Inspection on 12/07/08 for Bowmead

This inspection was carried out on 12th July 2008.

CSCI found this care home to be providing an Adequate service.

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

Bowmead 14/08/07

Bowmead 16/08/06

Bowmead 12/10/05

Bowmead 05/05/05

Bowmead 07/12/04

Bowmead 18/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Bowmead 75 Hollway Road Stockwood Bristol BS14 8PG Lead Inspector Sandra Garrett Key Unannounced Inspection 09:30 12 & 13th July 2008 12/07/08 07:30am 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 Bowmead DS0000036948.V364296.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. Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bowmead Address 75 Hollway Road Stockwood Bristol BS14 8PG 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) 0117 9039950 0117 9039951 brssbow@bristol-city.gov.uk Bristol City Council Mrs Loveta Elizabeth Allison Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46) of places Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of either gender whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is 46. 14th August 2007 Date of last inspection Brief Description of the Service: Bowmead is run by Bristol City Council and registered with the Commission for Social Care Inspection. It gives personal care only for older people over the age of 65 years. The home is situated within the residential area of Stockwood in Bristol and is close to a parade of local shops that includes a café. These allow easy access for people living in the home and there is a bus stop immediately outside. The home is arranged over two floors with lift access. The total fee payable for local authority care in 2008 is £471.24. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk Each person is given a copy of the summary from the last inspection report that they keep in a file in their rooms. The last inspection report was seen displayed in the entrance lobby and in other areas in the home. Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key or main inspection was carried out over a weekend. The reason for this is that a percentage of all our inspections are done out of office hours. This way we can check that services are giving consistent care to people whatever day of the week we visit. Before the visit, all information the Commission for Social Care Inspection (the Commission) has received about the service since the last inspection was looked at. This included the home’s own Annual Quality Assurance Assessment (AQAA) that they fill in each year, any notices of incidents affecting people and quality assurance survey reports, among others. From this an inspection record is prepared. This record is used to plan all our visits so that we concentrate on checking the most important areas. At the visit we spoke with several people living at the home and staff. The manager was on leave and an assistant manager was the home. We looked at a range of records that included assessments, staff records, complaints, activities and health records. a number of in charge of care plans, and safety What the service does well: People benefit from being given clear information about the home when they come into it. Proper use of contracts that give clear information about room numbers and fees makes sure people are aware of their rights and responsibilities. Satisfactory arrangements for people coming into the home make sure their needs are met. Proper access for disabled people including people with sight difficulties, means their needs are met. Good documentation of care plans that include regular checks, makes sure that staff are given the information they need to care for people living at the home. People are looked after well in respect of health and personal care needs. Encouragement of contact with the community helps people stay in touch with the outside world. Few restrictions placed on people living at the home gives them lots of choice in a relaxed atmosphere. Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 6 Arrangements for protecting people living at the home makes sure that they are protected from risk or harm as far as possible. What has improved since the last inspection? What they could do better: Whilst a requirement about medication had been partly met, the issue of giving ‘over the counter’ medicines such as pain relief for those not prescribed it hadn’t been resolved. The registered provider must make sure that people get adequate pain relief whenever they need it. A continuing issue about frequency of staff supervision will lead to enforcement action if the requirement made at the last visit isn’t met. People must be cared for by staff that get regular opportunities to discuss their work. New requirements were made as follows: Care plans were improved and covered health risks. They’re also written from the person’s own viewpoint and include their comments. However issues affecting people such as management of healthcare practice and behaviours weren’t always clearly recorded. Peoples needs must all be included on the plans so that staff are aware of what to do for them to keep them safe. More work is needed to make sure people get a range of activities that suit their individual needs and abilities particularly where they have a degree of dementia. This will make sure people get a stimulating and enjoyable life that helps them keep their skills. Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 7 Whilst the requirement about training above had been met there were still issues about the frequency of safeguarding adults from abuse training for some staff. Further, the provider needs to make sure night staff do the same range and type of training as others. This will make sure people are protected and cared for safely by properly trained staff. …… Good practice recommendations were made: Formal recording of complaints wasn’t properly done in some cases. Relatives’ concerns were sometimes recorded elsewhere but not treated as complaints. People must be able to feel confident that their concerns will be taken seriously and that staff don’t decide this for them. 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. Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 8 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 Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 9 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from being given clear information about the home when they come into it. Good use of contracts that give clear information about room numbers and fees makes sure people using the service are aware of their rights and responsibilities. Satisfactory arrangements for people coming into the home make sure their needs are met. Whilst people are looked after well by staff that are suitably trained and experienced, people with varying degrees of dementia may not get the specialist care they need. Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 10 EVIDENCE: Thirty-eight people were living at the home at this visit. A number of people have some degree of dementia or cognitive impairment (this means an undiagnosed condition that could affect their memory and reasoning skills). Some people also have sight or hearing difficulties. A requirement made at the last visit about updating the Statement of Purpose to make clear the home’s ability to meet peoples needs, was met. The Statement sets out the category of people it can care for but also what happens if needs can no longer be met. Further, the amended Statement also includes information on meeting the needs of people from other groups such as those of a different race, sexuality, gender, age and disability. Everyone that comes to live at the home is given a pack of information that includes the service users guide, complaints and a summary of the Statement of Purpose. People confirmed that they had these, although one person had said in the home’s own quality assurance survey (that was done in June 2008): ‘I don’t know about my rights’. The six people who filled in our ‘Have Your Say’ survey about life in the home before this visit, all said they had been given enough information about the home before they moved in. One person commented: ‘It was a long time ago but I’m sure I was told a lot about it’. We followed up a requirement made about contracts. We saw copies of contracts in peoples files and each was signed, either by the people themselves or by relatives. Contracts give information about peoples rights and responsibilities, room numbers and the amount of fee payable as well as the person responsible for paying the fees. One person that had recently come to the home has sight difficulties. The person was seen finding her/his way around the home without assistance and said all the information s/he needed had been supplied on tape. This included the service users guide and the complaints leaflet. This is good practice. Each person we case-tracked had a pre-admission social work assessment that had been done before they came to the home. Case-tracking means looking at all records associated with a number of people and tracking their care. This is also done by talking with both them and staff caring for them. It’s a way of thoroughly checking all the information about people living at the home. That way we can assess whether proper care is given that meets peoples needs. Assessments we saw covered all needs that people had at the time. These had been put into the home’s own care plan. This is put in place at the end of the four-week trial period. Staff collectively have skills, knowledge and experience to meet peoples general care needs. Training is given wherever a need is identified and we saw Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 11 this to be the case for dementia care training that’s currently happening. However not all staff have done this training yet and there are a number of people with dementia or cognitive impairment living at the home. Further, more work needs to be done about making sure people with dementia have the same rights to stimulating and enjoyable lives as other people living at the home. (Please see Standards 12 –15 for more about this). Bowmead DS0000036948.V364296.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 adequate. This judgement has been made using available evidence including a visit to this service. Good documentation of care plans that include regular checks, makes sure that staff are given the information they need to care for people living at the home. People living at the home are looked after well in respect of health and personal care needs. However failure to add healthcare practice and changing behaviours into care plans means people may not be fully protected. People living at the home are looked after well in respect of their medication needs. However, failure to deal with the issue of over the counter medicines may mean their need for pain relief will not be met. Being treated with dignity and respect benefits people living at the home. EVIDENCE: We looked closely at three peoples files. These were all orderly and written in person-centred ways. This means in a way that looks at people’s lives, history Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 13 and needs from their own point of view. It recognises and values them as an individual with rights and choices, rather than just focussing on meeting basic physical care tasks. However not everyone has a clear and detailed personal profile attached to the plan that gives staff information about who they are and their backgrounds. The assistant manager was able to tell us lots about one person that she knew from before they came to the home. However none of this had been put into any sort of record that would benefit other staff and help them get to know the person better. One person that has a degree of learning difficulty and serious healthcare needs, had a clear plan written from her/his own viewpoint. Safeguarding issues had been picked up and a protection plan put in place. Management of the person’s health was happening with regular contact from the GP. The person’s capacity to understand health and care issues had been regularly tested. The care plan showed improvement in the person’s overall health and welfare since coming to the home. The assistant manager was seen communicating well with her/him that showed a respectful and helpful approach. The care plan covered all issues including leisure interests, advocacy, diet, and wishes around death and dying, among others. There is an issue about the person’s weight and s/he is being weighed regularly. The health issue had been fully looked into and the person had been given full information about it. S/he had declined treatment and this was being respected. However the care plan and daily records showed lots of actions to be taken if necessary and the assistant manager was able to show how the person is being worked with to help her/him make proper decisions about future care. We spoke to the person who said s/he was happy at the home. The care plan showed that staff were able to meet her/his current needs and a statement about this had been signed. The person had declined to sign the plan and this was also recorded. A clear and detailed risk assessment about the health issue had been put in place following consultation with healthcare professionals. The other two care plans we looked at were both also written in personcentred ways and covered a wide range of issues. However we saw in both a lack of information about a) management of a healthcare practice put in place to benefit the person and control blood sugar and b), management of the challenging behaviour of another that could affect others. Care plans must show what is being done to manage peoples specific health needs and/or behaviours so that they and others are kept safe. All care plans showed regular review both monthly and yearly. Relatives are invited to a planned review and the deputy manager said that she was going to talk to relatives about a re-assessment of one person’s needs. Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 14 Because of the challenging behaviour of one person, two staff work with her/him at all times. Staff told us how the person challenges them and others although the daily records didn’t show much written about it. Healthcare professionals had filled in our ‘Have Your Say’ survey. From this concerns had been raised about staff not following the practice as mentioned above. The practice, of making sure people that need specific insulin injections don’t have breakfast before the district nurse visits, was allegedly not being met. We sat in on the staff handover early in the morning and observed people at breakfast. At the handover the assistant manager clearly told staff that people on this type of insulin were not to have breakfast. There was also a discreet notice in the kitchen servery to remind kitchen staff of this and who the people are. A district nurse visiting early in the morning was spoken with who said that people hadn’t had their breakfast so she was able to give the injection. It was also properly recorded in the district nurse message book. Staff we spoke to were clear about trying to make sure people had the injection before eating, but sometimes found it difficult if people forgot what they were told or insisted on eating. From all the evidence we saw, staff were trying to meet this need. The healthcare professionals we spoke with said that they believe staff have ‘lost confidence’ particularly in their ability to care for people with diabetes. Staff also told us that they didn’t feel entirely confident of meeting the needs of people with diabetes and would welcome some training. We also found that all care staff attend the morning handover session, leaving no one around the home to make sure people’s needs are met. The assistant manager immediately put in place a system of making sure at least one staff member is working ‘on the floor’ whilst the others have handover. This is good practice and will make sure peoples needs are met. We did a check of medication and found the medication room to be clean and tidy with no medication left out. We saw medicines being given out at breakfast. The assistant manager gave each person their medicines and stayed with them while they took it. Medication was properly signed for on Medication Administration Record Sheets (MARs) although there were occasional gaps. The controlled medication cupboard was looked at. All were properly signed for and witnessed and numbers left were correct. Generally people had their photographs at the front of their MARs although some didn’t. (However photographs were also seen at the front of care plans). We asked people in our survey if they received the medical support they need. Comments included: ‘What I need’, ‘That’s all taken care of’, ‘I had a bad back the other night & they called the doctor straight away’ and: ‘If you need it, yes. I’ve been taken to see the doctor and had one come out to visit me when I had a bug’. Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 15 A copy of the home’s medication policy was seen. This covers the ability of homes to keep ‘over the counter’ remedies such as pain relief for people to have if they’re not written up for them. We followed up a requirement about this from the last visit. We found that twenty people are written up for some sort of pain relief ranging from mild to strong. However, fifteen people weren’t written up for any pain relief. We asked the assistant manager about this who couldn’t give an answer except that homes have now been told not to give out ‘over the counter’ medicines. The registered provider must make a clear decision about the issue as people denied pain relief when they need it won’t have their needs met. This denies them their rights and could affect their health and quality of life. Further, people who can’t get pain relief when they need it may run the risk of ‘stockpiling’ such medication themselves that could also put them at risk. A healthcare professional that filled in our survey commented: ‘medication e.g. pain relief is not always given effectively’. One of the GP’s visiting the home also filled in our survey and commented: ‘Variable standard of care. Sometimes acceptable sometimes poor with regular organisational errors made that reduces standards of care. Sometimes staff struggle to follow GP or nurses instructions’. We saw staff speaking to people with respect and treating them with dignity. It’s clear people living at the home and staff enjoy good relationships with each other that are built on mutual respect and liking for each other. From the home’s own quality assurance survey that was done recently comments about this were made: ‘Privacy has improved recently, staff always knock’ (2 similar comments) and: ‘I am always treated with respect’ (2 similar comments). The healthcare professionals we spoke to said that they believe the quality of life people have in the home is ‘not too bad – they take great solace in each other but we’ve never witnessed a great deal of communication with staff’. They went on to say that they observe staff using a ‘herding approach’ that focuses on doing basic care tasks only. Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. Activities and lifestyle choices don’t fully meet the needs or wishes of everyone living at the home. Encouragement of contact with the community helps people stay in touch with what is happening outside the home. Few restrictions placed on people living at the home gives them lots of choice in a relaxed atmosphere. Meals at the home are well managed and provide daily variation, good nutrition and social contact for people. EVIDENCE: We asked people in our survey ‘Are there activities arranged by the home that you can take part in’? Comments were mixed e.g.: ‘There is something going on at times but not very often’, Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 17 ‘There aren’t any activities anymore - there’s not enough interest. We do have entertainers in quite regularly. Personally I think it’s a waste of time. There just isn’t enough interest’, ‘We get plenty of entertainment and the local church comes in every other Sunday. I go out to the greenhouse every day to look after the tomatoes’, ‘There’s plenty to do if you want to and I like to sit out in the sun as much as I can’ and: ‘I know there are entertainers but I don’t bother going, as it’s not my sort of thing’. The home’s own quality assurance survey scored 75 out of 100 for activities. Comments about it were also mixed: Trips out (2 similar comments), Happy Hour’ is good, when staff organise one (3 similar comments), Church service once a month (3 similar comments), Plenty going on if I want to join in and: ‘Go out regularly with family’ (2 similar comments). However, some negative comments about the issue from relatives were also seen: ‘Activities other than watching TV – this is appalling’, ‘Residents need proper stimulus, and responsiveness’, ‘Need specialist staff and volunteers to provide stimulating activities’ and: ‘More social activities would improve general morale’. A healthcare professional that also filled in our survey suggested what could be done better: ‘a more holistic approach to individuals, providing stimulating activities and encouraging more exercise. Use volunteers for art/music/bingo or coffee mornings’. This followed her/his comment that: ‘There is a lack of stimulation for people and individual skills lost’. All the above comments mirror what we found. Activities do happen and we saw records of these. They included for this year: - A Garden party, - Six people went to a Church fete, - Exercise and music in the garden, - Outside entertainer visiting, - A film show of Bristol, - Making Easter cards and an Easter celebration and: - ‘Happy Hour’ or sherry and music. All the records of these activities were well written up that showed peoples enjoyment of it. However the spread of activities wasn’t regular with three in March, only one each in April and May although more in June. Whilst no trips out had been made this year, two trips are planned and people told us about these (even if they didn’t want to go themselves). We saw a few questionnaires about a ‘person-centred activity project’. These were patchy in quality and content. One was very brief with little detail. Another was better and had more information including the fact that the person ‘likes golf’. A third was very brief and not well done or meaningful to the person. As one of the Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 18 people has communication and learning difficulties and another has behaviour that challenges staff, these should be as detailed as possible so that staff know what to do to occupy or distract them. We asked staff about the issue who told us they feel frustrated at not being able to do more with people. Key time (one to one time with key workers that people should have regularly) is usually done in the afternoons. However staff said they felt it would be better to do it in the mornings, as people like to doze after lunch, or watch TV. They also said that people don’t want to go out or leave their rooms. They did say however that people love to sit in the garden and would like to do some gardening. Even Bingo has been reduced as it wasn’t being received well but staff said is better now it doesn’t happen so often. Given the number of people with dementia or cognitive impairments living in the home, thought must be given to developing activities that are meaningful and easy for them to take part in. Simple activities such as baking, gardening, dusting, looking at scrapbooks of pictures/photos etc should be considered. People with dementia living in the home could become marginalised and isolated if they’re unable to take part in activities that no longer have meaning for them. Two of the people we case-tracked had in their care plans a liking for puzzles. There was no evidence to show that staff encouraged or helped them with this. Contact with the local community is good as the home is situated in an area of local shops. This makes it easy for people to go across the road to the shops that include a supermarket, hairdressers, greengrocer and coffee shop among others. Some people are able to visit the local GP surgery that’s also close by. The manager had filled in the AQAA and said that plans for improvement in this area include: ‘contact to be made with Church and library to find out local activities in our community’. Some people told us they don’t like to go out and this is respected. The assistant manager said that the library comes in to the home monthly but other community contact coming into the home has died out – possibly because of the need to do criminal records checks. The local school does however come in at Christmas to sing carols. People are able to choose what they want to do. Staff said that daytime TV is popular and people choose to watch it. People are free to move about the home, get up and go to bed when they want, join in with activities or not and go out or stay in among other choices they can make. One person, whose care plan showed weight issues, asks staff to buy sweets and biscuits for her/him, which they do. The assistant manager said however that s/he likes to give these out to others all the time and her choice to do this is respected. Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 19 To the question in our survey ‘Do you like the meals at the home’? People commented: ‘Yes I really do. You can’t grumble at all. You get a really good variety’, ‘I have no complaints with the food whatsoever’, ‘The food is very good. I can’t fault it here at all’, and: ‘I’m a vegetarian and they cater for me marvellously. They do me a different meal everyday’. In the home’s own survey meals also attracted positive comments: ‘Food is good, always a choice’ (2 similar comments) ‘Cook talks to me daily about my food’ ‘My diabetic diet is catered for’, ‘Always good and satisfying meals’ (2 similar comments) and: ‘My relative looks much better for being well fed since she moved into Bowmead.’ A healthcare professional that filled in our survey commented: ‘the meals are outstanding’. However a few less positive comments were made: ‘Dinners could be better’ ‘They don’t put salt in the food’ and: ‘Chips shouldn’t be black – need to change the fat.’ We arrived at breakfast time and saw a number of people enjoying a cooked breakfast. The kitchen staff said that several people like a cooked breakfast; particularly the men and they can have what they want. Some had a ‘full English’ and some had scrambled eggs or whatever they chose. We saw the meal for the day written up on a blackboard in the dining room. This didn’t fully match with what was actually offered e.g. the board said ‘bananas and custard’ for dessert but pear crumble and custard was actually offered. We sampled lunch with people. There was a choice of two dishes - a sausage plait with tinned tomatoes and mash, or home made quiche (including ham in it) with salad and mashed potatoes. People with dementia were shown both meals so that they could choose which one they wanted. Unfortunately the sausage plait proved popular so supplies ran out. Staff said this was unusual as the reverse usually happens! People that didn’t want either choice were offered cold meats and mashed potato as an alternative or whatever they fancied. We saw one person with dementia struggling to eat her/his meal (that needed cutting up) and advised the assistant manager that s/he should be offered help discreetly. Vegetarians are well catered for and one person told us she had been given her own vegetarian quiche. Copies of the weekly menus were seen displayed on a notice board in the corridor, together with a menu of vegetarian choices. People with diabetes have a similar diet to others but is sugar free. Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 20 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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Giving people the necessary information about how to complain makes them feel confident about being able to raise concerns about their care if they need to. However, lack of proper attention to handling complaints fails to meet peoples needs for action to be taken over them. Arrangements for protecting people living at the home makes sure that they are protected from risk or harm as far as possible. EVIDENCE: In our survey we asked ‘Do you know who to speak to if you are not happy’ and: ‘Do you how to make a complaint’? People commented: ‘I would go to the office or talk to my key worker’ (chain of command)’, ‘Oh definitely’ and: ‘I know exactly what to do’. From the home’s own survey which scored 76 , similar comments were seen: People living at the home: ‘Any complaints I have had have been quickly sorted out’ (3 similar comments), relatives: ‘Any issues I have raised have been addressed immediately’ and professional contacts: ‘The home is very aware of potential abuse or neglect and any instances are acted upon immediately’. Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 21 The complaints leaflet was seen that is put into accessible formats if people need this to be done e.g. on tape, although it’s not yet in picture format suitable to meet the needs of people with dementia. We looked at the homes complaints record file. This showed three complaints had been received since the last inspection. All three were about care practice. From those seen, records hadn’t all been fully completed i.e. one had notes only although action was quickly taken and one was partly upheld but the outcomes not clear enough – about action taken with the staff member. A meeting had been held with the manager, team manager and the agency providing staff, but this hadn’t been written up. We also looked at the home’s communication or message book. This showed more information about complaints that weren’t recorded on the file. Further, a complaint made by a relative about cleaning cream left in a person’s room, should have been recorded as a complaint as the cream could have been dangerous for the person if not noticed. Recording complaints in message books could lead to a ‘gatekeeping’ culture. This means that staff decide what is important or serious enough to be properly recorded rather than the person’s concern however minor it may be, being treated as a serious matter in it’s own right. Since the last inspection the home has managed a safeguarding adults from abuse situation. This has been done by having extra staff in place, having a clear plan in place about behaviour, a detailed risk assessment about the matter and regular meetings that we have attended. Further, staff have had specific training about caring for people who may have been offenders in the past. All the above has worked well, the staff have gained greater experience and knowledge and people are being kept safe. Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 22 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from living in a comfortable, clean, safe environment that is well decorated and looked after, physically accessible and meets their needs. EVIDENCE: All areas of the home were clean and smelled fresh at this visit. People were seen sitting in lounges or their rooms, watching TV. Rooms were personalised to each individual taste and adequately decorated. One person said she liked her room and it was near to toilets and bathrooms for her. Some rooms are on the ground floor and some are upstairs reached by a lift. One lounge isn’t used often and staff said they have plans to make this into a relaxation room that people may want to go to if they want pampering or just to chill out. This was discussed in a residents meeting, notes of which were seen. The discussion was around what to do to make the lounge more inviting Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 23 and people gave their comments i.e. ‘it was suggested we look at purchasing some lava lamps and having the sofas raised up as residents have said they are very low. There will be soft music playing and the room will generally be a calm, relaxing environment. One resident suggested keeping a selection of books there’. We asked people in our survey ‘is the home fresh and clean’? People commented: ‘They are always doing something or another’ and: ‘It’s very clean’. From the home’s own survey which scored 80 out of 100, people, their relatives and professionals commented: ‘Good, spacious room’ (3 similar comments) ‘My room is bright and clean’ (6 similar comments) ‘There is a toilet near my room’ ‘Dining room is clean’ ‘Laundry is very good’ (3 similar comments) ‘The home is quiet and well ordered’ ‘My relative’s room is clean’ ‘Always clean and smells nice’ and: ‘The home is well equipped to meet residents’ needs’. There were some action points from the home’s survey that included laundry issues (not getting back on the same day and missing items), institutional décor and subdued atmosphere, and one professional contact commented that ‘the atmosphere was drab and depressing’. However this wasn’t our experience at this visit. Domestic staff were cleaning the home, people were doing what they wanted inside or out in the garden and staff were working in the laundry. We did hear however one staff member say to another that: ‘we’d better look busy, the inspector’s here’! The home had recently had a bout of diarrhoea and vomiting within the home. This had proved difficult to get rid of despite good infection control measures. A healthcare professional commented in our survey: ‘Standards of cleanliness are satisfactory, having had to cope with bouts of Norwalk virus’. We had been promptly notified of the outbreak together with the local environmental health officers. The outbreak was eventually contained and people were recovered at the time we visited. Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 24 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home’ benefit from sufficient numbers of care staff to meet their needs. Good progress with National Vocational Qualification in Care training makes sure people are looked after well. Adequate recruitment processes make sure people living at the home are protected from risk. A lack of recording about staff essential training doesn’t show clearly enough what training is needed and by whom. EVIDENCE: In our survey we asked people about the care they get. Each person said ‘always’ to our question ‘do you get the care and support you need?’ and that staff listen and act on what they say. To the question ‘are the staff available when you need them’? Three people said ‘always’ and three said ‘usually’. On the first day of this visit six staff were on duty. Both the assistant manager and staff said this was very unusual as four care staff are normally on duty. One staff member escorted a person to hospital, so if there had been four on Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 25 duty that would have left three to care for thirty-eight people. We followed up a requirement made at the last visit about equal numbers of staff on duty at weekends as during the day. This had been met and staff confirmed this. The staff were a mix of permanent and agency. A staff member now starts at 7 am that the assistant manager said eases the morning situation. Staff told us the ability to cope with the number of staff on duty is: ‘ all according to what hits you and what you find’. They confirmed that the addition of a 7am person ‘works better’. Staff told us that dependency levels of people living at the home vary, with some being largely independent and needing little direct care at the moment. Others (particularly those with dementia) may need the assistance of two people for the majority of their care needs. The home’s message book showed lots of references to staff changing shifts, being asked to cover shifts and for an agency to be contacted to provide staff cover. People living at the home said: ‘They are a bit short at times’ and: ‘It seems to be particular times of the day when they can be a bit short’. From the home’s own survey people commented about staff: ‘Staff know their jobs and are very willing and supportive’ (2 similar comments), ‘Staffing levels seem good’ (6 similar comments), ‘Staff seem to be well trained’ (3 similar comments) and: ‘The staff are wonderful’ (2 similar comments). Relatives and professional contacts comments were about the way staff worked with people: ‘Most staff have built up a good relationship with my relative’, ‘The staff do their best, given scarce resources’ (2 similar comments), ‘The staff are always pleasant and willing to help’ (2 similar comments) and: ‘Staff have a good understanding of the residents’. However, issues about staffing that people and their relatives thought could be better were: ‘Need more staff on duty at times’, ‘Staff seem to be very busy at times’ (2 similar comments), ‘Lack of communication between staff’, ‘Need more staff on duty to meet all residents’ needs’ (2 similar comments) and: ‘More permanent staff, not agency – very confusing for residents’ Professional contacts also commented on staffing: ‘More staff in the day so that more time can be spent with residents’. Staff echoed this as they said they would like to spend more time with people. Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 26 The assistant manager said that only three care staff don’t have National Vocational Qualification in Care Level 2 at the moment. The deputy manager has Level 4 as well as the Registered Managers Award and two of the assistant managers have Level 3. This is good practice. We looked at a sample of staff training records. These were patchy with some staff doing lots of training in the last year including: managing aggression, dementia care, working with older offenders and person centred care planning, as well as the essential training such as: moving and handling, food hygiene and fire safety. However other staff didn’t have much training recorded. The deputy manager gave us copies of a ‘training review’ done for all staff including managers. These showed training to be done with dates. However, from all records seen it wasn’t clear whether staff had done refresher training in safeguarding adults from abuse. Some dates only showed training done in 2004 and one person had no date recorded. The Commission recommends that care staff receive regular safeguarding adults training at least every three years. Further, night staff didn’t show attendance at training sessions as much as day staff and whilst they had done the essential night staff training e.g. fire safety and medication, there were gaps in other training. This included safeguarding adults from abuse, dementia and managing behaviours that challenge. We saw notes of a night staff meeting in January ‘08 that three out of eight night staff had attended. Training wasn’t discussed at this meeting although we did see that it was discussed in individual staff’s yearly performance review meetings. A requirement from the last visit about training was met. The team manager for the home had sent us an email about mental health needs/behaviour that challenges and dementia awareness training dates. The dates, from 15/09/07 to 8/11/08, will mean that all staff will have done it over this period. We saw evidence that some staff had already done it in their individual training records. Staff also told us about having done the training and how much they had enjoyed it. Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 27 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): 31,32,33,35, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A trained and experienced management team, who understand peoples needs and the inspection process, makes sure they are well cared for. Suitable ways of making sure people can comment about life in the home helps them to be sure their views and opinions will be taken note of. However, failure to give the Commission necessary information about the home when required doesn’t show how well people are being cared for. Proper management of peoples money and health and safety makes sure they are protected from risk. Lack of regular opportunities for supervision fails to help staff to reflect on their working practices. Insufficient recording of supervision could lead to poorer quality of care given to people. Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 28 EVIDENCE: Management and administration scored 82 in the home’s quality assurance survey. Comments we saw were positive about the management team: ‘Managers are good and easy to talk to’ (8 similar comments), ‘Managers are always available, if needed’ (2 similar comments), ‘Managers seem to have good relationships with all staff’, ‘Managers always seem to have time for relatives’ and: ‘Good supervision of staff’. Professional contacts also commented: ‘Management is very good and understanding’. The manager was on annual leave at the time of the visit but the home was being properly managed. Mrs Enid Mullin, the assistant manager on duty on both days, was welcoming and open to the inspection process. The deputy manager Mrs Annette Roughly, also gave us lots of information and was equally open to the visit. Both were seen to have positive relationships with everyone. Although there were many demands on their time, they were calm, open and unhurried, particularly in their conduct with people living at the home. Throughout this report we’ve included comments from the most recent independent quality assurance survey report. The survey had been done in June and a copy of the report sent to us. Scores ranged between 75 – 82 rate of satisfaction overall headings. The subject areas had been re-done to more neatly fit with the National Minimum Standards as set out in this report. This year action sheets have been introduced to help managers’ focus on the less positive comments that may need action being taken. This is good practice. However, Part 2 of the AQAA that the manager had filled in wasn’t done at all so we had no information about staffing matters, complaints, equalities and diversity and policies and procedures. Neither did it include information about people living at the home that we need to help us plan inspections. This information is required under regulation and must be supplied in a timely manner. Although the manager had told us it had been sent we didn’t receive it by the due date or in the right format. The need for such information shows us that the registered provider and manager regularly review the quality of the service they give to people and understand what needs to be done to keep improving. We did a random check of peoples money held at the home. Each person’s balance matched with the record sheet and receipts were attached to this. Cash balances are checked weekly by a member of the management team and signed. A sheet is in place to make sure staff taking money out to buy things Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 29 for people, sign to say the amount taken and when it’s returned. A manager then signs to show that the right money has been returned. Each sheet was properly filled in and signed. We followed up a requirement made at the last visit and looked at a number of staff supervision records. It was disappointing that the situation hadn’t changed and staff aren’t always being supervised often enough. One staff member had no supervision records at all. Others had only two sessions in the last six months or over the last year. Some staff had only one session recorded each year for the last two years. Further, some records were very brief and didn’t show meaningful discussion or action about issues raised. However staff did have a performance review done that happens yearly. Whilst supervision records showed little evidence of discussion about training (particularly for night staff) the reviews did show this and training needs were highlighted. The requirement is therefore moved on with a short timescale. Failure to meet the requirement will lead to enforcement action being taken. Health and safety records were looked at. Regular health and safety checks are done particularly about fire safety and machinery such as lifts and hoists. Records showed regular weekly checks done on fire equipment and fire alarm testing. Staff get frequent fire safety training and fire drills are regularly done. From the AQAA sent in before this visit the manager had commented on the home receiving a five star kitchen award from the City Council’s environmental health department two years running. This is commended. Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 30 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 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 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 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 1 X 3 Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 31 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 OP8 Regulation 12(1)(a) Requirement Timescale for action 01/09/08 2. OP12 16(2)(n) 3. OP30 18(1)(c)(i) 4. OP33 24(2),(3) Where healthcare practices or behaviours change, these must be clearly written on care plans. This will make sure that people get the care they need and are protected from risk. Activities must be provided in 01/09/08 consultation with people and meaningful for people with dementia. This will make sure people have opportunities for creative and stimulating enjoyment more regularly. Records must clearly show 31/10/08 that all staff have regular training in safeguarding adults from abuse and that night staff do the same range of training as day staff. This will make sure that people are kept safe by staff that have the knowledge and skills to care for them. The yearly Annual Quality 10/06/09 Assurance Assessment (AQAA) must be fully completed and sent to the Commission by the DS0000036948.V364296.R01.S.doc Version 5.2 Bowmead Page 32 5. OP36 18(2) date required. Care staff must be supervised at the frequency as set out in the Bristol City Council policy. This will make sure they have opportunities to discuss their work and issues affecting people living at the home. (Timescale not met from the August ’07 inspection) 31/10/08 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 Personal profile sheets showing background, hobbies, interests and family information should be put in place for each person and combined with information about activities. This will make sure that people get care based on a better understanding of who they are and their previous history. Complaints should only be recorded in the file kept for the purpose and in such detail that makes outcomes and timescales for meeting them, clear. This will make sure people and their relatives are confident that the service will take their concerns seriously. 2. OP16 Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Bowmead DS0000036948.V364296.R01.S.doc Version 5.2 Page 34 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!