Inspection on 04/10/05 for Bowerfield House Private Nursing Home

This inspection was carried out on 4th October 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... 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 4th October 2005 09:51 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.V255578.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bowerfield House Private Nursing Home DS0000017290.V255578.R01.S.doc Version 5.0 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) Mr Peter F Bower 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 DS0000017290.V255578.R01.S.doc Version 5.0 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. 24th May 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 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 over two floors. The ground floor 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 in place to assist in the nursing of the service users. The home is a non-smoking environment. Bowerfield House Private Nursing Home DS0000017290.V255578.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over almost seven hours on Tuesday 4th October by two inspectors. A tour of the home took place and care and staff records were seen. Five of the twenty-six residents, one visitor (close relatives) and three staff were spoken to. Eight resident and eight visitors comment cards were left at the home. None had been returned at the time of writing this report. A short verbal feedback of the findings from the inspection was given to the manager of the home. What the service does well: What has improved since the last inspection? Some further decorating of residents’ bedrooms had been undertaken and some double glazed window units had been replaced. The manager had developed a paper audit trail for domestic staff to record the checks they have undertaken. Bowerfield House Private Nursing Home DS0000017290.V255578.R01.S.doc Version 5.0 Page 6 Staff rotas showed that staffing levels were kept, on the whole at a level which meet resident’s needs. 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 DS0000017290.V255578.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bowerfield House Private Nursing Home DS0000017290.V255578.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4 Information about the service and facilities offered by the home was not available. Residents needs are assessed before they move into the home. The home can confirm they can meet the needs of the resident on admission and contracts are provided. EVIDENCE: The home’s Statement of Purpose was available in the policy and procedure file, which was kept in the manager’s office. This was not accessible to residents or people visiting in the home. The manager did report that all prospective residents were provided with a copy of the home’s service information guide. One was not available to read at this visit, nor was there a copy of previous inspection reports. A sample of resident’s case files were viewed and these did contain the home’s pre-admission information and community care assessments or nursing assessments. Care plans to meet the clinical and physical needs were recorded. Bowerfield House Private Nursing Home DS0000017290.V255578.R01.S.doc Version 5.0 Page 9 Contracts which detailed the terms and conditions of residency were available, although, these did not contain information about the nursing care contribution each resident received. The home does not provide an intermediate care service. Bowerfield House Private Nursing Home DS0000017290.V255578.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Residents were treated with respect and dignity. The care planning documentation was insufficient to meet the emotional and social care needs of residents. Medication storage facilities are inadequate. EVIDENCE: A number of residents were spoken to. At this visit the home was providing nursing care and support to a number of very dependent residents who required assistance with all aspects of daily living. Residents in bedrooms or in bed appeared very comfortable. One visitor was very positive about the service the home provided and compared positively the care provided at Bowerfield to another care home. One resident had recently been assisted to move out of the home, to live in the community with support. Care planning records viewed contained detailed assessments, which had a corresponding care plan. The sample of care planning information seen did not reflect the quality or quantity of the actual care that was provided in the home. Staff –both nursing and care staff explained how they attempted to meet the individual needs of residents detailing the various approaches used. The staff Bowerfield House Private Nursing Home DS0000017290.V255578.R01.S.doc Version 5.0 Page 11 used examples to illustrate the individual care provided, for example staff were learning to understand a newer residents’ responses to different stimuli and so developing a communication strategy. This work the staff were undertaking on a daily basis was not recorded. The care records viewed provided a clinical picture of each of the residents’ health care needs with interventions to meet those needs but it did not provide a picture of the resident’s daily social interactions. Some records of social activity participation had been recorded but this was not linked to a personal care plan. Records were available for GP, tissue viability and other community medical support services. All three files examined had records that detailed the input of a physiotherapist. Medication practices were briefly sampled. Records, including the controlled drug register were maintained appropriately. Storage of medication continues to be a problem and the manager stated she was struggling to find one place to store medication. Systems for the safe disposal of medications were in place. Bowerfield House Private Nursing Home DS0000017290.V255578.R01.S.doc Version 5.0 Page 12 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 and 15 Residents social care needs are met but records to support this are not available. The food is good and choices are provided. EVIDENCE: A volunteer in the home visits every Tuesday morning to facilitate activities with residents and provide one to one support. The volunteer was enthusiastic. One care staff member said that staff also undertook activities time permitting, in the afternoon. A record of the activities undertaken was maintained but this did not relate to or inform the residents care plan. Staff had a clear awareness of resident’s individual preferences with regards to stimulation but this information was not recorded. It was reported that weekly trips out continued to be undertaken and the home now had two mini buses to assist residents to get out into the community. One relative said that her family member did go out regularly. A selection of morning newspapers was delivered to home daily. The manager was trying to organise regular resident’s meeting and one visitor to the home was reported to be keen to develop these. Bowerfield House Private Nursing Home DS0000017290.V255578.R01.S.doc Version 5.0 Page 13 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 lunch served at this visit consisted off roast gammon with onion sauce, fresh vegetables and creamed potatoes followed by a bread and butter pudding. There was enough staff available to provide discreet unhurried assistance to residents. Bowerfield House Private Nursing Home DS0000017290.V255578.R01.S.doc Version 5.0 Page 14 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 The complaint procedure is not readily available in the home. Residents are not fully protected from abuse. EVIDENCE: A copy of the complaints procedure was available in the home’s policy and procedure file. The manager reported that a copy of the procedure was also included in the home’s service user guide. A copy of the guide was not available at this visit. The manager did say she dealt with minor issues and concerns as they occurred, responding to and addressing the issue as part of the team’s daily business. The manager stated that the home had not received any formal complaints. Some training in the protection of vulnerable adults had been undertaken. The manager had attended a facilitators course. The free ‘Alerter’ training offered by Stockport Social Services department had not been used. One staff member confirmed that she had not had any in-house training in abuse, but had been assessed in this area as part of her NVQ. The staff member was very clear about the action she would take if she suspected abuse. Bowerfield House Private Nursing Home DS0000017290.V255578.R01.S.doc Version 5.0 Page 15 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, 24 and 25 Residents live in a clean home that needs some refurbishment, maintenance and tidying. Aids and adaptations are available to meet resident’s needs. EVIDENCE: This visit identified that more bedrooms have been redecorated and recarpeted. A number of other bedrooms do still need redecorating. Furniture and fittings both in private bedrooms and communal areas does need replacing or refurbishing. For example wardrobes and bedside cabinets were chipped and furniture-edging strips were missing, dining tables and chairs had been stripped of their varnish in places from continual use. Toileting and bathing facilities and specialist equipment to assist physically dependent people were available. Storage facilities in the home were inadequate for the amount equipment and medical supplies required for resident’s care needs. This meant in bedrooms Bowerfield House Private Nursing Home DS0000017290.V255578.R01.S.doc Version 5.0 Page 16 continence products were visible to visitors and the corridor handrails had floor mats hanging over them; air fresheners and toilet rolls placed on them. 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. This was a requirement from previous inspections. Outdoors the home has a well maintained garden and patio where residents can sit out. One resident was sat out smoking at this visit. Bowerfield House Private Nursing Home DS0000017290.V255578.R01.S.doc Version 5.0 Page 17 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 Recruitment practices and staffing levels ensure residents receive a quality service. Residents are cared for by staff who are trained and competent to do their job. EVIDENCE: The home’s rotas identify that staffing levels are maintained in the home at a consistent level to meet the needs of the residents. At the time of this visit there was three care staff, one registered nurse, the manager, one student nurse and two volunteers in the home. There were also three ancillary staff, a gardener and a maintenance person. One staff member said she felt that the staff team worked well together and supported each other. Comments from staff indicated that the increased care staffing levels in the home in the early evening had been beneficial to the residents. One care staff member had recently commenced working in the home and explained that she was supernumerary for two weeks and had received a detailed induction booklet. Some staff had achieved NVQ accreditation. The manager acknowledged that further NVQ training was required. A training diary was maintained which listed all the training staff had received. A sample of employment records were reviewed and these were maintained appropriately. References and CRB disclosures had been sought. Bowerfield House Private Nursing Home DS0000017290.V255578.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32, 33, 35 and 38 Residents are not fully involved in the running of the home but health and safety practices promote their welfare. Resident’s money is not totally safe. EVIDENCE: The manager reported she had commenced a NVQ 4 management training course and records were available of other clinical training she had undertaken. The manager explained that one resident ‘introductory’ meeting had been undertaken and a regular visitor to the home had facilitated this. Further meetings were planned. Staff confirmed that staff meetings had been held and these had been beneficial because ‘they enabled staff to voice concerns.’ The manager reported and provided copies of a quality assurance audit system, which she intended to implement. Resident questionnaires were also included in the system, however these had not been implemented. Bowerfield House Private Nursing Home DS0000017290.V255578.R01.S.doc Version 5.0 Page 19 The manager confirmed that the home held small amounts of cash for a couple of residents but formal records of transactions were not recorded and so did not offer a robust audit trail. 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. The manager stated that all bedroom doors were shut throughout the night shift. Fire records had been maintained appropriately. Maintenance records for the home were available and kept up to date. Bowerfield House Private Nursing Home DS0000017290.V255578.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 x x x x 2 2 x STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 x 2 x x 3 Bowerfield House Private Nursing Home DS0000017290.V255578.R01.S.doc Version 5.0 Page 21 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 OP1 Regulation 4, 5 Requirement Timescale for action 30/01/06 2 OP1 5 3 OP7OP12 12,14,15 4 OP9 13 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 and 31/07/05 were not met). The registered person must 15/11/05 ensure that a copy of the home’s most recent inspection report is readily available to service users and all visitors . The registered person must 30/11/05 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 must 31/01/06 ensure that medication is stored safely in one designated area away from other non prescribed items. (Timescale of the 28/02/05 and 30/06/05 were not met.). Bowerfield House Private Nursing Home DS0000017290.V255578.R01.S.doc Version 5.0 Page 22 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. 5 Standard OP16 Regulation 22 Requirement The registered provider must ensure that a copy of the home’s complaint procedure is readily available to residents and visitors in the home. 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. (Timescale of the 31/07/05 was not met). The registered person must ensure that furniture and fittings in the home are replaced or refurbished. The registered person must ensure that systems are implemented for the regular monitoring of hot water outlets and records maintained. (Timescales of the 28/2/05 and the 30/06/05 were not met.). The registered person must ensure that at least 50 of staff are trained to NVQ 2 level or equivalent by the end of 2005 Timescale for action 15/11/05 6 OP18 18 30/11/05 7 OP19 23 31/03/06 8 OP24 13, 23 31/03/06 9 OP25 13 15/11/05 10 OP28 18 31/12/05 Bowerfield House Private Nursing Home DS0000017290.V255578.R01.S.doc Version 5.0 Page 23 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. 11 Standard OP31 Regulation 10, 18 Requirement 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. (Timescales of the 28/3/05 and 31/07/05 were 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. (Timescales of the 28/3/05 and 31/07/05 were not met.) The registered person must ensure that a monitoring visit is undertaken on a monthly visit in accordance with regulation 26, and a copy of the report is forwarded to the CSCI. Timescale for action 31/12/05 12 OP32 10,12,24 30/11/05 13 OP33 12,24,26 30/11/05 14 OP33 12,24,26 30/11/05 Bowerfield House Private Nursing Home DS0000017290.V255578.R01.S.doc Version 5.0 Page 24 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. 15 Standard OP35 Regulation 17 Requirement The registered person must ensure that records of residents personal monies are clear and transparent and include signatures for each debits and credit. Timescale for action 15/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP2 OP38 Good Practice Recommendations The registered person should amend the home’s contract of residency to include the nursing care financial contribution the resident receives towards their stay. 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 DS0000017290.V255578.R01.S.doc Version 5.0 Page 25 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. 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