Inspection on 26/09/06 for Bowerfield House Private Nursing Home

This inspection was carried out on 26th September 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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

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 Tracey Rasmussen Unannounced Inspection 26th September 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bowerfield House Private Nursing Home DS0000017290.V292912.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.V292912.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 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.V292912.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. 4th October 2005 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 has recently been purchased by a new 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 are 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 £700 to £1800 according to the package of care. Further details regarding fees are available from the manager. Bowerfield House Private Nursing Home DS0000017290.V292912.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection site visit was undertaken by one inspector on the 26th September 2006 and was completed in the course of one day. The inspection included a review of all available information received by the Commission for Social Care Inspection (CSCI) about the service provided at the home since the last inspection. All key inspection standards were assessed at the site visit and information was taken from various sources which included observing care practices, talking with residents; speaking with visitors; interviewing the manager and other members of the staff team. A tour of the home was also undertaken and a sample of care, employment and health and safety records seen. Questionnaires for residents were left at the home and comments from these are included in this report where applicable. The home has been recently purchased by a new company. Residents, relatives and staff were positive about this and all stated that the new owners seemed to be investing in the home. There has been some improvement in service delivery since the last inspection, however a number of the areas of development identified in this report have been repeated in previous inspection reports. The manager was optimistic that the new company was going to introduce new systems to address the shortfalls in the service provided at Bowerfield. A brief explanation of the inspection process was provided to the manager at the beginning of the visit and verbal feedback of the findings from the site visit at the end. In the week following this inspection site visit a caller to the CSCI voiced concerns about the afternoon staffing levels in the home. These concerns were forwarded to the owner to investigate. It was reported that the home’s investigation into the caller’s concerns found them to be unproven. What the service does well: The home was peaceful and offered a relaxed pleasant atmosphere. Staff were friendly and good humoured with residents and visitors to the home and they undertook their caring duties in a professional manner. One resident said ‘I know all the staff’ and ‘Staff are pleasant, polite and helpful’. A visitor to the home said, ‘it’s a pleasure to come here’. Bowerfield House Private Nursing Home DS0000017290.V292912.R01.S.doc Version 5.2 Page 6 Information about the home and the services provided was readily available at the main entrance, although this needed up dating. A copy of the last inspection report was also available for people to read. The home offers care to people with varying dependency needs but many residents were very dependent requiring full assistance with all aspects of care. Residents appeared well cared for with attention to hair, nails and clothing coordination. A hairdresser was working in the home and the residents were assisted and encouraged to have their hairs styled. Residents were very complimentary about living in the home and praised both the manager and staff. One visitor said, “staff are very conscientious about making sure people are presentable”. Members of the staff team spoken with were also positive. One care assistant said ‘I love it here’ and ‘We work well here, there’s good team work. Visitors were seen coming and going all day. Some were assisted to take their loved ones out, other arranged trips out with the home’s driver. Staffing levels in the morning were appropriate to meet the dependency levels of the residents. Staff were trained and almost half the care staff team had a NVQ 2 qualification. Residents were complimentary about the choice and quality of the meals provided in the home. What has improved since the last inspection? What they could do better: All documentation in the home needs up dating to ensure it refers to the new owners this includes the information guides and the complaint procedure. The recording method for safeguarding resident’s personal monies could be safer. Bowerfield House Private Nursing Home DS0000017290.V292912.R01.S.doc Version 5.2 Page 7 Care planning records need improving in areas particularly in relation to wound care. Improvements are also needed in the recording of medication coming into the home and in the writing other medication records. Recruitment vetting practices need improving to make certain that all the required information about new employees is obtained before they start work. This process is necessary to reduce any potential risks of abuse to residents by new staff. Staff training in NVQ should continue and a review of the afternoon staffing levels should be undertaken to ensure resident’s needs are met in a timely manner The CSCI needs to be notified in writing of all significant incidents, deaths, accidents and pressure sores. Social activities could be developed further and records for each resident wishes or preferences for social stimulation could be improved. The manager should ensure that staff attend the free training on protecting vulnerable adults from abuse which is provided by Stockport’s Social Services. The redecoration and refurbishment of the home should continue and action undertaken to improve storage facilities in the home. Taps on the hand wash basins in resident’s rooms need thermostatic controls fitting and resident’s need risk assessing to reduce the risks of scalding. Quality assurance systems need to be implemented so the service development and improvement can be identified and planned for. This should include opportunities for residents and relatives to comment on the home and service it provides. Please contact the provider for advice of actions taken in response to this inspection. Bowerfield House Private Nursing Home DS0000017290.V292912.R01.S.doc Version 5.2 Page 8 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 DS0000017290.V292912.R01.S.doc Version 5.2 Page 9 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.V292912.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is adequate. The Information about the service and facilities offered by the home although available, was not up to date. The home confirms that they can meet the needs of the resident on admission. This judgment has been made using available evidence including a visit to the service EVIDENCE: Information about the home in the form of a Service User Guide and a Statement of Purpose was available at the entrance into the home The information guide contained details about the home and the services the home provides. The contents of the information guide were out of date and referred to the previous owners of the home and to the organisation that inspected care homes before the start of the CSCI. The new company that owns Bowerfield should update this information quickly. The manager did state that the information guides were in the process of being updated by the company. Bowerfield House Private Nursing Home DS0000017290.V292912.R01.S.doc Version 5.2 Page 11 At the main entrance of the home there was a copy of the last inspection report, which was readily available to residents and visitors. There were also blank questionnaires provided by CSCI for residents and relatives to comment on the service in the home. Three resident care files were seen and these contained detailed information about each of the residents care needs. The care records included information that indicated that the home had made pre-admission assessments or checks on the resident’s care needs before they came into the home. This enabled the manager of the home to assess whether the new resident’s care needs could be met properly by the services provided in the home. One care file had a copy of the letter sent to the resident and his next of kin stating the home could meet the care needs of the prospective new resident. Other professional assessments from social workers and from community nurses were also available on the residents care files. This information provided a more detailed picture of the new resident’s care needs and enabled the home to prepare for the arrival of the new resident. The home had recorded care plans detailing the type of care and support that would be required in response to the identified needs from these assessments. Residents and their relatives spoken with were very positive about the home. One resident said she had looked at two care homes before deciding on Bowerfield. She said she chose Bowerfield because’ ‘everyone was much friendlier’. A visitor to the home said, “They are absolutely fantastic with (resident) here”. Bowerfield House Private Nursing Home DS0000017290.V292912.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. The care and support for residents is set out in detailed care plans and provided respectfully. Improvement is needed in medication record keeping. This judgment has been made using available evidence including a visit to the service EVIDENCE: The home provided nursing, care and support across a range of needs; this included caring for very dependent residents who required assistance with all aspects of daily living. Residents in bedrooms or in bed appeared comfortable. Resident’s requests regarding staying in their bedroom or sitting in the communal lounge were respected. A number of residents were spoken with and all provided positive feed back about living in the home. One resident stated that ‘Staff are pleasant, polite and helpful’ and staff ‘will do as you request’. Another resident said ‘I am very comfortable’ and a relative said she visited everyday and said, ‘it’s a pleasure to come here’. Bowerfield House Private Nursing Home DS0000017290.V292912.R01.S.doc Version 5.2 Page 13 Residents were presentable and dressed according to their preference, clothing co-ordinated, hairs were set and finger nails were manicured. The hairdresser was in the home doing resident’s hair at this visit. Staff were respectful, attentive and caring in their approaches and interactions with residents. Staff spoken withwere cheerful about working in the home and spoke positively about the care they provided and were complimentary about the manager of the home. Care plans viewed contained assessment information based on the activities of daily living, moving and handling, nutritional, falls, skin and Waterlow assessments. Where a risk or need was identified then a care plan was recorded. The three care plans looked at in detail had on the whole good care plan interventions which explained how care was to be given according to the diverse needs and wishes of the resident (person centred care). Reviews and evaluations of the care plans were not routinely undertaken but were reviewed and amended as the resident’s care needs changed. Wound care planning records were not as detailed as they should be which meant, the healing progress of wounds could not be monitored. Attention is also required to ensure that all residents benefit from nutritional monitoring. The care plans seen did not have much information in respect of the resident’s social care needs and the manager acknowledged that this area did need further development and she stated that she had been looking at developing an activity programme for the residents in the home. This should be developed further. Records of contact with community health services such as GP, physiotherapy and optical support were available. Residents are taken by the home for all hospital appointments and the driver said he usually waited with them until the resident was ready to go home. There was considerable improvement in storage of medications in the home. The treatment room had been cleared of wheelchairs and medications had been moved into the treatment room. It was reported that the drug trolley was also being moved to the treatment room. Medication records were seen for three residents. Medication recording practices were not always safe. Records of all medication entering the home were not consistently kept which means that the home could not track the amount of medication in the home. Other recordings on some of the resident’s medication administration record sheet were also missing. The manager should review medication recording practices and ensure all staff work to a consistent safe standard. Bowerfield House Private Nursing Home DS0000017290.V292912.R01.S.doc Version 5.2 Page 14 Staff said they were trained and supported to provide a high standard of care. Nearly half the staff had achieved and NVQ 2. Bowerfield House Private Nursing Home DS0000017290.V292912.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. Life style choices are available and resident’s family and friends are welcome in the home at any time although not all resident’s social needs are met. The quality of food provided is good. This judgment has been made using available evidence including a visit to the service EVIDENCE: The manager said she was trying to develop an activity programmes for the home. A programme of activity or person centred one to one time should be developed for each resident. Records were available of resident’s social preferences and needs but the staff team had not used these to record their interactions or activities with the resident. The social care records should be used by the staff team to evidence the type and level of social support they provide to each resident. Some activities and one to one support was provided, although recording of this was not regular. A diary was used to record activities for example “Plucked XXX eyebrows. Filed and cut nails x three residents”. Another entry recorded, ‘we read the paper together’. The home did provide a selection of broadsheet newspapers each day. Bowerfield House Private Nursing Home DS0000017290.V292912.R01.S.doc Version 5.2 Page 16 One resident spoken with said that, ‘The vicar comes in at least once a week and we do games, quizzes and dominoes’. The resident also said ‘ on Thursday afternoons we have a trip out but not at the moment. I miss that very much’. The resident did explain that the Thursday trip out was stopped temporarily because a staff member was learning to drive the coach in which the residents went out. Staff spoken with said that there wasn’t always time to undertake activities, however they tried to do something in the afternoons. Relatives were seen coming and going all day and they were assisted to take out their loved ones for walks or to sit on the patio. Relatives were also observed to arrange trips outs for their loved ones with the home’s driver. One relative was particularly complimentary about the home and said’ ‘Everyone is very kind to me’ and ‘Staff always ask me if I would like a drink or any help’. A written menu of the meals served in the home was not available, however a chalk board in the dining room detailed the menu for the day. During the course of the morning a staff member went round to each resident and discussed discreetly each resident’s preference with regards the lunchtime meal. The kitchen was very clean and tidy. The cook maintained records required by Food Health and Hygiene regulations. The home’s larder was well stocked with a variety of branded foodstuffs. The home has regular deliveries of fresh meat and vegetables. The cook said she followed a 3 week menu today’s lunch: melon and grapefruit starter, roast gammon with vegetables and chipped potatoes, rice pudding or apple tart and custard. Tea was reported to be a birthday tea which meant that residents were offered soup, various sandwiches, sausage rolls, salads and cakes. A menu plan should be made available to residents to ensure that a balanced and varied diet is offered. Residents said the food was good. One resident commented, ‘Food is very good, there is a good selection, choices and there is enough food at teatime’ and ‘I don’t eat supper’. A visitor said, ‘They use the best butcher and greengrocer in the area and it is delivered fresh every day’. Bowerfield House Private Nursing Home DS0000017290.V292912.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. Training in safeguarding vulnerable adults could be better and although there is a complaints procedure this is not up to date. This judgment has been made using available evidence including a visit to the service EVIDENCE: A copy of the complaints procedure was available in the home and the home’s information packs also contained a copy. The complaint procedure did need updating as it referred to the previous owners of the home. The manager reported that this was being addressed. The manager stated that the home had not had any complaints. Residents and relatives did say that any issues were sorted out quickly. One relative said any worries or concerns ‘Just mention it and it is sorted out –it’s done’. However a user of the services at the home who wished to raise some concerns contacted the inspector after the inspection. The person raising the concerns would not direct their concerns to the manager or the new owners of the home as they feared ‘retribution’. The person’s concerns have been forwarded to the home to investigate. In light of this person’s worries about being able to discuss their concerns directly with the home; the manager and owners of the home should look at ways to promote an open and transparent service where complaints are welcomed as a method of improving service quality. Bowerfield House Private Nursing Home DS0000017290.V292912.R01.S.doc Version 5.2 Page 18 Staff said that they would inform the manager or nurse if they received a complaint. Staff at interview did say they had had training in abuse- this included induction training and NVQ training. A recommendation was made at the last inspection for staff in the home to attend Stockport’s Social Service’s free training (Alerter Training) for the protection of vulnerable adults. The majority of the staff team had not attended this valuable training resource which runs on a monthly basis. The manager did say she was planning on sending staff on this training and this should be done. Bowerfield House Private Nursing Home DS0000017290.V292912.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25 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 judgment has been made using available evidence including a visit to the service EVIDENCE: Bowerfield is a purpose built care home that was built several years ago when the dependency levels of the people entering care homes was not as high and the need for space for equipment and storage for personal aides was not necessary. Today most of the dependent residents living in Bowerfield require the use of special wheel chairs and hoists. This has resulted in areas of the home being cluttered with equipment. The manager reported that the new owners of the home were assessing ways of improving the home’s environment. The home was clean and odour free and domestic staff were observed to be thorough in undertaking their duties. Some redecoration had been undertaken Bowerfield House Private Nursing Home DS0000017290.V292912.R01.S.doc Version 5.2 Page 20 in the home, however further redecoration and renewal of furnishings needs to continue. At this visit, one vacant bedroom was being fully redecorated and refurbished. There was an acknowledgement by staff in the home that the new owners were improving the home. More than one staff member commented incredulously that residents had got new soft towels. A number of bedrooms had been highly personalised and decorated according to the resident’s taste and preference. One resident said ‘I have a nice bedroom – nice and bright.’ Toileting and bathing facilities and specialist equipment to assist the diverse care needs of the residents were available. The kitchen and laundry were compact, clean and tidy. The garden areas were neat and presentable with a patio and furniture which resident’s said they enjoyed in good weather. Other storage facilities in the home also need improving. The lift shaft maintenance cupboard was used to store some of the domestic’s equipment. This is a health and safety hazard and was identified at the last statutory lift inspection. The lift shaft cupboard should be kept locked and not used to store anything. Storage in resident’s bedrooms was also inadequate and ways of improving this should be sought. The corridor’s handrails continued to be places for storing air fresheners and hanging floor mats. Despite requirements from previous inspections hot water temperatures of hand washbasins in resident rooms were not thermostatically controlled. Systems to monitor the temperature of the hand washbasins had not been developed. The manager did say that the home did have some thermostats to put on the hot water taps and this work would commence shortly. However risk assessments had not been recorded to ensure safeguards were in place to reduce the risk of accidental scalding. Bowerfield House Private Nursing Home DS0000017290.V292912.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. Staffing levels, training and skill mix were appropriate to meet residents’ needs. Evidence did not show that recruitment vetting procedures were always followed for the protection of service users. This judgment has been made using available evidence including a visit to the service. EVIDENCE: The home has a pleasant relaxed atmosphere and all staff spoken with were good humoured and at ease. Staff were positive about working in the home and said they enjoyed working there. One nurse said, “The care staff are caring, respectful and go that extra mile. They bring in CDs or plants for the residents”. Comments from residents included ,‘Staff are pleasant, polite and helpful’ and ‘…the staff they are absolutely fantastic’. A person contacted the CSCI after the inspection visit to raise concerns about staffing levels in the afternoon but was full of praise for the staff team. At this visit staffing levels appeared appropriate to meet the needs of the residents living in the home. The caller to the CSCI raised concerns regarding the adequacy of staffing in an afternoon and evening and indicated that residents were left waiting for assistance because there was not enough care Bowerfield House Private Nursing Home DS0000017290.V292912.R01.S.doc Version 5.2 Page 22 staff available to meet the dependency needs of the residents. This concern has been forwarded to the home to investigate and respond to. NVQ training was established in the home, 40 of the staff had the level 2 qualification. A number of staff were also seeking to undertake a NVQ level 3. Interview with staff indicated that they were supported and encouraged to attend training. One care staff member listed the training he had received whilst working in the home and this included “moving and handling; fire safety, NVQ2 just completed – now doing level 3; I am doing Dementia Care at the Dialstone Centre –I am really enjoying it; health and Hygiene and abuse – leaflets etc”. Training certificates were available on the staff files seen. Employment records were checked for three newer staff members. The manager did say that systems were still in a transitional period with the new company –they now undertook PovaFirsts and CRBs. One staff file seen did not have the PovaFirst and CRB available, the manager was certain that these had been obtained and thought that the details were with the company’s headquarters. The other two files did have evidence that the disclosures had been undertaken. References were available on two out of the three files and again the manager was sure the references had been obtained for the third file. The manager must review the home’s administration and recruitment practices to ensure residents are not put at risk from the employment of unsuitable staff. Application forms also need amending to ensure that a full working history is obtained. Bowerfield House Private Nursing Home DS0000017290.V292912.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is adequate. The management of the home promotes the health, safety and wellbeing of the residents. Residents are not consulted about how the home is run. Arrangements are in place to ensure resident’s money is safe. This judgment has been made using available evidence including a visit to the service 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. The manager has completed her NVQ 4 in management. The manager explained that quality assurance systems had not been implemented in the home but the new owners were introducing a new quality Bowerfield House Private Nursing Home DS0000017290.V292912.R01.S.doc Version 5.2 Page 24 system and this would be implemented shortly. Most of the residents, relatives and staff spoken with said they could approach the manager with their concerns. The manager stated that she had tried get a resident’s meeting off the ground but could not drum up any interest. One resident said ‘There was a residents meeting arranged once but staff didn’t turn up’. The manager should consider chairing resident and relatives meeting to establish openness and contribute to the quality assurance systems that will be implemented in the home The home does hold small amounts of money for a few residents and a record book was available to track both income and expenditure. It is recommended that the manager amend the records so that each resident’s financial transactions are recorded on their own page. Fire safety records, maintenance records and health and safety training records were available and indicated regularly monitoring and checks were undertaken in the home. The home has a fire risk assessment that allows residents to have their bedroom doors held open through the day however 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. The manager stated that all bedroom doors were shut throughout the night shift. Consideration should be given to introducing an electronic fire safety system which would allow residents the option of having their door open at night. The Care Home’s Regulation 2001 requires all registered care homes to notify the CSCI of all deaths, accidents or incident s that occur in the home. No notifications had been received since January 2006. The manager acknowledged that she had not been doing this but provided reassurances that she would notify the CSCI of all significant incidents in the future. Bowerfield House Private Nursing Home DS0000017290.V292912.R01.S.doc Version 5.2 Page 25 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 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 x x x x x 2 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x 2 Bowerfield House Private Nursing Home DS0000017290.V292912.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 30/10/06 1 OP9 13 2 OP29 19 3 OP38 37 The registered person must ensure that a current, accurate record is maintained of all medications entering the home The registered person must ensure that all information and documents stated in Schedule 2 of the Care Homes Regulations 2001 are obtained in respect of employees at the home and must ensure that checks against the POVA list are made prior to employment. The registered person must ensure that notice is given to the CSCI of any serious injury, illness or incident affecting residents. 30/10/06 30/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000017290.V292912.R01.S.doc Version 5.2 Page 27 Bowerfield House Private Nursing Home 1 2 Standard OP1 OP7 3 OP9 4 5 OP16 OP18 The registered person should ensure the Statement of Purpose and Service User Guide are contin up to date information. The registered person should assess the social care needs of the service users accommodated at the home and develop and implement person centred stimulation activities for each resident. The registered person should ensure that handwritten medication details on the medication administration records are signed and dated by the person writing the record and the details are validated by the staff member and an additional member of staff. The registered person should consider ways of ensuring a open and transparent approach to responding to complaints or criticism. The registered person should ensure that all staff attend one of the ‘Alerter’ training courses provided by Stockport Social Services. The registered person should continue with the redecoration and refurbishment of the home. The registered person should ensure that systems are implemented for the regular monitoring of hot water outlets and records maintained. The registered person should review the staffing levels in the home particularly in the afternoon. The registered person should ensure that at least 50 of staff are trained to NVQ 2 level or equivalent by the end of 2005 The registered person should ensure that service user meetings are facilitated and undertaken on a regular basis and records maintained. The registered person should 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. The registered person should ensure individual written records of financial transactions are available for each resident that money is held for. 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. The registered person must ensure that wound care planning records are recorded for each wound and this includes details of the size, location and dressing regime. DS0000017290.V292912.R01.S.doc Version 5.2 Page 28 6 7 8 9 10 11 OP19 OP25 OP27 OP28 OP33 OP33 12 13 OP35 OP38 14 OP8 Bowerfield House Private Nursing Home Bowerfield House Private Nursing Home DS0000017290.V292912.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs 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 DS0000017290.V292912.R01.S.doc Version 5.2 Page 30 - 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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