual files, such as oral assessments. The Manager confirmed there were no pressure sores in the home. We saw in the records that the home was regularly recording blood pressure levels. We reminded the Manager that the home is residential. Although some of the staff were trained as nurses in their own countries, they are working as care workers at The Boyne and need to ensure that they are working within these boundaries. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 13 The home has its medication in 28 day blister packs and is stored in a lockable medication trolley. We examined the medication for five people and found that the Medication Administration Record sheets and medication were satisfactory for four of the five viewed. On the fifth Medication Administration Record (MAR) sheet, the stock for one medication showed two tablets too many. The staff checked and found that this was because of the wrong number of tablets had been carried forward from the previous MAR sheet. We recommended that two staff are involved in checking when stock is carried forward. The staff said that the medication not stored in blister packs is checked on a daily basis. They also informed us that the “bulk” medication is also checked. We found that the home has a bulk supply of medication, such as aspirin and paracetomol, and this is not supplied in individual packets for the person needing this medication. We consulted with the Care Quality Commission’s Pharmacy Inspector who subsequent to the inspection spoke to the Manager on the telephone to clarify the situation about the bulk medication. The Pharmacy Inspector was informed by the Manager that the GP on his own initiative had written a bulk prescription for ten of the people on his caseload for the following four medicines Aspirin 75mg, Adcal D3, Lactulose and Paracetamol. The Manager informed the Pharmacy Inspector that all the packs are numbered when then are received into the home and they are used in number order and there is a stock count/reconcilliation twice a day at handover. Although this is an unusual practice, the Pharmacy Inspector stated that it does not contravene the Regulations. The Manager was asked to make sure she has a local policy/procedure with all the people and their medicines prescribed as bulk listed, together with the ordering and audit process so that there is clarity and no risk in these medicines being used for other people living in the home. It is recommended that this procedure is developed as soon as possible. Only the senior carers are involved in giving medication. Some have previous experience as nurses in their county of origin and there has been in-house training. The Manager said that she was also booking training with a pharmaceutical company and one senior was to attend a medication course in June. Staff who give medication had completed a medication test and these were due to be marked in the near future. The home was looking to hold “homely remedies” but said that this would be checked on an individual basis with the person’s general practitioner. The Care Quality Commission Pharmacy Inspector advised us that homely remedies should only be used for about 48 hours with the GP agreement for certain conditions like headache, cold, pulled muscle or similar. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 14 A survey completed by a health professional confirmed that they had seen carers respecting the person’s dignity and privacy. People can see their visitors in private if they want to. People were seen to be wearing clean clothes, which we were informed are labelled to avoid items going missing. The files viewed recorded if a person had a preferred name they wanted to be called by and staff were heard to use the preferred names. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15 were assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to take part in social activities. People are supported to maintain social contact with their friends and family. The home supports people to exercise control over their lives. Food in the home is varied and well balanced. EVIDENCE: The home has an Activities Organiser, who works six days a week. A new activities planner was in the process of being compiled by the Organiser and the Manager. We saw a number of activities taking place, including exercises, and some people were enjoying the music and dancing with staff. There was also a variety of music being played in the lounge and the dining room. They also have quieter activities, such as quizzes, painting and crafts. The dining room is also used for quieter activities. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 16 The Manager has purchased a number of resources, for reminiscence, including some for the people with dementia. The visitors we spoke to confirmed that they saw activities when they visited although not all of their relatives wished to join in. A recent outing had taken place, involving most of the people in the home, to a garden centre, which had been enjoyed. Photographs have been taken of all of the events which had been held under the new ownership, including St Patrick’s Day and St George’s Day events. A survey from a person living in the home commented that there were “plenty of activities” in the home. Overall the staff team have been pro-active in improving the activities on offer and are aware of the need for the whole staff team to engage in activities with the people living in the home. There will be differences amongst the needs, interests and capabilities of each person and the staff team are working hard to meet these needs. We met with four visitors, all of whom were very positive about the care and support the home provides. All said that their relatives were “looked after well” and they found the staff to be “friendly and approachable”. They were particularly positive about the cleanliness and freshness of the home. They confirmed that their relatives had been able to personalise their rooms where they wished to do so. A large board has been placed in the main entrance for relatives to see information, such as advocacy services, the complaints procedure, Service Users Guide and Statement of Purpose. The staff team have worked hard to make improvements to the home and there had been a significant number of visitors to the home on the day of the inspection. We saw on a sample of files viewed that people had been visited by a local church and that people can continue to follow their beliefs when they move into the home. The home also encourages people to have independent advocates if they do not have any family contact. We saw people were being encouraged to remain as independent as possible by carrying out small tasks, such as laying cutlery. People confirmed to us that they were able to go to their rooms if they wished to watch television or listen to the radio. The files viewed on a sample of people recorded that, where possible, people should be supported to do things for themselves. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 17 The people we spoke to said that they enjoyed the meals. The Manager said that they have changed the menu after consulting with people. Although we were told by the cook that salads were available daily, one person said that this was not so. The Manager said she was aware of this issue and would be looking to provide more varied salads. Surveys returned to us by the people living in the home commented positively on the meal provision in the home. The food is delivered, with meat and vegetables being delivered from smaller suppliers. The cook confirmed that there is a better choice of ingredients. Although there are no specific cultural needs in regards to food at the present time, the Manager said that they had been able to provide a special diet for a person staying for a short period of time. They currently provide for diabetic and gluten-free diets. We saw details of people with special needs or allergies recorded in the kitchen. The dishes of the day were displayed on a board and pictures of the meals are being added. The cook asks people what they would like for lunch and for the evening meal. Following comments by the Local Authority at their recent monitoring inspection, the home has introduced a buffet style breakfast. We observed the lunch and saw that carers assisted people to eat their meals in a patient manner. People were not rushed to eat their meal and were encouraged to focus on eating the food. We observed that people were offered more food if they wanted it and were given a choice of drinks with their meal. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 16 & 18 were assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that their complaints would be listened to and acted on. There are procedures and systems in place to protect people from abuse. EVIDENCE: The home has had one complaint since the new Providers bought the home in December 2008. We saw that the Manager had addressed the concerns raised and that the matter had been resolved. We advised the Manager to develop a complaints record. The record can provide an accurate picture of complaints raised and can assist the Manager if there is a pattern to any of the complaints made. The Manager showed us a new pictorial complaints procedure. Every person who completed a survey said they knew who to speak with if they were unhappy and how to make a complaint. Those visitors asked also confirmed that they would speak with the Manager if they had any concerns. There have been no adult abuse allegations made, (known as safeguarding). The Manager has a pictorial abuse procedure in place and has a copy of the Local Authority’s policy on safeguarding. We discussed with the Manager the new version of the Department of Health’s No Secrets document that is due out in 2009. She agreed to obtain a copy when it becomes available. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 19 In house training had been provided to the staff team and we advised the Manager to consult with the Local Authority to see if they also provided training on this subject. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26 were assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is well maintained and clean. EVIDENCE: There have been changes made to the layout downstairs. There is now a new small office where people’s files and medication is stored. This is a room near to the lounge. We were informed that many of the bedrooms had been decorated and new carpets were in these rooms. The Manager is keen to continue to make improvements to the home. Some people have agreed to have their photos placed on their bedroom doors, whilst other people did not want this. The Manager was aware that she needed to respect the choices people made. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 21 We briefly met the domestic cleaner. She has worked in the home for approximately two years and is the main cleaner working six days a week. She said she was able to keep the home clean and tidy. The home was observed to be clean and free from any odours. Surveys confirmed that people felt that the home was comfortable and kept to a good standard of cleanliness. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30 were assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A review of the numbers of staff working in the team should be looked at, as some staff are working long hours and several days in a row. The recruitment checks protect the welfare of the people living in the home. Staff are receiving relevant training and are supported by regular supervision sessions. This enables them to work to a high standard and deliver good care. EVIDENCE: We spoke to a number of staff, three in private. All were positive about working in the home, and all said that there was “good teamwork” in the home and they received good support. Surveys completed by a sample of the staff team commented positively about the support they receive from the Manager. They also stated that they get feedback on their work and that the Manager suggests areas where they need further training. Overall the staff team commented that the home had improved and provides a “good standard of care”. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 23 We viewed the rota. In the morning shift there is a senior carer and four carers, plus the activity organiser. The afternoon shift has a senior carer and two carers, with another carer coming in at 4pm-10pm. At night there are two waking night carers. The Manager explained that all care staff work both days and nights. We saw that for one carer they were working on the rota for eight days in a row, one of which was a long day (working an early and late shift) and another of these shifts was a waking night. This was discussed with the Manager as, regardless of the previous week’s working hours, a member of staff should not be working that amount of hours without a day off. Another member of staff was on the rota as working eight days in a row. Two of these days were long days and again this is unacceptable. The Manager informed us that she had recently recruited a new member of staff. There must be enough care staff working in the team to cover all the shifts needing a senior carer or carer to ensure that health and safety is not compromised. The majority of the staff team have either obtained an NVQ or are in the process of studying for this qualification. Many of the carers have obtained an NVQ 2 or 3 and five carers are studying for an NVQ level 4. The Manager is keen to ensure the staff team have the necessary skills and knowledge to work in the home. We viewed four staff employment files. Where applicants had little employment history, then the Manager had obtained a reference from the College or educational organisation. All appropriate checks had been carried out. Some files had a separate health declaration form completed, whilst others had detailed their health record on the application form. The Manager should ensure applicants complete all the documentation the home needs to hold on file. Many of the care staff working in the home are from abroad and therefore there could be difficulties in obtaining references. This needs to be considered by the Manager to ensure she has obtained recent and relevant information about the applicant. Some of the carers have come through via a College and are working forty hours a week. Twenty of these hours are seen as working towards an NVQ qualification. We viewed the induction and training the staff team receive. The home accesses training through a variety of ways. Some is provided in-house, for example through workshops and discussions or by accessing external trainers such as the Local Authority. We saw that inductions were on all of the four files viewed. Staff in the surveys confirmed they had received an induction and that they attended training. Those staff who we met said they had been offered the opportunity for training and said that trainers came to the home and they were also able to attend external training courses. They all had a good understanding of safeguarding adults’ procedures. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 24 The Manager showed us the individual training records that she would be introducing to record each member of staff’s attendance. We were given a copy of the overall training record of the staff team. Overall staff had received training from the new providers and this should continue to ensure people are supported by a competent and skilled staff team. We saw confirmation that the staff team had received regularly one to one supervision with the Manager. This formal support is important as the home goes through this period of change. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 & 38 were assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manager is providing clear leadership throughout the home with staff demonstrating an awareness of their roles and responsibilities. People are protected by the home’s robust financial procedures. The maintenance checks of the hot water need to be improved so that people are not placed at risk. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 26 EVIDENCE: The Manager has the Registered Managers’ Award and has been managing the home for the past six months. We found significant improvements to the home and we commended the Manager for the hard work the Management team and staff team had achieved over the past few months. The staff surveys commented positively on the support they receive from the Manager and visitors also spoke highly of the Manager and that the staff team were considerate and approachable. We spoke to the Manager about how she will be assessing and reviewing the care being provided in the home. She explained that surveys have been given out to people. We discussed with the Manager the benefit in developing a short report each year outlining the work the home has been doing to improve the service and areas still to be addressed. At present, the Providers manage only people’s personal allowances for small sums for hairdressing, chiropody, newspapers and toiletries. One person is able to manage their own money. Families generally bring in money for the each person and are asked to sign for this. Withdrawals are signed by one of the Providers and another member of staff. We checked the cash held for three people and found it to be in order. The Manager said that they would be opening a separate account for a person whose money had been managed by the home’s previous Provider. We examined the home’s health and safety files. We found that the home has a fire risk assessment dated February 2009. In the care planning files, there were individual assessments in regard to evacuation. We recommended that the information is incorporated into the fire risk assessment so that there is clear information about the number of people who would need to be evacuated and the problems that might be encountered. This should assist with ensuring that the precautions are sufficient. Staff have had training in using the equipment to move people from the first floor without using the lift. We saw details of three recent fire drills. The fire alarms, emergency lighting, alarm calls system, and hoist had all been serviced in May 2009. Certificates were not yet received for recent Legionella and small electrical appliance testing but the Provider provided us with the information to show these had taken place. We found that staff were observing good health and safety practices by keeping fire door shut. We found the hot water in the bath and the wash basin, in one bathroom, to be very hot. The Provider adjusted the bath and this was satisfactory. The wash basin required further adjustment. This room needs to be locked until this issue is resolved. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 27 The Providers said that the problem had followed recent work by a plumber. Subsequent to the inspection the Manager confirmed that the plumber had adjusted the hot water thermostat setting in the boiler house plant. The water must continue to be carefully monitored to ensure residents are not placed at risk. The hot water temperatures have been checked regularly and we saw evidence of this. Staff also check the water before baths are given and we saw recordings of this. The London Borough of Hillingdon Environmental Health visited in May 2008 and gave the home a 3 star “good” rating for food hygiene. We saw three areas where there were no radiators covers, in areas where people might be at risk, and discussed with the Manager the need to have these made safe. Subsequent to the inspection we were sent evidence that the radiators had been covered and one radiator had been removed from outside bedroom nine. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement Timescale for action 01/07/09 2. OP27 18(1)(a) 3. OP38 13(4) The Registered Manager must ensure that there are systems in place so that the medication stock is carried forward accurately to the next Medication Administration Record sheet. To ensure people are supported 01/07/09 by an effective staff team, staff must not work excessive hours or days in a row without taking a day off. The health and safety of people 05/06/09 must be protected. Therefore the excessive hot water issue in the first floor bathroom must be addressed. The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations Pre-admission assessments should consider whether a person has a preference for receiving personal care. E.G receiving care and support from staff who are either gender. It is recommended that the Manager writes to the person and their representative confirming they can offer the person a place to live and outline any specific requests or needs agreed at the time of offering a place. The home should have in place a clear procedure outlining the details of the people who use the bulk prescribed medication and how this is monitored and checked to ensure no one else living in the home receives this medication. 2. OP3 3. OP9 The Boyne Residential Care Home DS0000072314.V375600.R01.S.doc Version 5.2 Page 31 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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