Inspection on 18/07/08 for Bower Croft

This is the latest available inspection report for this service, carried out on 18th July 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bower Croft 18/07/06

Bower Croft 20/10/05

Bower Croft 04/05/05

Bower Croft 08/03/05

Bower Croft 03/11/04

Bower Croft 15/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Bower Croft Bower Croft 5 Bower Mount Road Maidstone Kent ME16 8AX Lead Inspector Helen Martin Unannounced Inspection 18th July 2008 11:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bower Croft Address Bower Croft 5 Bower Mount Road Maidstone Kent ME16 8AX 01622 672623 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) naba@blueyonder.co.uk Dr Mohottalalage Navaratne Mrs Chandra Kanthi Navaratne Mrs Chandra Kanthi Navaratne Care Home 18 Category(ies) of Dementia - over 65 years of age (18) registration, with number of places Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th July 2007 Brief Description of the Service: Bower Croft provides accommodation and support for up to 18 older people who have dementia. Resident’s bedrooms are on ground and first floors. A passenger lift and stair lift is available between the ground and first floors. A smaller stair lift assists residents with the steps to the second level on the first floor. All residents have single bedrooms. Most bedrooms have en-suite facilities. Bower Croft is situated in a quiet road a short distance from the centre of Maidstone; bus stops are nearby and a mainline railway station is in the town centre. Car parking is available at the premises. Residents, staff and visitors have access to a garden and patio area and, within the premises, to a lounge, visitor’s room and conservatory. Twenty-four hour support is provided with 2 members of staff (one awake and one asleep) on duty at night. Current fees for the home range from £425.35 funded by the local authority to £495.00 for a privately funded individual per week. Additional costs include hairdressing, toiletries, chiropody and personal spending. Full information about the fees payable, the service provided and the home’s Statement of Purpose and Service Users’ Guide are available from the Registered Manager. Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced visit took place on 18th July 2008 and included talking with the Registered Manager, two members of staff and some people who live in the home. Due to the nature of residents’ needs, some time was spent in observation. Some judgements about the quality of life within the home were taken from observation and conversation. Some records were looked at. A tour of the premises and garden was undertaken. The home returned a completed Annual Quality Assurance Assessment (AQAA) to the CSCI. Postal surveys were received from one service user, five members of staff, two care managers and one health professional. The above have been used within the inspection process and mentioned in this report where appropriate. Mostly positive responses were received in postal surveys. Additional comments included: ‘When (my relative) first arrived at the home (they) commented on how (they) felt … treated as someone special.’ ‘Before going into care my client was socially isolated and very confused. Staff helped (them) settle into the home.’ ‘(The home) provides a caring environment for their residents.’ ‘Residents appear to be contented.’ ‘The home is clean, tidy and odourless.’ ‘(They take) part in social activities.’ ‘(Their) memory has improved as (they) are now eating well and getting (their) medication appropriately.’ ‘(My relative had to go to) hospital with a fall and the staff commented on how well nourished she was.’ ‘All meals (are) freshly cooked.’ ‘…(a) weight chart (is) in place…(this) will be reviewed…then referred to (a) dietician if needs arise.’ ‘(A) risk assessment (is) in place (with a) care plan update regularly.’ ‘Staff appear to be willing and friendly.’ ‘When I reviewed (their) care (they) informed that (they are) very happy and (don’t) wish to go home.’ ‘(Any) shortfalls (in staff skills) (are) addressed by (the) manager through training.’ ‘(The service could be improved) by listening to service users, advocates and other associated professionals…’ Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 7 Care plans and risk assessments could better reflect that residents’ personal, health and social care needs are met. Residents’ quality of life may be enhanced by a review of their activities. The quality of life of one resident may be improved by a review of their room layout and dimensions. Improvements could be made to some written records and policies and procedures. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bower Croft DS0000023896.V367357.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 Bower Croft DS0000023896.V367357.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, 6. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are given the information they need before making a decision to move into Bower Croft. Procedures are in place to ensure that the home is suitable to meet prospective residents’ needs. EVIDENCE: Prospective residents and their representative receive written information about the service and facilities. There is a statement of purpose, service user’s guide and leaflet that give written information about the home. The Registered Manager assured the inspector that the gap left in the Service Users’ Guide for contact details of the CSCI was an oversight, which would be corrected immediately. Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 10 The Registered Manager stated that prospective residents and their representatives had the opportunity to look around the home before they decided to move in. The Registered Manager assesses prospective residents before they move in, in order to ensure that the home is suitable to meet their needs. This is recorded and kept in individuals’ care plans. Local and health authorities also undertake assessments for those residents who are funded by them; documentation was seen. Letters are sent to prospective residents confirming that the home can meet their needs. On the day of this visit it was observed that a representative of one prospective resident looked around the home and was given written information; discussions took place regarding assessment before admission with a care manager. The home has a four-week trial period for residents prior to a permanent placement to confirm that the home is suitable. Comments received in postal surveys stated that residents are treated with care and helped to settle into the home by staff. When this is agreed, the Registered Manager stated that all residents are provided with a written contract detailing their terms and conditions of accommodation. The home does not provide intermediate care and currently there is no respite care provided. Bower Croft DS0000023896.V367357.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are treated with respect and their privacy and dignity are upheld. Residents’ personal, health and social care needs are met, although these could be better reflected in care plans and records. EVIDENCE: Individual plans of care for each resident are developed from assessments undertaken prior to their admission to the home. These aim to identify the action required from staff to meet residents’ personal, social and health care needs. Three care plans were looked at. Documentation includes guidelines around health care needs, memory loss and cognitive issues, any challenging behaviour and social interaction. Notes are kept of the day-to-day support provided and regular evaluations of the information are recorded. There is also Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 12 information provided by local authorities and health care trusts. Individual risk assessments are included in care plans and identify hazards such as wandering, falls, scalds and choking. Comments received in postal surveys confirmed that care plans and risk assessments are in place and updated regularly. Documentation seen during this visit generally reflected the changing needs of residents, although one exception to this was the recording of mobility issues for one resident; the care plan needs updating and the risk assessment should be expanded to reflect the current use of a wheelchair and hoist. Another care plan includes guidelines for staff around infection control, although the risks involved are not recorded in a written assessment. Records seen confirmed that a range of health and social care professionals are accessed to support staff to meet residents’ needs including consultation and referral to medical professionals. Residents’ weight is monitored and recorded. The nutritional needs of individuals that need it are monitored closely by the home and charts are maintained for food and fluid intake and output; two examples were seen. The Registered Manager stated that these individuals have been seen by the GP, although not referred on to a dietician. Staff guidelines are included in these care plans but not in risk assessments. Comments received in postal surveys stated that the weight of residents is monitored and reviewed. A district nurse visits regularly to provide dressings and to assist with skin condition issues where appropriate; these visits are recorded. The last inspection identified that Waterlow charts, designed to measure the risk of pressure sores, were activated where a district nurse provided support for residents. It was noted during this inspection that although district nurses provided support for some residents; some were immobile and incontinent and one ulcer was present; care plans did not include wound charts or Waterlow assessments. The Registered Manager explained that they would review this together with district nurses to confirm that the appropriate documentation is maintained. A senior member of staff explained that hospital transport was usually used for a resident who had a hospital appointment. It was said that residents’ families would be invoiced if a taxi had to be used, as the home does not provide it’s own transport. Arrangements are in place for staff to manage residents’ medication; an easily monitored system is used. Comments received in postal surveys stated that residents were given their medication appropriately. Medication is stored appropriately in a lockable trolley secured to the wall. Administration records are completed appropriately after staff observe that residents have taken their medication. The Registered Manager stated that currently the home does not Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 13 keep medication that requires refrigeration. It was said that there are currently no controlled drugs, although a designated storage facility is available. Drugs taken on a ‘when required’ basis are also recorded in an additional book. Staff spoken with and the Registered Manager demonstrated a good understanding of when to administer ‘when required’ medication on an individual basis, although this information is not written down. Senior staff are responsible for medication and their signatures are recorded. These members of staff receive training. The Registered Manager stated that the training courses undertaken assessed their competence and that assessment for competence was also undertaken on an ongoing basis and recorded in supervision records. The home provides a written medication policy, although this does not include the need to keep any medication for 7 days after the death of an individual. The Registered Manager said that this was included in the guidelines from the Royal Pharmaceutical Society, which are available for staff to reference. Residents are treated with dignity and respect. During the visit, staff were observed to be kind and helpful, attend to residents’ needs in privacy and respond quickly when needed. Staff spoken with demonstrated a good understanding of individuals’ needs. Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are able to exercise choice over their lives within a risk framework. They enjoy contact with their family and friends. Residents’ quality of life may be enhanced by a review of their activities. They benefit from a varied and balanced diet. EVIDENCE: The routines of the home appear generally flexible. Staff spoken with said that residents could choose when to get up and go to bed and demonstrated a good understanding of the various habits of different people. It was stated that residents could choose whether to spend time in their rooms or in the communal areas of the home. It was observed at the time of this visit that Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 15 residents could walk about freely and spend time where they wished. The premises are suitable for this. Staff spoken with said that they supported residents with some one-to-one time every day by talking with them, spending time with them and/or supporting them with activities such as soft ball games, jigsaws and listening to music. A hairdresser visits the home weekly. It was stated that someone comes to the home once a week to provide exercise and motivation for residents; in addition a visiting singer comes every six weeks; residents enjoy this and sing along. The Registered Manager said that residents’ birthdays are celebrated. It was stated that the home provides a Christmas party and summer Barbeque for residents and their relatives and photographs of people enjoying the most recent events were seen. Comments received in postal surveys stated that residents take part in social activities. It was noted that staff had positive interaction with residents and provided them with encouragement. It was observed during this visit that the hairdresser was present and some residents enjoyed getting their hair done; staff spent time playing a spontaneous soft ball game with some residents. The television was on in the main lounge, although not all residents could see it and those that could were not all watching it. A chart is kept for recording residents’ activities; those seen contained many entries for manicures and watching television. Activities take place on a spontaneous basis; there is no planned programme of events. Residents keep in contact with their relatives and friends. Visitors are welcome in the home at any reasonable hour, one was observed at the time of the visit. There is a designated visitors’ room should this be needed. Residents are taken out by their relatives; the home does not provide organised trips out. It was mentioned that some residents are taken out for short walks along the street or helped to access the garden by staff. The menu is planned in advance and shows a variety of meals. Staff said that hot and cold options are available for all meals, including breakfast and supper. Comments received in postal surveys stated that all meals are freshly cooked and resident are well nourished. During the visit some residents were observed to be enjoying a hot snack in the dining room, whereas others were being supported and encouraged by staff in their rooms. The Registered Manager said that specialist diets could be catered for, although currently there are none needed. Dietary supplement drinks are provided via the GP for those Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 16 residents who need them. A diary is kept to generally record residents’ meals and choices, although this is not itemised for each resident. The Registered Manager explained that more detailed food and fluid charts are kept for residents with nutritional issues. Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The views of residents and their representatives are listened to and receive appropriate consideration. Residents are protected from potential abuse. EVIDENCE: At the time of this visit, residents were at ease talking and being with staff who listen to their views and concerns. Comments received in postal surveys indicated that residents are contented and happy. Staff demonstrated good levels of communication with residents. There is evidence that relatives and friends of residents are asked to give their views (informally and via questionnaires) about services and facilities. The Registered Manager confirmed that no complaints had been received, although the home has the facility to record these should this be the case. A written complaints policy and procedure is available for residents’ representatives. A file containing many letters of thanks and compliments was seen. Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 18 Procedures are in place, which aim to protect residents from potential abuse. The Registered Manager demonstrated an understanding of the protection of vulnerable adults. The home provides it’s own policy, although this does not include specific information regarding reporting procedures. The Registered Manager stated that this was not necessary, as they had obtained the Kent and Medway procedures from Social Services and ‘No Secrets’ documentation. Training issues are mentioned under the ‘Staffing’ section of this report. Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents enjoy living in a clean, comfortable, warm and homely environment. The quality of life of one resident may be improved by a review of their room layout and dimensions. EVIDENCE: The home is clean, well maintained, comfortable and an appropriate temperature. Communal facilities are well decorated and homely and include a lounge, dining room, visitors’ room and conservatory. The Registered Manager said that since the last inspection, some essential maintenance and refurbishment Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 20 had been undertaken. This included decorating the hallway and dining room ceiling. Four toilets have been completely replaced, retiled and refurbished. There is a small attractive laid out garden and patio area. Since the last inspection the pond has been covered appropriately and a gate has been installed to deter residents from an external fire escape. As the premises and outside area are secure, residents are able to come and go as they please safely. All residents have single bedrooms. Some are personalised by residents and/or their representatives. As the property is a converted older style house, bedrooms vary in size and shape. All bedrooms seen were attractively decorated and adequate for their purpose, although discussion took place regarding one room. The Registered Manager stated that this could be a difficult room because of its dimensions and layout. It was observed that this room provided a few items of furniture and space to move around was limited. There are enough bathrooms and toilets throughout the building. Most bedrooms have en-suite facilities. In one case two single bedrooms have a linked en-suite. Resident’s bedrooms are on ground and first floors. A passenger lift and stair lifts are available between the ground and first floors. In order to safeguard residents, all the external doors are alarmed, with the front door having a keypad lock. There is a staff call system in place. Hoists and bath hoists are available. Frames around toilets assist residents, although these would be safer if they were of the type that was not portable but fixed to the wall. All the radiators seen were the type providing a low surface temperature. The Registered Manager said that no pipe work was exposed. Hot water outlets are fitted with valves designed to regulate temperature to reduce the risk of scalding for residents. Temperatures are tested and recorded regularly; one outlet checked during this visit was an appropriate temperature to the touch. All the areas of the home seen were clean and tidy with no unacceptable odours. Comments received in postal surveys confirmed this. Some bedrooms have lino surfaces; most have carpets. The laundry room, although small was clean and tidy; there is a sink especially for hand washing. Since the last inspection the home has purchased a new washing machine with a high temperature and sluice cycle. The Registered Manager described how infection control was maintained. Clinical waste is disposed of appropriately. The registered manager assured the inspector that they would purchase nail clippers and files for individual residents before providing any more manicure sessions. Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from staff who understand and anticipate their wishes and needs. Residents are protected by an adequate number of appropriately recruited, trained, qualified and supervised staff. EVIDENCE: Staff spoken with were very committed to their roles and knowledgeable about residents’ needs. Staff observed at the time of the visit were confident and competent and managed all their required tasks without compromising the needs of residents. There were enough staff on duty to meet residents’ care needs at the time of this visit and staff spoken with confirmed this. At least three carers are on duty each day, with two at night, one awake and one asleep. The home employs a cook and a cleaner, who also work as carers; these duties are separated. The senior member of staff on duty is highlighted on the staff roster. This record contained all the relevant detail except the full name and hours worked of the Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 22 cook. The senior member of staff spoken with stated that this would be rectified directly. The senior member of staff spoken with explained that most of the staff who left last year were nurses from abroad, who on completion of their adaptation training, had moved to different jobs. The recruitment procedure in place within the home aims to ensure that suitable staff are appointed to meet the needs of residents. The Registered Manager described appropriate pre-employment checks. Files for three staff members were looked at and the necessary documents were present. An agency recruits many staff from abroad, most of whom are hospital-trained nurses in their country of origin. (Some will later undertake “adaptation courses”, when working at the home in order to obtain UK registration.) Police checks are carried out in people’s country of origin and in the UK. Work permits are obtained where necessary. The Registered Provider explained that after appointment, all new staff are provided with induction training. It was stated that the induction procedure complies with ‘Skills for Care’ guidelines. Induction records for newer members of staff were not available to look at. The Registered Manager explained that these were held by members of staff currently working through them. The home provides staff with an ongoing programme of training with that aims to meet the needs of residents. Staff spoken with confirmed that they had undertaken training in moving and handling, fire prevention, Dementia, medication, care planning, first aid, adult protection, infection control and nutrition. This is recorded in a staff-training matrix together with courses for food hygiene, health and safety, medication, diabetes, challenging behaviour and risk assessment. Staff spoken with stated that their training needs are identified in supervision. Comments received in postal surveys stated that any shortfalls in the skills of staff were addressed by the manager through training. Records show that most staff have completed most core training courses. The Registered Manager stated that there are updates in July and August. Training course certificates are kept in staff files. Staff spoken with stated they had recently completed their NVQ level 3 qualification. Written information about staff qualifications is contained within the home’s statement of purpose and in the office. The Registered Manager said that nine out of twelve staff currently hold or are working towards NVQ qualifications; three at level 2, two at level 3 and four at level 4. All staff including those with nursing experience and qualifications in other countries receive induction, ongoing training and the opportunity for NVQ qualification. Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 23 Staff spoken with mentioned that there is a good rapport with the Registered Manager and that they are always available. It is evident that the staff group works as a team and supports each other; there is ample opportunity during the working day to consult the Registered Manager or each other about any problems or concerns. Recorded formal supervision is currently provided for staff; individuals spoken with confirmed this and felt supported. Staff spoken with stated that their training needs are identified in supervision. Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37, 38. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents enjoy living in a home that is effectively managed and run in their best interests. The health, safety and welfare of residents and staff is protected. EVIDENCE: The Registered Manager is knowledgeable about the needs of older people with Dementia who require residential care. They are a registered nurse (RMN), have extensive NHS experience, have achieved the registered manager’s Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 25 award (RMA) and have additional qualifications in law and accountancy. The Registered Manager has many years of experience of running the home and are usually present on a daily basis. The Registered Manager explained that they were currently in the process of recruitment for a day-to-day manager for the home; it was hoped that this individual would eventually become registered with the CSCI, whilst the current Registered Manager undertook the Provider’s role only. The atmosphere is open and friendly and very much that of a family run service. Observations during this visit demonstrated a respect by staff for residents. Individuals are at ease speaking with and spending time with staff and the Registered Manager. The Registered Manager described the home’s quality assurance system. It was mentioned that surveys were last sent to residents and their representatives in January of this year. These requested feedback and comments on the quality of the service that the home provides. A file containing many letters of thanks and compliments was seen. The home returned a completed Annual Quality Assurance Assessment (AQAA) to the CSCI and this was used within this inspection process. The Registered Manager explained that the home does not sent their own surveys to health and social care professionals but relies on any sent by the CSCI for this purpose. Comments received in postal surveys indicated that people were happy with the service provided; only one stated that this could be improved by listening to peoples’ views. Issues regarding staff supervision have been mentioned previously under the ‘Staffing’ section of this report. Residents’ families and/or their representatives manage their finance. The Registered Manager stated that the home does not hold any cash on behalf of residents nor were they an appointee for any individual. It was mentioned that two residents hold small amounts of loose change, for which lockable facilities are provided. At the time of this visit an item of lost property was discussed. The Registered Manager said that they had tried to find the owner but would continue to keep it secure in case it was claimed. The home provides a range of written policies and procedures designed to provide guidance for staff. Samples were looked at. Records of accidents and incidents are recorded appropriately. Other records and some policies and procedures have been mentioned elsewhere within this report. A sample of documents and certificates seen at the time of this visit generally indicated the regular testing and maintenance of systems and equipment within the home. The Registered Manager stated that, although serviced, regular checks were undertaken for the staff call system, although these were Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 26 not recorded. It was said that the system was in full working order. Environmental risk assessments are undertaken and recorded. A written fire risk assessment is provided. The Registered Manager stated that the opening of all windows is restricted in order to reduce risks to residents. Storage for food and cleaning chemicals is appropriate. The Registered Manager stated that since the last inspection, the home has received a Four Star award for hygiene from the local council. Issues regarding staff training have been mentioned previously within this report. Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 27 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 2 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO 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 OP7 Regulation 15 Requirement The registered person shall prepare a written plan as to how the service user’s needs in respect of their health and welfare are to be met. The service user’s plan must be kept under review. In that, All care plans must be reviewed to ensure that all contain updated information and guidelines for staff, including the use of a wheelchair and hoist. Risk assessments must be recorded for all risks involved in the provision of care to residents in order to give staff clear guidelines; including infection control and nutritional issues. Timescale for action 01/09/08 Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 29 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 OP7 Good Practice Recommendations It is recommended that, with regard to care plans: 1. All risk assessments should be recorded in detail, including the use of a wheelchair and hoist, in order to provide staff with adequate guidance. 2. The Registered Manager should complete their stated intention to liaise with district nurses with regard to the appropriate recording of risk assessments for pressure sore prevention and wound care. 2 OP9 It is recommended that, with regard to medication: 1. Although staff are aware of when to administer ‘when required’ medication for each resident, this should be recorded. 2. Although contained within available guidelines from the Royal Pharmaceutical Society, the homes own medication policy and procedure should include the need to keep any medication for 7 days after the death of a resident. 3 OP12 It is recommended that the activities provided for residents should be reviewed in order to confirm that these are both adequate and appropriate for residents’ needs. Although contained within available guidelines from the local authority, the homes own adult abuse policy and procedure should include specific information regarding reporting procedures. It is recommended that a risk assessment should be recorded for the use of equipment and adaptations in toilets; this should show whether portable toilet frames (as used currently) or fixed adaptations would best minimise the risk to residents. DS0000023896.V367357.R01.S.doc Version 5.2 Page 30 4 OP18 5 OP22 Bower Croft 6 OP23 It is recommended that the dimensions and layout of one resident’s room should be reviewed to ensure that adequate furniture and space to move around is provided. It is recommended that the home include social and health professionals in their quality assurance system. 7 OP33 Bower Croft DS0000023896.V367357.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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