Inspection on 13/06/06 for Bosworth Court Nursing Home

This inspection was carried out on 13th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Bosworth Court Nursing Home 13/03/09

Bosworth Court Nursing Home 04/11/08

Bosworth Court Nursing Home 15/04/08

Bosworth Court Nursing Home 23/05/07

Bosworth Court Nursing Home 14/11/05

Bosworth Court Nursing Home 16/06/05

Bosworth Court Nursing Home 22/12/04

Bosworth Court Nursing Home 21/06/04

Bosworth Court Nursing Home 13/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bosworth Court Nursing Home Station Road Market Bosworth Nuneaton Warwickshire CV13 0JP Lead Inspector Lesley Allison-White and Keith Charlton Unannounced Inspection 13th June 2006 10:00 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 DS0000001891.V299789.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. DS0000001891.V299789.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bosworth Court Nursing Home Address Station Road Market Bosworth Nuneaton Warwickshire CV13 0JP 01455 290867 01455 292455 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) www.givecare.hotmail.com Dr Kumar Tripurari Prasad Mr Anthony C Marson Mr Stuart Smithers Care Home 47 Category(ies) of Dementia - over 65 years of age (5), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (5), Old age, not falling within any other category (47), Physical disability (5), Physical disability over 65 years of age (24) DS0000001891.V299789.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No person under 55 years falling within category PD may be admitted to the Home Service User Numbers No person falling within categories MD(E) or DE(E) may be admitted to the home when 5 persons in total in these categories/combined categories are already accommodated within the home. No person falling within category PD(E) may be admitted to the Home when 24 persons of that category are already accommodated within the Home No person falling within category PD may be admitted to the Home when 5 persons who fall within that category are already accommodated within the Home 14th November 2005 3. 4. Date of last inspection Brief Description of the Service: Bosworth Court is a care home registered for forty-seven residents of both sexes over sixty-five years of age. Its registration categories include mental health, older persons, physical disability and dementia. The home is situated in the historic town of Market Bosworth in Leicestershire and is within driving distance of Ibstock, Hinckley, Leicester, Coalville and Nuneaton. It is traditional in style and is situated on two floors, which are accessed by passenger lift. The home has two lounges and each lounge has a separate dining area. On the ground floor, there is also a large conservatory. The home is staffed twentyfour hours per day by trained staff and care staff. Outside the home is a garden patio area, which is accessible to residents both by foot and in wheelchairs. There is adequate parking at the care home, is situated on the main road close to tourist attractions such as Bosworth Field and Country Park, and also to shops, hotels and restaurants. The current range of fees is from £400.00 to over £450.00 per week. DS0000001891.V299789.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home was inspected against the Regulations as in the Care Standards Act 2000. This was an unannounced inspection, which took place over one day commencing at 09.10am to 4.05pm on Tuesday 13th June and again on Wednesday 14th June 2006 08.50 to 11.05am. The Registered Manager assisted with the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting four service users and tracking the care they received through review of their records, discussion with them, care staff and observation of care practices. This inspection report additionally addresses specific areas where requirements and/or recommendations were identified at the previous inspection. During this inspection a selected tour of the home took place and the inspectors viewed internal records, and care plans. The inspector’s spoke to residents, nurses, care and ancillary staff, a relative and GP. What the service does well: Residents generally spoke highly of the relationship they shared with staff members. The visitors spoken to praised the standard of care provided by staff. Staff spoken with was clearly committed to providing a good service to residents. Residents spoke highly of the standard of meals provided. Catering staff work hard to meet the individual needs of service users. Residents also praised the DS0000001891.V299789.R01.S.doc Version 5.2 Page 6 cleanliness of the home and the fact that it was odour free. This is a credit to the domestic staff. Most staff working in the home was friendly and took the time to talk to Residents when they were able. What has improved since the last inspection? What they could do better: Ensure that residents’ needs are identified and referred to the appropriate authorities for assessment for equipment. This will enable up to date care plans to be developed and will ensure staff follow them. For staff to be more proactive in ensuring that residents needs are met in the following areas :- to have their spectacles on, that their clothes are well mended. It was observed that a staff member was not respectful of a resident when she spoke with her in the lounge. Two other residents said that a small number of staff spoke curtly with them on occasions and this was upsetting for them. A number of residents said they could not always understand internationally recruited staff. A concern was raised again in relation to moving and handling of residents - in relation to the brakes not being used when assisting a resident. Please contact the provider for advice of actions taken in response to this DS0000001891.V299789.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000001891.V299789.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 DS0000001891.V299789.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an admission process, which identifies whether the home is able to meet the needs of the residents or not. EVIDENCE: There was evidence of assessments though these were limited in terms of residents social care needs, e.g. limited past histories, hobbies and interests sketchy. Discussed with the Registered Manager identified that assessments are being reviewed. Respite care was offered by the home but intermediate care was not (Standard 6). DS0000001891.V299789.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home meets individual care needs of residents, however individual assessments need to be improved in order to meet all their care needs. EVIDENCE: Residents had a care plan in place generally detailing how their care needs should be met. Overall care plans were of reasonable quality and content. They were routinely evaluated by a named key worker. The evaluation did not accurately reflect the changes seen on inspection of the individuals and there was no evidence regarding risk assessments. The property lists were not always done in the Care Plan’s seen by an inspector. Residents could not remember having a Care Plan though their signatures were seen on the plans. The Registered Manager said he would ask key workers to remind residents they had plans and they could view them if they wished. DS0000001891.V299789.R01.S.doc Version 5.2 Page 11 Residents were generally very complimentary of the friendly care they received from staff. However it was observed that a staff member was not respectful of a resident when she spoke with her in the lounge. Two other residents said that a small number of staff spoke curtly with them on occasions. The Registered Manager said this issue would be followed up with staff. A number of residents said they could not always understand internationally recruited staff. The Registered Manager said that further support could be provided to staff to assist with their communication skills. A concern was raised in relation to moving and handling of residents - the inspector observed brakes were not used on a wheel chair when assisting a resident. A resident said that staff did not always use the hoist when transferring to the wheelchair – they were lifted instead. The Registered Manager said this allegation would be followed up with staff. Footplates were not always placed out of the leg area and so were left resting against the back of a residents shin. Staff passed by failing to notice this small but significant detail, which would later cause skin problems if done regularly. A resident said that as there is a weekly visit from a General Practitioner (GP) and staff did not call the GP if residents were feeling ill outside this time slot. The Registered Manager said this was definitely not the case. He agreed to include relevant information in this residents Care Plan as to the circumstances when the GP would be called. The Registered Manager was asked to review the accident procedure as there was an instance where medical authorities were not alerted following a head injury to a resident. An inspector was able to speak to a visiting GP for the home. The GP confirmed that a doctor visited every Tuesday and would see anyone who was ill or terminally ill and on any other days as required. The GP explained that staff followed instructions there had not been any problems reported to the Surgery regarding medication errors etc and the staff at the home were always courteous and polite. The GP reported that feed back from the District nurses was also positive about the home. Discussions took place with care staff about their knowledge of care plans and all showed awareness of care plan contents. However it was noted that for one resident his glasses were still in his bedroom when he was in the lounge. An inspector also observed that buttons were missing on some resident’s clothes and unclean and stained trousers on one resident’s trousers. There were other examples of similar findings with other residents in the home. The Registered Manager said he would appraise staff as to be aware of residents needs to assist them with their quality of life. Medication records were inspected and were generally found to be well managed and recorded though there were some gaps. The Registered Manager DS0000001891.V299789.R01.S.doc Version 5.2 Page 12 said that staff was fully trained through the Nurse Adaptation Course and by Nurses in the home before they could issue medication. The Controlled Drugs (CD) cupboard was found to be unlocked on the first day of inspection. Money belonging to the home for emergencies was stored in the Controlled Drugs cupboard. The Manager explained that the unlocked medication cupboard was an error and he would look into it. He also said that he felt the storage of the emergency money in the Controlled Drugs cupboard was the most satisfactory place for it. There was a lockable key cupboard in the medication room it was suggested that this was used instead the Manager said that he would consider the suggestion. The Controlled drugs were checked and found to be satisfactory. The drugs stored in the fridge were checked although some discussion took place around the issue of some eye medications being stored on the trolleys when they state store at below 25 degrees centigrade and on a hot day this was not being done. A peg site swab taken earlier that morning was seen by the inspector in the afternoon in the medication fridge. On discussion with the Nurse it was sent immediately to the Surgery for storage by the homes handy person. DS0000001891.V299789.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home meets the identified social needs and the outcome is satisfactory for the residents. EVIDENCE: A number of residents said that there were not enough activities or outings. The residents in the upstairs lounge sat quietly many with no effective stimulation. The Registered Manager acknowledged that this is an area that needs to be improved – efforts had been made to recruit an activities organiser but this was unsuccessful to date - and it was agreed that a activities programme would be devised based on residents preferences, and would be sent to the inspector. Activities are provided one day per week with an arts/crafts class – this was observed by an inspector and residents said they enjoyed this activity. The Registered Manager said that also carer provides two hours, twice a week with activities such as dominoes. The indications were however that for residents DS0000001891.V299789.R01.S.doc Version 5.2 Page 14 there continues to be a general lack of stimulation other than the television. The last Inspection Report stated the home should provide a stimulatory environment in line with current good practice guidelines. It was recommended that support be obtained from an appropriate external source in training staff to provide a programme of activity, which is appropriate to the needs of those residents, accommodated currently. Residents said that staff welcomed their visitors. A relative was spoken to who praised the care given by staff and confirmed that he could visit whenever he wanted. General discussion with staff raised concerns regarding the flexibility of routines in the home in relation to when residents are expected to get up or go to bed. The Registered Manager said that staff should know this was the resident’s choice and he would be reminding them and recording preferred times to rise and go to bed in Care Plans. A resident said that he wished to have eggs for breakfast on a regular basis. The Registered Manager said that the GP had stated that having too many eggs was a health concern. However this restriction had not been agreed with him or outlined in his Care Plan. The Registered Manager said this would be carried out. Residents said the food was either good or very good. Lunchtime was observed. The meals were well presented and of good quality and at an appropriate temperature. This was sampled by the inspector. Residents who needed help to eat their meals were given help and both floors received their meals in good time and with a reasonable amount of time between each part of the meal. Food records did not always show a choice – the Registered Manager said that would be followed up. It was discussed that there appeared to be a high frequency of soup and sandwiches on the menu – the Registered Manager said there had been improvements in this area and he was looking for further choices to be offered. DS0000001891.V299789.R01.S.doc Version 5.2 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has robust procedures for dealing with complaints and protection this will ensure that residents are protected from abuse. EVIDENCE: Residents said that they would go to the Registered Manager if they had concerns and thought this would be sorted out. A relative spoken to also thought this was the case. Examination of the complaints procedure and associated records indicated that complaints are appropriately managed. A staff member spoken to was not fully aware of the correct reporting procedures for allegations /incidents of abuse in that she was not aware of external agencies such as the Commission for Social Care Inspection or Police. The Registered Manager said that a short procedural statement would be compiled and staff reminded of the full Adult Protection Procedure. DS0000001891.V299789.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a safe, hygienic and comfortable environment. EVIDENCE: Residents said that they liked their bedrooms, the home was kept clean and tidy and odour free. The accommodation inspected was generally in a good state of repair though a bathroom on the ground floor was being used as a laundry room and the bath was broken. The Registered Manager said there were plans to make one room a shower room and the bathroom to be brought back into use. Communal areas were overall clean and reasonably maintained. The first floor corridor area was dimly lit and the Registered Manager said that would be reviewed and action taken to deal with this. DS0000001891.V299789.R01.S.doc Version 5.2 Page 17 A work desk was located in lounge where some documentation was stored. The staff work on these documents when on duty. The Registered Manager has been advised to develop a risk assessment ensuring confidentiality is maintained. There was scrape damage to paintwork from wheelchairs, which the Registered Manager said was in hand to be dealt with. DS0000001891.V299789.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a robust recruitment procedure therefore protecting residents. EVIDENCE: There were comments received that staffing levels in the afternoon/evening were not sufficient to meet residents needs. A Registered nurse is on duty twenty-four hours per day; six care staff are on duty in the morning and four in the afternoon, which means two care staff for approximately twenty residents on each floor for afternoon (pm) periods. The Registered Manager recognised this and said he was to increase pm staffing levels. There is domestic cover six days a week. The Registered Manager said this would be increasing to seven days a week in the near future. Inspection of staff files identified that recruitment practice was satisfactory. Criminal Record Bureau checks and Protection of Vulnerable Adults checks (POVA first) checks were in place – the Registered Manager provided evidence of these sent from head office nearby. References brought by oversees staff are requested and received before employment commences, in order to prevent fraudulent references being accepted. DS0000001891.V299789.R01.S.doc Version 5.2 Page 19 Staff said they were due to receive training on dementia practice. Training files were inspected and indicated that staff had received training on Moving and Handling there was evidence of training. DS0000001891.V299789.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of residents. EVIDENCE: Comments received from residents and staff indicated they thought the new Registered Manager was good at managing the service. There was an acknowledgement from the Registered Manager that there has been no Quality Assurance system carried out this year to check the views on the service from residents, relatives, District Nurses, GPs etc. but this will be carried out. DS0000001891.V299789.R01.S.doc Version 5.2 Page 21 There are regular staff meetings, which are documented. The Registered Manager acknowledged that there have been no resident meetings but said there were plans to commence these to give residents a voice in the running of the home. There was also an acknowledgement that there has been no formal supervision of staff and this will be introduced and carried out on a regular basis. Generic risk assessments were not fully completed however the Registered Manager said this would be carried out shortly. Fire checks were done although they could be done on a more regular basis. Fire bell testing had been carried out on the required weekly basis. The Registered Manager said he was to review the fire risk assessment for the home with the Fire Officer in the following two weeks. It was identified in a bathroom and bedroom area that the water temperature was above the required level. The home undertakes a regular review of hot water outlets which is documented. Documentation sent by the home informed the Commission of Social Care Inspection (CSCI) that this has now been corrected. Resident’s money is managed by the home and their financial interests safeguarded. Two residents were identified to be private. The Manager has now provided evidence of other residents financial records which indicate that financial records are appropriately managed. DS0000001891.V299789.R01.S.doc Version 5.2 Page 22 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 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 3 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 3 DS0000001891.V299789.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 OP37 Good Practice Recommendations It is recommended that care plan evaluations are accurate and reflective of care needs as detailed in them. DS0000001891.V299789.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI DS0000001891.V299789.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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