Inspection on 18/10/07 for Bowerfield House Private Nursing Home

This inspection was carried out on 18th October 2007.

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

Bowerfield House Private Nursing... 26/09/06

Bowerfield House Private Nursing... 04/10/05

Bowerfield House Private Nursing... 24/05/05

Bowerfield House Private Nursing... 09/02/05

Bowerfield House Private Nursing... 29/07/04

Bowerfield House Private Nursing... 02/03/04

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

CARE HOMES FOR OLDER PEOPLE Bowerfield House Private Nursing Home 1 Broadwood Close Disley Stockport Cheshire SK12 2NJ Lead Inspector Mrs Fiona Bryan Unannounced Inspection 18th October 2007 14:45p 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 Bowerfield House Private Nursing Home DS0000017290.V346732.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. Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bowerfield House Private Nursing Home Address 1 Broadwood Close Disley Stockport Cheshire SK12 2NJ 01663 764291 01663 764356 bowerfield.mmnh@gmail.com 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) Bowerfield House Limited Miss Jackie Campbell Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27), Physical disability (27), Physical disability of places over 65 years of age (27) Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No service user may be received in the home who is less than 20 years old, male/female. 26th September 2006 Date of last inspection Brief Description of the Service: Bowerfield is a care home that provides 24 hour nursing care and accommodation to 26 service users over the age of 20. Many of the service users accommodated at the home have high physical dependency needs. The home is owned by a company and the responsible person for the home is Miss Maria Twarowski. The home is situated in High Lane, Disley, and is fairly close to the borough of Macclesfield. Access to the open countryside and Lyme Park are minutes away. Local amenities and access to local bus services are readily available. Bowerfield House is a purpose built home which was built a number of years ago, situated in a leafy suburb with attractive garden areas at the front of the home. Car parking facilities are provided at the side of the main entrance. Accommodation at the home is over two floors. The ground floor has a dining room, lounge and small conservatory. A small passenger lift is available for the benefit of service users. All bedrooms are single and some have en-suite facilities. A choice of bathing facilities is available on each floor. A wide variety of adaptations and aids are in place to assist in the nursing of the service users. The home is a non-smoking environment. The current weekly fees range from £760 upwards. Many fess are negotiated individually, according to the package of care. Further details regarding fees are available from the manager. Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection, which included a site visit, took place on Thursday 18th and Friday 19th October 2007. The home was not told beforehand of the inspection visit. All key inspection standards were assessed at the site visit and information was taken from various sources, which included information known about the service, observing care practices and talking with people who live at the home, visitors to the home, the manager and other members of the staff team. Three people were looked at in detail, looking at their experience of the home from their admission to the present day. A partial tour of the building was conducted and a selection of staff and care records was examined, including medication records, employment and training records and staff duty rotas. Before the site visit, residents and relatives’ surveys were sent to the home to distribute. Three residents and three relatives responded and some of their comments are included in this report. We sent the manager a form before the inspection for her to complete and tell us what she thought they did well, and what they need to improve on. We feel she completed this honestly and we agree with what she wrote. She told us what plans she has in place to address the weaknesses identified in the service. What the service does well: Bowerfield seemed to be a friendly and happy home. Staff were seen to get on very well with the residents and treated them respectfully as individuals. Staff were very enthusiastic and said they enjoyed working at the home. Residents, relatives and staff were all extremely complimentary about the manager, saying the she led by example and always had time to listen and act on concerns. Extremely thorough assessments are undertaken before the manager agrees to admit a new resident to the home. This is because often the prospective residents have quite complex needs and full discussions are held to make certain that the home will be able to care for the person properly. Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 6 Care plans were very detailed and gave the staff all the information they needed to ensure that people were cared for and monitored properly. Staff worked well with other health care professionals, such as GP’s and specialist nurses, to provide the best care for the residents and were conscientious in evaluating the care they gave. On the day of the site visit a good proportion of the residents were out of the home visiting Barton Grange garden centre and returning at teatime. Regular trips out are provided, especially in the summer months, and the home was about to receive a new minibus for this purpose. The home makes sure that staff receive training so they have the skills and knowledge to care for people properly and exceeds the standard for staff having completed NVQ training. The home is accredited by Manchester University as a placement for student nurses and one of the home’s own nurses recently won an award as the best “mentor” in the Stockport area. Residents were very positive about the home and its staff and enjoyed living at the home. Comments included “I am content to stay here, I have no fears or worries about anything”, “I haven’t shed one tear being here and I don’t think I ever will”, “Wonderful staff, absolutely excellent”, “the staff look after me very well”, “the meals are great”, “I look on this as my home”, “the roast dinners are lovely” and “I know and trust the home”. What has improved since the last inspection? Since the last inspection the service user guide and statement of purpose have been updated to include accurate information about the company and the services provided by the home. The complaints procedure has also been updated and residents said they were aware of their right to complain and felt that if they did so their concerns would be listened to and acted on. More staff have attended the “alerter” training run by Stockport Social Services so most are now trained in safeguarding adults. The company is making efforts to refurbish and improve the environment and a number of rooms have been redecorated. This work still needs to continue. Since the last inspection, a satisfaction survey has been conducted by the company and residents’ meetings have been held to gain feedback from residents and their relatives about how the home is operating. Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Bowerfield House Private Nursing Home DS0000017290.V346732.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 Bowerfield House Private Nursing Home DS0000017290.V346732.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is excellent. Extremely detailed and thorough assessments are undertaken before people are offered a place at the home; this means that, if accepted, people can be confident that their needs can be met. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Since the last inspection the service user guide has been updated to provide people with accurate information about the services the home provides. Service user guides are provided in each resident’s room. Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 10 It was reported that a service user guide is normally displayed in the reception area of the home, but as building work and redecoration was being carried out in this area at the time of the site visit, none of the information that would normally be available was present. The manager said that all relevant information would be displayed again once the work was finished. Three residents were case tracked. All had extremely detailed summaries of their care needs and thorough assessments had been undertaken for all of them before they came into the home. Where indicated, specialist assessments had also been carried out, for example, by the speech and language therapists, occupational therapists and physiotherapists. One of the younger residents had been assessed regarding their capacity for rehabilitation. Staff said that they were involved in full discussions before a new resident was admitted to the home, so they were aware of the care they would need to provide. Where residents had specific conditions, this was always discussed to ensure that staff were happy and confident in delivering the care required. If the need for extra training about specific conditions was identified, this was arranged. Residents said that staff understood their care needs well and were confident that staff could meet their needs. Bowerfield House Private Nursing Home DS0000017290.V346732.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. Physical and health care needs were well met, with evidence of good multidisciplinary working taking place on a regular basis. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Three residents were case tracked. The files for each of them contained extremely detailed care plans, based on their assessments, to address all their identified needs. Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 12 Care plans were person-centred and contained specific information about each person’s likes and dislikes and preferred routines. Information about, for example, the type of mattresses residents were being nursed on was provided; this is good practice as it ensures that staff have the necessary details to check that equipment is working correctly and is suitable for the resident’s needs. Care plans gave the reader a very good overview of the resident’s needs. Care plans and risk assessments had been reviewed regularly and it was evident from the records that they were evaluated very thoroughly. Communication between staff at the home and the residents’ GP’s showed that staff were monitoring the effect of treatment prescribed to the residents and liaising well with other health care professionals, to optimise the health and well being of residents. Staff were acting as advocates for residents to ensure their health care needs were met, for example, contacting the relevant PCT to obtain upgraded equipment when it was deemed that a higher specification of pressure mattress was required to protect a residents’ pressure areas. All care plans and most risk assessments were reviewed at least monthly. Some risk assessments were reviewed every three months but it was clear that this was as a result of an informed decision that more frequent reviews were not needed, as that particular aspect of the resident’s condition was stable. A number of the residents had highly complex health care needs and these were managed well. Some of the residents had suffered with infections such as MRSA and clostridium difficile and risk assessments had been undertaken regarding this. Staff had ensured that specimens and samples requested by the hospital to monitor treatment and check if the infections had cleared were collected and sent at the correct times. Where necessary, decisions that had been made about the end of life care for residents were clearly recorded and staff were aware of residents and their representatives’ wishes. The weight for one resident had been recorded in their file until June 2007 but they did not appear to have been weighed since then . Further discussion with the manager found that residents’ weights had been recorded in a separate book and had not always been transferred to each resident’s own file. Records should be kept in individuals’ own files so that all relevant information is readily available when staff review the care plans. Residents said that they received good care at the home. One resident said she had recently been unwell and staff had looked after her very well. One resident said, “If you want any help you press the buzzer and they come and help you”. Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 13 Staff were able to describe the care needs of the residents and showed us the individual care charts they completed daily to record and monitor what care has been given to each person – staff said this system worked well as it allowed the nurses to pick up on any issues that needed further intervention or monitoring. Examination of residents’ medicine records showed that the management of medicines was, in the main, satisfactory. However, the records for one medicine had not been signed for one resident for a week, although it had been administered. Staff also need to review the stocks of medicines, as some overstocking was apparent. The manager said she had recently appointed one of the nurses to act as lead nurse regarding the medicines to review the ordering, storage and recording procedures. Interactions between staff and residents were observed to be friendly, courteous and helpful. One carer was overheard speaking to a resident in a nearby room saying, “don’t forget to ring if you need anything at all”. One visitor said that the staff were “wonderful, absolutely excellent” and residents said that staff knew them well and understood what their care needs were. Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. Staff are aware of the need to provide opportunities for social stimulation and interaction for people living at the home and, in the main, meet these needs well. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: There is no designated activities organiser employed at the home, as it is seen as part of the carers’ role to meet residents’ social care needs. Residents said that at lunch time every day a programme was displayed on all the dining tables advertising what the afternoon’s activity would be. Activities included sessions such as exercises to music, dominoes, card games, scrabble and reminiscence. It was reported that sometimes there was an entertainer who came to the home to sing. Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 15 The home has its own bus and residents said that they went on trips out most Thursdays. Trips had been made to Buxton, Macclesfield and various garden centres. On the day of the site visit many residents were out of the home when we first arrived as they had gone on a trip to Barton Grange garden centre. The manager reported that a new bus had been ordered, which was due for delivery on 29th October 2007. Residents are encouraged to continue with interests they enjoyed at home if possible, for example, one resident was busy making a rug and another resident had birdseed hanging outside his bedroom window and a poster on his wall so that he could try to identify the different birds in the garden. The residents spoken to said time went quickly and they didn’t get bored. One resident said he preferred to spend most of his time in his own room and read the papers or watch sport on television. This person said opportunities were provided for socialisation but residents were not made to join in if they did not wish to. Residents said that routines were fairly flexible and they were able to choose how to spend their day. One resident had been out for lunch with friends and was therefore not hungry at teatime so he was able to refuse tea and ask for something later if he felt like it. Residents said their families and friends were made welcome. One resident said, “It’s my home and if you want to invite anyone to come, you can do”. Another resident said staff always helped her to get ready in good time if she was going out with her family and made it easy for her to maintain her relationships. Records showed that staff acted as advocates for the residents, for example, a letter had been written on behalf of one resident to the optician, as the resident was unhappy with the new spectacles he had been given. Kitchen staff work to a three-week menu (although this is not actually displayed anywhere). However, residents said that staff came round each morning to ask everyone what they wanted for lunch and tea. Typical food for the main meal of the day included a starter of either melon, fruit juice or soup followed by roast dinners, braised steak and onion, casseroles and stews, chicken or beef pies, fish, gammon, spaghetti bolognaise and curry. Lighter teas included food such as sardines on toast, cauliflower cheese, soup, sandwiches, salads and jacket potatoes. A cooked breakfast is not routinely provided, although the manager said the weekend cook sometimes made bacon and eggs and a resident said that she thought if she really “fancied” a cooked breakfast she could have one. Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 16 Residents were complimentary about the meals. One resident said, “The food is very good. There is always a choice. It’s plaice and vegetables today. The food is always beautifully cooked. We get plenty of food and a cup of coffee or tea mid morning and mid afternoon. I have marmite on toast in bed at 9pm for supper”. Another resident said there was a good variety of food. This resident also said that when it had been her birthday the cook had made her a birthday cake and all the residents had enjoyed a “birthday tea”. It was noted that although some residents said there was a choice of dishes at each meal, there was usually only one option on the menus that the kitchen staff worked from. The meal at teatime on the first day of the site visit was sandwiches with assorted fillings and soup, followed by jelly and cream. Residents said that sandwiches were usually served on a Thursday teatime as many residents went on the trip out and it was easier to serve cold food rather than try to time hot food which might spoil if the residents were delayed getting back home. Most residents ate in the dining room, which was quite small for the number of people accommodated. Tables had been laid attractively with cloths, cutlery and condiments. Staff were observed offering residents sandwiches and asking what fillings they wanted. Staff knew the residents’ likes and dislikes well, for example, knowing who took sugar in their tea or coffee. It was noted that all the staff remained standing up when feeding some of the residents. This was brought to the attention of the manager who acknowledged that she was aware that this was often the practice, either because space was limited or because staff were trying to rush. The manager should review this practice again with staff and try to find more suitable arrangements that ensure residents feel they are able to eat in a leisurely and more social way. Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. People feel that their views are listened to and acted upon. The arrangements in place protect people from abuse. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The complaints procedure is included in the home’s service user guide, which is provided in each resident’s room. Residents were aware of how to make a complaint. One resident said, “this is laid down very clearly in the rules of the home – I don’t like to complain but am entitled to as it’s laid down there”. Another resident said they had complained to the manager “about little things, which have been sorted out straight away”. Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 18 A record of complaints had been maintained. Fifteen complaints had been recorded since the last inspection, together with full details of the nature of the complaint and the action taken; most of the complaints had been fairly minor and easily rectified. One complaint was still outstanding and the manager had arranged a staff meeting to address the issues raised. No complaints have been received by the CSCI. Many of the staff have now received training in safeguarding adults and were able to describe the action they would take if they suspected abuse. One person spoken to had not yet attended training and was therefore somewhat vague about the procedure to follow. The manager said that training would be arranged for them. It was reported that safeguarding training had been booked for 14th November 2007. Staff said that envelopes were provided in the reception area so they had the means to report something anonymously if they wished. A telephone number was also provided for them to report any concerns and all staff said that the manager made sure that everyone was aware of these facilities. One resident said “I am content to stay here: I have no fears or worries about anything”. Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. Residents live in a clean and tidy home but further redecoration and refurbishment is required. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: A tour of the home was conducted. Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 20 Residents’ rooms were very personalised and homely, showing their individual interests and personalities. People had been able to bring photographs, ornaments and items of their own furniture into the home with them. One room had lots of flowers and plants, another room was decorated with lanterns for Halloween and examples of the resident’s own artwork. Another room was very feminine and pretty, whilst another contained lots of Manchester City memorabilia. Residents said they liked their rooms. From information requested from the manager before the site visit, it was reported that the lounge, dining room, corridors/stairs and four bedrooms had been redecorated. Flags had been re-laid outside the conservatory. The exterior of the building had been redecorated and 20 window panels replaced. Three more car parking spaces had been provided and parts of the kitchen refurbished. Some of the rooms had been redecorated but others are still in need of refurbishment. The manager said they were trying to do this as rooms became vacant. Carpets and bedding need replacing. Bedding, in particular, was very threadbare and some of it appeared to be hospital type blankets and sheets. In one room it was noted that a mirror behind the door was cracked and needed replacing. A lot of the furniture was shabby and worn. Relatives who had returned a satisfaction survey distributed by the company had also noted this. At the time of the site visit work was being carried out on the foyer and gardens. Tables and chairs were provided for residents wishing to sit outside. The home was clean and tidy, considering that storage space was very limited and a number of residents have different pieces of equipment such as wheelchairs that take up a lot of room. As at the last inspection, the lift shaft maintenance cupboard was still being used to store some of the domestic’s equipment. However, the manager said that the fire service had advised that as long as bottles of cleaning products were removed from cardboard boxes this was acceptable. Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. Staff are well trained but insufficient recruitment practices do not protect the residents. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Examination of the staff duty rotas showed that generally one nurse and six or seven carers were on duty in the mornings and one nurse with four carers were on duty in the afternoons, whilst one nurse and two carers were on duty at night. Since the last inspection, a visitor to the home has raised concerns that staffing levels at the home are insufficient, especially in the afternoons. For this reason this unannounced site visit started at 3.45pm. On arrival we found that a number of residents were out of the home on a trip and therefore staffing levels were satisfactory. However, the manager was open and frank about staffing levels and said that she had recently discussed her own concerns with the company about staffing levels, in the light of the number of residents being cared for with quite complex needs. Minutes of a meeting held Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 22 between the manager and senior representatives of the company provided evidence that this discussion had taken place and the manager said that she had secured agreement from the company to employ another nurse for the morning shift. The manager was hoping that it would also be sanctioned for her to employ a carer to work a twilight shift and was waiting for further instruction regarding this. An extra carer would be beneficial, as one of the carers is mainly engaged in ancillary work, such as serving the tea and extra assistance in feeding residents and tending to their personal needs would be useful. Residents said that they felt confident in the staff’s ability to care for them and thought the staff morale and teamwork were very good. This meant that the atmosphere was pleasant and relaxed, which was clearly a positive factor for the residents. One resident said “Laughter goes through the house”. Three staff personnel files were examined. Since the last inspection, the application form for new staff has been amended to provide more room for staff to be able to detail their employment history. However, it was noted that one of the staff had a gap in employment, according to the dates they had written, for which there was no explanation. Any gaps in employment must be explored. One of the three files contained all the records needed to ensure that suitable checks had been made. However, the references for one of the other staff were only pre-written testimonials; the manager should have written to the referees to ensure they were authentic, and there were no references provided at all for the third member of staff. Furthermore, this person had started working at the home before checks had been made to ensure that they had not been referred for inclusion on the POVA list and their CRB had been received after their employment had commenced. A requirement was made concerning these issues at the last inspection and the manager must take steps as a matter of priority to ensure that this requirement is complied with. The manager said that she was in the process of transferring all the staff training records from paper copies to electronic ones. From the records available, it was evident that a range of training had been provided since the last inspection, such as person-centred dementia care, introduction to dementia care, communicating with people with dementia, person-centred approach to care, life story work and reminiscence. Some staff were undertaking a home study course in infection control through NCFE and one nurse has nearly completed a diploma in Multiple Sclerosis care. Training had been arranged for one nurse to attend further training in care of tracheotomies and two nurses to attend training in venepuncture and catheterisation. The majority of staff had received training in safeguarding, fire safety and moving and handling. Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 23 Information provided by the manager showed that 62 of the carers had NVQ’s and another six staff were working towards this qualification. From information provided by the manager before the site visit, it was reported that the home is accredited with Manchester University as a placement for student nurses and very good feedback is received by the university from student nurses who find their placement at the home a positive experience. One of the nurses recently won an award for the best mentor in the Stockport area. Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. The manager has the skills and knowledge to properly manage the home and systems in place create an open and consultative atmosphere, promoting active involvement from staff and people living at the home to build a positive home for people to live in. This judgement has been made using available evidence, including a visit to this service. Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 25 EVIDENCE: Residents, relatives and staff were positive about the contribution the manager makes to the home. All said the manager was accessible and very willing to listen and act on concerns. A certificate from the Registered Nursing Homes Association showed that the manager had updated her knowledge on topics such as CRB disclosures, preventing illegal working, prevention and treatment of pressure ulcers, CSCI thematic inspections and different aspects of the CSCI methodology, i.e., quality ratings and Inspecting for Better Lives. The manager also said she had completed distance learning courses in nutrition and care of gastrostomies. Residents said that meetings were held with them periodically and that they were encouraged to make suggestions regarding any changes or improvements they would like to see in the home. Minutes of the meetings are taken and displayed for the information of people who can’t attend. Staff said that meetings were held with them about once a month and that the meetings were a two way process in which they were invited to put forward their views and suggestions. Staff also said that the area manager visited at least every month and we were shown an action plan that had been developed between the manager and the area manager identifying the areas that needed further work. Prior to this site visit we sent surveys to residents and relatives asking for their opinion about the home. Three residents and three relatives responded and feedback was generally very positive. Comments included “well motivated staff who seem to enjoy their jobs. They all have a good sense of humour and share this with the residents” and “the matron is excellent and leads by example”. The manager was carrying out her own audits to ensure that staff were following the home’s procedures in areas such as care planning and medicine management. The company had distributed a satisfaction survey to relatives and a report of the analysis was available. The home holds small amounts of money for a few residents and since the last inspection the system for recording financial transactions had been amended so that each resident’s financial transactions are recorded on a separate ledger sheet. These records had been audited by the area manager on 1st October 2007 but were not looked a by us at this site visit. Throughout the site visit staff were observed to be working using safe working practices. Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 26 Fire safety records, maintenance records and health and safety training records were available and indicated regularly monitoring and checks were undertaken in the home. Records of a routine service to the emergency lighting system on 7th February 2007 listed quite a number of repairs that were needed. The manager said these repairs had still not been carried out. A food hygiene inspection on 5th June 2007 raised a small number of informal issues. The most recent certificate to show that the hoists had been serviced was dated 20th September 2006 although the manager was sure they had been serviced since then. The manager is requested to confirm the last date on which the hoists were serviced. Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 27 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 X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 2 Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 28 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 OP9 Regulation 13(2) Requirement Timescale for action 30/11/07 2 OP29 19 3 OP38 23(4) Staff must ensure that when they administer medicines to residents an accurate record is kept so that it is clear what medication people have had. To prevent unsuitable staff being 30/11/07 recruited, all information and documents stated in Schedule 2 of the Care Homes Regulations 2001 must be obtained in respect of employees at the home and must ensure that checks against the POVA list are made prior to employment. (Timescale of 30/10/06 not met). The emergency lighting identified 15/12/07 at the last annual service must be repaired so that people are kept safe. Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 29 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 OP9 OP15 Good Practice Recommendations Systems should be put in place to ensure that the stock of medicines is rotated and overstocking does not occur. The menus should be reviewed to ensure that clear options are available at each mealtime and consideration should be given to offering a cooked breakfast to residents at least twice a week. Thin and worn bedding should be replaced. Worn and heavily stained carpets should be replaced. The registered person should continue with the redecoration and refurbishment of the home. The registered person should review the staffing levels in the home, particularly in the afternoon and evenings. Gaps in employment histories should be explored with candidates for employment and a record should be made detailing the reasons for any break in employment. The registered person should install an electronic system linked to the fire alarm that allows service users the choice of having their bedroom door open at night whilst ensuring their safety. 3 4 5 6 7 OP19 OP19 OP27 OP29 OP38 Bowerfield House Private Nursing Home DS0000017290.V346732.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Manchester Local Office 11th Floor, West Point 501 Chester Road Old Trafford Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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