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Inspection on 04/11/08 for Bosworth Court Nursing Home

Also see our care home review for Bosworth Court Nursing Home for more information

This inspection was carried out on 4th November 2008.

CSCI found this care home to be providing an Poor 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

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:   zero star poor 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: 0 4 1 1 2 0 0 8 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. the things that people have said are important to them: They reflect 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 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 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 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Dr Kumar Tripurari Prasad,Mr Anthony C Marson care home 47 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 admitted to the home when 5 persons in total in these categories/combined categories are already accommodated within the home. Date of last inspection Care Homes for Older People Page 4 of 26 Over 65 5 5 47 24 0 0 0 5 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 26 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: zero star poor 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 included a visit to the service. We (the CSCI) visited Bosworth Court on the 4th November 2008. The Registered Manager, Stuart Smithers, and the deputy manager and staff in the home helped us during the visit. Two inspectors visited the home, one arriving at the service at 7.30am and the other arriving at 10.00am. Both inspectors finished the inspection at 4.00pm. 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 the people who live in the home, Care Homes for Older People Page 6 of 26 - talking to staff and management, - watching how people are given support, - looking at records. We also 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. As well as this, we looked at information that had come to our attention since the last key inspection in May 2008. We spoke with five people who live at Bosworth Court during our visit. People told us that staff were good and helped them. One person said staff are brilliant. Another who had recently arrived at Bosworth Court said staff have been very kind, and helped me settle in. None of the people spoken with had any complaints about attitude of staff, however three commented on the lack of availability of staff. One, who uses a wheelchair, said I sometimes get up and walk because I get fed-up waiting for them to come and help me. Another, when asked what do you do during the day replied what Im doing now, just sitting here. The third said they would like to play more dominoes and cards but the staff dont have the time. We spoke with nine members of staff during our visit to the home who told us about working in the home and gave us their views. They all were very positive about working at Bosworth Court and wanted to provide excellent care to people living there, however many of them said there was not enough staff available for them to do as much as they wanted to ensure that people living at Bosworth Court had a good quality of life. Their comments were, We havent got enough staff and had the training to deal with dementia - we could do with an extra carer on duty at night who can support those that wander. I just dont feel I have the time to sit and talk to people. I would like to have more time to spend with residents. We should have more nurses- mistakes can happen because nursing staff are easily distracted. 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. What the care home does well: What has improved since the last inspection? What they could do better: Medication must be administered safely. We found errors in the recording of medication, the storage of medication, and one example of poor clinical practice. Staff must have a clearer understanding of how to safeguard people who live at Bosworth Court. We found some staff were not fully aware of practice, policies and procedures that protect people at the home from abuse. We saw that the environment does not fully support people living at Bosworth Court who have dementia. The service would benefit from having the environment audited by a dementia specialist to help improve the quality of life of people living at Bosworth court with dementia. Care plans were not in place for every person we case tracked. The service must ensure that each person living at the home has a care plan to support their care and well being. Care Homes for Older People Page 8 of 26 Care plans should give as much emphasis to the social and emotional needs of people living at Bosworth Court, as the physical needs. We found that although plans had some information regarding emotional and social well-being they did not clearly show how staff were going to help meet the these needs. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 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 10 of 26 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 living at Bosworth Court have their needs properly assessed before moving into the home. Evidence: We case tracked a person living in the home who had recently moved in to Bosworth Court. We checked that they and their family had received information to help them with the choice of home, and the family said they had received enough information. We also checked that the person now living at the home had their needs properly assessed prior to moving in, to ensure that the staff at the home could meet their needs. Care Homes for Older People Page 11 of 26 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Aspects of health and social care practice at Bosworth Court are poor and could potentially put people living at the home at risk. Evidence: We checked the care plans of the six people living at the home who were case tracked. Five of the six people living at the home had care plans to support their care, but one did not. There had been sufficient time between the person arriving at the home and the inspection for a care plan to be devised, and the complex needs of the person meant that their care may have been compromised as a result of one not being in place. This was rectified on the day of inspection. The other care plans showed good detail regarding the support required by staff to ensure the physical health of people living at the home, and there was information to inform staff of the lives people led prior to living at Bosworth Court, but this did not sufficiently translate into action plans to ensure social and emotional well-being is fully supported. We checked the medication records, and found that not all were an accurate recording Care Homes for Older People Page 12 of 26 Evidence: of the administration of the medicines in the home. We saw one incident of poor practice with regard to the administration of medication. Staff were not aware that they were doing anything wrong, however on being informed of this, management said they would ensure it didnt happen again. We also saw that the instruction for the storage of one type of medication hadnt been followed. Continence pads are not put in peoples own rooms - staff said that they are stored in a cupboard - the reason they are not stored in the bedrooms of individual service users is that it would take ten times as long to help people if they were in their rooms. We spent a lot of time watching staff interaction with people living at Bosworth Court. We saw staff being gentle and caring to people as they got up and had their breakfast, and throughout the day. We observed the staff at Bosworth Court as trying their best to meet the needs of people living at the home, but that there wasnt enough of them to meet the complex needs of people living there. We observed that generally, people are treated with respect and their right to privacy was upheld. But when we asked if there was a quiet room to discuss the inspection we were taken to a bedroom of someone living at the home. This person was not using the room at the time, and does not use it during the day, however it was acknowledged by management that it was custom and practice for senior staff to use it occasionally as a quiet room to write up notes. We saw that it was already in use by a member of staff. Management accepted this was not appropriate and said they would stop the practice straight away. Care Homes for Older People Page 13 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities for people to take part in activities have improved, however daily life for many is limited by waiting for staff to be available to meet their needs. Evidence: Visitors are welcomed at Bosworth court and we were informed by one visiting family that they were usually made to feel welcome but sometimes staff were very busy, they said staff were very friendly and interacted well with residents. We saw breakfast and lunch being served. Staff are employed by the service to specifically support people who are unable to feed themselves. This was done with a great deal of respect, and maintained the dignity of people whilst they were being supported in eating. Two staff work a total of two and a half days between them to provide activities to people living at Bosworth Court. These include one-to-one activities such as walking around the garden, reminiscing with people, communal activities such as skittles, chair exercises and soft ball games. Other staff also try to provide activities for one hour each afternoon when it is quieter. Care Homes for Older People Page 14 of 26 Evidence: During the morning of the inspection we observed a number of people who live at Bosworth Court sitting in the lounges with nothing to do. We observed that staff were very busy meeting the physical needs of people living at the home and did not have the time to meet their social or emotional needs. We noticed that people living at the home have to wait a long time to get what they need. We saw three people living at the home who had not moved from the dining room area after eating their breakfast, and were still there when lunch was being served - they had not chosen to stay there. We observed one resident wait at least 20 minutes to be supported in going outside the home so he could have his cigarette. Staff told us they wished they had more time to sit and talk with people living at Bosworth Court, but the range of complex needs meant they were often unable to do so. Many people living at the home have some form of dementia, and although we found out that staff have been booked on a course to help them understand more fully how to care for people with dementia, there was at the time of the visit, not enough support being provided to meet these needs. We saw breakfast and lunch being served. Staff are employed by the service to specifically support people who are unable to feed themselves. This was done with a great deal of respect, and maintained the dignity of people whilst they were being supported in eating. The service has a 4-week menu, and we observed lunch being served. There was a choice of two hot dinners, both were well presented and looked appetizing, with good portions being served to each person. We saw that it wasnt clear to people what was on the menu, particularly those who had some form of dementia. Care Homes for Older People Page 15 of 26 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Safeguarding and recruitment processes are not sufficiently followed or understood to ensure that people who live at Bosworth Court are protected from potential abuse. Evidence: We saw the complaints record and found that complaints had been taken seriously. Verbal complaints had been noted, and the acting manager had written to the complainant to outline what she had done. We talked to staff to find out how much they knew about protecting people in the home from abuse. Although records showed they had received training about safeguarding adults from abuse, not all staff were clear about what constitutes abuse, and what the service should do if an allegation of abuse is made. We looked at the staff recruitment records to see whether all the proper checks had been made on staff before they started employment at Bosworth Court. We found records which showed two staff had started work at the home before management had received information from the Criminal Records Bureau (CRB) to help them reach the judgement that people were safe to start employment. We could not find any record which showed that the staff in question had been supervised whilst awaiting CRB clearance. We saw that staff were issued with a contract, and two written references were obtained before being offered work at Bosworth Court. Care Homes for Older People Page 16 of 26 Care Homes for Older People Page 17 of 26 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 safe and well maintained environment. The environment does not fully meet the needs of the increasing number of people living at Bosworth Court who have dementia. Evidence: We saw people at Bosworth Court living in a clean and well maintained environment. The furnishings in the communal area are homely, and people are encouraged to bring their personal possessions and have them in their bedrooms. We saw staff using specialist equipment to help people move around the home, and we saw staff being gentle when moving people with a hoist. Records show that the home is well maintained, and good measures are in place to control infection and keep the home hygienic. We did not observe much in the environment to support people with dementia, such as reminiscence areas, information boards, photographs, and tactile objects. Care Homes for Older People Page 18 of 26 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. There are many good training initiatives at Bosworth Court, but the staffing numbers and skill mix are not meeting the complex needs of people living at the home. Evidence: We saw that there are not enough staff on duty to meet the complex needs of people living at Bosworth Court, and we were told by staff and people living at the home that staff are busy and dont always have time to help people. We spoke with management and staff who told us that they had become increasingly aware of this and had planned a meeting scheduled three days after the inspection. This meeting was to look at how they could improve staffing to meet the needs of people living at the home. We found that staff have been on a number of training events to help update their practice on areas such as Moving and Handling, Fire Safety, Infection Control. We also were told by staff that they are going to be having training to help them with Dementia Care. We found that the service is training staff with a view to working with the Gold Standard Framework. This is a programme designed to improve the quality of care for all residents on admission to the home, to work more effectively with G.P.s and care teams, and to enable more people to die with dignity at home instead of being referred Care Homes for Older People Page 19 of 26 Evidence: to hospital. Care Homes for Older People Page 20 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management have good plans to improve the quality of life for people at Bosworth Court, but their plans have yet to impact on people with complex needs. Management have overseen poor practice in relation to recruitment checks and administration of medication. Evidence: Both the registered manager and the acting manager have the relevant qualifications to be in charge at Bosworth Court. We found that management are in the process of re-designing care plans to make them more accessible for staff and people living in the home, and have been up dating staff practice with a series of training events. We found that management were aware of the increasing needs of people living at the home and had begun to look at how they could improve the service, but improvements had not yet had an impact on the quality of life for those people at Bosworth Court. We heard from staff that management do listen and act upon their concerns, and we Care Homes for Older People Page 21 of 26 Evidence: saw evidence that management use different ways of finding out from people who live at the home and their relatives, what their views are about the care given at Bosworth Court and how they can improve. We were informed by staff that they felt appropriately supervised to do their jobs. We checked records of money transactions, and were satisfied that the service was managing the personal allowances of people living at the home well. Management are accountable for some of the poor practice that has been evidenced in earlier parts of the report. Care Homes for Older People Page 22 of 26 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 23 of 26 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 9 13 The provider must ensure 25/11/2008 that staff follow the correct procedures for the administration, storage, and recording of medication. Poor practice can put people who live at the home at risk. The provider must ensure that staff do not commence employment prior to the receipt of their Criminal Records Bureau disclosure. Under exceptional circumstances they can be employed after a POVA first clearance, but with documented supervision arrangements. To protect people living at the home from staff who may not be safe to look after vulnerable people. 25/11/2008 2 18 19 3 18 13 The provider must ensure staff at Bosworth Court know what constitutes abuse, and abusive practice 25/11/2008 Care Homes for Older People Page 24 of 26 and what procedures to follow if they suspect abuse has taken place. To safeguard people living at the home from poor and abusive practice. 4 27 18 The provider must ensure 31/12/2008 there is sufficient staff on duty throughout the day and night to meet the complex needs (including emotional and social) of people living at Bosworth Court. This will improve the quality of life for people living at the home. 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 7 Care plans should give more consideration to the emotional and social needs of people living at Bosworth Court, in particular those who have some form of dementia. The provider should undertake an environmental audit of the home to determine how the service can best meet the needs of people living at Bosworth Court who have dementia. 2 22 Care Homes for Older People Page 25 of 26 Helpline: 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 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 © (2008) 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 26 of 26 - 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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