Inspection on 20/10/05 for Bower Croft

This inspection was carried out on 20th October 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

Bower Croft 18/07/07

Bower Croft 18/07/06

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 Debbie Sullivan Announced Inspection 20th October 2005 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.V260250.R01.S.doc Version 5.0 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.V260250.R01.S.doc Version 5.0 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.V260250.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th May 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. Bower Croft DS0000023896.V260250.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over five and quarter hours, during the inspection standards were looked at that were not examined at the previous inspection on 4th May 2005. Due to the nature of the service most of the information gained was from discussion with the manager, with care and ancillary staff and from reading documentation and a tour of the building. Some residents were spoken with in communal areas of the home, as were relatives visiting. The pre inspection questionnaire and comment cards added to the available information. Throughout the day staff were helpful and there was a friendly atmosphere in the home. A music session took place during the morning. Lunchtime and part of the medication round were observed. The home was fully staffed and there were no vacant bedrooms. What the service does well: What has improved since the last inspection? Medication recording has improved with no gaps being left on MAR sheets. Improvements have been made to the environment in terms of repair and redecoration of two bedrooms, the sleeping in room and a staff toilet. Residents are now able to access the patio area via ramp. Bower Croft DS0000023896.V260250.R01.S.doc Version 5.0 Page 6 Staff are given regular supervision which is recorded. What they could do better: 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.V260250.R01.S.doc Version 5.0 Page 7 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.V260250.R01.S.doc Version 5.0 Page 8 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): 1,2,3,4 and 5. Prospective residents and their relatives have access to information so that they can make an informed choice about moving into the home. EVIDENCE: The home has a statement of purpose and service user’s guide. Following referral the manager carries out an assessment of need before agreement to admission is given. Prospective residents and their relatives are welcome to visit the home to look at the facilities; at the time of the inspection there was a waiting list for places. Residents are supplied with a statement of the terms and conditions in the home, it is recommended that following a successful needs assessment confirmation that a place can be offered is made in writing. Choice of room is offered if possible and residents in the shared room are offered the choice of a single room when one becomes available, unless they prefer to continue sharing. The home does not offer intermediate care. Bower Croft DS0000023896.V260250.R01.S.doc Version 5.0 Page 9 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 and 10. Residents can be sure that their needs are well recorded and care is provided with dignity and respect. EVIDENCE: Care plans are kept in a format that is easy to access with sectioned information, those read were up to date and included information on health and personal care, risk assessments, monthly reviews and daily report sheets. Some information is transferred to folders when care plans become too bulky but remains easy to access. Evidence was seen that relatives had signed plans on behalf of residents and that health input is requested when needed. On the day of the inspection one resident was very unwell so the GP had been asked to call. Care plans included information on requests for medical investigations, in one case regarding recent changes in behaviour. Where necessary beds had pressure-relieving mattresses. One resident spoken with had recently been equipped with a hearing aid. Two carers administered the lunchtime medication round in the dining room; the trolley is tethered in the office when not in use. Medication record sheets did not show any inconsistencies as they had at the last inspection. Currently all staff giving medication have a nursing qualification gained in their country of origin and receive medication training provided by the home. Bower Croft DS0000023896.V260250.R01.S.doc Version 5.0 Page 10 Care staff observed attended to the residents sensitively and respectfully. One comment card from a relative stated, “The staff really care about my relative and look after her very well”. Bower Croft DS0000023896.V260250.R01.S.doc Version 5.0 Page 11 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 and 15. Residents are supported in maintaining contact with friends and family and offered choice in their daily lives. Meals need to be more varied and all those requiring help at mealtimes need to be assisted. EVIDENCE: The interests of the residents vary; this can be in accordance with ability. The home has a small number of residents who do not have dementia but who have chosen to remain there and who usually prefer not to join in with activities in the main lounge. On the day of the inspection a fortnightly session provided by a musical entertainer took place, most residents enjoyed singing and clapping along to songs they knew whilst those more able preferred to be in the conservatory. The activities book showed that staff offer activities in the afternoons such as dominoes, music and ball games. Contact with relatives and friends is promoted and welcomed and a relative said that they could visit at any time. A room is available for residents to see visitors in private. Residents are able to exercise choice in their daily lives, one example being choice of where to eat, if a resident does not wish to eat in the dining room they can do so in the lounge or in their room. One resident who, due to disability is uncomfortable eating with others was assisted appropriately in the Bower Croft DS0000023896.V260250.R01.S.doc Version 5.0 Page 12 lounge. Residents had personalised their bedrooms and if able to manage their personal finances. Menus need to be regularly reviewed to offer more variety and choice, and to make sure that each meal is balanced. The main lunch on the day of the inspection was chicken pie and vegetables, followed by apple pie and custard. A small number of residents had chosen an alternative meal. There were no complaints about the food but whilst staff assisted some residents who needed help to cut up food, others struggled with the pastry, more awareness is needed of those who may require help with some foods. Residents’ views on the meals are sought and favourites included in the menus. One resident who by choice only eats a very limited range of foods was provided with an option of their choice. Options were not being recorded in respect of any resident. Bower Croft DS0000023896.V260250.R01.S.doc Version 5.0 Page 13 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 and 18. Residents can be confident that any complaints will be listened to and acted upon and they are protected from abuse. EVIDENCE: The home has a complaints procedure that is available to residents and visitors, the procedure is clearly displayed in the entrance hall. There had been no complaints since the last inspection other than one that CSCI had been notified of and that had been resolved to the satisfaction of the resident and their relative. Staff are provided with adult protection training from an accredited provider, evidence of dates booked for care staff, training certificates and the training matrix were seen. All the care staff currently working at the home had been recruited from abroad, some via an agency. Staff files showed that police checks are taken up from the country of origin and in the UK. In the case of those from outside Europe checks had been undertaken by an employment agency. There had been no adult protection alerts since the last inspection. Bower Croft DS0000023896.V260250.R01.S.doc Version 5.0 Page 14 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 and 26. Residents live in a comfortable and clean home. Continued improvements to the environment will enhance their quality of life and independence. EVIDENCE: Accommodation at the home is on three floors; a new extension was added to the building in 2004 providing additional bedrooms. These are all well decorated and residents were able to choose the colour schemes that are very varied. The bedrooms in the older part of the building are comfortable, although there are areas in need of repair, such as where plaster is beginning to peel and wood and paintwork is chipped and worn. The standard of cleanliness was high and the cleaner has worked hard to eliminate odours from rooms where residents have continence problems, carpets are regularly cleaned and only one room had a very slight odour present. Two bedrooms are not carpeted for this reason. All the bedrooms were comfortably furnished and personalised to differing degrees, curtaining is provided in the shared room. One resident spoken with confirmed that they were happy with their room. Bower Croft DS0000023896.V260250.R01.S.doc Version 5.0 Page 15 Communal areas consist of the main lounge, dining room, conservatory and visitors room; there is access via a ramp to the well-kept small garden and patio area. Residents have access to sufficient toilets and bathrooms on each floor and thirteen bedrooms have ensuite facilities. There was evidence throughout the building of equipment to maintain and aid independence, radiators were guarded and windows had restricted opening. The floor in the laundry had been repaired since the last inspection although a hole had reappeared in the flooring that will need to be repaired again It remains a recommendation that more signs be put up so that residents can more easily and independently recognise their own rooms and other parts of the home. Bower Croft DS0000023896.V260250.R01.S.doc Version 5.0 Page 16 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 and 30. A competent and well-trained team of staff meets residents’ needs. EVIDENCE: The home employs senior carers,carers, a part time cleaner and two cooks who job share. At the time of the inspection two seniors and one other carer were on duty as well as the cleaner and the cook. One waking and one sleeping carer are on duty at night. All care staff were nursing trained in their country of origin and had been at the home for varying lengths of time, some were undertaking a nursing conversion course. The home was fully staffed. Staffing files, supervision and training documentation showed that staff are well supported and training is given in core areas of work and in topics specific to the service such as dementia and challenging behaviour. Recruitment for some oversees staff is via an agency that vet applicants and provide documentation. References for applicants were on their files as were police checks, and employment contracts. There is a reasonably high turnover of care staff who are employed for pre arranged timescales. Care and other staff spoken with enjoyed working at the home and the opportunity to gain experience in this country. During the inspection staff exhibited competence in dealing with the service user group and when one resident became quite agitated and was becoming aggressive dealt with the situation appropriately. Bower Croft DS0000023896.V260250.R01.S.doc Version 5.0 Page 17 Bower Croft DS0000023896.V260250.R01.S.doc Version 5.0 Page 18 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 and 38 The management of the home is satisfactory. Improvements to some working practices would increase the health, safety and welfare of residents. EVIDENCE: The home had a friendly atmosphere, staff were approachable and visitors were seen to come and go freely. Staff are well supported, and receive regular recorded supervision, staff spoken with said they felt that the manager was approachable and they enjoyed working with the residents. One staff member said “the staff, environment and residents are nice” and they go home feeling they “ have achieved”. A quality assurance survey of residents and relatives takes place annually. Records are securely kept in the office and the home has necessary policies and procedures, a sample of these were read. Bower Croft DS0000023896.V260250.R01.S.doc Version 5.0 Page 19 A valid insurance certificate is clearly displayed and investment is being made in improving facilities, during the inspection measuring took place for a planned new stair lift. Safe working practices are followed with more vigilance required to make sure that residents are not subject to toxic conditions, for example with use of shared toiletries. The kitchen was inspected and apart from jars in the fridge that had not been labelled with the opening date food was stored correctly and at correct temperatures. Most residents have an advocate or appointee to manage their finances; it is recommended that in the case of one resident whose finances are managed by the home, the relevant sponsoring local authority is asked to make alternative arrangements. Details of transactions such as payments to the homes’ hairdresser are recorded. Bower Croft DS0000023896.V260250.R01.S.doc Version 5.0 Page 20 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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 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 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 2 Bower Croft DS0000023896.V260250.R01.S.doc Version 5.0 Page 21 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 15 Regulation 16(2)(i) Requirement “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. Timescale for action 31/12/05 2. 15 12(1)(a) 3. 19 23(2)(b) “The registered person shall ensure that the care home is conducted so as to make proper provision for the health and welfare of service users.” In that those residents who require help with their meals are identified and assisted and the need for assistance recorded on the care plan. “ The registered person shall ensure that the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally.” In that repair needed to peeling plaster in a bedroom and to wood and DS0000023896.V260250.R01.S.doc 31/12/05 31/12/05 Bower Croft Version 5.0 Page 22 4. 26 12(1)(a) 13(3) 5. 26 13(4)(c) paintwork in the old part of the building is undertaken. “The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home” and “The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users”. In that the laundry floor must be made good. This is a requirement from the last inspection; repair to the floor was made but is needed again. “The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and as far as possible eliminated.” In that toiletries must not be situated where residents could share them, particularly in the double room. This remains a requirement from the last inspection. 31/12/05 31/12/05 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 4 Good Practice Recommendations It is recommended that following positive assessment residents or their representatives receive confirmation that a place in the home is offered in writing. This remains recommendation from the last inspection. It is strongly recommended that alternative meal options provided for residents are always recorded. It is recommended that signage be fitted to residents bedroom doors and throughout the building to aid DS0000023896.V260250.R01.S.doc Version 5.0 Page 23 2. 3. 13 22 Bower Croft 4. 5. 36 38 identification of rooms. This remains a recommendation from previous inspections. Work to action this is planned. It is strongly recommended that alternative arrangements be made for the finances of a resident to be managed by an agent other than the home manager. It is recommended that all open jars of food in the fridge are labelled with the date of opening. Bower Croft DS0000023896.V260250.R01.S.doc Version 5.0 Page 24 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. Extracts may not be used or reproduced without the express permission of CSCI Bower Croft DS0000023896.V260250.R01.S.doc Version 5.0 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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