Inspection on 14/08/07 for Bowmead

This inspection was carried out on 14th August 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bowmead 12/07/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bowmead 75 Hollway Road Stockwood Bristol BS14 8PG Lead Inspector Sandra Garrett Key Unannounced Inspection 09:30 14 and 15th August 2007 th 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.V346407.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.V346407.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.V346407.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. 16th August 2006 Date of last inspection Brief Description of the Service: Bowmead is a Local Authority home registered with the Commission for Social Care Inspection. It provides personal care only for older people over the age of 65 years, with a condition of registration that includes one resident under 65 years of age. Six beds at the home are used as an interim unit for people discharged from hospital but waiting for a place in another care home. This service is currently not running but will re-start in the Autumn. Bowmead is situated within the residential area of Stockwood in Bristol and is close to a parade of local shops that includes a café. These provide easy access for residents and there is a bus stop immediately outside the home. The home is arranged over two floors with lift access. The total fee payable for local authority care in 2007 is £460. 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 inspection report isn’t displayed anywhere else in the home. Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 5 Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This key or main inspection took place over two days. The manager was present on both days and was welcoming and open to the inspection process. We had visited just before the inspection and helped eleven people fill in our surveys to find out what life in the home is like. Some people declined to fill in the survey as the home has been under serious threat of closure recently and they were understandably worried about the future. Whilst the decision to close the home has now been changed, people were still clearly distressed by the threat and talked to us about it. A meeting had been held at which they, together with relatives, had been able to express their views about the home closing to local authority councillors. This situation has clearly had a negative effect on both people living at the home and staff. However, the atmosphere was good at the visit and plans were being finalised for at summer fete to be held on the 18th August. A range of records was looked at. These included care and medication records, staff records, complaints and health and safety. Six residents and five staff were spoken with. What the service does well: What has improved since the last inspection? Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 7 Two out of three requirements made at the last visit in August 2006 were partly met. People with severe dementia or mental health needs hadn’t been admitted to the home. The registered provider had issued guidelines to all homes about admitting people with high levels of need that managers should follow. This makes sure that staff at the home know they can meet peoples needs at the time they come into the home. A system of looking at each person’s care plan regularly had been put in place. A new sheet was seen that had dates they are looked at, any changes and when recorded. This is good practice. The majority of care plans looked at showed that they had been reviewed and changed regularly. Care needs of people living at the home are therefore picked up and met quickly. What they could do better: Eight new requirements were made at this visit and one was moved on from the last one. The home’s Statement of Purpose must be changed to make sure that all information in it is correct, particularly about the range of needs to be met and the circumstances in which people come to the home. Further, the Statement should include information about how the needs of people from other groups in society will be catered for so that they know the home can meet those needs. People must be given a contract to sign that tells them their room number and details of how their fee is to be paid so that they are aware of their rights and responsibilities. Signed contracts must be made available for inspection and a copy given to each person. Where it’s clear that a person is at risk because of particular health issues, clear risk assessments must be written that show how the risks are to be managed. This will make sure people living at the home are kept safe from risk of harm. If over-the-counter medicines or ‘homely remedies are kept in the home, a supply for that purpose must be kept and the arrangement for doing so agreed with GPs and the supplying pharmacy. Further, individual peoples medicines must only be used for them and not given to other people, or returned to the pharmacy if no longer needed. The medication needs of people living at the home must be managed properly in order to keep them safe. All care plans must be signed by a representative of the home to show that peoples care needs can be met whilst they’re living there. Further people living at the home must be consulted with and encouraged to sign their care plans so that they are fully involved in all aspects of their care. Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 8 The home must be run for the people that live there and they must be given rights and choices to use the home as they wish. People must therefore be consulted about choices available to them and the daily routines of the home, so that they can feel comfortable living there and to avoid the creation of ‘rules’. The same number of staff must work at the home at the weekends as well as during the week so that people living there get the continuing level of care that they need. A requirement to make sure staff get proper, regular training in how to care for people with dementia or mental health needs is moved on from the last visit. Training must be of enough detail and length so that staff are fully aware of peoples needs and how to support them properly. Failure to meet the requirement could lead to enforcement action being taken. Care staff must have opportunities for regular supervision at the frequency as set out in the relevant policy, but at least six times a year. This will make sure they have opportunities to discuss their work and issues affecting people living at the home and get support. Good practice recommendations made at this visit included: Staff should treat people living at the home with proper dignity and respect by using person-centred language about them and waiting to be invited into their rooms after knocking. The weekly menus should be displayed in the home so that people can see what meals are available to them throughout the week. Further, people that are vegetarian should have their choice of meal displayed and a vegetarian option added to the menu so that they have the same degree of choice as meat-eaters. Training in safeguarding adults from abuse should be reviewed and updated where necessary so that people living at the home will be kept safe from risk of abuse happening to 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.V346407.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 Bowmead DS0000036948.V346407.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 adequate. This judgement has been made using available evidence including a visit to this service. Out of date information doesn’t keep people fully informed. Further, people from minority groups may not feel welcome at the home without positive information available about this. Contracts lack information that people need to feel secure within the home and know what they are paying for. Satisfactory admission arrangements including day visits and social work assessments ensure peoples needs can be met. EVIDENCE: Both the Statement of Purpose and service users guide were looked at. People have a copy of the Statement of Purpose and the service users guide in a file in their room. The service users guide is in the form of a pack that includes: Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 11 A copy of the complaints procedure together with details of The Commission for Social Care Inspection (the Commission), Information about the home and services offered, A sheet detailing current fee payable, A list of room sizes, A copy of the summary from the last inspection report (August 2006), Information about staff training and qualifications and: A copy of the last quality assurance survey report (September 2006). The Statement of Purpose had the present manager’s name and details on it but other aspects hadn’t been looked at, particularly in the range of needs to be met, or changed in some time. The responsible individual (the person named by the provider to make sure legal responsibilities under the Care Homes Regulations are met) had issued recent guidance to all local authority care homes. This was following an admission to another home that broke down and caused distress to the person concerned and other people living there. The guidance states that the Statement of Purpose has been revised and: ‘does allow us to provide care to people that have a level of dementia that is manageable providing the primary and presenting needs are concerned with their physical care and not their dementia’. The Statement seen in the home didn’t fully reflect this and was unclear about admission of people with dementia. Further, neither the Statement of Purpose nor the service users guide (copies of which were seen in peoples rooms) included any information about meeting specialist needs of people from diverse groups such as black or minority ethnic, sexual diversity, gender, disability or religion. (The Statement of Purpose is one that is the same for each Council home. Therefore each home’s Statement of Purpose should contain the same information). From our survey filled in before this visit, four people said they had been given a contract although seven said they hadn’t. Contracts were seen in files kept in each person’s room. Some contracts were blank and had no signatures or room numbers and no information about fees payable. However one contract was seen that was fully completed and signed. Five people said they got enough information about the home before they moved in so they could decide if it was the right place for them. However six people said they hadn’t. Comments about it included: ‘My family did all that –I wasn’t fit to do it’; ‘I wasn’t in any fit state to do anything but move here’ and: ‘my daughter dealt with it’. The manager had filled in the Annual Quality Assurance Assessment. The Commission for Social Care Inspection requires this to be filled in each year. It’s a record of events in the home, details of staff and people living there and gives information on what the home does well, has improved or could do Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 12 better. It also has a part to fill in on equalities and diversity – the different needs people have because of their ethnic origin, culture, religion, disability, sexuality or gender. The manager had answered each question although had assumed answers to one of them, about sexuality. Equalities information was seen on Adult Community Care assessments that are done before people move into the home, but this information hadn’t always been transferred into care plans or other documents. Assessments had been done by social workers and sent to the home so that peoples needs could be looked at before moving in. Assessment information was clear and detailed and showed the level of risk to the person if they didn’t enter the home. From the assessments specialist needs had been properly picked up and transferred into care plans. Such needs included: help needed with swallowing, visual impairment, history of falls etc. People can visit the home for a day’s visit to see if they would like to move in for a four-week trial period. The manager said that no one from the home does visits to people to assess their needs because of this. However some people are admitted as an emergency and don’t have the opportunity to visit the home beforehand. The six-bedded interim short stay unit was closed at this visit. This was because it was under-used and because of the threat of the home closing. The manager said that it was hoped that the unit would re-open again in the autumn. Meanwhile more short-stay places are being offered and one person came in for this on the first day of this visit. Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 13 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. People living at the home are looked after well in respect of health and personal care needs although health risks are not always identified and assessed. Failure to keep to the home’s medication policy and practice could mean people aren’t kept safe nor their property respected. Peoples right to privacy in their rooms isn’t always respected. EVIDENCE: Five peoples care plans were closely looked at. A requirement made at the last inspection was met: the manager had put in place a clear review sheet that has space for any changes to be recorded. The sheets that are colour coded for ease of reference were completed monthly and changes entered. Care plans were detailed and gave clear information about how peoples needs are to be met. Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 14 However some people had healthcare needs that needed to be risk assessed. These included: swallowing difficulties, a history of falls, poor mobility, and sight impairment. Risk assessments were seen for moving and handling and self-medication but not for the others. It wasn’t clear therefore how people were being kept safe from risk of choking, falling and the effects of poor sight. From our survey nine people said they ‘always’ get the care and support they need and one said ‘usually’. Very few people commented directly about this although one said: ‘They do their best’. To the question ‘do you receive the medical support you need?’ nine people said ‘always’. Comments were mixed about this e.g. ‘If you want it’, ‘they sort all my tablets out’, ‘they take me round to the clinic whenever I need to go’, ‘I know they would if I needed it but I don’t take medication and very rarely need to see my doctor’ and: ‘they are very limited in what they can do and only on the Dr’s say so which he doesn’t always give.’ A check of medication was done. A medication policy is in place that is in the process of being changed and replaced with a more detailed one. Medication practice was done correctly. Medicines were signed for after giving and administration sheets didn’t show any gaps. Instruction leaflets were seen in individual peoples files together with their photograph. The medication cupboard that is kept locked within a locked room was looked at. Supplies of controlled medication are kept within the cupboard and signed for in a separate book. All controlled medication was correct and tallied with the book that was signed and witnessed with no gaps. One person had a large supply of medicine that had collected over time. The manager was advised to send this back to the pharmacy to avoid having excess stock. The only over-the-counter medicine or ‘homely remedy’ kept in the home is Paracetamol. This is kept in the night care staff cupboard for them to give if a person complains of mild pain for which painkillers aren’t prescribed. When looked at this was found to be a named person’s supply with the name scratched out. The manager admitted that the supply should have been returned to the pharmacy when the person left the home and a returns book was indeed seen with large numbers of Paracetamol that apparently were returned in March ‘07. The manager admitted that she knew night staff were using this to give to people as and when they needed it and was about to do a review with them to discuss it. The manager was immediately required to stop using the supply and return it to the pharmacy. She did this and purchased a supply of Paracetamol from the local chemist. A procedure for dealing with over the counter medicines must be put in place with agreement of GP’s and the local pharmacy as named medication remains the property of the person it’s prescribed for and cannot be given to anyone else. Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 15 While we were talking to a person in her/his room, a member of staff knocked and walked straight in. The person said that this happens all the time and staff don’t wait to be invited in. When speaking with staff as a group some comments e.g. about people being ‘difficult’ or ‘heavy’ to manage were heard. This shows a lack of respect and understanding of the needs of older people. Bowmead DS0000036948.V346407.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. People living at the home continue to have opportunities for socialising although activities don’t happen regularly. Contact with the local community benefits people. Development of a ‘rules’ based culture means that rights and choices are not the same for everyone and affects individual dignity and autonomy. Whilst meals at the home are well managed, nutritious and change daily, people with dietary needs such as vegetarianism aren’t given the same information about them. Menus aren’t displayed weekly so that people can see what’s on offer. EVIDENCE: From our survey seven people said there are ‘always’ activities arranged by the home, one said ‘sometimes’ and one said ‘never’. Comments included: ‘There’s plenty of activities going on all the time’, ‘I can go down and see a show sometimes’, Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 17 ‘they do a lot here and I really enjoy the happy hour. I’m looking forward to the fete on the 18th’, ‘we have two big outings and activities a couple of times a week and happy hour most evenings’, ‘I like going to the happy hour and the entertainment is quite good’. However two people said: ‘not a great lot’ and: ’not that I know of’. From activities records looked at a core of between eight to sixteen out of the thirty-three people living at the home regularly join in activities. Some people said they prefer not to join in and like to stay in their rooms. From records seen it’s clear that activities don’t happen every week. However records did show how people enjoyed the various activities and entertainment put on for them. Types of events and dates held were: 04/04/07: Entertainment. 15/06/07: Entertainer. 20/07/07: Entertainer. 26/07/07: Bingo. 07/08/07: ‘Happy hour’. 08/08/07: Bingo. Minutes of a meeting were displayed on one of the notice boards in the home. The manager had told us that a donation of £200 had been made to the home and people had been asked what they wanted to spend it on. The minutes showed that outings including meals were chosen i.e. a pub lunch, a fish and chip supper, trips out (Westonbirt, Swanage, Clevedon, Gloucester cathedral, Horseworld etc). People also said they’d like a Karaoke evening. A couple of people told us that they don’t like going out, as they feel unsteady and lacking in confidence. Staff were seen taking people across the road to the shops and people that can go out clearly benefit from having them close by. Because the home is so close to the shops and GP surgery, people living there have a good quality of contact with the outside world. A hairdresser visits the home every week and a religious group visits monthly to hold a service that people attend. An issue of lack of choice and autonomy (the person’s right to selfdetermination) was seen at breakfast. A person was stopped from coming into the dining room because s/he wasn’t dressed in day clothes. Another person said this was the rule – that no one can come into the dining room unless fully dressed. The person concerned had to wait outside until staff could meet her/his needs. No chair was available for her/him to sit on and s/he had to stand outside the door. in our opinion the person’s rights and choices were reduced and her/his dignity affected. The manager later explained the reason for this but accepted it could be put right. As Bowmead is a home, not a hotel, people should be able to Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 18 choose whether to get dressed before or after breakfast and shouldn’t be stopped from entering any room, particularly for meals. The manager was advised to consult with people about the issue at a residents’ meeting and discuss the issue with the person affected so that s/he has the same rights as others. From our survey six people said they ‘always’ like the meals at the home, although three people said ‘usually’ and one person said ‘never’. The cooks keep a book of peoples meal preferences in the kitchen and this person’s choices were seen recorded. On the first day of this visit the person was offered and accepted a ready meal of Chinese food, as s/he didn’t like the meal on the menu. Both a breakfast and a lunchtime meal were observed. Staff knew what peoples individual breakfast preferences were and at lunchtime both choices were taken to tables so that people could choose which one they wanted. Although the meal included fried potatoes no vinegar bottles were on the tables and people had to ask. A Beatles CD was put on halfway through the meal although people weren’t consulted about what they wanted to hear. Some people clearly enjoyed the music but not everyone. One person who is vegetarian told us how the cooks meet her/his needs. S/he praised the quality of the vegetarian meals and said ‘the cooks know what I like’. However when we asked what s/he would be having for lunch on the second day of the visit, s/he couldn’t tell us nor was it written on the blackboard in the dining room. Whilst s/he said s/he didn’t mind not knowing, s/he isn’t given the same information as other people in the home about meals. The cooks said that some of the people coming to the home for short stays also want vegetarian meals. Therefore a vegetarian choice as well as a meat one should be offered at each lunchtime meal. The manager said that the blackboard had replaced the previous whiteboard in the dining room as people said that they couldn’t see the writing on the whiteboard and found the blackboard easier to read. The cook writes up the daily choice of main meal on the board but people have to come into the dining room to see it. The weekly menus aren’t displayed anywhere around the home so that people can’t see what’s on offer during the week. Staff said that menu holders on each table used to be used for this purpose but had disappeared over time. Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. Satisfactory complaints management and recording ensures people living at the home can be confident in raising concerns about any aspect of their care. Arrangements for protecting people living at the home makes sure that they are protected from risk or harm as far as possible. EVIDENCE: From our survey nine people said they know who to speak to if they’re not happy although one said they didn’t. Further, the same nine said they know how to make a complaint. Comments were mixed and included: ‘We’re told clearly to say what we need to say. Not sure about the leaflet’, ‘I would just go down to the office’ (two comments), ‘If I needed to (complain) I would be happy to’, ‘I had to complain about another person coming in and out of my room and they sorted it out’ and; ‘Not seen the leaflet but they give me stuff to read and I don’t read it anyway’. The complaints log was looked at. Two complaints had been received since the last visit. One of these was about care practice and the other was about another person’s offensive behaviour. Both complaints were upheld and dealt with within a very short time. Details of the responses to the people complaining were recorded and there satisfaction with actions taken. Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 20 One of the complaints was about abusive care practice by an agency staff member towards a person living at the home. This had been swiftly dealt with and the agency informed. The decision not to have the staff member back again was recorded. From the Annual Quality Assurance Assessment no safeguarding adults incidents had happened since the last inspection. The home has clear safeguarding adults and ‘Whistleblowing’ policies in place. Staff are aware of the need to report any suspicions that abuse may have happened. Staff records that include training are all kept in separate files that made it difficult to look at each one in the time available. Therefore it wasn’t possible to see if training was up to date for everyone. However seven staff files were closely looked at. From those seen, safeguarding adults training had last been done in 2004. It wasn’t therefore possible to know if the rest of the staff had done the training and when. The manager said she was putting in place a sheet that shows when various training sessions are done and due to be redone for all staff. She was advised to do this as soon as possible so that she can be sure all staff have regular training in vital subjects such as safeguarding adults. Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 21 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 living at the home’ benefit from living in a comfortable, clean, safe standard of accommodation that is well decorated and maintained, physically accessible and meets their needs. EVIDENCE: Everyone who filled in our survey said that the home is always fresh and clean. Comments about it included: ‘It’s very clean and I like to do my bit’; ‘They’re always cleaning in here’ and: ‘It’s certainly very clean in here’. Although the home was due to close the standard of the environment is good and re-decoration had been done since the last visit. Domestic workers were Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 22 seen cleaning all areas during the two days of this visit and individual bedrooms were homely, clean and smelled fresh. Work to make the home more accessible for disabled people had been done with self-opening front doors and a toilet that had been made fully accessible, close to the ground floor lounge. This had a good space for turning wheelchairs, had grab rails and a raised toilet and was very clean. However there was no sign on the door to show that it was a disabled person’s toilet and the manager was advised to put a sign on it so that could find it easily. Staff had done training in Control of Substances Hazardous to Health and Hazard Analysis. No substances that could harm people such as detergents, cleaning fluid etc were seen lying about the home. The first floor of the home smelled fresher than the ground floor on occasion. The gardener/handyperson does weekly checks of water temperatures and said he had a list of jobs to do to make sure the environment is updated and safe. A decorator was seen redecorating one of the rooms. Management team staff were busy preparing for the summer fete that was to be held the following weekend. The manager had been able to get a grant from the Department of Health for works to improve the environment. This includes updating the garden areas so that people can make more use of them and some internal works. Bowmead DS0000036948.V346407.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, & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lack of sufficient staffing particularly at weekends could put people at risk and lead to inconsistency in care given. Continuing progress with National Vocational Qualification in Care training makes sure staff have the skills to meet peoples needs although training in dementia and mental health needs isn’t sufficient to meet peoples needs. EVIDENCE: Four care staff were on duty each morning of this visit. Staff spoken with said that there are usually four staff during the week but fewer at weekends. The manager agreed, saying that it was difficult to get cover for at least one of the weekend days. Rotas looked at showed the difficulties of covering when staff were unable to come in or were on sick or annual leave. The manager said that there are currently four care staff vacancies. Three interviews had been due to be held the previous week but people hadn’t turned up for them. This may be due to the fact that the home had been due to close. The four vacancies are now to be advertised again. Four temporary staff that have worked at the home for some time have now been made permanent. However problems with getting enough staff remain. Three of the four staff on duty on the first day of this visit were from an agency although the manager Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 24 said that she uses the same people regularly so that consistent care is given to people living at the home. From the Annual Quality Assurance Assessment (AQAA) filled in before this visit 1820 hours of temporary or agency staff time had been used in the past three months. From our survey eight people said staff were ‘always’ available when they needed them and one said ‘usually’. Comments about staff were positive i.e. ‘They seem to be able to cope with all their duties and have treated me really well today as I’ve been feeling a bit under the weather’, ‘There is always plenty around’, ’They get a bit busy sometimes according to what they’ve got to do but on the whole can’t grumble at all’ ‘They’re available for me’ although one person said: ‘I’m not sure’. The home is making progress with training staff to National Vocational Qualification in Care Level 2. From the AQAA, seven staff out of seventeen already have the qualification and six were doing it. However the manager said two had now dropped out. The home therefore meets the recommended minimum of 50 trained to Level 2. From the seven staff files looked at, very little training was seen particularly in essential subjects or mental health. Some staff had done a mental health ‘refresher’ in 2005 and others had done a one-day course in 2006. Some of the sessions were only an hour and a half long, which in a year or two years is not enough. Further, given that the home cares for twelve people with dementia, only one staff file recorded dementia training that was done in 2004. Bowmead DS0000036948.V346407.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, 35, 36, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the manager is trained and experienced, failure to manage specific issues doesn’t keep people’s rights or property respected. Proper management of peoples money makes sure they are protected from financial risk. Staff don’t get full opportunity through regular supervision to reflect on their working practices that could lead to a loss of quality of care given to people. Peoples health and safety is promoted by clear policies and procedures that keep them safe. Proper fire safety measures and training keeps people safe. Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 26 EVIDENCE: The manager Ms Loveta Allison was on duty both days of this visit and was welcoming and open to the inspection process. Ms Allison said she had finished her National Vocational Qualification in Care Level 4 and was finishing off the Registered Managers Award. She had done various training courses in the last year that included: Medication Management of staff appraisals Managing people Health and safety refresher training and: Hazard analysis. She went on to say that she is doing a five-day ‘effective leadership’ course in September ’07. Ms Allison showed a calm and confident style of management and clearly has a good relationship with people living at the home. One person said: ‘Loveta’s quiet voice is an asset and I couldn’t be anywhere better’. S/he went on to say ‘They’re a really listening home’. It’s clear that the issue of the home closing then being reprieved has affected people living there and staff alike. People showed concern about filling in our surveys and spoke about it to us at the visit. Everyone we spoke to said they were happy at the home, that they are looked after well and that they don’t want to move. The inability to recruit permanent staff has also had a negative effect and we witnessed an incident of challenging behaviour towards agency staff by a person living at the home, that was racist. The incident was challenged by another person but showed the degree of stress people and staff are under. However, issues picked up at this visit reflect on the management of the home. These included: the manager’s admission that she was aware of the medication issue but did nothing about it, the creation of a ‘rule’ that robs people of choice and disadvantages them, and the failure to make sure staff are regularly supervised. The conclusion drawn therefore is that the home isn’t always run in the best interests of people living there. The home had been due to have its quality assurance survey done by an independent organisation. However because of the proposed closure this hadn’t happened. The manager said it would be done later in the year. A random check of peoples cash was done. All balances were correct and cash sheets properly filled in. Receipts were seen attached to the sheets and where possible two signatures for each transaction or balance check. The manager Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 27 said that there are no difficulties in getting peoples personal allowances for them so that they have money to spend. Staff supervision dates were looked at. This showed that out of the seven staff records looked at only two people had had supervision this year (one in January and one in March ‘07). Other supervision records were infrequent i.e. no supervision record since June 2005 (one person), no supervision record since June ’06 (three people). One person had a brief supervision note on record but this was undated. The Bristol City Council policy on supervision recommends 6 times a year as does the National Minimum Standards. Although the proposed closure is a factor to consider, staff need more supervision not less to help support them during difficult times. In general daily records were well written and showed clearly how people spend their lives at the home. People were able to confirm what was written in the records and all were written respectfully. However some records looked at were mis-sorted or filed. These included Adult Community Care care plans and staff records. Some staff records were old and hadn’t been sorted to show recent activities such as training and supervision. Fire safety records were looked at. A fire safety risk assessment was in place and regular checks of the alarm system, fire doors and fire fighting equipment were recorded. Fire safety training was seen in individual staff files as well as in the fire safety log. Between 23 May ’05 and 30 April ’07 eight fire drills had taken place. These were all recorded with comments and numbers of staff attended. Night care staff had done group training in September ’06. Bowmead DS0000036948.V346407.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 2 2 3 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 1 3 3 Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 6(a) Timescale for action The Statement of Purpose must 31/12/07 be reviewed and amended to make sure it is up to date and gives clear information about the types of needs the home can meet and the circumstances in which people are admitted. This will make sure that people considering a move to the home will get the information they need. People should be given a 31/10/07 contract to sign that includes their room numbers and details of how their fees are to be paid. Each signed contract must be available for inspection. This will make sure people are aware of their rights and responsibilities and the amount of money they have to pay. When people accept a 01/10/07 permanent place at the home after the trial period, they must be consulted on their care plans and should sign to say they agree with them. Staff must confirm in writing that they are able to meet the Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 30 Requirement 2. OP2 5(1)(c) 3. OP7 14 (1)(d) 4. OP8 13(4)(c) person’s assessed needs. This will make sure that the home is the right place for the person whose needs can be met there. Where health risks are known 15/09/07 when a person comes to the home, clear risk assessments must be put in place that show how the risks are to be managed. This will make sure people living at the home are kept safe from risk of harm. Proper arrangements for giving 15/08/07 ‘over the counter’ medicines must be put in place and agreed with GP’s and the pharmacy supplying them. Individual peoples prescribed medicines must only be used for them or returned to the pharmacy when no longer needed. Large amounts of medication must be returned to the pharmacy to avoid over stocking of supplies. This will make sure that peoples medication needs are managed properly to keep them safe. People living at the home must 15/09/07 be consulted and given choices about their daily routines to avoid the creation of a ‘rules’ based culture. This will make sure that individuals aren’t discriminated against and people have the right to live their lives as they wish. The same number of staff must 15/09/07 be available at weekends as well as during the week. This will make sure people living at the home are given the proper DS0000036948.V346407.R01.S.doc Version 5.2 Page 31 5. OP9 13 (2) 6. OP14 12(3) 7. OP27 18(1)(a) Bowmead 8. OP30 18(1)(c)(i) 9. OP36 18(2) level of care every day of the week. All care staff must be given 31/12/07 proper training of sufficient detail and length, in mental health needs of older people, managing behaviours that challenge and dementia awareness and care. This will make sure staff have the skills to recognise and care for people with these needs. (Timescale not met from the August 2006 inspection) Care staff must be supervised at 31/12/07 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. 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 OP4 Good Practice Recommendations The Statement of Purpose should be amended to show how people from different groups in society e.g. black or minority ethnic, sexual diversity, gender, disability and different religions can be cared for. All staff should respect the people living at the home by using proper, person-centred language about them and waiting to be invited into their rooms. Menus should be displayed in the home so that people living there can see what’s available to them throughout the week. Details of any vegetarian meal made for individuals should also be displayed as well as the meat choice for other people. A vegetarian option should be added to the daily menu. This will make sure that people that are vegetarians Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 32 2. 3. OP10 OP15 4. OP18 have the same degree of choice as meat-eaters. Training in safeguarding adults from abuse for all staff should be reviewed and monitored to make sure everyone has had recent training. Bowmead DS0000036948.V346407.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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.V346407.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. 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