Inspection on 07/05/08 for Bowburn Care Centre

This inspection was carried out on 7th May 2008.

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

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

Other inspections for this house

Bowburn Care Centre 29/04/09

Bowburn Care Centre 10/05/07

Bowburn Care Centre 08/05/06

Bowburn Care Centre 06/04/05

Similar services:

The Highlands

Turret Villa Retirement Home

Moor House

Blenheim House

1 Lanark Close

Mendip House

Beaconsfield Court Care Home

Ann Charlton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Bowburn Care Centre Durham Road Bowburn Durham DH6 5AT Lead Inspector Mr Clifford Renwick Unannounced Inspection 10:00 7th & 8th May 2008 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bowburn Care Centre DS0000061553.V363878.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 Manager post vacant 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.V363878.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 10th May 2007 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 separate units 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. Fees range from £364.50 - £479.00 per week. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. Before the visit: We looked at: • • • • • • Information we have received since the last visits in May 2007. How the service dealt with any complaints & concerns since the last visit. Any changes to how the service is run. The provider’s view of how well they care for people. The provider in the annual quality assurance assessment (AQAA) submitted information to confirm what they are doing in the service. Information received from other professionals who use this service. The Visit: An unannounced visit was made on the 7th May and an announced visit on the 8th May 2008. During the visit we: • • • • • • • • • • Talked with people who live in the home and also staff who were on duty. Spoke to relatives of residents that were visiting at the time of the inspection. Held discussion with the Manager. Observed staff working practices. Looked at information about the people who live in the home & how well their needs are met. Looked at other records, which must be kept in relation health and safety and staffing. Checked that staff had the knowledge, skills & training to meet the needs of the people they care for. Looked around the home to make sure it was well maintained, safe and free of any hazards. Checked what improvements had been made since the last visit. We also carried out a survey on safeguarding adults and this involved us talking to staff, residents and the manager in order to obtain specific information in this area. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 6 We told the manager what we had found. The people who live in this home prefer to be known as residents therefore this term of reference is used throughout the report. At the time of the visit there were 33 people living in the home. The remainder of the rooms are currently unoccupied. What the service does well: What has improved since the last inspection? Since the last key inspection in May 2007 a new deputy manager has been appointed to build upon the senior management team. A gardener has been appointed and this has had a positive impact upon how the external amenity space has been developed for the use of residents. The garden has been designed in such a way that it offers a pleasant and stimulating environment for residents. Though not quite finished plans are in place for there to be a water feature, wind chimes and an assortment of fragrant plants. A new sensory room that is fitted with coloured lights and other stimulating features has been developed from what was originally a room used by the maintenance person. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 7 Due to its design and how it has been equipped residents use the room for relaxation and comments made by staff confirmed that this is a positive development within the home. The building though in need of personalisation on the three living units is well maintained, clean and free of any hazards. A good cleaning programme is in place to prevent any odour. Relatives are more involved with the home and the manager has encouraged them to be involved in social events in the home. The manager has ensured that there is always someone present in the main reception area so that there is always someone to greet visitors. Staff training has continued to be provided and this results in staff developing their skills to assist them with their work. The manager has ensured through a detailed action plan that requirements made in the last inspection report have been addressed. This has included putting in place a thorough assessment process for people moving into the home. Risk assessments that demonstrate how staff will support residents whilst at the same time maintaining their safety are now in place. The written plan of care (care plans) that set out how residents assessed needs are to be met by staff are improved and follow a better format. Though there is a need for these to be developed further a good start has been made. The manager has reviewed staffing levels in the home and has deployed staff across the three living units to ensure that there are sufficient staff to meet residents needs. What they could do better: Individual written plans of care for residents must continue to be developed in order that they contain enough information to show how staff are meeting residents assessed needs. They must demonstrate how those people who have needs related to mobility, hearing and behaviours that challenge are recorded in detail. In addition to this work must continue in developing the information about resident’s previous lifestyle and background. In order that the written care plans can be developed to show how staff will meet the residents social needs. This will assist staff in planning activities that interest residents and which are personal to them, Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 8 Secondary dispensing in which the medicines are removed from the packet supplied by the pharmacist and them placed into unnamed containers potentially places the residents at risk. Therefore this practice on the residential unit must be changed in order that the safety and well being of the residents is ensured. Work must continue on liaising with residents and their families regarding the complaints they have made about catering. Since the visit was completed written notification has been received from the company confirming that the frozen meals will now stop. And the home will be reverting back to the original 4week menu that was in place. Residents must be given the opportunity to have meals of their choice and preference that cannot always be accommodated at present due to how on ready prepared frozen meals are provided to the home. The manager should ensure that the dining room practices while serving meals are addressed as discussed within this report. The staffing levels within all three living units must be kept under review particularly on the afternoon shifts when there is a reduction in staffing numbers. In order to ensure that resident’s needs can continue to be met effectively. Training in safeguarding adults must be arranged for those staff who are new in post and who have not yet completed this training. This will ensure that are kept up to date with best practice. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 9 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.V363878.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 6 Quality in this outcome area is good. We have made this judgment using a range of evidence, including a visit to this service. Before anyone is admitted to the home a full assessment of needs is carried out. This helps to ensure that prospective residents are offered the right type of care at the home. Once an admission has been agreed written confirmation is given to the resident that their needs can be met in the home. Intermediate care is not provided at Bowburn Care Centre. EVIDENCE: The care file for the person most recently admitted to the home confirmed that the person making the placement and also the home had carried out a detailed assessment. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 11 The homes manager had completed the assessment and ensured that comprehensive information had been obtained in order to demonstrate how the home would meet this individual persons needs. A moving and handling assessment had been completed and this highlighted any preferences in how the person was supported and also what specialist equipment if any was needed. Assessments had also been completed on pressure care, diet and nutrition and also identifying any risks that may be presented as part of the care process. Work has commenced on building up a range of social information in order that staff have a better understanding of the persons previous lifestyle and background. The manager stated that this would assist staff in developing activities that residents like to take part in and also give staff a greater insight about the person so that the care services can be tailored to the individual. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, 9 & 10 Quality in this outcome area is adequate. We have made this judgment using a range of evidence, including a visit to this service. Each resident has a care plan that sets out how individual assessed needs are to be met by staff. However further work is required to ensure that staff follows consistent practices to meet residents needs. Resident’s health care needs are identified through assessment and observation, and areas such as pressure care and falls prevention is subject to adequate supervision and care practice. Medication is recorded and audited in a way that follows recognised good practice, however poor practice in the administration of medication on the residential unit needs reviewing. To ensure resident’s general health and wellbeing. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 13 EVIDENCE: Four residents care files that include the written plan of care were looked at to assess what information was recorded. 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 health professionals. However in the files that were viewed there is some inconsistency in the level of detail to clearly demonstrate how assessed needs are being met. For one person it is recorded that there is a hearing difficulty but there is information as to whether the person requires a hearing aid or how staff are to communicate effectively with this person. In addition to this the person has also been described as having behaviours that challenge but does not give the details as to how staff manage this. For example what triggers this behaviour and how do staff respond. From observations made and discussion with staff they do know how to manage this effectively. One resident has recently experienced changes with mobility and is now dependent upon the use of walking aids. The care plan does not clearly identify what the walking aids are. This person also has difficulties in communicating due to a hearing problem. The care records do not indicate that this person wears a hearing aid and what support is needed. The records did confirm that a referral has been to the audiologist 12 months ago but since then no further action has been taken. Observations made indicated that staff have developed an effective way of communicating with this person using pen and paper. Though this could be developed further to assist in communication. Information relating to one persons background and their particular interests in music and gardening that were an important feature prior to them moving into the home are not recorded in the care plan. The manager confirmed he is aware of how more information needs to be recorded in order to demonstrate how resident’s social needs are met. And a document called a life history is being introduced. This will be used to obtain more detailed information from the residents about their lifestyle and interest and how this can be supported in the care plan. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 14 This was discussed with the manager who confirmed that work would be developed in this area now that the care plan format has been revised. The manager explained that the format that is now in use is more person centred and by this he meant that each care plan is based on individual assessed needs and how they are to be met by staff. Risk assessments are in place and these demonstrate how staff will support residents and these are reviewed monthly which is good. Records are kept of any falls and this assists the manager and staff in monitoring a change in any persons needs so that appropriate action can be taken. The records that are used to record health needs clearly demonstrate visits by the G.P, community nurses and other professionals. And as part of supporting people with the diet and nutrition records are available to confirm that people are weighed on a monthly basis. Should there be any unexplained weight loss/gain then advice is sought from the appropriate professional. Overall there is a range of evidence to demonstrate how resident’s health care needs are met. Appropriate systems of storage, record keeping and administration of medication is in place though the practice of administering medicines in the residential unit is unsatisfactory. The practice of removing medicines from the sealed blister packs provided by the pharmacist the putting them into unnamed containers to give out could result in errors being made. This was discussed with the manager who was advised of the immediate actions to take to change this practice. An audit of medication was carried out and in particular those medicines referred to as controlled drugs and this was satisfactory. The home have recently fitted a new lockable cupboard for medicines, which has been supplied by a specialist supplier. Changes to the legislation that cover the storage of controlled drugs have recently come into effect and as such this type of cabinet may not be suitable for storing controlled drugs. The manager should seek advice from the pharmacist. Discussions held with relatives of residents that were present during the visit confirmed that they had seen a number of improvements in the home. They confirmed that they are kept up to date with what is happening and they stated that the new manager was approachable. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 15 Families said that staff inform them of any changing health issues and ring them if necessary. Observations made confirmed that staff work well with residents and there was a good rapport between them with the odd joke being shared. Some staff practices however were discussed with the manager as one resident asked for the toilet three times before staff responded. And on another occasion a staff member shouted across the dining room to one person “ do you want the toilet”. As a result everyone in the dining room was aware of what was being said and this compromised the dignity of the resident. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. We have made this judgment using a range of evidence, including a visit to this service. A planned, activities programme organised by the activities coordinator is contributing to a more interesting and stimulating lifestyle for residents. The residents are supported maintain contact with family and other contacts should they wish. This can help ensure they do not become socially isolated. The residents are actively encouraged by staff to a good degree in exercising choice and control over their lives though there are some limitations due to a change in how meals are provided in the home. EVIDENCE: An activities coordinator takes an active part in developing a range of activities for the residents. Time is spent between the three living units in the home so that every resident has an opportunity to take part in activities. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 17 A number of the activities are 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. However this is still a need to develop more individual activities around people’s interests and previous lifestyle. As stated previously in the report work has commenced in this area as part of the overall development of the care plans. Discussion with the manager confirmed that residents and relatives meetings are held 2 monthly and these are linked to a social event. Use is made of the sensory room that has been developed and this is discussed in more detail in section 19 – 26 of this report. The enclosed garden that is accessible to all lounges on the three living units is fitted with raised flowerbeds that are wheelchair accessible and this enables residents to use these if they wish. The garden area, which has recently been developed, is also discussed more fully in sections 19 – 26 of this report. In addition to organising activities the activities coordinator runs a small trolley shop whereby she goes around the lounges offering snacks, sweets and refreshments for residents. Residents 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. They confirmed that there are no restrictions on visiting the home and staff always make them feel welcome. Staff were relaxed with visitors and it was evident that they had established a good rapport with them They said that the staff work hard to ensure that their relative is well cared for and they confirmed that they were satisfied with the care. However all relatives made complaints about the food and this was supported in discussion with the residents. The food that is currently being provided changed in the last 5 weeks and all main meals, which includes lunch and dinner, now come in portion controlled frozen packages. In discussion the families stated that if anything could be improved in the home it would be the main meals that are provided. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 18 One family now brings food into the home for their relative, as they do not like a lot of the meals that are prepared using the frozen packs. The cook confirmed that he uses fresh vegetables to accompany the main meal but the limitations have been placed on preparing traditional meals such as mince and dumplings. And the choice can be limited due to how the frozen meals are provided to the home. He does however vary some of the meals to provide dishes that residents like such as egg and chips sausages with vegetables and cauliflower cheese. Discussion with the manager confirmed that the change in catering services had been implemented by the company without consulting residents or their families. As a result of the concerns expressed by the families the manager has made representation to the chief executive to make him aware of the concerns. In addition to this the manager has issued questionnaires to families to seek their views on the catering services in order that he can positively address the issues they are raising. Lunch was taken with the residents and it was hot and tasty though staff could not tell me what the dish was other than “braised pork” in a sauce. This was served with fresh seasonal vegetables an alternative meal of sliced turkey and vegetables were also available. The dessert was home made rice pudding and the cook had provided this as an alternative to the main dessert, which like the main meal, comes in a frozen pack. The residents said that they enjoyed the rice pudding and liked it when the cook made his own desserts. There were no alternatives to the dessert other than an orange though a check of the menus held by the cook listed three alternatives for dessert, though these were not offered by staff. There were no menus available in the dining room for residents to refer to and condiments such as salt and pepper were not put on the table but stored on a windowsill in the dining room. There were no napkins or serviettes and some tables were not set with cutlery until residents had sat at the table. Cold drinks were provided by staff but no alternative drink or a hot drink was offered. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 19 The cold drink of juice was served in a ceramic mug and there were no glasses available for use. This did not support residents to know what was in the mug until they drank it. Staff offered support to those residents who required assistance to eat their meal. And the mealtime was unhurried and relaxed allowing residents the opportunity to talk while having their meal. Breakfasts have not changed and the residents said that “you can have a full cooked breakfast as well as cereals and this was now the best meal of the day”. Overall residents and their families confirmed that they want to see improvements with the main meals that are being provided in the home. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. We have made this judgment using a range of evidence, including a visit to this service. Appropriate systems are in place to ensure that all complaints are investigated properly and outcomes recorded and robust policies and procedures ensure that residents are protected from potential harm or abuse. Though there is a need for some staff to undergo training in safeguarding adults. EVIDENCE: Written policies and procedures are in place to deal with complaints and the relatives spoken to say they were aware of these. In discussion with relatives they confirmed that they had recently complained about the changes in how food is supplied to the home in frozen packs. The manager had responded positively to this and had issued questionnaires to the families in order to address their concerns. Residents said they would complain to the staff if they had any concerns. The manager has worked closely with social services and the primary health care trust to resolve concerns about the home some of which were dealt with under safeguarding adult’s procedures. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 21 The manager implemented an action plan and several meetings have taken place to monitor progress. These have now been resolved satisfactorily and information received from social services confirmed that they are satisfied with the progress that has been made in the home. Discussion with the manager confirmed that during induction safeguarding is discussed with new staff and this is also supported through NVQ training. Some staff have received safeguarding adults training to ensure that they are familiar with the policies and procedures that are in place to protect vulnerable adults from abuse. In discussion the manager and staff team were clear and confident in the protection of vulnerable adult procedures. There are a number of new staff in the home that have not received training in safeguarding adults and this is an area where improvement is needed. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 & 26 Quality in this outcome area is good. We have made this judgment using a range of evidence, including a visit to this service. The home is clean, and well maintained. This can help promote a positive image for residents, and ensure they remain safe. External space addresses the specific needs of all of the people who live in the home particularly those residents with a physical disability. This means that ready access to a safe and well laid out garden space is available. EVIDENCE: All communal areas and a representative number of bedrooms were viewed in those parts of the home that are currently occupied by residents. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 23 From those bedrooms that were viewed it was evident that residents had been encouraged to personalise them. The residents have use of a sensory room. It is fitted with fibre optic lights, bubble columns, gel projector slides which can change the overall appearance of the room and other effects. This offers residents the opportunity to sit a in a relaxed and stimulating environment. The relatives have been involved in a competition to name the sensory room with the manager offering a bottle of champagne for the name that is chosen. The building was clean and tidy and free of any noticeable defects or hazards and there were no unpleasant odours. Discussion with families confirmed that there had been a number of physical improvements in the home during the last 12 months. The garden area is enclosed and is easily accessible for all people who use the ground floor living units. It has level walkways, wheelchair access to all areas a recently constructed timber shelter, which is styled, on a Victorian/Edwardian bandstand similar to those that used to be in public parks. The bandstand as it is known requires some minor works to finish it before residents will be able to use it. Work is currently being carried out to complete the weatherproofing. Once completed the manager confirmed that seating will be provided and other items will be added to make the area an attractive area for the residents to use. There is a greenhouse that residents can use and nicely laid out flowerbeds offering a relaxed and inviting area for the residents and their families to use. A trellis fence has been installed ready for growing a climbing plant that will be visual and also aromatic. There is a water feature and wind chimes have been ordered. Discussion with the manager confirmed that when the garden is finished it would provide a range of items that will hopefully stimulate residents. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. We have made this judgment using a range of evidence, including a visit to this service. Staffing levels are sufficient to ensure that resident’s needs are met and staff receives sufficient training to support them in their work. However the staffing levels at times reduces at different times on the units and this may have an impact on their work. Robust recruitment procedures are in place. This ensures that unsuitable candidates do not gain employment in the home. Good training opportunities are in place for staff and this can contribute to staffs’ understanding of residents needs and ensure sufficient competence to undertake their job. EVIDENCE: During the visit staff were allocated to work on each of the three living units. The three living units are referred to as Harvey, Hutton 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.V363878.R01.S.doc Version 5.2 Page 25 In the afternoon the staff on the “Hutton” unit reduces from 3 persons to 2 and depending on what work is being carried out this can place additional demands on staff. Similarly on the Tilley unit staffing reduces from 2 persons to 1 in the afternoon. Staff are of the opinion that reducing the staffing level at this time of the day can sometimes have an impact on the delivery of care. This was discussed with the manager who has been reviewing and will continue to review how staff is deployed around the homes 3 units. And whether staffing levels remain appropriate. The manager has also looked at the current dependency levels of residents on each living unit and allocated staffing levels appropriate to meet residents assessed needs. Since the last inspection there have been eight new persons employed in care roles one of who is employed as deputy manager. The home has also employed a gardener. Staffing files were looked at and this confirmed that good recruitment systems are in place. With appropriate references being obtained as well as the necessary police check. Any gaps in employment are covered and a written record is maintained on file. There was a gap in information for one person and this was discussed with the manager. Each member of staff has a personal training record and this records any training undertaken since commencing work in the home. The training records confirmed that staff undergoes mandatory training such as fire safety, moving and handling and health and safety. For one member of staff who has recently commenced work in the home there was no record to confirm that they have received the necessary fire training as part of their induction. This was discussed with the manager who was advised of what action to take to ensure that this training takes place. All staff that commence work in the home undergo common induction training and complete a workbook. This ensures that they are supported in their work and are made aware of health and safety within the home. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 26 Some staff that are new have not yet completed safeguarding adults training and this needed to ensure that they are kept up to date with current practice. Discussion with staff throughout the visits confirmed that they are positive about the changes being made in the home by the manager. Generally staff morale is good and all staff commented positively about the new deputy manager confirming that he was offering additional support with their work. Bowburn Care Centre DS0000061553.V363878.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. We have made this judgment using a range of evidence, including a visit to this service. The home is well managed by a person who has the necessary experience and qualifications to ensure that systems are in place to ensure the health, safety and welfare and well being residents and staff. Internal quality assurance systems are in place to enable the views of residents, relatives and others to be sought and the internal quality management of the service to be progressed. Resident’s personal monies are managed in a good way to ensure their interests are well served. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 28 EVIDENCE: The manager is a qualified nurse and has a range of experience in managing residential and nursing homes. Though not yet registered with the commission an application has been submitted and the manager will undergo his registration interview with the commission in May. Since taking up post in the home over 12 months ago the manager has implemented a number of changes to improve upon the services within the home. This has included providing a range of training courses for staff particularly in the area of health and safety. The manager has been active in recruiting new staff to work in the home and new deputy manager now forms part of the management team. Active discussions are taken place between the manager and the residents and their relatives as an aid to develop the service. This takes place as a result of 2 monthly meetings and also by issuing surveys to the relatives. The manager works closely with GP practices and other professionals in order to ensure that communication between them and the home is good. This has resulted in developing the relationships to provide a good all round service to residents. In addition to this the manager has worked closely with social services in order to meet the requirements of previous safeguarding meetings. Discussion with staff confirmed that staff meetings are held but these are held for people who do different jobs. For example nurses and senior carers meet separately from carers and heads of department. Therefore there is no opportunity for all of the staff employed in the home to attend the same meeting. This was commented upon by staff that said they would welcome the opportunity to have a full meeting that included all staff who are employed in the home. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 29 Monies are currently held on behalf of 26 residents and records are in place to confirm that that this is managed correctly. A person is employed to carry out maintenance in the home and this person is also the designated fire marshal who carries out fire training with staff. With the exception of one person the fire records were in good order and demonstrated that staff receive regular fire instruction training and also take part in fire drills. Accident records are maintained of any accidents to residents or staff and these demonstrated that staff take appropriate actions if any resident has an accident. Discussion with the manager confirmed that surveys have been issued to families in order that they can comment on the service and offer a view as to how it can be improved. As previously stated in this report the most recent survey was issued due to the changes in the catering arrangements. Twelve surveys were returned and the manager is currently acting upon the comments that were made. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 30 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 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 X 29 3 30 2 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.V363878.R01.S.doc Version 5.2 Page 31 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) 18(1)(a) Requirement To avoid placing people at risk the manager must make sure that secondary dispensing of medication on the residential unit ceases, immediately. The manager must keep the staffing levels at the home under review. This will ensure that the numbers employed at all times are sufficient to meet the assessed needs of the residents. All staff that have not received training in safeguarding adults must receive appropriate training. This will ensure that they are kept up to date with best practice. Timescale for action 08/05/08 2. OP27 30/09/08 3. OP30 18 (1) (i) 31/10/08 Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 32 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 OP15 Good Practice Recommendations The manager should review the practices in the dining room at mealtimes as discussed within the report. Bowburn Care Centre DS0000061553.V363878.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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