Inspection on 24/05/05 for Bowerfield House Private Nursing Home

This inspection was carried out on 24th May 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bowerfield House Private Nursing... 18/10/07

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

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

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 SK12 2NJ Lead Inspector Tracey Rasmussen Unannounced 24th May 2005 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. Bowerfield House Private Nursing Home F54-F04 Bowerfield S17290 V226184 240505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Bowerfield House Private Nursing Home Address 1 Broadwood Close Disley Stockport Cheshire SK12 2NJ 01663 764291 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) Mr Peter F Bower and Mrs Wendy Bower 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 F54-F04 Bowerfield S17290 V226184 240505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date Imposed 11 October 2002 1. No service user may be received in the home who is less than 20 years old, male/female. Date of last inspection 9 February 2005 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 Mr and Mrs Bower. 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, 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 provided over two floors. The ground floor facility has a dining room, lounge and small conservatory. A 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 are available on each floor. A wide variety of adaptations and aids are provided to assist in the nursing of the service users. Bowerfield House Private Nursing Home F54-F04 Bowerfield S17290 V226184 240505 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 five hours in the afternoon and early evening by two inspectors. One further visit has been made to the home since the last inspection in February 2005. This was to check that the home had improved the areas of concern identified at the last inspection, which included afternoon staffing levels and storage of oxygen. A tour of the two floors in the home took place and care and staff records were seen. Six of the twenty six residents, two visitors (close relatives) and three staff were spoken to. Several resident and visitors questionnaires were left at the home. Six visitor’s questionnaires had been returned. These all contained positive responses. Since the last inspection a number of the issues identified have been dealt with. At this inspection staffing levels in the afternoon were not satisfactory nor were there enough staff rostered to work in the afternoons for the week. An immediate requirement was made at the inspection for the home to ensure that there was enough care staff on duty each afternoon and evening. The week prior to this visit the Commission for Social Care Inspection received two separate telephone calls from relatives expressing concerns about a scabies infection in the home. The inspection did identify that there was a potential scabies problem in the home and the manager had sought guidance from a dermatologist in monitoring the situation, however the manager was advised to contact the infection control department to seek up to date advice on treating everyone living and working in the home. A short verbal feedback of the findings from the inspection was given to the manager of the home who called following a day of training. What the service does well: Residents said they liked living in the home and were complimentary about the staff. Care staff were described as ‘caring’ and willing to do anything to help. One visitor said she was made welcome at the home. Residents said that they enjoyed their meals and one resident said he particularly enjoyed the strawberries and cream he had after lunch. Trips out into the local community were organised weekly – weather permitting and residents said they really enjoyed these. Bowerfield House Private Nursing Home F54-F04 Bowerfield S17290 V226184 240505 Stage 4.doc Version 1.30 Page 6 Gardens and patio areas were pleasant What has improved since the last inspection? 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. Bowerfield House Private Nursing Home F54-F04 Bowerfield S17290 V226184 240505 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 Bowerfield House Private Nursing Home F54-F04 Bowerfield S17290 V226184 240505 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 Resident pre-admission assessments lack some detail so the home cannot confirm it can meet the individual needs on admission. EVIDENCE: Outcomes for standards one and two were not fully assessed as the manager was on training at the time of this visit. However, information about the home in the forms of a service guide or statement of purpose were not readily available, although one resident’s relative did say that she and her husband were given all the information they needed about the home before admission. A range of care records was inspected. There was a marked improvement in the quality of information recorded in the resident’s care files. All the care records viewed had copies of the home’s pre-admission assessments that did identify the needs of the new resident but did not always clearly detail the nursing needs. Community care assessments were not available on the files viewed and this could lead to significant information for example about past medical or social history not being recognised. One newer resident to the home stated that the home cared for his physical care needs but socially he was bored because the other residents couldn’t chat with him. Bowerfield House Private Nursing Home F54-F04 Bowerfield S17290 V226184 240505 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 The care planning documentation was insufficient to meet the social care needs of residents (privacy and dignity of residents was respected). Medication practices did pose a potential risk to residents and staff. EVIDENCE: Residents living at the home were positive about living there and said that they received good care from ‘lovely’ staff. Two residents said that the increase in the numbers of staff in an afternoon and the return of the manager had improved the care in the home. Residents were nicely dressed and attention had been paid to nails, hair and clothing co-ordination and accessories. The hairdresser was working on the day of inspection. Residents said that they felt that their rights to privacy were respected in the home. One resident was still in his pyjamas and dressing gown and he said he liked wearing these. One resident said she was aware of what was in her care plan because she had discussed it with the nurses. Since the last inspection the quality of information recorded in the resident’s care plans was much improved. Risk assessments had corresponding care plans and these were more detailed. Information was recorded which detailed Bowerfield House Private Nursing Home F54-F04 Bowerfield S17290 V226184 240505 Stage 4.doc Version 1.30 Page 10 the individual medical and physical needs, including regular weighing and observations. Social care needs were not recorded. Records were available for GP, physiotherapy and other community medical support services. Two callers to the CSCI in the week before this visit had voiced concern about the home’s inaction in dealing with an out break of scabies. The manager explained she had struggled to gain consistent GP support in tackling a suspected outbreak of scabies in the home. A dermatologist had been into the home and a strategy was being implemented to establish if scabies were present. Advice from the Infection Control Unit, Stockport had not been sought since winter 2004. The home’s medication practices had improved in some areas since the last inspection however medication was still being stored with written records in one cupboard and in another cupboard a box labelled ‘spare med’ contained various strips of different medications potentially putting residents and staff at risk of administering non prescribed medication. Bowerfield House Private Nursing Home F54-F04 Bowerfield S17290 V226184 240505 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, 14, 13, 15 Residents social needs are not met on a daily basis. Choices are available and resident’s family and friends are welcome. The quality of food provided to residents is good. EVIDENCE: One resident said that on Thursdays, weather permitting, a trip out was taken and a group of residents took it in turn to go out. He said he had been out to Goyt Valley and Chapel-en-le-Frith. This resident also said he went to bed early because ‘there was no one for him to talk too’. Other residents confirmed that trips out were undertaken and records indicated that all residents were offered an opportunity to go out. Activity records indicated that residents were also assisted to vote in the recent national elections. Staff at interview said they rarely had time to undertake activities and that residents with severe incapacity did not have any person centred interventions other than physical care. Care plan records did not have detailed social history or care plan. The care plan records focused on the physical aspects of care and did not provide a three dimensional picture of the resident as a person. One relative stated she had never seen any type of stimulation activity being undertaken with her relative. Bowerfield House Private Nursing Home F54-F04 Bowerfield S17290 V226184 240505 Stage 4.doc Version 1.30 Page 12 Visitors were seen coming and going all day and one relative said he was always made welcome by the home. Residents bedrooms were made personal with possessions and mementos. Residents were complimentary about the meals provided in the home and said they could request alternatives. Records of what residents had eaten were kept and it was reported that the registered person and some staff had started on a Food Health and Hygiene training course. The kitchen was clean. A menu was not available. At this visit staffing levels were inadequate and this resulted in the evening meal being rushed for residents who needed assistance. Bowerfield House Private Nursing Home F54-F04 Bowerfield S17290 V226184 240505 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) 17,18 Residents rights are protected and promoted. Despite some training, residents are not fully protected from potential abuse EVIDENCE: A number of residents were assisted to vote in person at the recent general election. The home also requested postal votes for residents who could not vote at a polling station, however only one postal vote arrived and the manager has formally complained about this. Staff at interview stated that they had not received any formal training in abuse but the manager had told them to report all concerns. The manager was not aware of the ‘Alerter’ training for staff being provided by Stockport social services but she stated she would look into this. Bowerfield House Private Nursing Home F54-F04 Bowerfield S17290 V226184 240505 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, 20,21,25, 26 Residents live in a clean home that needs some refurbishment, maintenance and tidying. Aids and adaptations are available to meet resident’s needs. EVIDENCE: Some bedrooms had been redecorated and fitted with new carpets since the last inspection and so provide pleasant private living spaces. Other areas in the home do still need refurbishing. Toileting and bathing facilities are available and specialist equipment to assist physically dependent people is also available. Outdoors the home has a well maintained garden and patio where residents can sit out. The home was clean but parts of the home were cluttered and untidy with equipment and medical supplies placed on hand rails along the corridors. Records of hot water temperature monitoring of hand wash basins in resident’s rooms were not available Bowerfield House Private Nursing Home F54-F04 Bowerfield S17290 V226184 240505 Stage 4.doc Version 1.30 Page 15 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) 27,30 Staffing did not meet the resident’s needs. EVIDENCE: Staffing levels at this visit were inadequate to meet the needs of the residents in a timely manner. One resident said he had had to wait for assistance from the staff ‘the last couple of days, because they are very busy’. As a result of the low staffing, one resident was observed hanging over the side of his chair for a lengthy period of time after tea even though his care plan records the assistance required to prevent this. An immediate requirement was issued to the home to increase staffing levels in the afternoon and evening. Rotas for previous and future weeks did have higher levels of staffing on duty. Recruitment records were not seen at this visit. The care staff on duty demonstrated a knowledgeable insight in to the needs of the residents and could identify the gaps in their own skills and abilities. Some training had been undertaken in the home and one staff member detailed the induction training she received and said this was beneficial. Records were not seen. A programme of training in moving and handling and fire safety was being implemented, although a new member of staff had not had full training in moving and handling and training in specific diseases/ illnesses had not been provided. Bowerfield House Private Nursing Home F54-F04 Bowerfield S17290 V226184 240505 Stage 4.doc Version 1.30 Page 16 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) 31,32,33,36,38 Management of the home is improving, although residents do not have a say in the way the home is run and quality monitoring has not been undertaken, but health and safety practices do promote the resident’s welfare. EVIDENCE: The manager had not commenced a management training course but did keep herself up dated with clinical issues. Staff supervision had commenced and records were available, although this does require further development to include the social aspects of the service and the staff member’s self development. Residents and relatives stated that the home had improved since the manager returned to the home from her extended leave, however a resident’s meeting had not been held. Bowerfield House Private Nursing Home F54-F04 Bowerfield S17290 V226184 240505 Stage 4.doc Version 1.30 Page 17 Quality assurance systems had not been developed although the manager had obtained some sample questionnaires to use with different stake holders. A number of environmental risk assessments had been developed since the last inspection, which raise staff awareness about potential hazards in the home. Many bedrooms doors were held open according to the resident’s preference with a metal or stone doorstop. The home’s risk assessment states that for the duration of the night shift all doors including bedrooms are closed as a fire safety precaution. Bowerfield House Private Nursing Home F54-F04 Bowerfield S17290 V226184 240505 Stage 4.doc Version 1.30 Page 18 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 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 2 3 3 3 x x 2 3 STAFFING Standard No Score 27 1 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x 3 2 2 2 1 x x 3 x 3 Bowerfield House Private Nursing Home F54-F04 Bowerfield S17290 V226184 240505 Stage 4.doc Version 1.30 Page 19 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 1 Regulation 5 Requirement The registered person must ensure that the home’s Statement of Purpose and Service User Guide are readily available in the home to service users and all visitors . (Timescale of the 30/04/05 was not met). The registered person must ensure that pre-admission assessments undertaken for prospective service users detail comprehensively their needs and records how these needs are met. (Timescale of the 28/02/05 was not met). The registered person should ensure that community care assessment are obtained prior to admission to the home. All medication must be maintained safely and securely in accordance with Regulation, the Royal Pharmaceutical Guidance and NMC Guidelines. (Timescale of the 28/02/05 was not met). The registered person must ensure that medication is stored safely in one designated area away from non prescribed F54-F04 Bowerfield S17290 V226184 240505 Stage 4.doc Timescale for action 31/7/05 2. 3 14 15 30/6/05 3. 3 14 15 13, 17 30/6/05 4. 9 30/6/05 5. 9 13 30/6/05 Bowerfield House Private Nursing Home Version 1.30 Page 20 6. 12 12 16 7. 12 12 16 8. 15 12 16 17 12 16 18 13 9. 15 10. 18 11. 12. 19 25 23 13 (Timescale of the 28/02/05 was not met.). The registered person must assess the social care needs of the service users accommodated at the home and develop and implement person centred activities for each service user maintaining records of activities undertaken. The registered person must ensure service users and/or representatives are consulted about the type of recreational and social activities the home intends to provide and information about the activities is circulated to service users. (Timescale of the 28/2/05 was not met.). The registered person must ensure that a menu is available to service users which details alternative choices including special diets. The registered person must ensure that there are enough staff employed by the home to assist service users with their meals in timely manner. The registered persons should ensure that training in the protection of vulnerable adults is provided to all staff. The registered person must continue with the redecoration and refurbishment of the home. The registered person must ensure that systems are implemented for the regular monitoring of hot water outlets and records maintained. (Timescale of the 28/2/05 was not met.). The registered person must ensure staffing levels are maintained in the later afternoon F54-F04 Bowerfield S17290 V226184 240505 Stage 4.doc 30/6/05 30/6/05 30/6/05 Immediate 30/6/05 31/7/05 30/6/05 13. 27 18 Immediate Bowerfield House Private Nursing Home Version 1.30 Page 21 14. 30 18 15. 31 10 18 16. 32 10 12 24 17. 33 12 24 26 and evening with a minimum of one registered nurse and four care assistants on duty, with immediate effect to ensure that the needs of service users are met in a timely fashion, and that the level of staffing is regularly reviewed in line with the service user’s changing needs. The registered person must ensure that the homes training programme is further developed to ensure staff receive the appropriate training to meet the specific care needs of the residents. The registered manager must ensure management training meets the required standard or that training is competed to meet this standard by the end of 2005. The registered person must ensure that service user meetings are facilitated and undertaken on a regular basis and records maintained. (Timescale of the 28/3/05 was not met.) The registered person must ensure quality assurance systems are implemented in the home and maintain a written record of unannounced monthly visits has required by regulation 26 of the Care Homes Regulations 2001.(Timescale of the 28/2/05 was not met.). 31/7/05 30/12/05 31/7/05 31/7/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations F54-F04 Bowerfield S17290 V226184 240505 Stage 4.doc Version 1.30 Page 22 Bowerfield House Private Nursing Home 1. 2. 8 38 The registered person should ensure advice and support is sought from the Control of Infections Unit in combating potential scabies infections. The registered person should install an electronic system linked to the fire alarm which allows service users the choice of having their bedroom door open at night whilst ensuring their safety. Bowerfield House Private Nursing Home F54-F04 Bowerfield S17290 V226184 240505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 2nd Floor Heritage Wharf Portland Place Ashton under Lyne OL7 0QD 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 Bowerfield House Private Nursing Home F54-F04 Bowerfield S17290 V226184 240505 Stage 4.doc Version 1.30 Page 24 - 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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