Inspection on 18/07/06 for Bower Croft

This inspection was carried out on 18th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bower Croft 18/07/07

Bower Croft 20/10/05

Bower Croft 04/05/05

Bower Croft 08/03/05

Bower Croft 03/11/04

Bower Croft 15/01/04

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

CARE HOMES FOR OLDER PEOPLE Bower Croft Bower Croft 5 Bower Mount Road Maidstone Kent ME16 8AX Lead Inspector Mrs Ann Block Key Unannounced Inspection 18th July 2006 09:30 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 Bower Croft DS0000023896.V296157.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. Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bower Croft Address Bower Croft 5 Bower Mount Road Maidstone Kent ME16 8AX 01622 672623 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) Dr Mohottalalage Navaratne Mrs Chandra Kanthi Navaratne Care Home 18 Category(ies) of Dementia - over 65 years of age (18) registration, with number of places Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th October 2005 Brief Description of the Service: Bower Croft is large detached property with accommodation on the ground and two upper floors. Access to the upper floors is available to people with mobility difficulties via a shaft or stair lift. There are 16 single bedrooms and one shared room, 14 of the bedrooms are equipped with en suite facilities. There are staff call bells in each bedroom and some rooms have telephone points. Each room has a television point. The home has a pleasant small and secluded garden, patio and a conservatory. A parking area is at the front. Bower Croft is situated in a quiet road a short distance from the centre of Maidstone, bus stops are nearby and the mainline railway station is in the town centre. Current fees range between £401.00 and £450.00 per week. Hairdressing, chiropody and personal toiletries are charged separately. Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key inspection was carried out by Ann Block, regulatory inspector with an unannounced site visit to the home between 9.30am and 16.30pm on Tuesday 18th July 2006. During the site visit the owner, staff and visitors agreed to speak with the inspector. There was some conversation with residents but due to the nature of the service judgments were made mainly from observation, talking with staff and visitors and records. Four clients were case tracked which included observing the resident where possible, talking with staff involved in their care and looking at associated records. A tour of part of the home was made. As part of the inspection process questionnaires were sent to residents (which were completed by relatives), relatives and health professionals. A number of respondents had concerns about communication difficulties with staff as so many did not have English as their first language, also at the high turnover of staff. General responses expressed satisfaction with the service provided. One health professional recorded that: ‘Bower Croft has such a lovely feel when you walk in. Everybody is greeted warmly by staff and visitors. Staff are always interested in what you are doing and do their best to carry out care plans. Clients look happy and well dressed.’ A relative commented that ‘I have found the atmosphere and standard of care very good. Staff are kind, caring and considerate of patient and visitors.’ What the service does well: Bower Croft offers a responsive service to residents who need a higher level of care due to their confusion and inability to live in their own home, often at very short notice. Residents have a comfortable, clean home to live in and bedrooms which they can personalise. They are able to keep contact with family and friends and have a visitors room which they can use for privacy. Staff are committed to providing a good quality of life for residents and treat residents with dignity and respect. Staff ensure there are enough staff on duty and willingly put residents needs before their own. Staff undertake induction and training as soon as possible after they commence employment. Many staff hold nursing level qualifications in their country of origin. Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Residents would be better placed to know the home can meet need when a proper assessment is carried out before admission and a letter is written as required confirming this. Residents’ needs can be better individualised when care plans record more information on how processes are to be carried out, record social needs and how these are met, have sufficient detail to aid the moving in process, that the need to maintain skills is recognised rather than areas of care and support being seen as a ‘problem’, detail of wishes for later stages of life are recorded and individual preferences and how these have been identified are also recorded. Residents’ pleasure in meals will be enhanced when the menu is more varied and practices at meal times recognise the needs of people with dementia. Residents’ safety will be better maintained when all staff received regular fire drills, the use of fabric towels and communal toiletries ceases and the bath panels are replaced. That medication is administered as prescribed will be better evidenced when handwritten entries are witnessed, receipt of medication is recorded, triggers for as required medication are recorded and medication is not left beside residents for taking later. There can be a more proactive response to complaints when there is a suitable complaint recording format to use. That staff are competent to work in the home will be better evidenced when 50 of staff hold NVQ level 2 or equivalent, and the correct authority supports any statement of equivalency. Accountability that residents’ best interests are met will be provided by amending the systems of recording monies given to residents, ensuring adverse events are properly notified and that records as detailed in Schedule 3 are available for inspection in the care home at all times. Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 7 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. Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 8 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 Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4,5 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents or their representatives have information about the home but cannot be confident that their needs can be met at the time of admission. EVIDENCE: The last inspection report recorded there is a statement of purpose and service users guide, these documents were not examined at this site visit. It was also recorded that residents receive a contract or statement of terms and conditions. Those requested as part of case tracking were not available for inspection on site, the owner said she had them at home. A response from a care manager felt the home was ‘a good home with an ideal balance of clients with mental health needs and those without, offering an integrated inclusive environment’. A resident had recently been admitted from hospital at short notice following a verbal referral from a care manager. The owner had not visited the prospective resident as he was then in Gravesend. She said she had obtained basic detail from family but was waiting for a care management Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 10 assessment. There were no records covering the admission process other than in the daily records made by care staff. Whilst it is recognised that there may be situations where there are emergency admissions, a number of such admissions have taken place and places both current and prospective residents at risk as the majority have a diagnosis of dementia and some exhibit challenging behaviours. Residents are offered a month’s trial stay to see whether Bower Croft can meet their needs. The owner said she includes a statement that following assessment the home can meet need but this was unable to be evidenced,. The home is usually fully occupied, often having a waiting list, respite care is not provided. Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 & 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have their health and care needs met but where better recording systems would promote consistent personalised care. EVIDENCE: The majority of residents have a care plan which covers a range of areas including health and personal care. The scope of information on ‘how’ care and support should be carried out varied. In particular there was limited guidance for staff on how to defuse or prevent challenging behaviour particularly those related to dementia. Each care or support need is separated into ‘problem number ’. The use of this terminology does not direct staff into viewing care plans as maintaining the individuals skills. One resident who had been in the home for 5 days had no care plan or information to support transition into the home. Separate files are held for daily records, risk assessments and care plan reviews. Staff use the care plan reviews and risk assessments to provide the most up to date practices. Daily notes are made Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 12 at the end of the shift, some being comprehensive others being brief records of the shift. Care plans recorded various risk assessments through clinical screening such as nutrition, falls and weight. The outcomes were updated through subsequent risk assessments. Daily notes referred to attendance at other health services such as the optician, dentist and hearing clinics. A nurse from the district nursing team visits twice a week, mainly to carry out dressings. A senior carer is responsible for medication. Medication is stored in a suitable trolley which was clean and well ordered. Medication requiring refrigeration is held in the smaller domestic fridge in the kitchen. Medication administration records are maintained, some handwritten entries are made, it was recommended that where a handwritten entry is made two people should check and sign accuracy. Medication is checked in on receipt with queries made to the pharmacy where there are inaccuracies. This check should be recorded on the medication administration record. A returns book is held. There were two omissions without explanation, the resident concerned was in hospital. There is use of medication on an ‘as required’ basis to manage difficult behaviours. There were no records of the triggers for use, the medication administration record showing only ‘when required’. A reminder was given that medication should not be left beside a resident to take later but should be administered and signed for at the required time. At the time of the site visit all staff giving medication had a nursing qualification gained in their country of origin, staff also receive medication training. Staff on duty showed respect to each resident ensuring they were treated with dignity. Residents are called by their preferred names. Privacy is maintained by the use of locks on doors, screening and good practice by staff. Residents are supported through the later stages of life. To substantiate any decisions made at this time, especially as a number of residents have dementia, the inspector recommended that the manager consider setting up end of life care planning. Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have a basic level of social and emotional support, there could be better practical evidence of how their needs in respect of dementia are being met. EVIDENCE: Staff responded to requests which indicated that choice of routine is provided, Some daily routines, such as bath days and mealtimes, are at set times to aid with orientation. To evidence which routines are by choice, individual preferences should be recorded in the care plan. Staff were seen to spend time with residents on a one to one playing throw and catch games and chatting. The radio and TV were on in the lounge. The pre inspection questionnaire recorded that TV, board games, visits by professional musicians, group activities and bingo are offered. Visitors are welcomed to the home and may choose to meet with their relative in private in the visitors’ room. A visitor was clearly at ease and chatted to staff and other residents. The owner said that it is difficult to find suitable advocates in the area and mentioned that relatives would often take that role. Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 14 Currently two particular staff in take a lead in catering and work shifts as cook or carer. The owner said that they would be undertaking training in nutrition in the future, when this takes place the training should include the nutritional needs of people with dementia. Weights are monitored on a regular basis. The cook on duty prepared toad in the hole and roast chicken followed by Bakewell tart and custard. The food seen looked appetising. Yoghurts and fruit were also available. The menu identifies positive choice on certain days of the week but a fixed single option on three days of the week. The owner said she kept to certain foods as the residents like them. Where a resident has a special meal by choice this is recorded in a hardback book. Residents were served politely, some practices however did not evidence the special needs of people with dementia Drinks were offered during the day. One resident had lunch in her bedroom as she prefers this, another was able to eat in the lounge so she could be with her visitor. Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents or their representatives can make comment about the quality of the service. To evidence how outcomes are reached, a better recording system should be available. EVIDENCE: A written complaint procedure is on display. The owner said there had been no complaints. A hardback complaint book is held but does not provide confidentiality or structure to record a complaint, its investigation and outcomes. Staff have certificated training in adult protection. Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable and clean home. Systems to aid orientation and repairs to the baths will enhance residents’ quality of environment. EVIDENCE: Accommodation at the home is on three floors accessed by stair lifts and a shaft lift. A new extension was added to the building in 2004 providing additional bedrooms. The inspector carried out a walk around tour of the home. The laundry floor has been replaced with vinyl tiles. The bedrooms in question at the last inspection have been redecorated. A patio leads off the conservatory to the rear of the property. Tables, chairs and a parasol were set up. A slope leads to a small landscaped garden area with a waterfall and pond (which were unfilled at the time). The front garden has parking space but is not so well presented. There is a good sized lounge with separate dining room and a visitors/treatment room. The home employs one cleaner. At the time of Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 17 the site visit the home was clean and odour free. Care staff carry out laundry using a laundry room accessed through the office. The majority of bedrooms are for single occupancy, many were well personalised and the majority carpeted and with lockable doors, screening is provided in the shared room. A number of rooms have en-suite facilities, in addition bathrooms and communal toilets are provided. There is a separate toilet which can be used by visitors. The side panels on two of the baths had damage with the damaged edges presenting a risk of injury to residents, particularly those with frail skin. A number of washing facilities had fabric towels for use, this presents a risk of cross infection. Toiletries in communal areas remain which also presents a risk of cross infection. As requested at the last inspection signs have been put on doors. Signs are in written format such as ‘toilet’, ‘dining room’. There is no use of pictorial signs or colours to aid recognition. Bedroom doors are not identified other than by number. There should be use of systems such as pictorial images and colour to aid orientation for residents with dementia. Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A committed, respectful and polite staff team cares for residents. 50 of staff should be trained to NVQ level 2 in Care or equivalent which should be properly evidenced. EVIDENCE: The home is fully staffed. A staff roster is held which may be changed according to need. Care staff willingly cover staff absences and at these times work 12 hour shifts if necessary. There is one sleeping and one wakeful member of staff on duty at night. Two staff act in a dual role as cook and carer. A part time cleaner is employed. A senior carer is on duty at all times and will give out the medication. Staff have contact numbers for use in emergency. Due to stated difficulties in recruiting locally, all the care staff are employed from overseas, mainly from Eastern Europe. Those spoken with welcomed the opportunity to work in England, appreciated the assistance they had to find accommodation and liked working at the home. Recruitment takes place through an agency where suitability for employment checks are carried out with records of recruitment provided to the home. A number of staff are on short term visas which leads to a relatively high staff turnover. Staff were Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 19 seen to be polite and respectful. Their knowledge of English varied from basic to good. Staff undertake a range of training, including moving and handling, dementia awareness, basic food hygiene and safe handling of medication. Previous staff acting as cook had training in nutrition, the current post holders were said to be booked on a course later in the year. The owner believes that as the staff hold nursing level qualifications in their home country, this naturally equates to NVQ level 3. This can only be verified by approach to the ‘Skills for Care’ organisation who can assess the training provided and judge equivalency. Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from experienced management. Their safety would be improved by more regular fire practices. EVIDENCE: At the time of the site visit there was a pleasant, relaxed atmosphere in the home. Staff related well to each other and to the residents. The owner has a nursing background, holds NVQ 4 and has run the home for many years. The management structure is the owner supported by senior carers, carer and the cleaner. Staff were aware of the levels of responsibility and knew when they should contact the owner. Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 21 The owner sends out quality annual assurance questionnaires. The commission’s service user surveys had been given to residents and sent to families and associated health and social care professionals. Staff have regular team meetings and regular documented supervision with the owner. Records are securely kept in the office. Not all records as listed under Schedule 3 are available for inspection in the care home at all times as is required. The home has necessary policies and procedures. Staff are asked to sign that they have read and understood policies. A current certificate of employer’s liability was seen and there has been evidence of investment in the service. The owner said she only has involvement in one person’s finances as there is no one else who can take this responsibility. A written record is held but indicates that the money is given weekly rather than four weekly as is received by the owner. Staff were seen to follow safe working practices including wearing protective clothing. Annual fire training takes place but there are no interim fire drills or practices. Staff spoken to however knew the procedures to follow. Accident and incidents are recorded. Not all events as required under Regulation 37 are reported to the commission. The pre inspection questionnaire recorded that servicing of supplies and equipment are carried out in the required timescales. Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 22 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 1 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 3 3 2 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 2 3 1 1 Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14 (1) Requirement The registered person shall not provide accommodation to a service user at the care home unless the needs of the service user have been assessed by a suitably qualified or suitably trained person and the registered person has obtained a copy of the assessment and: That the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in respect of his health and welfare. – This was a recommendation from the last two inspections. This must be carried out for all future admissions The registered person shall, after 31/08/06 consultation with the service user or a representative of his, prepare a written plan as to how the service users needs in DS0000023896.V296157.R01.S.doc Version 5.2 Page 24 Timescale for action 31/07/06 2 OP7 15.1 Bower Croft respect of health and welfare are to be met in that: An initial care plan should be set up following pre admission assessment to support as smooth as possible transfer into the home for each resident at the time of admission. The care plan can then be reviewed and updated as the stay progresses. An improvement (action) plan detailing how this will be achieved with timescales must be received by 31 August 2006 “The registered person shall provide in adequate quantities, suitable, wholesome and nutritious food which is varied”. In that the menu needs to be more regularly reviewed to ensure that it is suitably varied and balanced. This is repeated from the inspection of 20/10/05 Action must be taken by 31 July 2006 The damaged bath panels must be replaced by 31 July 2006 as they present a risk to residents. Records as detailed in Schedule 2 must be at all times available for inspection in the care home. This will include copies of any contract/statements of terms and conditions issued to residents Records must be available by 31/07/06 and thereafter The registered person must ensure that persons working at the care home are aware of the procedure to be followed in the case of fire. This will include DS0000023896.V296157.R01.S.doc 3 OP15 16(2)(i) 31/07/06 4 5 OP19 OP37 13(4)(a) 17(3) 31/07/06 31/07/06 6 OP38.2 23(4)(e) 31/08/06 Bower Croft Version 5.2 Page 25 regular fire drills and practices which are recommended at intervals of not more than 3 months for night staff and six months for day staff. An improvement (action) plan detailing how this will be achieved with timescales must be received by 31 August 2006 7 OP38 37 (1) Incidents which affect the wellbeing of any resident must be notified to the commission, this will include where a resident is diagnosed having a serious illness that indicates a need for nursing care (e.g. admission to hospital) This must take place in respect of all future incidents which come within the reporting guidelines. 31/07/06 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 OP7 Good Practice Recommendations The use of the words ‘problem’ to identify areas in the care plan should be reviewed to enable staff to recognise the need to maintain residents’ skills rather than seeing areas recorded in the care plan as a ‘problem’. Care plans should give more detail of ‘how’ care and support should be carried out, particularly where this can be used to avoid or diffuse difficult behaviours. Where a handwritten entry on the medication administration record is made, two people should check and sign for accuracy. Medication received into the home should be recorded on the medication administration record. DS0000023896.V296157.R01.S.doc Version 5.2 Page 26 2 3 4 OP7 OP9 OP9 Bower Croft 5 6 7 8 9 OP9 OP9 OP11 OP14 OP15 The triggers for administration of medication as required should be recorded, including action to take to reduce the behaviours to avoid over use of as required medication. Medication should not be left beside a resident to take later but should be administered and signed for at the required time. To support any decisions made about later stages of life, especially as a number of residents have dementia, it is recommended that end of life care planning is set up. To evidence which routines are by choice, individual preferences should be recorded in the care plan. Staff practice at mealtimes should routinely recognise the special needs of people with dementia including the manner of assisting with meals, use of aids to eating, the manner of offering choice and being observant to situations during the meal. A complaint recording format should be available which protects confidentiality of information and the nature of the complaint, its investigation and outcomes. As recommended at the last two inspections signage should be used to aid residents to identify communal area and their own rooms. Whilst it is commendable that signs have been put in place in communal areas, the format (being written format) is unlikely to assist residents with dementia. Signage and colouring should be suitable for the client group and include systems to aid residents to identify their own rooms. 10 OP16 11 OP22 12 OP26 The use of fabric towels, bars of soap and storage of toiletries in communal areas should be discontinued to reduce the risk of cross infection. Part of this recommendation is repeated from the inspection of 20 October 2005. 13 OP27 There should be a minimum ratio of 50 of staff trained to NVQ level 2 or equivalent. Where qualifications are gained overseas and are being stated by the home as an equivalent, this should be formally confirmed by ‘Skills for Care’ organisation. 14 OP30 As planned, staff responsible for catering should undertake training in nutrition of the elderly. Training for staff should incorporate the special needs of people with dementia such as nutritional intake, Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 27 presentation of food, determining and offering choice, aids to independent eating and assistance and support with eating. 15 OP35 The system for recording monies given to a resident should evidence that they are given four weekly. Bower Croft DS0000023896.V296157.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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