Inspection on 04/05/05 for Bower Croft

This inspection was carried out on 4th May 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 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 18/07/06

Bower Croft 20/10/05

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 5 Bower Mount Road Maidstone Kent ME16 8AX Lead Inspector Debbie Sullivan Unannounced 4 May 2005 11:00 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 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 H56-H06 S23896 Bower Croft V220068 040505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Bower Croft Address 5 Bower Mount Road Maidstone Kent ME16 8AX 01622 672623 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) Dr Mohottalalage Navaratne Vacant CRH Care Home 18 Category(ies) of DE(E) Dementia-over 65 (18) registration, with number of places Bower Croft H56-H06 S23896 Bower Croft V220068 040505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 8 March 2005 Brief Description of the Service: Bower Croft is large detached property with accomodation 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 double 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 secluded garden and 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. Shopping facilities are those of a large town. Bower Croft H56-H06 S23896 Bower Croft V220068 040505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over four hours. Time was spent with the homes’ Manager, Senior and other care staff, the cook and a number of residents. Observation of the daily running of the home took place. Care plans, staffing records and other records, policies and procedures were inspected. A tour of the premises took place and each bedroom was viewed. During the inspection staff were open and helpful, documents were readily available. Judgements have been made on the basis of written information, observation and verbal information given. Throughout the inspection residents were observed to be well supervised and cared for. What the service does well: What has improved since the last inspection? Since the last inspection on 8th March 2005 the recording on care plans has been improved, this process continues. The medication trolley is now tethered Bower Croft H56-H06 S23896 Bower Croft V220068 040505 Stage 4.doc Version 1.30 Page 6 in the locked staff office when not in use. Non prescribed medication is no longer kept in bedrooms. Staffing rosters include the full names of staff and shifts worked, any amendments to the roster are clearly included and reasons colour coded. 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 H56-H06 S23896 Bower Croft V220068 040505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Bower Croft H56-H06 S23896 Bower Croft V220068 040505 Stage 4.doc Version 1.30 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 standard(s) 3,4,5 and 6. Service Users are supported in making an informed choice about going to live at the home. EVIDENCE: Prospective residents are fully assessed by Mrs Navaratne following referral. This takes place either at home or in hospital and verbal agreement is given that the home can meet needs. Prospective residents, their relatives and other representatives are encouraged to visit to view the accommodation offered. It is recommended that agreement to admission be followed up in writing to the resident and a copy be kept on file. The home has a waiting list and will follow up referrals should a place be available. A four week trial period takes place following admission to give time for the resident and the home to further ensure that needs can be fully met. If possible residents are able to move rooms if once settled in the home they would like to change location, one resident spoke of moving from an upstairs to a downstairs room. The home does not provide intermediate care. Bower Croft H56-H06 S23896 Bower Croft V220068 040505 Stage 4.doc Version 1.30 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 standard(s) 7,8,9,10 and 11. Residents would benefit from care plans being expanded upon to provide clearer direction and consistency of care. EVIDENCE: The format of care plans had been improved at the time of the last inspection on 8th March 2005. Care plans are presented in an easily readable indexed format. A sample of care plans was inspected, they included information on health, daily care and social needs and risk assessments. One risk assessment had not been signed or dated. Health needs are reviewed if necessary, evidence was gained of recent reassessment due to changing needs and health professionals being consulted. Medication procedures were inspected, the medication trolley is kept safely tethered in the staff office when not in use. Medication record sheets showed a slight inconsistency in the methods of recording. Residents spoken with said that they were treated with respect and satisfied with the care received, they liked the care staff and were treated respectfully. One resident was sad that a much liked member of staff was soon leaving. During the inspection care staff were observed to treat residents with respect and were attentive. Bower Croft H56-H06 S23896 Bower Croft V220068 040505 Stage 4.doc Version 1.30 Page 10 A record is made on the care plans of residents’ wishes in the event of their death, if they do not wish to discuss this it is noted. Bower Croft H56-H06 S23896 Bower Croft V220068 040505 Stage 4.doc Version 1.30 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 standard(s) 12.13,14 and 15. Residents have opportunities to make choices about their lives and are supported in maintaining contact with friends and family. EVIDENCE: Residents spoken with during the inspection said that the home caters well for their needs in terms of activities, that they did not often wish to participate but appreciated the option being available. Residents confirmed that friends and relatives can visit freely, there is a room available on the ground floor so that private space is available for visitors other than bedrooms. A chart which details activities that are provided on a daily basis is completed by staff. The activities are not planned in advance but chosen in accordance with preferences on the day, these include music sessions, games and quizzes. During the inspection a game was being played involving residents in the lounge overseen by staff and causing some excitement amongst residents. There is choice of area to sit in during the day of lounge or conservatory. Personal possessions are brought into individual bedrooms and rooms are personalised to differing degrees. The midday meal was being prepared during the inspection. It was well cooked and wholesome although alternatives were limited. The cook completed Food and Hygiene Training in January 2005. Bower Croft H56-H06 S23896 Bower Croft V220068 040505 Stage 4.doc Version 1.30 Page 12 Residents said that meals were good, choice was available on request and portions were generous. Residents are offered drinks and snacks in between meals. One resident was able to take meals in their bedroom, this was their choice and respected. Bower Croft H56-H06 S23896 Bower Croft V220068 040505 Stage 4.doc Version 1.30 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 standard(s) 16 Residents can be confident that their concerns would be listened to and acted upon. EVIDENCE: The home has a complaints procedure, which is available to residents and visitors. There had been no complaints since the last inspection. Three residents spoken with were aware that there was a complaints recording book and felt that if there was anything they were unhappy with they could make this known. One resident said they had ‘no complaints’. Residents spoken with felt that they could go to Mrs Navaratne if they were not happy about anything, such as the meal on offer, and receive a positive response before the issue became a complaint. Bower Croft H56-H06 S23896 Bower Croft V220068 040505 Stage 4.doc Version 1.30 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 standard(s) 19,20,21,22,24,25 and 26. Continued improvements to the environment will enhance residents’ quality of life and safety. EVIDENCE: All areas of the home were viewed during the inspection. The overall standard of décor was satisfactory however some of the older parts of the home required redecoration. Mrs Navaratne advised that a schedule of works would be implemented. This includes making good a wall in one en suite facility where previous repair had taken place and repair needed to the laundry floor, this remains outstanding from the last inspection. Individual bedrooms vary in size, all were comfortably furnished and personalised to varying degrees. Residents spoken with were happy with their rooms. One bedroom inspected had an odour present; the manager advised that the flooring in the room would be reviewed. The home provides a comfortable and safe environment, evidence was seen that fire extinguishers had been tested in April 2005, and a report from Bower Croft H56-H06 S23896 Bower Croft V220068 040505 Stage 4.doc Version 1.30 Page 15 Maidstone Borough Council Environmental Health Department confirmed that the kitchen complied with regulations. There are sufficient toilets and bathrooms in the home. On the day of the inspection the cleaner was on leave and care staff were responsible for the cleaning. This had been completed to an acceptable standard although a small number of toiletries had been left in communal bathrooms. Care staff were aware these should have been removed to reduce risk of cross infection. Residents with mobility difficulties can access the upper floor via a stair or shaft lift. There is limited access to the garden and patio as steps need to be negotiated; it is strongly recommended the home address this by seeking advice from an Occupational Therapist. The home would benefit from a full Occupational Therapy assessment, and although some areas indoors are equipped with grab rails and aids, additional appliances would increase independence as some residents are unable to access the garden. Residents spoken with would have liked to go outside more. At the last inspection it was recommended that some signage be fitted to each residents bedroom door to aid recognition and personalise rooms further, this remains an outstanding recommendation. Bower Croft H56-H06 S23896 Bower Croft V220068 040505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30. Residents needs are met by a competent staff team. EVIDENCE: During the inspection staff were seen to be supporting residents competently, ensuring their safety and there were sufficient care staff on duty. Staffing rosters have improved and clearly show the full names of staff on duty and shifts worked. Staff from Poland had been recruited via an agency .The agency provided the necessary references and checks, which were inspected on two staff files. Evidence of training and supervision was inspected. Staff meetings are held as required when topics require discussion, more regular scheduling of meetings is recommended. Prospective new staff are interviewed by Mrs Navaratne, the procedure for recording interviews can be improved as currently no written record is kept. The two care staff spoken to confirmed that induction training had been provided and update training on such topics as moving and handling, Health and Safety and dementia are provided. Evidence of training certificates and a list of training attended and on offer was seen. At the time of the inspection four members of staff had completed their NVQ 3 training in care, one was undertaking NVQ 3,2 were on NVQ2 and the cleaner was on NVQ1. Mrs Navaratne had completed the NVQ 4 in Management mid 2004. Bower Croft H56-H06 S23896 Bower Croft V220068 040505 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,36,37 and 38. The management of the home is satisfactory. Improvements are needed in some records to ensure the health, safety and welfare of residents. EVIDENCE: Mrs Navaratne has completed the NVQ in management and care. Staff and residents observed and spoken with during the inspection were complimentary of the style of management. Care staff spoken with confirmed that supervision is provided and they felt well supported although no recent notes of supervision were available. One resident stated that they felt happy ‘asking for anything and another that there were ‘nice staff’, ’the manager is very good’. Records are stored safely in the staff office. The health, safety and welfare of residents and staff is taken seriously as evidenced by the recent Environmental health report and general cleanliness of the home. Food was seen to be stored the fridge and freezer at correct Bower Croft H56-H06 S23896 Bower Croft V220068 040505 Stage 4.doc Version 1.30 Page 18 temperatures and a cleaning schedule in place for the kitchen signed by staff completing the tasks. Bower Croft H56-H06 S23896 Bower Croft V220068 040505 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 1 3 2 x 3 3 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 3 x x 2 3 3 Bower Croft H56-H06 S23896 Bower Croft V220068 040505 Stage 4.doc Version 1.30 Page 20 YES 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 9 Regulation 13(2) Timescale for action The registered person shall make Action arrangements for the recording, plan to be handling, safekeeping, safe received by 30.6.2005. administration and disposal of medicines received into the care This should home.In that medication be actioned as a administration record sheets be completed correctly and staff be priority. aware of the correct codes to use. The premises to be used as the Action plan care home are of sound to be construction and kept in a good received by state of repair externally and 30.6.2005. internally. The registered person shall make Action plan suitable arrangements to prevent to be received by infection, toxic conditions and the spread of infection at the 30.6.2005. care home. In that the laundry floor must be made good.This remains a requirement from the last inspection. Unnecessary risks to the health Action plan and safety of service users are to be identified and as far as possible received by eliminated.In that toiletries must 30.6.2005. not be situated where they could be shared by residents. All parts of the home to which Action plan service users have access are so to be Version 1.30 Page 21 Requirement 2. 19(2) 23(2)(b) 3. 26 12(1)13(3 )(4) 4. 26 13(4) 5. 26 13(4)(a) Bower Croft H56-H06 S23896 Bower Croft V220068 040505 Stage 4.doc far as reasonablty practicable free from hazards to their safety.In that the en suite bathroom in one bedroom upstairs be made good and measures be taken to eliminate offensive odours in the room. received by 30.6.2005 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. 3. Refer to Standard 4 19 22 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. It is recommended that a shedule of repairs necessary be drawn up and actioned as a priority. It is strongly recommended that an Occupational Therapy assessment take place of the premises to advise on aids and adaptations that could enhance the lives of residents.This remains a recommendation from previous inspections. It is strongly recommemded that ramping and a grab rail be fitted to allow residents access from the conservatory to the patio.This remains a recommendation from the last inspection. It is recommended that some signage be fitted to residents bedroom doors to aid identification of rooms.This remains a recommendation from previous inspections.Work to action this is planned. It is recommended that a record of questions asked when interviewing staff is kept and that if possible there are two interviewers. It is strongly recommended that staff supervision be formalised and written records of supervision be maintained .Supervision must be given at least 6 times per year. 4. 22 5. 22 6. 7. 29 36 Bower Croft H56-H06 S23896 Bower Croft V220068 040505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent 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 H56-H06 S23896 Bower Croft V220068 040505 Stage 4.doc Version 1.30 Page 23 - 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. 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