Inspection on 06/07/05 for Bowden Derra Park

This inspection was carried out on 6th July 2005.

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

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

Other inspections for this house

Bowden Derra Park 20/02/07

Bowden Derra Park 21/03/06

Bowden Derra Park 26/01/05

Bowden Derra Park 11/05/04

Bowden Derra Park 16/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Bowden Derra Park Polyphant Launceston Cornwall PL15 7PU Lead Inspector Philippa Cutting Unannounced 6 July 2005 09:30 am th 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Bowden Derra Park D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Bowden Derra Park Address Polyphant Launceston Cornwall PL15 7PU 01566 86230 01566 86803 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Bowden Derra Park Limited Mr Maurice Clement d`Entrecasteaux Care Home 46 Category(ies) of Learning disability (46) registration, with number of places Bowden Derra Park D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Total numbers not to exceed 46 of whom up to 20 may have an associated physical disability Service users to include up to 31 adults with a learning disability (LD) to be accommodated in Bowden Derra House (Main House) Service users to include up to 5 adults with a learning disability (LD) to be accommodated in Medrow House Service users to include up to 10 adults with a learning disability (LD) to be accommodated in Orchard House Date of last inspection 26/1/05 Brief Description of the Service: Bowden Derra Park Ltd is a privately owned company that provides care and accommodation for up to 46 people in one of three houses. The Main House has rooms on the first floor and ground floor where there are also three communal sitting rooms and a large dining room. Orchard House provides care and accommodation for people who may present with challenging behaviour. Medrow House is situated on the limits of the campus and is home to service users who have been identifed as people who would benefit from a more independent life style where they could participate in the running and organisation of their home. There are large grounds surrounding the home, which is situated on the outskirts of a village approximately seven miles from Launceston. Bowden Derra Park D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out by two inspectors between 9.30 am & 6.00 pm. One of the managers, Jonathon Steed, was present and available to answer queries etc. Previous inspections have looked closely at how service users spend their day and the provision made for activity and personal development. As this has been shown to be satisfactory, on this occasion the main focus of the inspection was on peoples’ functional ability, personal independence and hygiene etc. Records were looked at, staff and service users were met and opinions sought and a lot of time was spent in observation. This was mainly in Orchard House and later Medrow House. The occupants of the Main House were mostly out at Day Centres etc. not returning until after 4.00 pm. What the service does well: What has improved since the last inspection? What they could do better: Personal activities of daily living were highlighted on this inspection and therefore whilst service users receive good care it was felt that the home should detail more specifically people’s functional abilities in order to help this improve and develop. A need to review the storage of medication was noted. Bowden Derra Park D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 6 The home has already identified areas within the properties that need attention. The main concern was the evidence that records show staff are starting employment without all necessary documentation being in place. Whilst there has not, to date, been any subsequent problem with staff, this is not good practice and contrary to the national minimum standards. 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. Bowden Derra Park D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Bowden Derra Park D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The statement of purpose & service users guide remain unchanged and is available for all service users and/or their families. EVIDENCE: These standards were not inspected although there was a brief discussion about the need for reviews of service users by their relevant social workers and the possibility of people progressing to a point where they could live more independently than the services provided at Bowden Derra Park. The manager stated that the needs of some service users have increased, but also the needs of some have decreased and constant daily supervision has been reduced. Examples were cited of successful reductions of one:one supervision from constant during waking hours to 19 hours per week & to 4 hours per week without detriment to the service users concerned. The home provides care to 6 service users under the remit of continuing care and are looking to set up reviews from health to reevaluate the funding. Bowden Derra Park D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9,10 Service users’ individual needs and difficulties are known and met but the documentation needs to be more specific in some care plans. EVIDENCE: All service users have care plans that are set out in sections under relevant topics. A lot of these were broad brush in approach, some bits in a personal profile and some in a care plan. The manager’s comments, that to outline every part of each identified need in detail would result in a large document, are accepted. However there was, in some cases, very detailed information on certain service users’ particular problems with a note of the signs to look for and action to be taken. This was good and it was readily available for staff to see. Consideration should be given to having a similar more detailed assessment/record of peoples’ functional ability, with regard to their personal activities of daily living and their ability to perform this with or without help. Staff did appear to be aware of how much help people needed but the manager commented that some staff will do more for the service users than is necessary, thereby potentially causing a reduction in their independence. He added that there were sometimes time constraints that caused this. A written Bowden Derra Park D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 10 record of people’s independence skills would be helpful as this is objective and provides a measure to monitor progress. Risk is well assessed and steps to reduce it taken. For many service users this has to be organised on their behalf as well as explaining it to them. The care plans were signed and dated. Bowden Derra Park D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,1516,17 All service users are encouraged to develop their personal & social skills. It is important to remember to include and promote personal activities of daily living and functional abilities as well. EVIDENCE: The home provides all service users with good opportunities to develop social skills. Service users returned from various activities during the inspection having been accompanied and assisted by staff to accomplish these. As this progress has previously been noted as very satisfactory, it was one of the reasons that functional ability was looked at in particular on this occasion. The inspectors would like to see evidence that this aspect of the service users’ lives is promoted as well. One practical example was seen during the day. Healthy eating is encouraged. Service users who have problems with their food are provided with a quiet environment and enabled to take their time over their meals. Bowden Derra Park D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20, Service users’ health care needs are fully explored and supported. The home needs to review the storage of medication. EVIDENCE: As already mentioned, some good examples of how personal support (in this case personal care) should be delivered were seen. Service users’ preferences are noted in records. Very few people are able to manage their own medication so senior staff undertake this for the most part. It was noted that medication trolleys are not secured to the wall when not in use. The manager stated this was so that they could be easily moved in an emergency e.g. if a service user suffered an epileptic fit. Reference to the Royal Pharmaceutical guidelines should be considered. In Orchard House and Medrow House, medication is stored in locked cupboards near a heat source (oven etc). The home needs to consider relocating this medication due to its possible deterioration from the potentially fluctuating temperature of the environment. The procedure for medication when people are out for the day, namely preparations being dispensed into a named ‘dosette’ container with the person dispensing this signing the medication administration record sheets (MAR) and Bowden Derra Park D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 13 then the carer who administers it signing the MAR sheet on return, was not supported by the evidence. MAR sheets were not seen to have two signatures. The team leader stated that sometimes the carer signs on return only. There was a discussion concerning the assessment of carers’ training and competency to administer rectal diazepam. Equipment to help care for older, less able or unwell service users was seen. Bowden Derra Park D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The complaints procedure remains unchanged and has been produced in different formats. EVIDENCE: The home’s complaints procedure was not looked at on this occasion but training on the protection of vulnerable adults is on going. Bowden Derra Park D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29,30 Service users are able to exercise their taste and preferences in their rooms. This was very much in evidence on touring the premises. All the homes have good communal space but the bathrooms will benefit from new flooring. EVIDENCE: MAIN HOUSE. A number of bedrooms have been redecorated as part of an ongoing programme and all rooms were seen to reflect the occupant’s taste and interests. An area of damp was noted on the first floor landing where a previous water leak has caused damage to the passage wall and interior of one bedroom. The door to the cellar area was unlocked. This poses a risk to service users who might be in the area. Two service users occupy the upstairs flat. The bathroom, toilet and wash hand basin in particular, was dirty and the carpet stained. One of the service users is responsible for keeping this clean as part of his independence programme. It was not clear how much supervision or help he had or what part the other service user played in keeping the area clean and tidy. Bowden Derra Park D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 16 The bathrooms outside room six were malodorous – a combination of damp and urine. The inspectors were told that where there is currently carpet on bathroom floors, this will be replaced with nonslip ‘altro’ flooring. Improved ventilation would be helpful. ORCHARD HOUSE. Orchard House was re decorated throughout recently but it takes a lot of wear and tear from some of the equipment that is used there. There is adequate equipment to deal with any spillages on floors or furniture. Some bathroom flooring has been changed to good effect. Service users’ rooms were bright and cheerful and people had things that they like to look at or listen to around them. MEDROW HOUSE. This property is now in need of redecoration, which the manager acknowledged. Service users living there have been discussing the colours they would like. If the garage is to be used by staff or service users to house laundry equipment, it needs attention to tidy up the considerable amount of stored items in it. Again the suitability of the present bathroom floor needs to be reviewed. Service users had arranged their rooms to their satisfaction. Bowden Derra Park D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,32,33,334,35,36 Staff are supported by the management structure and receive planned training but the registered manager must ensure that staff checks and references are taken up before they start work. EVIDENCE: The home has a very large compliment of staff as administrative, domestic and maintenance people are employed as well as carers and cooks. Training plays an important part and there is a programme outlining what sessions have been planned. Any training that a member of staff has undertaken is recorded in their individual files. Prospective staff are invited to spend a day at the home before sending in their application. This has helped people realise what might be involved in a caring role and whether it is what they want to do. New employees spend their first three weeks working under supervision in all areas of the home so that, again they can decide where they feel best able to respond to service users. However from eight staff records that were randomly sampled it appeared that staff were routinely commencing employment – on a period of induction and supervision - prior to references or CRB / POVA first checks being received. Bowden Derra Park D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 18 Service user/staff interventions were observed mainly in Orchard House. Generally these were good and the staff appeared to have a calm and relaxed approach. The inspectors noted two occasions where they felt the member of staff (a new employee who had completed her induction) felt nervous of the person she was being asked to care for. This showed in her body language. However overall the significant changes and improvement of several, quite demanding, service users in Orchard House was good to see. Bowden Derra Park D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40 Service users’ interests are at the heart of the home’s ethos. EVIDENCE: Bowden Derra Park Ltd has a team of three on site managers who consult regularly to plan strategies for the homes & service users within the complex. This has resulted in new ideas being implemented and provides back up when people are away. The policies and procedures were reviewed and updated last year. Any incidents or outbursts are recorded. The person completing the form has to note and recognise any trigger factors that may have precipitated the situation. The inspector gave these a cursory look on this occasion but it is important that they should be checked carefully before being filed to identify any patterns that may be occurring. Bowden Derra Park D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 20 MAIN HOUSE. Less time was spent in the Main House on this inspection. The service user mix there is varied, as there are a number of older people who have lived at Bowden Derra for many years. A proportion of these are experiencing the problems and ailments associated with ageing and spend much of their time in the home. New younger people are being offered accommodation with individually planned programmes, in the Main House and they are mostly out by day. It was noted that some people have expressed a wish to move to different parts of the complex. This can be done if it is agreed to be suitable but people are not moved around without consultation or to accommodate the more pressing needs of others. ORCHARD HOUSE. The development of Orchard House into a home for people with more challenging behaviour has been successful. There is a high service user:staff levels but the home did not feel overcrowded and the staff and service users seemed to be well matched. Where one:one staffing is required, staff work with a number of service users during the week so that service users become accustomed to different people. MEDROW HOUSE. The inspector felt that the ethos underpinning Medrow House needed to be reviewed. Its original aim was to provide care and accommodation for service users who were more independent, went out daily and then returned home where they helped with the daily domestic tasks. Because of this pattern the home is not staffed when service users are out, (unless someone is ill). On this inspection it was noted that two of the people living there spent their day in the Main House. They do not go to day centres or other activities on a daily basis and when asked, said they had spent the day watching television. Whilst the accuracy of this statement was not checked, the inspector had concerns that if people do not go out and maintain a ‘normal’ home/work pattern then they should be able to spend the time when they are not at ‘work’ in their own home. Alternatively, the purpose of Medrow House needs reviewing and re evaluating. Bowden Derra Park D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bowden Derra Park Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x x x D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 22 No Are there any outstanding requirements from the last inspection? 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 YA 20 Regulation 13 Timescale for action The registered person shall make Immediate on receipt arrangements for the recording, handling, safekeeping, safe of this report. administration and disposal of medicines at the care home. In this instance this refers to the storage of medication away from a heat source, an assessment of the security of medication trolleys and signing for medication that is dispensed to be administered later. References, CRB & POVA checks Immediate must be in place prior to staff on receipt taking up employment. of this report. Requirement 2. YA 34 19 Schedule 2 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. 2. Refer to Standard YA6 YA 42 Good Practice Recommendations The home should assess and record service users functional abilities in their activities of daily living in more detail The access to the cellar should be assessed as to the risk that this poses for service users living in home and staff D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 23 Bowden Derra Park 3. YA 30 who have to use the space. More attention should be paid to the ventilation & cleanliness of bathrooms and toilets pending the provision of new floor covering. Bowden Derra Park D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell, Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bowden Derra Park D52-D04 S8982 Bowden Derra Park V227814 060705 Stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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