Inspection on 11/04/07 for Bowles Lodge

This inspection was carried out on 11th April 2007.

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

The inspector 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

Bowles Lodge 24/09/08

Bowles Lodge 05/09/05

Bowles Lodge 03/05/05

Bowles Lodge 21/12/04

Bowles Lodge 13/08/04

Bowles Lodge 04/11/03

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Bowles Lodge All Saints Road Hawkhurst Kent TN18 4HT Lead Inspector Mrs Ann Block Key Unannounced Inspection 11th April 2007 09:10 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 Bowles Lodge DS0000037778.V334200.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. Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bowles Lodge Address All Saints Road Hawkhurst Kent TN18 4HT 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) 01580 752775 01580 754622 Kent County Council Mrs Beverley Seal Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th September 2005 Brief Description of the Service: Bowles Lodge is a Linked Service Centre owned and operated by Kent County Council. It offers residential care for 36 older people. There is a day centre on the site which caters for older people from the local area. Residents of Bowles Lodge can attend on a scheduled basis. The Home is a detached, purpose built, premises on one level with 34 single bedrooms and one shared bedroom. There are staff call points and television points in all bedrooms. There are telephone points in some bedrooms and at other places around the Home. There is a large garden to the rear of the building and car parking to the front. Bowles Lodge is located near to the centre of Hawkhurst village with easy access to bus services. The nearest shops and other amenities including churches, library, chemist, post office and public houses are within half a mile. The Homes senior staffing team comprises the Manager, a Senior Team Leader and Team Leaders. The Home employs Care Workers who work a roster to give 24-hour cover and additional staff for catering, domestic and administration duties. At the time this report was written, fees were set at a maximum of £364.79 per week, each resident will be subject to a Social Services financial assessment to decide the actual amount payable by the individual. Residents pay separately for hairdressing, newspapers and magazines, personal telephone installation and charges, chiropody and personal toiletries. Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Bowles Lodge is owned by Kent County Council and has been run as a care home for older people for a number of years. A key inspection was carried out by Ann Block which included an unannounced visit to the home on Wednesday 11 April 2007. The day was spent at Bowles Lodge talking to residents, visitors, staff and the manager and observing general life in the home. At the time of the inspection there were 34 residents living at the home. Residents, staff and visitors gave their full cooperation to the process of gathering evidence for service provision. Judgements made from conversation, observation and records indicate that the home is well managed giving residents a good quality of life. A sample of records was seen. Feedback was given to the manager at the close of the visit. Information from a pre inspection questionnaire completed by the manager was also used to inform judgments of service provision. The lead inspector has known the service for some time. Where judgments made at previous inspections remain the same, these have been included in the assessment of standards in this report. To further obtain views of the service comment cards and survey forms were sent to a sample of residents, families, and professionals. Verbal and written comments were consistently favourable and included: ‘I find the home very nice, I have no problems, I am very happy here.’ (Resident) ‘I can think of no faults at all with it (Bowles Lodge).’ (Resident) ‘The food is good, the staff are very nice.’ (Resident) ‘Bowles Lodge is a very caring home. Staff are very friendly, food is excellent with good variety. They also have entertainment at different times which (my relative) is involved in.’ (Relative) ‘Staff are caring & friendly but there are times when they are stretched’. (Relative) Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 6 ‘Seems to be run very well, all credit to all concerned’. (Relative) ‘I feel the home communicates well with care management and families.’ (Professional) ‘NVQs are promoted for staff, the home manager encourages this.’ (Professional) ‘A comfortable relaxed environment, food is always reported to be good.’ (Professional) Respite care has always given full help, assistance and good feedback.’ (Professional) Privacy has always been respected. I can always see my client in private.’ (Professional.) ‘The home provides an interesting environment for service users, there are good activities and stimulation.’ (Professional) ‘Residents I see there are very happy and settled.’ (Professional) What the service does well: Residents like the way they are cared for at Bowles Lodge. They appreciate being asked about their preferences and that, wherever possible, these will be met. Due to good admission systems, residents know people will only come to stay who can be properly cared for. Residents feel safe in this knowledge and know that, as far as possible, no harm will come to them. If they are at risk in any way, such as having falls, staff will look at ways the risk can be avoided. Residents understand that Bowles Lodge can never be the same as living in their own home but are pleased to have a room of their own where they can be private if they wish yet have a chance to be sociable and join in activities if they want to. They like the food, especially the new system where they have more choices available. They particularly like the practice of flexible breakfast times. Residents like the staff who they think work hard and are friendly. They like having a special member of staff (their keyworker) who takes a particular interest in them. Residents know that there is always someone who they can talk to about any problems and who will listen and help resolve any difficulties. Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 7 Residents understand that as they get older often they have health problems. They are confident that not only will staff help them in the home with medication and basic care, they will also help make appointments with other health professionals. Residents look forward to visits from their family and friends and appreciate being able to talk to them in private or sit and chat in the lounges, to include them in any reviews of their care if they choose and to be able to offer them tea or a meal while they are visiting. Staff say they feel confident in caring for older people as they have support from senior staff and the manager, have a range of training they can attend and are able to talk though any problems at the regular team meetings. What has improved since the last inspection? What they could do better: Kent County Council has accountability to the general public regarding budget provision for all its services. Annual budgets are made available to each Linked Service Centre but may be restricted at central level. The home endeavours to maintain a good environment and use fund raising to provide ‘little luxuries’ for residents. Current budget restrictions leave a number of rooms where furniture needs replacing, carpeting fitted and a bath hoist replacing Other areas needing upgrading have been included in budget requests for the current financial year but it was not known whether these would be approved. Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 8 Residents would know all staff are aware of individual needs, including agency staff if a care summary and ‘pen picture’ were included in care plans. They would also be assured medication is given as directed if the prescriber verifies that regular delayed administration of morning medication is safe for the individual. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bowles Lodge DS0000037778.V334200.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 Bowles Lodge DS0000037778.V334200.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ suitability to move into Bowles Lodge benefits from good admission and assessment practices. EVIDENCE: The manager said that the statement of purpose and service users guide have been revised, copies are available in the entrance hall for interested people to read, a copy of the last inspection report is also available there. Most of those residents spoken with said they had their admission arranged by other people, often family or care managers. None had used the service users guide but considered people acting on their behalf gave them information about the home. Two survey responses indicated that the respondents felt Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 11 they didn’t have sufficient information about the home before they moved in. One resident said she came to Bowles Lodge as she had friends who had stayed there and recommended it. Where a resident is able to visit in person, they have the opportunity to stay for a meal and meet other residents and staff. Prospective residents are fully assessed before admission with as much information as possible obtained from the resident, relatives and professionals. Great care is taken to ensure that, at the point of admission, the assessment process indicates that the home is suitable and can meet the resident’s needs. Proposals to accommodate people with dementia at the time of admission are still in the early stages. Tranches of staff are undertaking dementia training and until this is completed, any further plans remain on hold. Systems are in place to ensure that emergency admissions can be accepted providing sufficient information is given to assure the home that needs can be met there. The manager was very clear that she would not accept any resident who she believed had needs which would be better met elsewhere, this would include taking into consideration the current dependency levels in the home and staff skills and capacity. As a safeguard to both the resident and the service, each stay starts with a trial period. During this time the resident and staff at the home can decide whether the home is right for the resident. Where a later change in circumstances means the home is no longer suitable, support will be given in cooperation with families and professionals to find a more appropriate service. Respite care is available and periods of respite care can be booked in advance. One resident said she came every 6 weeks for a weeks care. She looked forward each time to her next visit as she liked it at Bowles Lodge and had made friends with people there. There is no specific accommodation for short term care although some rooms are more frequently used for short term stays. Short term residents are free join in with daily life in the home and often find their stay is a good introduction to longer term care. Kent County Council has its own rehabilitation unit for older people. Where necessary systems are in place for residents identified as needing rehabilitation to transfer there. Bowles Lodge DS0000037778.V334200.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. 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. Residents’ care and health needs are well met, minor improvements to records would better evidence how they have been met. EVIDENCE: Each resident has a plan of care. They are advised they have the right of access to all their records and that details about their care needs will be recorded. Most residents spoken with had little interest in documentation about their care even when shown their care file, they were more interested in how care was provided and felt that staff were generally very good at knowing what was needed and doing it. A simplified, concise care record could be useful for agency staff. Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 13 Staff spoken with and observed knew each resident well and adjusted their approach to match the resident. This is assisted by a good keyworking system. Whilst care plans have improved and contain better detail of the individual, there remains more knowledge stored mentally by staff than recorded. Previously, entries in the daily record hadn’t been sufficiently detailed. This was of recent importance when a review was held regarding a resident with behaviour which was challenging the service but where written evidence couldn’t be produced to substantiate issues. As a result, staff are now much better at making sure they record significant events and tie these up to risk assessments. Care and support needs are regularly revised both formally and on a day to day basis. Residents, relatives and professionals are invited to take part in the review process. Any outcomes from reviews are used to update the care system Care plans include risk assessments which detail how a risk will be reduced or removed. General practice includes a risk assessment being carried out where an incident or observation indicates a risk. Individual mental and physical health needs are identified and recorded, including reference to support from other specialist services. Residents spoke of their own health issues and how these were met. Reference was made to the district nurse visiting and of visits to the chiropodist and optician. Any action needed from such visits are recorded and followed through by staff in a specific section in the care plan. Records of weight are held and any loss or gain will be assessed to identify whether action needs to be taken. Specific dietary needs arising from health assessments will be passed on to the cook. Medication is stored securely in a designated room which is temperature controlled. Controlled drugs are stored securely and properly accounted for. A sample of medication remaining and administration records tallied. Records of medication and observation of practice indicated that normally medication is given as directed by the prescriber. For a minority of people who choose to get up mid morning, medication which on the medication administration record records 8.30 am administration isn’t being given until 10.30. Staff knew that some medication had to be given earlier and made sure that happened, speaking of how they would take something for the resident to drink and eat at the time. It was recommended that the prescriber approve regularly delayed medication. Only those staff who have received medication training are permitted to administer medication. A team leader holds lead responsibility for medication management. Staff currently are not permitted to assist with blood testing and insulin injections, if necessary the district nurse will provide support. Residents made frequent references to the qualities of staff. There was evidence throughout the site visit that privacy and dignity was well maintained Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 14 and residents agreed this was standard practice. Staff felt that each person must be treated as an individual and respected this individuality with patience and understanding. Lockable doors where needed provide additional privacy. There are phones which can be used in private with some residents having their own phone line. Bowles Lodge DS0000037778.V334200.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. 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. Residents live in a setting which recognises them as individuals with the right to exercise control over their lives, who they see, what they eat and what activities they want to do. EVIDENCE: Bowles Lodge is a place where residents can live a life as much as possible to their own choosing and where they can welcome friends and family. Whilst the home aims to provide a homely atmosphere, this is compromised to some extent by the layout of the building and need to upgrade some décor and furnishing. Whilst there are the expected routines of a well managed service and residents understand this, as far as practicable residents can make their own choices about their day. Residents said they can get up and go to bed when they choose. They appreciate particularly the flexibility of breakfast time. Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 16 When staff time is available, staff will offer activities such as a quiz. In house activities include a communion service, bingo, quizzes, a summer fayre arranged by the League of Friends, themed parties and arts & craft. External activities which residents join in include the friendship club, bridge club and days out. Some residents have specific days when they attend the on site day centre. Residents are also able to occupy themselves with their own hobbies such as reading, knitting, watching TV, listening to music or just having a chat. Two residents responded that there were limited activities. One person said: ‘Sometimes I think there are limited activities for me to join in with.’ Others felt there were things to do with their day. A number of residents have their own daily paper. The village of Hawkhurst is close by and some residents like to take themselves up to the village to do a bit of shopping or go to the cash machine. One resident likes to have a ride out in the day centre minibus and sometimes joins the run to collect day centre attendees. Visitors are welcomed to the home and various visits took place during the day with many others recorded in the visitors’ book. The conservatory offers space to meet in private, although this is also the designated smoking area. There are other places where people can chat in private including residents own bedrooms. Family can involve themselves in the practical and social care of their relative if the resident chooses and to be included in the formal review process. Visitors are routinely offered refreshment and may stay for a meal at reasonable cost. Residents’ individuality is well supported, they said they are encouraged to maintain independence but will be assisted in areas where they need help. Residents are encouraged to take responsibility for their own financial affairs and to use their money as they wish. Residents are encouraged to personalise their rooms with their own possessions if they wish. The home has catering staff who have many years of experience in catering for older people. The manager also has a special interest in diets for older people and had recently changed the menus to offer greater choice particularly at lunch time. The new system requires residents to be asked for their preferences for the following day. Whilst residents said they liked the better choice it was acknowledged that some couldn’t remember what they had chosen or wished to change their minds when they saw what their neighbour was having. The manager explained the system was in its trial stages and would be reviewed and changes made if necessary. Residents said they have plenty to eat and that the food is well prepared. One resident said she liked to being able to have a vegetarian option. New recommendations in nutrition for older people are taken on board when planning menus. Seasonal produce is used with the emphasis on fresh vegetables and quality products. Care staff are sensitive to the needs of those residents who find it difficult to eat and discretely give assistance with feeding. They are aware of the Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 17 importance of ensuring residents are unhurried and comfortable with the process. Drinks, both hot and cold, are offered through the day. One resident said she liked to be in bed by 7pm and was pleased to have an evening drink brought down to her. Specific dietary needs and personal preferences are made known to the cooks and provided. The majority of residents eat in the dining areas in the centre of each unit but meals can be taken in individual rooms if preferred. One resident said she had all her meals in her room by choice and was relieved she was able to do so as she would have disliked having to eat communally. Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 &18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to make comments about the service and be listened to. Residents are protected from the risks of abuse. EVIDENCE: The home has a complaint procedure which is accessible to residents and visitors and gives timescales for response with contact details. Verbal responses from residents said they have had no need to make a complaint, some referred to ‘having little grumbles at times’ but said these were always dealt with. Residents said they can talk to the manager or staff about any concerns and they are listened to. In this way minor issues are dealt with promptly before they become a complaint. The complaint record evidences how complaints have been dealt with to the complainant’s satisfaction. In addition to the in house complaint procedure, complaints can be channelled through the Kent County Council formal complaint procedure. Permanent residents are placed on the electoral roll and have the opportunity to vote in person or have a postal vote. One resident said she wouldn’t vote in local elections as the party she liked ‘never got in anyway’. Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 19 Staff have received training in adult protection issues which is regularly updated and link to local and Kent & Medway Joint Working policies. Staff have a good understanding of how abuse may present itself and make sure residents are safe from any such abuse. They are aware that any such abuse would have to be reported. Recruitment practice ensures that staff have satisfactory criminal records bureau and POVA (protection of vulnerable adults) checks before they start work unsupervised. Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a well maintained and comfortable environment in which to live but which will be improved when budgets allow for upgrading to furniture and fittings. EVIDENCE: Bowles Lodge is a large purpose built home owned by Kent County Council. Residents have single rooms, there are some rooms which can be used for shared occupancy if specifically requested. The home is divided into four units. There are two communal areas which include dining and seating space with a TV, each having a kitchen area where residents can make their own drinks and snacks if they choose. There are plenty of easy chairs and Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 21 occasional tables can be made available if a resident wishes. There is a conservatory leading from a large inner hall, a staff room and training/meeting room. The home also includes offices and a sleep in room, kitchen and laundry. Residents have easy access to the rear garden areas. The design of the home gives a somewhat institutional feel which is in part reduced by redecorating and carpeting communal areas and redecorating rooms when budgets and occupancy allows. The conservatory is currently used for residents who wish to smoke. The area of the home used by residents is on one level and gives access for people with mobility problems. Since the last inspection, one bathroom has been refitted to provide ease of access to the toilet, washbasin and bath for wheelchair dependent residents. In addition to this bathroom, there are other bathrooms with hoists and toilets accessible to both sleeping and communal areas. One in bath hoist was stained and rusty and needs to be replaced to prevent the risks of cross infection. There are separate visitors and staff toilets. Adaptations include grab rails and toilet aids as required. A call system linked to staff pagers is fitted. Call points are available in each bedroom and in communal areas. Bedrooms have space to fit a single bed, hanging and drawer space and an easy chair. Residents are encouraged to personalise their rooms by bringing in personal effects and, by agreement, items of furniture. Some rooms have hospital style beds although the resident occupying the room does not necessarily have need of an adjustable bed. A number of rooms contain outdated and shabby furniture, some families choose to furnish their relatives rooms themselves. The manager said she has to carefully prioritise what is a relatively small renewals and repairs budget. Some bedrooms are uncarpeted. One resident said she preferred to have a washable floor covering. Previous reports have noted that there is a fire door between bedrooms 1 and 2 on each wing which restricted placing of furniture in case it obstructed the emergency fire route. The manager said that she had been advised that the fire doors did not form part of any emergency evacuation route and when budgets allowed, could be blocked up. Domestic staff are employed who carry out cleaning with standards at the time of the visit good. Staff are also employed to carry out general maintenance and gardening. An administrator oversees office arrangements. A fire risk assessment has been carried out. The Environmental Health Officer issued a Gold Award for kitchen standards. The home feels light and airy with plenty of natural lighting. Residents said the home was suitably warm in winter months. Since the last inspection new plumbing has been installed. Each bedroom has a radiator with adjustable thermostat. Radiators in high risk areas are provided with safe surface covers to prevent the risks of burns. Hot water from baths and washbasins used by Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 22 residents have safety valves to reduce the risks of scalds, temperatures from these outlets are regularly monitored. The manager said that hot and cold water was now available in all areas of the home. A resident occupying a room towards the end of one unit said that the water wasn’t hot however, when felt by hand from the tap during the afternoon, the water was of acceptable temperature. There is a laundry with heavy duty washing machines and tumble driers, one drier was out of action at the time of the site visit. Care staff carry out the laundry duties. Bed linen is sent out to a commercial laundry. Staff are aware of the principles of control of cross infection and are advised where special precautions are needed. Staff spoke of systems to deal with contaminated laundry. Since the last inspection a separate wash handbasin has been fitted in the laundry. There are sluice rooms although one was out of order at the time of the site visit. Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are cared for by properly recruited and well motivated staff. EVIDENCE: Residents said they like most of the staff, they often have a special bond with their keyworker. They are aware that staff are busy but also know that if they need anything staff are available. Staff monitor the call system to make sure that calls on both their allocated unit and other units are being answered promptly and that residents don’t have to wait too long to get assistance. Bowles Lodge is staffed by a manager, senior team leader, team leaders, care staff, domestic, catering, administration and maintenance staff. During the day five carers are on duty with two allocated to each end of the home and one ‘floating’ between the two. Two waking staff are on duty at night with a senior sleeping in on call. The manager said that staff would be rostered according to resident need and any admissions to the home would take into account staffing and dependency levels. All care staff are expected to work alternate weekends and some evening shifts so they become more familiar with residents needs throughout day hours. A staff roster is held which Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 24 records the names of staff working on shift and shows where shift vacancies occur and how these have been covered, in addition a separate record is kept of hours actually worked. There is some use of agency staff and other staff are employed to work on a casual basis. Many staff have worked at the service for some years. Staff follow a structured induction process. A newly appointed member of staff spoke of shadowing another more experienced member of staff. The manager understands that sound recruitment is key to providing residents with suitable staff. Recruitment for senior staff is carried out by Kent County Council with records held by the human resources department. Other recruitment is carried out locally with records available at Bowles Lodge. Records seen evidenced that overall good recruitment practice was carried out with good documentation, POVA and criminal records bureau systems and evidence of physical and mental fitness. Equal opportunities are met. The home has a training programme, which aims to enable members of staff to update their levels of competence, gain new skills and confirm good practice. Training includes manual handling, health and safety, infection control, fire, adult protection, first aid and medication administration. Catering staff are trained in food hygiene, other staff said they have food hygiene awareness training. Staff spoke of training courses they had undertaken and felt they had a good grounding to provide care. Training matrices are held which record training already undertaken and planned/booked training for the forthcoming year. Future training planned includes dementia training for all staff and diversity training. Copies of staff training certificates evidence training achieved. The manager said that twenty five staff have obtained an NVQ level 2 or above in care from a care staff team totalling thirty five, others are working towards NVQ qualifications. An NVQ in housekeeping is available to domestic staff. Eight staff hold the four day first aid certificate. Seven staff are trained and able to administer medication. Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a needs led and safe service, which is run in their best interests by a manager and staff who are committed to providing a good quality of life for older people. EVIDENCE: The manager is competent to run the home and has had many years experience in the care sector, including managerial posts. She holds an NVQ level 4 in care and the Registered Managers award. Residents consider the manager is accessible and approachable. All those spoken with felt that the Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 26 manager was committed to providing a good standard of service and had the needs of older people at heart. The home has a quality assurance system in place and individuals are able to express their views. Resident and staff meetings are held on a regular basis. Staff meetings are well attended, including meetings for night staff. Staff have time off in lieu for attending meetings. A file containing meeting minutes plus any useful current information which affects staff is accessible in the staff room. Plans are to introduce regular relatives meetings. Internal and external audits take place, including monthly visits by a representative of Kent County Council. The manager recognises that both residents and staff need to express their opinion of the service and that they have the right to have their views taken into account in any developments of the service. Residents are also able to talk directly to the manager and felt she was easy to speak with. Written policies and procedures are available to provide guidance for staff. Specific policies, including any updates, are discussed at staff meetings. The home has a system for the maintenance and storage of information relating to residents and staff, including accidents and incidents, which preserves confidentiality, meets data protection guidelines and is accessible on a need to know basis. Notification of accidents and adverse events is provided to the commission as required by regulation. General record keeping is good and well ordered. The home assists a few residents with day to day management of their monies. Kent County Council holds an account into which residents’ monies are paid into individual sub accounts. Where additional money is needed which might put the resident in a debit balance, the home’s ‘imprest’ account is used. Records seen showed how this was managed. Records are held of transactions with receipts held detailing any expenditure on the resident’s behalf. Residents spoken with who have assistance with their finances felt their money was in safe hands yet accessible to them when they needed, or to pay bills on their behalf such as for hairdressing. A resident showed the lockable unit she had where she could put anything she needed to keep safe. The registered manager is the delegated budget holder for the home with supervision and support being provided by Kent County Council. As already mentioned there has been capping of the budgets over the last year which resulted in some plans for upgrading services and the environment not met. An up to date insurance certificate is displayed in the home. Staff have regular supervision within the line management structure. Staff thought supervision sessions were very good and said that they also had opportunities during the course of work to talk through any issues with the manager and seniors. Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 27 From observation and discussion with residents and staff, there is a good awareness of health and safety. Staff spoke of fire drills and practices attended and when fire alarms were tested, records are held to evidence fire safety practices. A revised fire evacuation system has been implemented with staff trained in the new procedures. Staff are trained in moving and handling. Residents thought that staff ‘knew what they were doing’ when they used the hoist or helped them in and out of their wheelchair or easy chair. Specific guidelines are put in place where there are moving and handling risks. Routine maintenance of supplies and equipment is carried out. Information provided by the home recorded maintenance and checks are carried out within correct timescales. Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 29 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 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 OP7 Good Practice Recommendations A concise summary care plan particularly for use by agency staff would assist in ensuring residents needs can be consistently met in the preferred manner. Whilst most staff know individual residents well, especially the keyworker, there is limited formal recording of such information. The production of a ‘pen picture’ or ‘personal history’ section as part of the care plan, which could be developed as staff got to know the resident better, would offer all staff the chance to familiarise themselves with the resident as a person. As the flexibility in breakfast times results in some medication not being administered at the recorded time of DS0000037778.V334200.R01.S.doc Version 5.2 Page 30 2 OP7 3 OP9 Bowles Lodge 8.30, it is recommended that the prescriber verifies that regular delayed administration of morning medication is safe for the individual. 4 OP19 When budgets permit, furniture and fittings in a number of residents rooms should be replaced and consideration given to carpeting those bedrooms with vinyl floors unless the resident chooses otherwise. It is strongly recommended that hospital style beds are only used where assessed as being necessary to meet the service users needs. This recommendation is repeated from the inspection of 5th September 2005 The in bath chair hoist which is stained and rusty and should be replaced to prevent the risks of cross infection. 5 OP19 6 OP26 Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bowles Lodge DS0000037778.V334200.R01.S.doc Version 5.2 Page 32 - 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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