CARE HOMES FOR OLDER PEOPLE
Bowgreave Rise Bowgreave Rise 1 Garstang Road Garstang Preston Lancashire PR3 1YD Lead Inspector
Mrs Christine Marshall Unannounced Inspection 13th July 2006 10:00 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 Bowgreave Rise DS0000033165.V304638.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. Bowgreave Rise DS0000033165.V304638.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Bowgreave Rise Address Bowgreave Rise 1 Garstang Road Garstang Preston Lancashire PR3 1YD 01995 603637 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) Lancashire County Care Services Mrs Joyce Reynolds Care Home 32 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (22) of places Bowgreave Rise DS0000033165.V304638.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 32 service users to include up to 10 service users in the category DE (Dementia) and up to 22 service users in the category OP (Older Persons over 65 years) 1st December 2005 Date of last inspection Brief Description of the Service: Bowgreave Rise is a purpose built three storey Local Authority home, located a short drive from the centre of the market town of Garstang. It is set in its own grounds, and has car parking space at the front and rear of the home. A garden area with seating can be found at the back of the home. The home provides personal care for older people, including people with dementia, and is equipped to suit the needs of its residents. All of the bedrooms are single rooms. Toilets and bathrooms are conveniently situated. There is a passenger lift to the upper floors, grab rails, raised toilet seats and ramps for easy access. There is ample communal space, with a large dining room and large lounge offset by smaller spaces around the home. A designated area is provided for people with dementia, with a dining room and two small lounges. Staffing is provided over 24 hours, every day of the year. The home is furnished to a satisfactory standard, and has a friendly ambiance. The most recent inspection report is available in the reception area of the home. At the time of this visit, (13/07/06) the information given to the Commission showed that the fees for care at the home are according to Local Authority funding scales, with added expenses for hairdressing, chiropody and newspapers. Bowgreave Rise DS0000033165.V304638.R01.S.doc Version 5.2 Page 5 The home’s registered manager is Mrs Joyce Reynolds. Bowgreave Rise DS0000033165.V304638.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection process of Bowgreave Rise included a site visit to the home which was completed in one day, and unannounced, which means that the manager, staff and residents did not know it was taking place until the inspector arrived. Time was spent sitting and talking with people who use the service and observing the day-to-day routines of the home and care staff, as they provided support. A tour of the home was undertaken and included bedrooms, lounges and dining areas, toilets and bathrooms. This was to assess whether the home provided a comfortable, homely environment for the enjoyment of everyone, and to ensure their safety. The manager completed a pre-inspection questionnaire before this key visit, which gave good information about the operational management of the home. Comment cards were sent to the home for residents, relatives and visiting professionals to fill in; a good number were returned and these showed that they were happy with the care at Bowgreave Rise. Discussions took place with the registered manager and members of the care staff and administration records were looked at. Everyone at the home was friendly, welcoming and co-operative throughout the visit. Bowgreave Rise DS0000033165.V304638.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection?
The home has been under review by the Local Authority, and therefore improvements and plans for the home have been on-hold. The outcome of this review is due within the next few weeks. Bowgreave Rise DS0000033165.V304638.R01.S.doc Version 5.2 Page 8 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. Bowgreave Rise DS0000033165.V304638.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 Bowgreave Rise DS0000033165.V304638.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): 3 Standard 6 does not apply to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home gathers enough information about prospective residents to ensure that their needs can be met. EVIDENCE: Pre-admission assessments were looked at and were completed satisfactorily; they include all aspects of physical, social and psychological care. These assessments are done by a delegated social worker and agreed by the resident and/or their family. Three residents were able to say that they knew about these assessments and that they were happy with them. Members of staff aslo knew about the assessments and what was in them.
Bowgreave Rise DS0000033165.V304638.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents health and social care needs are met and people are treated with dignity and respect at this home. Residents are supported and protected in their daily lives. EVIDENCE: Care plans are written records that describe the care that is given to each resident. Three of these were looked at and all of them were reviewed and updated. The senior carer on duty said that they knew about the care plans and that these generally reflected the care that was being given to each person. Bowgreave Rise DS0000033165.V304638.R01.S.doc Version 5.2 Page 12 Three residents were able to say that they knew about their care plans, but that they were not really interested in them because they were well looked after. Health care opportunities are offered to all residents and there are records of GP, chiropody and physiotherapy visits. The medication system at the home is a monitored dosage system (MDS). Records were satisfactory and the home’s policy and procedure for medications have been updated to reflect the system. A new controlled drugs cabinet has been ordered and in the meantime a fixed, locked container is kept within a fixed larger medication cupboard. The residents were treated with respect, privacy and dignity, and there was a good personal interaction between resident and carer. Those residents who were able, and three visiting relatives said that they were happy with the care given at the home. Bowgreave Rise DS0000033165.V304638.R01.S.doc Version 5.2 Page 13 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are supported so as to promote the quality of their daily lives. EVIDENCE: There were records of activities programmes for the residents that included bingo, video, manicures, arts and crafts and outings. The activities programme at the home could be improved if there was a delegated activities coordinator to lead the programme, to devote time to this very important part of residents’ care. All residents are treated equally in that they were offered activities, therapies and outings, regardless of their level of understanding or mobility. Some residents were able to say that they enjoyed the activities, others said they were not really bothered and liked a quiet life. All residents seemed to be supported in their contact with the community, and a religious minister was at the home on the day of the visit.
Bowgreave Rise DS0000033165.V304638.R01.S.doc Version 5.2 Page 14 Three visiting relatives said that they were welcomed at any time to the home and were always offered refreshments. The home provides meal choices, a nice dining area and unhurried mealtime routines. There was equality of opportunity, facility and choice for those residents on the dementia unit, who were served their meal in a nice dining room, with table settings and the same choices of food as those residents on the general care side of the home. The lunchtime meal was presented in an appetising way and when sampled, tasted very good. The residents generally said that the food was good and that they had choices and good portions. There are four-weekly menus in place that are varied and nutritious. The kitchen was kept extremely clean and the last Environmental Officer visit report showed some minor issues that were immediately addressed. Diabetic and vegetarian diets are catered for thus again providing equality of choice for all residents. Bowgreave Rise DS0000033165.V304638.R01.S.doc Version 5.2 Page 15 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s policies, procedures and practice make sure that residents are supported and protected. EVIDENCE: There are policies and procedures in place for complaints, whistle-blowing and adult abuse issues, and staff said that they were aware of these. Residents who were able and three visiting relative confirmed that they knew about the complaints policy and had no complaints whatsoever to offer. There has been one complaint since the previous inspection visit and this has been investigated by the Local Authority personnel staff. The outcome of this investigation is being forwarded to the Commission. Training files showed that all staff have had abuse awareness training on induction to the home and staff confirmed this. Bowgreave Rise DS0000033165.V304638.R01.S.doc Version 5.2 Page 16 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): 19,20,21,22,23,24,25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are provided with a comfortable, clean and hygienic environment and bedrooms are personalised. This means that residents feel at home with their belongings around them. EVIDENCE: A tour of the home showed that the general environment was good; furnishings were comfortable and there are aids and adaptations in place to give acces to all areas of the home and to help with the residents’ toilet and bathing needs. This makes sure that there is equal access for those residents who suffer from mobility problems or who have difficulty with bathing routines. However, the bathroom on the dementia unit was not in use and this is going to be addressed as a matter of priority, so that the resdients on this unit do not have to go to another floor of the home for their bathing routines.
Bowgreave Rise DS0000033165.V304638.R01.S.doc Version 5.2 Page 17 Bedrooms were personalised and comfortable and a number of residents were able to say that they were happy with their rooms. There are ten dementia resident bedrooms on the first floor unit, however one of these is used for staff sleep-in duty. This must be addressed in order to comply with their conditions of registration, which states that the home can accommodate ten people in this category. Policies are in place for the prevention of any cross infection. The laundry area was in need of a general tidying up and the back wall and equipment pipes were in need of cleaning. The manager gave assurances that she would be visiting the laundry area to address this issue. Bowgreave Rise DS0000033165.V304638.R01.S.doc Version 5.2 Page 18 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents care needs are basically; however staffing levels do not reflect the residents’ assessed needs. EVIDENCE: Staff provision includes male, female and overseas personnel, showing that there is equality of opportunity at this home. The quality outcome of these standards would have been good but for the low staffing levels, particularly on the dementia unit. The duty rotas showed that there were basically adequate staff on duty to take care of the residents on the general care side of the home; however there was only one member of staff for 9 residents on the dementia unit, which restricts the amount of time that can be dedicated to each resident and may pose a safety problem in the event of an emergency. Reviews to increase staffing levels have taken place and are awaiting the Local Authority decision about the future of the home. Bowgreave Rise DS0000033165.V304638.R01.S.doc Version 5.2 Page 19 The level of care staff with National Vocational Qualifications (NVQ) at the home were 70 which is above the required 50 and therefore very good indeed. All records that were examined in the staff recruitment files were satisfactory and staff siad that they had undergone all of the employment checks before starting work at the home. All staff training records that were examined showed that induction and training and the mandatory health and safety training programmes were in in place. Bowgreave Rise DS0000033165.V304638.R01.S.doc Version 5.2 Page 20 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): 31,33,35,36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents are supported by an experienced manager and there are quality systems in place to make sure that they are protected. EVIDENCE: The quality outcome of these standards would have been good but for the dementia unit having one bedroom used as a staff sleep-in room. The manager is very experienced in managing care homes and holds the Registered Managers Award. Bowgreave Rise DS0000033165.V304638.R01.S.doc Version 5.2 Page 21 The residents said that she was friendly and approachable and often seen around the home. There is a quality monitoring system is in place and the manager undertakes regular quality surveys. The results of these surveys, including graphs and a sample of stakeholder comments, are posted on the home’s notice board for residents and visitors to see. There are regular staff and resident meetings and staff confirmed that they had meetings. Records of residents personal monies that are kept at the home and monitored by the manager. Staff supervision programmes are in place and records of these were seen. Staff also confirmed that they had regular supervision. The manager was aware of the responsibilities of maintaining all health and safety certificates of service for fire, equipment, electric, gas and nurse call systems. However, the dementia unit is registered to accommodate ten residents but one of these bedrooms is used as a staff sleep-in room. It is the registered manager’s responsibility to ensure that adequate private accommodation is provided for the residents and this must be addressed as a matter of priority in order to comply with the home’s category of registration. Bowgreave Rise DS0000033165.V304638.R01.S.doc Version 5.2 Page 22 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 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 17 X 18 3 3 3 2 3 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Bowgreave Rise DS0000033165.V304638.R01.S.doc Version 5.2 Page 23 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 OP21 Regulation 23 Requirement The dementia unit must have a functioning bathroom for the residents to bathe in. There must be suitable appropriately trained staff working at the care home, in all areas of it, in such numbers, as are appropriate for the assessed needs, health and welfare of the residents, particularly on the dementia unit. The registered categories of the home must be complied with in that ten bedrooms for dementia residents must be provided. Timescale for action 31/10/06 2. OP27 18 31/10/06 3. OP38 23 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations It is strongly recommended that an activities co-ordinator is appointed to develop and promote social and diversional
DS0000033165.V304638.R01.S.doc Version 5.2 Page 24 Bowgreave Rise 2 OP26 activities for the residents. The laundry area should have the wall and floor cleaned behind the washer and dryer. Bowgreave Rise DS0000033165.V304638.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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