Inspection on 13/03/09 for Bosworth Court Nursing Home

This inspection was carried out on 13th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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 13/06/06

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 06/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bosworth Court Nursing Home Station Road Market Bosworth Nuneaton Warwickshire CV13 0JP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Fiona Stephenson     Date: 1 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Bosworth Court Nursing Home Station Road Market Bosworth Nuneaton Warwickshire CV13 0JP 01455290867 01455292455 managementteam@givecare.co.uk www.givecare.hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr Kumar Tripurari Prasad,Mr Anthony C Marson care home 47 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 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 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 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 Care Homes for Older People Page 4 of 27 Over 65 5 5 47 24 0 0 0 5 admitted to the home when 5 persons in total in these categories/combined categories are already accommodated within the home. Date of last inspection Brief description of the care home Bosworth Court is a care home registered to provide care and accommodation for up to forty-seven people, both men and women. The home is registered to provide care for people who have needs relating to mental health, becoming older, physical disability and dementia. The home is situated in the historic town of Market Bosworth in Leicestershire. It is situated on two floors, and there are stairs and a passenger lift to enable access. The home has two large lounges and each lounge has an adjoining dining area. On the ground floor, there is also a large conservatory. Outside the home there is an enclosed garden patio area for residents use. The home is staffed twentyfour hours per day by trained nursing and care staff. The home is situated on the main road close to attractions such as Bosworth Field and Country Park, and also to shops and restaurants. At the time of this inspection the weekly fees ranged from £450 to £850 per week. A copy of the last inspection report was available at the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection took place on Friday 13th March 2009. We (the CSCI) arrived at Bosworth Court at 9.15am and finished the inspection at 4.50pm. The inspection was unannounced, this means the service was not aware that we were coming. The main method of inspection we used was case tracking. This means looking at the care given to people in different ways. We did this by, - talking to people who live at Bosworth Court and their visiting relatives and friends, - talking to staff and management, - looking at records. Care Homes for Older People Page 6 of 27 We looked at the Annual Quality Assurance Assessment (AQAA). This is a document the provider (the person who owns the service) sends to us at the CSCI, and it tells us what the provider thinks about the service they deliver to people who live at Bosworth Court. We also looked at the surveys called Have your Say About... which are sent out to people who live at Bosworth Court, to those who work there, and to Health Care Professionals who are in contact with people who live at the home. We received seven responses from people who live at Bosworth Court, five responses from staff, and two from health care professionals. All seven responses from the people who live at Bosworth Court or their relatives, were positive about the care they received. Typical comments were: very happy with the care received food is excellent I am pleased with the home, all the staff are caring and kind. The bedrooms are immaculate. there are exciting new times ahead with new projects to enhance the lives of people with dementia...the training of all staff on Dementia has been a tremendous plus. The five staff who sent information back to us, again were positive about the care being provided to people, and felt supported in their roles. Two made comments about staffing. One said there is not enough staff on duty at night time, and another said when asked what the service could do better discipline staff who have too much time off work or who turn up late for work. The two health care professionals were satisfied with the care they saw being given at Bosworth Court. One said the acting manager does not seek advice from our service, however when suggestions have been made at individual clients reviews - the suggestions have been taken on board and acted upon as far as possible. The other said that the service responds well to the concerns of relatives and the doctors. We spoke with five people who live at Bosworth Court and six visiting relatives. We also spoke at length with six staff members, as well as the Acting Manager, and Registered Manager of the service. The people who live at Bosworth Court and the visiting relatives told us: we are all very please with the care X has been receiving, he has improved since being admitted the food is excellent, and the home is always very clean I am happy with the care my relative receives but there isnt enough staff the staff are very kind, I dont have the patience to do their job the puddings are lovely sometimes there isnt enough staff, the catch word here is in a minute. the food is adequate, theres not much of a hot meal at night, mainly sandwiches and cake the cleaner is top class Staff spoken with said : Staffing has improved, most of the time its better unless people phone in sick Generally I think people get well cared for here, but it might help if there were more staff the training has improved, things are coming together, the dementia training has helped us understand things better. the induction training was good there arent enough staff on during the early part of the night shift. We checked all the standards that the Commission for Social Care Inspection has decided are key standards during this inspection. The information below is based only on what we checked in this inspection. We have kept details about individual people out of the report to make sure we respected their confidences. Care Homes for Older People Page 8 of 27 What the care home does well: What has improved since the last inspection? New groups have been set up to improve the care of people living at Bosworth Court, and to plan for future service delivery. Membership of the groups include the management of the service, staff, and relatives of people who live at the home. Staff have received further training and supervision in the administration of medication. They have also received further training and supervision to ensure they are aware of how to safeguard people in their care. The administration of medication is now good, and staff are now aware of how to safeguard people who live at Bosworth Court. The care planning process has improved and continues to improve. All people living at Bosworth Court now have an up to date care plan with an up to date risk assessment. Care plans are also being improved to ensure that the social and emotional needs of people are catered for as well as their physical and health care needs. The service has given staff more time to provide one-to-one activities for people living at Bosworth Court, as well as arranging group activities. There are now two members of nursing staff on each shift at the week-end when before there was only one nursing member of staff per week-end shift. Registered Mental Health nurses have been employed to support the mental health needs of people who live at Bosworth Court and to provide support to those with dementia. All staff working in the home have received training to help them meet the needs of people living at Bosworth Court who have dementia. Relatives have also taken part in Care Homes for Older People Page 9 of 27 dementia care training. Some staff have received further training to support them in providing palliative care (care for people with life threatening illnesses). 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 set out 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. Care Homes for Older People Page 10 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 thinking of coming to Bosworth Court have the information they need to help them decide whether it is the right home for them. Evidence: We case tracked a person who had recently been admitted in to Bosworth Court care home. We saw that they had a written needs assessment in place. We talked to the person who had been admitted and their relative. The relative had spent time visiting the home before their family member had been admitted. They felt able to come at times when staff were not expecting them to check to see whether it would be suitable for their relative. We saw the RMN (mental health nurse) undergoing an assessment of this person, and was very thorough in ensuring all of the persons care needs, including social care needs were explored. Care Homes for Older People Page 12 of 27 Evidence: The AQAA sent to us by the provider, told us that people thinking of coming to Bosworth Court are given a service user guide, the Statement of Purpose, and can look at information about the home on the services website. Care Homes for Older People Page 13 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 living at Bosworth Court have their health and personal care needs met well. Evidence: We looked at the care plans of people who live at Bosworth Court and saw that these had improved since we last visited the home. The plans gave information not only about the health needs of people who live at Bosworth Court, but also about their social and emotional needs. The care people required was clearly documented and reviewed when their needs changed. There was also good risk assessments in place linked to their care plans. We looked at the administration and storage of medication. We saw that this again had improved since our last visit. We found no errors in the administration of medication, and we saw that the service now has good medication auditing procedures in place. Staff have received further training in medication management. We watched staff support people who live at Bosworth Court. We saw staff being respectful and treat people who live at Bosworth with dignity. We also saw staff and Care Homes for Older People Page 14 of 27 Evidence: people living at the home laughing with each other and enjoying each others company. Care Homes for Older People Page 15 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 daily live and social activities available to people who live at Bosworth Court has improved, and is now good. Evidence: We looked at the menu, talked to people who live at Bosworth Court, and watched people eating their meals. We saw that the service offers a good range of menu options during a four week period. The food is nicely presented, and people who have a soft food diet also have their food presented so they can distinguish between the different food groups on their plates. We saw that although every one eventually had their meal, there were people in the upstairs lounge who had to wait a while before there were staff available to help support them to eat. We saw a big improvement in the opportunities given to people who live in the home to take part in group or individual activities. We were told that the number of hours staff now have to support activities has gone up from 18 hours a week to 49 hours a week. We saw people who live in the home icing cakes, playing dominoes, and one resident was playing the organ and entertaining the others in the downstairs lounge. We were told by a visitor that there are less activities for those who live on the first floor of the home, and their relative used to be invited downstairs to take part in Care Homes for Older People Page 16 of 27 Evidence: activities, but this hadnt happened for a while. The service now has an activities forum and a relatives group to support the emotional and social needs of people who live at Bosworth Court. We saw more attention being paid to the personal histories of people who now live at Bosworth Court, to help staff in reminiscing sessions and in planning activity care plans. During our visit we saw six different sets of relatives visiting their family members who live at Bosworth Court. We were told they were able to come at any time during the day or evening. Care Homes for Older People Page 17 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 living at Bosworth Court are protected by good safeguarding and complaint processes. Evidence: We spoke with management, looked at the AQAA sent to us, spoke with staff, and looked at the training staff have had to ensure they understand how to protect people who live at the home from abuse. We found that staff know how and why it is important to report any allegations or suspicions of abuse, and that management know how to alert the relevant authorities. We saw that there had been one complaint made to the manager since the last inspection of the service, and that this had been responded to well. We were told by visitors that if they have any concerns relating to the care of their relative that staff and management act quickly to address their concerns. There have been no complaints made to the CSCI since the last inspection. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Bosworth Court live in a clean, tidy and well furnished environment. Evidence: We looked at the communal lounges and the bedrooms and bathing facilities of the people we case tracked. We found all areas of the home to be very clean and tidy, and one of the visitors to the home we spoke with said the cleaner is top class. We looked at the furnishings and found these to be of good quality. The home used to have an office desk and chair in each lounge area for the staff to use to write up reports. These have been removed and in doing so has created a warmer and more homely environment for people who live there. We saw that there are now orientation boards in each lounge area to help support people who live at Bosworth Court know the day and date, and any other information needed for the day. We saw some people who use the first floor lounge, struggle to get the attention of staff. We were told by one of the people who live at the home that she has to put her hand up to get attention. One of the relatives commented that there are no call bells in the lounge area for people to press and alert staff of their needs. They felt this would be particularly helpful during times when staff were not in the lounge area, so they could hear if someone needed assistance. Care Homes for Older People Page 19 of 27 Evidence: We saw the research that staff and management have done to look at how they can improve the environment for people living at the home, with particular emphasis on those who have dementia care needs. Options are currently being considered, and although there hasnt been the time to put them into action as yet, we found a real commitment from management to improve the environment for people with these care needs. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally, there is satisfactory staffing at Bosworth Court to promote the health, safety and wellbeing of people who live there. Evidence: We looked at the staff rota, talked to staff and management, and talked to people who live at Bosworth Court about their experiences of staffing in the home. We saw that in the day time there are more staff hours provided to support people in doing either group or one-to-one activities. We also saw that during breakfast and lunchtimes there is more support to help those who require assistance with eating their meals. On speaking with staff we were told that during the day there is usually enough staff as long as people do not go off sick unexpectedly. During our visit a member of staff had phoned in sick, and another had to leave early. This did have an impact on the lunchtime experience, particularly for those having lunch on the first floor. Management told us that they try hard to minimise the sickness levels of staff and the impact this has on people living at the home, but often they find out a person is going to be sick very close to the time they are due to be on duty. We heard from staff that they had concerns about the level of staffing at night time, particularly during the period 8.00pm to 11.00pm when people want to go to bed. We saw that there are four people in total on duty from 8.00pm through to 7.00am. We Care Homes for Older People Page 21 of 27 Evidence: were told that two staff are on duty on each floor, and if two staff are needed to support taking someone to bed, then there is no-one in the communal areas checking that those left in the room are safe. We looked at the complex needs of the people living in the home and the numbers who require assistance in getting to bed during this period. We also looked at the accident record for February 2009 and found that there were more accidents/falls during this period than at any other period of the day. We spoke with people living at Bosworth Court and visiting relatives. They all said that staff working at Bosworth Court were caring, and did their best to help people who live at the home. They said that they felt there could be more staff to help, and one resident said they should re-name the home in a minute. We saw that since our last visit, management have recruited an RMN (a nurse qualified to support people with mental health issues and dementia). The nurse has started work at the home, and has already been involved in training staff, and offering support to relatives about dementia care issues. We were told that two further RMNs have been recruited to further support people with mental health needs. Management have also improved the nursing levels at the week-end and there are now two nurses on duty during each shift instead of one. We looked at the recruitment records of staff and found that management had ensured that all the checks needed to be made, had been made to ensure the safety of people who live at Bosworth Court. We also saw that staff new to the service had received thorough induction training, and existing staff had been on an extensive training programme. This included training in medication management, dementia care, palliative care (care of people in the advanced stages of illness), and safeguarding adults. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management are working well in improving the delivery of care to people who live at Bosworth Court. Evidence: The management team have worked hard to improve the quality of care being provided at Bosworth court, and to meet the requirements set at the last inspection. The service is looking at focusing on dementia care needs and palliative care, and an Action group has been formed to look at how these services can be delivered well. Other groups have been formed in the home that comprise of staff and relatives. These groups look at fund raising activities, the provision of activities in the home, and dementia care support. A questionnaire was sent out to people who live at the home, and their relatives in December 2008 asking their views on the quality of care; and a further one is being sent out in April 2009. Care Homes for Older People Page 23 of 27 Evidence: During our visit, we saw staff use correct moving and handling procedures, saw good food hygiene practice and infection control measures. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 18 The provider must ensure there are sufficient staffing levels during the evening to support the health and safety of people living at Bosworth Court. Without adequate staffing levels it is more likely accidents and injuries will occur to people left unattended 12/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 22 The provider should consider installing call bells into the lounge areas so that the less independent resident can alert staff to their needs without having to compromise their dignity. The provider should continue to move forward on the plans to create an environment more suited to the dementia care needs of people living in Bosworth Court. 2 22 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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. 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