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Inspection on 29/04/09 for Bowburn Care Centre

Also see our care home review for Bowburn Care Centre for more information

This inspection was carried out on 29th April 2009.

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

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

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

Key inspection report CARE HOMES FOR OLDER PEOPLE Bowburn Care Centre Durham Road Bowburn Durham DH6 5AT Lead Inspector Clifford Renwick Key Unannounced Inspection 29th April 2009 09:30 DS0000061553.V375057.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bowburn Care Centre Address Durham Road Bowburn Durham DH6 5AT 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) 0191 377 8214 0191 377 8063 bowburn@guardian-care.com www.guardiancarehomes.co.uk Guardian Care Homes (UK) Limited Mr Keith Garside Care Home 80 Category(ies) of Dementia (44), Old age, not falling within any registration, with number other category (34), Physical disability (5) of places Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 34 Dementia - Code DE, maximum number of places: 44 2. Physical disability - Code PD, maximum number of places: 5 The maximum number of service users who can be accommodated is: 80 7th May 2008 Date of last inspection Brief Description of the Service: Bowburn Care Centre (Formerly Morgan House) is a purpose built two-storey building situated in the village of Bowburn on the outskirts of Durham. The home was registered 16th February 2005 with the Commission for Social Care Inspection to provide accommodation for 80 service users and provides residential and nursing care for older people The home is divided into 5 separate named units, Harvey, Tilley, Hutton, Low Main and Brockwell. To meet the collective needs of the service users the home accommodates. Sleeping accommodation is on both floors with service areas, communal lounges and dining areas located on the ground floor. There is a large courtyard garden for service users to sit in and enjoy. The home also have a separate day care facility that shares its main entrance with the home but is separate from the homes facilities once inside. Fees range from £434.50 - £702.00 per week. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 5 Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that the people who use this service experience good quality outcomes. The last key inspection of this service was carried out on 8th May 2008 and a random inspection was also carried out on 28th July 2008. Before the Visit. • • • • • We looked at. Information we have received since the last inspection visits. How the service has dealt with any complaints or concerns. Any changes to how the service is run. How the home has dealt with any safeguarding alerts The Visit. An unannounced visit was made on the 29th April 2009. During the visit we. • • • • • • • • • • Met with the people who are living in the home who are currently receiving a service and also spoke with the staff that was on duty. Held discussion with the persons in charge. Observed staff working practices. Looked at information about the people who are receiving support and how well their needs are met. Looked at other records which must be kept in relation to health and safety and staffing. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the home to make sure it was accessible, well maintained, safe and free of any hazards. We also gathered information from looking at, care records to assess how staff supports people with their assessed needs. We also focused upon looking at the records for 4 people who are currently receiving a service. We refer to this as case tracking. And this involves looking at all of the care records for a named individual. We told the operations manager and the person in charge what we had found. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 7 At the time of the visit there were 43 people living in the home. All of the units with the exception of Brockwell were being occupied. The remainder of the rooms are currently unoccupied. The people who live in this home prefer to be known as residents therefore this term of reference is used throughout the report. Following the inspection discussion was also held with the registered manager and information that was available during the inspection was provided. What the service does well: Discussion with relatives confirmed that they were satisfied with the services in the home and they also commented on staff stating that they were supportive whenever they visited. The manager acts upon comments made by residents and relatives to improve services within the home. The staff commented upon the positive changes that had been made in the home. Good opportunities are available for staff to receive training appropriate to their work. The home provides a good range of meals and is able to cater for people who have special dietary needs. Good records are available to confirm that people’s health needs are met. Robust recruitment procedures are in place to ensure that suitable staff is employed in the home. The building is clean and well maintained offering a pleasant environment for people to live in. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: The care plans should continue to be developed to include more information about the actions that staff is taking when there is a change in needs. There must be no gaps on the medicines administration records. And the records must show that if medicines have been offered and refused then a written explanation is recorded. During the working week/working day Monday to Friday. And when the manager is absent from the home. Appropriate arrangements should be in place whereby a person is designated as being in charge of the home. This person should be supernumerary from the nursing staff and should not carry out the combined role of nurse and manager while being responsible for the management of the service. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 9 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 10 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 Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A full pre-admission assessment of needs ensures that new residents are offered the right type of care at the home. Furthermore, residents are aware of what service they will receive, through the issuing of a written contract/statement of terms and conditions. Intermediate care is not provided at Bowburn Care Centre. EVIDENCE: The care file for a person most recently admitted to the home confirmed that a detailed assessment had been completed before offering this person a place in the home. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 12 And following admission a detailed review was being held with the homes staff and also the authority who arranged the placement to ensure that the person had settled into the home. Discussion with staff confirmed that they always receive sufficient information from the manager about any person who has been assessed to move into the home. The home carries out assessments once an enquiry has been made. The assessments documents are comprehensive and cover a range of areas that include moving and handling, pressure care, diet and nutrition and also identifying any risks that may be presented as part of the care process. In addition to the home carrying out their own pre admission assessment they also obtain an assessment from the placing authorities. Once a person has moved into the home a care plan is implemented which sets out how staff will support people with their assessed needs using information obtained from the assessment documents. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Though individual written plans of care require further development staff takes appropriate action to ensure that each residents health and social care needs are met. Medication is recorded and audited in a way that follows recognised good practice, however poor record keeping of administration of medication on the residential unit requires reviewing. This will ensure resident’s general health and wellbeing is being met. EVIDENCE: We looked at four residents care files and these include the written plans of care to assess what information was recorded. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 14 This process is known as case tracking and includes looking at all documented information in their care file, and all records that relate to residents health and welfare. Each resident has a written are plan and this offers advice as to how staff have to support residents. The file also confirmed how individual health needs are met and how use is made of community health professionals when required. Health records were clearly set out, easy to read and confirmed when people were seen by the doctor and the community nurse. They also gave a clear description of what care actions were taken by nursing staff. Care plans are much improved and are set out in a way that show what actions staff must take to support people. The care plans are evaluated on a monthly basis and this records whether any progress has been made or if there has been a change in the care needs. Evidence was available to confirm where there had been changes the care plan had been rewritten to reflect the new actions to be taken by the staff. However there were occasions for two people where changes relating to weight loss had not been addressed in the care plan. In addition to the care plans a range of other documentation is in use that is used as part of the care process. These include various assessments that cover nutrition, weight, and pressure care and continence management. Risk assessment documents are kept under review particularly for those people who have been assessed as being at risk of falling. And this has assisted in reducing the number of accidents/falls for those persons identified as potentially being at risk. Weight charts are in place and the records we looked at confirmed that these are being reviewed, some monthly and some two monthly. For two people the weight charts showed a consistent weight loss over a period of 5 months however the chart did not record whether this was a concern or an acceptable loss. Discussion with staff confirmed that there were no concerns in this area. This type of information should be recorded in the care plan as it would them make the records more clear. One person who requires continuous nursing support to prevent pressure sores developing has been provided with appropriate equipment to support them. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 15 In addition to this staff have implemented a care plan and monitoring charts that confirms regular positional changes are carried out. And also charts to monitor food and fluid intake. The family of the resident have been involved with the care plan and are fully supportive of the actions being carried out by staff. Information relating to peoples background and their particular interests are now being recorded in the care plan. Overall though the care plans are much improved since our last visits there are some further developments are needed. For example for one person who has been assessed as requiring support with continence management there are insufficient written records in place to demonstrate how this is being achieved. Appropriate systems of storage, record keeping and administration of medication are in place though the administration medicines records in the residential unit are unsatisfactory. For three people there were gaps on the administration records and no written explanation was recorded to explain if medication had been offered but refused, or if administration of medication had been overlooked. In discussion with the senior care worker in charge of the unit they were aware of these gaps on the administration records. Though an explanation could not be offered as to why this had not been taken up with the people responsible for administering medication on the days that medication had not been signed for. It was confirmed by the senior care worker that all staff who administer medicines have received various levels of training in the safe handling of medicines. The level of training varied from completing a short course by Boots the chemists or by undertaking a distance learning accredited course from a college. It is essential that all staff that is responsible for administering medicines is up to date with best practice and this should include receiving updated accredited training in the safe handling of medicines. The records of medicines administration were in good order on the nursing units and there were no unrecorded gaps. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 16 Observations made during the visit confirmed that good care practices were followed by staff when supporting people with their mobility and appropriate use was made of lifting equipment. Discussion held with families of residents who were present during our visit confirmed that the staff kept them informed of any change in health needs. The also went on to say that they were very satisfied with the care that was offered in the home. One person stated that they were pleased with how their relative had settled into the home and felt this was attributed to the support offered by the staff and the manager. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents lead fulfilling lifestyles through exercising choice and control over how they spend their day. People’s lifestyle is good with regular contact being maintained with relatives and friends and the residents receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. EVIDENCE: An activities coordinator continues to take an active part in developing a range of activities for the residents. Time is spent between all of the living units in the home so that every resident has an opportunity to take part in activities. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 18 And in addition to this residents can also use the day care facilities and join in regular planned activities that have been organised for the three people who come in for day care. The homes activities coordinator is using the day centre as an extra resource and links in with day centre staff so that all residents have improved opportunities to take part in activities. The activities continue to be personal centred in that they are planned around an individual and this has included pampering /manicuring sessions where people have an opportunity to have their hands massaged and nails manicured. An activity recording sheet is in place in each persons care file and this lists the type of activity that people have taken part in. In discussion with the residents they said that there is always plenty to do, they went on to say. “We play bingo on a Friday” “Watch films on the big screen television” “And take part in activities in the day centre” The residents also took part in a project in which they received an incubator and some eggs and during a period of weeks were able to observe small chicks hatching. In discussion with the residents they said that this had been very interesting as well as enjoyable. The enclosed garden that is accessible to all lounges is fitted with raised flowerbeds that are wheelchair accessible and this enables residents to use these if they wish. And an addition to the garden has been an aviary that contains birds. This has proven to be a point of interest for the residents and has encouraged them to make use of the garden. The activities coordinator still runs a small trolley shop whereby she goes around the lounges offering snacks, sweets and refreshments for residents. This has proven to be a popular event for the residents who said that this was a good idea especially if they did not want to go to the shops. Throughout the visit a number of residents relatives were visiting the home and they commented positively about the care being offered. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 19 They confirmed that there are no restrictions on visiting the home and staff always makes them feel welcome. They went on to say that they are always kept informed about what is happening in the home especially if their relative takes ill. Staff are relaxed with visitors and it was evident that they had established a good rapport with them. On relative that we spoke to said that they could not think of a better place for their relative to live in. They felt that staff had done everything possible to help their relative settle in to the home. Discussion was held with the cook about the meals being served in the home and how menus had developed since the visit. It was confirmed by the cook that all food products are now purchased fresh and the pre packed frozen meals that were in use during our last visit are no longer used. The menus in use and which are issued by the company run over a 4 week period and show 2 choices for each main course and dessert. The cook confirmed that he will also change a meal dependent upon a resident’s choice. For example some of the residents do not like lasagne so this is substituted for a mince dish that they enjoy. And similarly a creamed turkey dish has been substituted for lamb leg steaks. In discussion with the cook he confirmed that he was hoping to spend time with the manager so that the menus could be reviewed to include these changes on a permanent basis. The cook was aware of any special diets and nutritional needs for the residents as well as their likes and dislikes. For example one person has extra fortified drinks, milk shakes and smoothies to assist them with their nutritional needs. The manager ensures that the cook is informed of any special dietary needs. In addition to the cook there is also a person employed to assist in the kitchen and also to set up the food trolleys to go to each unit at mealtimes. This has had a positive impact on the catering service and has assisted in many of the improvements that have been made. In discussion with the residents they confirmed that the food in the home is very good. They particularly commented upon the cooked breakfasts stating that you could have anything that you wanted. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 20 Discussions with families also confirmed that they too though that the food was much improved and that a good range of meals were provided. Lunch was taken with the residents on the residential unit and this was a good experience. Tables were nicely set out with tablecloths and serviettes and condiments were on the table. The meal was hot, well presented and very tasty and this was commented upon by the residents, who said “it’s always nice”. Cold drinks were available throughout the meal and the meal was relaxed and unhurried enabling residents to eat at their own pace. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clear accessible complaints procedure gives residents and their relative’s confidence that they will be listened to and taken seriously. Furthermore it provides information that is effectively used to improve the service. The manager and staff have a good understanding of local adult protection procedures, which helps to ensure the protection of residents from abuse. EVIDENCE: Since our last visits there have been two safeguarding adult referrals made to the commission. Both of which were dealt with appropriately and involved other agencies that included social services and health representatives. On each occasion there was sufficient evidence to confirm that in each instance staff in the home had acted professionally at all times and their practices had ensured that people were protected from harm. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 22 The manager has continued to work closely with social services and the primary health care trust and this has been positive in resolving the concerns that were raised and dealt with under the safeguarding adult’s procedures. Discussion was held with the manager following the inspection as records of safeguarding training were not present during our visit and the manager had been on leave. This discussion confirmed that all staff has received safeguarding adults training at various times. The manager confirmed both verbally and in writing that induction training covers basic awareness of safeguarding adults. And following this safeguarding adults training is then ongoing for all staff. Close links have been formed with the Local Authority safeguarding officer who has visited the home 4 times in recent weeks to work with staff. Discussion held with the administrative officer also confirmed that they had recently updated a training list for safeguarding adults. In discussion with staff they were clear about the procedures to be followed to protect residents from the potential of abuse occurring. Written policies and procedures are in place to deal with complaints and the relatives spoken to say they were aware of these. Residents said they would complain to the staff if they had any concerns. The complaints process was on display and our knowledge of the service has confirmed that the manager and staff act promptly on any concerns or complaints that are made. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, well maintained and has a good range of facilities. This promotes a positive image for residents and furthermore ensures that they remain safe and well. EVIDENCE: All communal areas and a representative number of bedrooms were viewed in those parts of the home that are currently occupied by residents. From those bedrooms that were viewed it was evident that residents had been encouraged to personalise them. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 24 The building was clean and tidy and free of any noticeable defects or hazards and there were no unpleasant odours. The garden area is enclosed and is easily accessible for all people who use the ground floor living units. And has been designed with level walkways offering wheelchair access to all areas. The timber shelter, which is styled, on a Victorian/Edwardian bandstand similar to those that used to be in public parks makes a nice seating area. And the addition of an aviary of birds has added extra interest for the residents. There is also a greenhouse in the garden that is used by the gardener to grow plants for the home and this can also be used by any residents who express an interest. The garden provides a nice relaxing area for residents to sit in and for walking around whilst at the same time maintaining their safety. Discussion held with the maintenance/handyperson confirmed that every day there is ongoing maintenance work being carried out to ensure that the home is kept in good decorative order. He also confirmed that estimates are being received to paint all of the doors that are stained dark and currently showing signs of chipping and wear. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are sufficient to ensure that residents’ needs are met. Furthermore staff receives sufficient training to support them in their work, to ensure residents receive good quality care. Robust recruitment procedures are in place to prevent unsuitable people being employed. EVIDENCE: During the visit staff was allocated to work on each of the four living units. The four living units are referred to as Harvey, Hutton, Low Main and Tilley and are named after local mines that used to operate in the area. The staffing levels are sufficient for the number of residents that reside on each of these units. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 26 On the day of the visit a member of staff rang in sick at the last moment for both an early and a late shift but the person in charge was able to arrange appropriate cover. Since our last visit the home has employed a weekend administrative assistant and this has helped maintain the front reception service when people are visiting the home. Staffing records were not looked at for new staff who have been appointed as previous visits have confirmed that the home follow a robust procedure when recruiting people to work in the home. In addition to the care staff and the nurse who were on duty there were also other staff working that contributed to the daily running of the home. Such as catering staff, housekeeping staff, the gardener, maintenance worker, activities coordinator and the administrator. Discussion with staff confirmed that a range of training opportunities are available and a training matrix confirmed what training staff had received. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An experienced and qualified manager is in post, who ensures that the service is effectively run in the best interests of the residents; that they are safe and well cared for and their rights are safeguarded. However the management arrangements in place when the manager is absent from the home require reviewing. EVIDENCE: Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 28 At the time of our visit the manager was on holiday and the deputy manager had unexpectedly gone on sick leave. The service was being managed by a nurse who was also responsible for carrying out nursing tasks on the nursing unit. This nurse had worked the previous nightshift and was working for part of the day which resulted in them working a 17 hour shift. In discussion with them they said that this was not the normal practice and were due to a sequence of events some of which were unexpected. However there main aim had been to ensure the home had both management and nursing cover and therefore this long shift had been necessary. In the afternoon another nurse came on duty and took responsibility for the managing of the home and also providing a nursing service on the nursing units. During their shift they had to deal with a number of management tasks that involved attending a review with social workers, meeting with families and also arranging staff cover for staff that had rang in sick. This meant that at times they were not available as a nurse but operating as a manager. Also during the administration of medicines the nurse had to leave this to deal with other staffing matters that required their attention This situation was not satisfactory and in discussion with the nurse it was confirmed that there had been no supernumerary management hours allocated in the absence of the manager. In addition to this the staffing roster showed that for later in the week an agency nurse was being used. And as well as being the sole nurse in the home they would also be expected to manage the service. The nurse in charge at the time of our visit confirmed that when an agency nurse is used they would normally operate as the person in charge of the home as well as being responsible for carrying out nursing tasks. And one of the permanent nurses from the home would be on standby and accessible by telephone should there be any queries from the agency nurse. This arrangement is not satisfactory and in the absence of the manager and deputy manager particularly during the working week Monday to Friday then a person should be designated as being in charge of the home. And this position should be supernumerary as opposed to carrying out a dual role of both nurse and manager. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 29 We discussed this with the manager following our inspection who confirmed that under most circumstances there are appropriate management and nursing arrangements in place during his absence. And that the situation presented during our visit had been unavoidable and would be addressed. Discussion was held with the administrator who confirmed that they do hold small amounts of money on behalf of some of the residents. These were not looked at during our visit as previous visits have confirmed that satisfactory arrangements are in place. In discussion with the nurse in charge it was confirmed that good arrangements are in place for all staff to receive formal supervision from the manager. And that the manager is supportive towards staff. Staff confirmed in discussion that the home was nice place to work in and that the atmosphere had improved within the home. The manager has continued to works closely with GP practices and other health professionals in order to ensure that communication between them and the home remains good. Good relationships have alos been developed not only with health professionals but also with social services representatives and this has resulted in providing a good all round service to residents. The person employed to carry out maintenance in the home is also the designated fire marshal who carries out fire training with staff. And records are kept to confirm that staff take part in regular fire drills and also receive regular fire instruction. Accident records are maintained of any accidents to residents or staff and these demonstrated that staff takes appropriate actions if any resident has an accident. Following our last visit evidence was available to confirm that the home act upon the comments made by residents and their relatives. And this was evident with the major changes to how meals are now prepared and provided within the home. The manager was described by residents and relatives as “being approachable, easy to talk to and always willing to change things for the better”. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 30 Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 31 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 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 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 2 Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2)Reg ulation 17(1)(a)S chedule 3 (k) Requirement To ensure that people are being offered their prescribed medicines the manager must make sure that administration of medicines records on the residential unit are completed in accordance with the guidance issued by the Royal Pharmaceutical Society. (Immediate) Timescale for action 29/04/09 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 OP38 Good Practice Recommendations In the absence of the manager during the working week Monday to Friday. Steps should be taken to ensure that a designated person is responsible for the management of the home. This person should be supernumerary to the nursing hours provided. Bowburn Care Centre DS0000061553.V375057.R01.S.doc Version 5.2 Page 33 Care Quality Commission North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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