Inspection on 05/05/05 for Bowmead

This inspection was carried out on 5th May 2005.

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

The inspector 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 14/08/07

Bowmead 16/08/06

Bowmead 12/10/05

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 Unannounced 5 May 2005 09:30 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 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 D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Bowmead Address 75 Hollway Road Stockwood Bristol BS14 8PG 0117 9039950 0117 9039951 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Bristol City Council Mrs Loveta Elizabeth Allison PC Care Home 46 Category(ies) of OP Old Age (46) registration, with number PD Physical Disability (1) of places Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate up to 46 persons aged 65 years and over requiring personal care. Six of the 46 beds to be used for intermediate care only for a period of six weeks up to ten weeks duration. One of the six beds to be used for a person of 55 years or over. Date of last inspection 7-Dec-2004 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. The home recently included a six bed Intermediate Care Unit. This was set up to provide short-term care for older people who were not ready to return home after a hospital stay and needed some further support. However this unit may now be transferred to the management of South Bristol Rehabilitation Centre based in Knowle. When this occurs Bowmead will cease to manage the unit and resident numbers will revert to 40. 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 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. Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day. Opportunity was taken to tour the premises, examine a range of records and talk to residents and staff. Most of the residents were seen during the inspection and at least six out of the 32 living at the home at the time of this visit were spoken to. What the service does well: What has improved since the last inspection? What they could do better: Information such as the Statement of Purpose available to prospective residents and their relatives, needs amending and updating so they are clear Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 6 about what the home can deliver. Further work is needed to improve contracts signed by residents or their relatives so that they know exactly what they have to pay at the point of admission. Medication is well managed in the home. However staff must make sure medication records are promptly filled in to make sure residents are protected. From the last inspection it was noted that water temperatures were low in some residents’ rooms, despite a requirement made to address this. Temperatures had not improved at this visit. Attention is needed to make sure water is delivered at the correct temperature that meets residents’ needs. Systems in place are on the whole well managed. However improvement is needed with putting in place records required under the National Minimum Standards that are for residents’ protection i.e. personnel records. Further, records required under regulation must be kept under regular review and updated where necessary. Despite staff training in effective recording skills, little improvement was seen in the way care records are written. Some of those seen focussed on negatives or basic personal care tasks only, and are not satisfactory. Care records should be written in a way that positively reflects each resident’s quality of life in the home and respects their privacy and dignity. 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. Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3 Prospective are not given all the information they should have before admission to the home. Residents may not be confident of the amount of fees payable when they enter the home and sign their contract. Not all residents can be confident the home is able to meet their assessed needs. EVIDENCE: The Statement of Purpose, although clear and detailed, has some factual errors and also contains misleading information about the type of care that can be provided under registration conditions. Incorrect statements include: the City Council being responsible for registration and inspection, admission of people outside of the registration category, management of complaints and incorrect details of the Commission for Social Care Inspection. Residents have contracts that contain information about rights responsibilities and room numbers. However information on fees payable the amount and method of payment is not completed when residents asked to sign. Ongoing discussions with the local authority have so far resulted in amendments to the contract. This is not satisfactory. Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 and and are not Page 9 Pre-admission assessments carried out by social workers are done and form the template for the home to develop its own care plan for each resident. Care plans are clearly developed from these. Care plans examined followed the assessments and covered all presenting issues. Emergency admissions are accepted and evidence of regular review contained in care records. Attention is needed in respect of admissions of people with mental health impairments including dementia i.e. one resident admitted as an emergency, may not be appropriately placed at the home, because of her/his mental health needs. The manager said she was working towards trying to ensure the resident was correctly placed elsewhere and evidence was seen of this. While staff work hard to care for these residents, the home is not registered to care for people with assessed needs of this type. Further the admission of people out of the registration category may impact negatively on existing residents. Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 &10 Residents are well looked after in respect of their health and personal care needs. Care plans are regularly reviewed and updated. Attention needs to be given to the quality of medications record keeping. Residents’ dignity may not be respected and maintained at all times. EVIDENCE: Three care plans and risk assessments were examined in detail. Care plans were positive and written from the residents’ own perspectives. Reviews were being carried out on the day of inspection and social workers and family members attended these. A requirement made at the last inspection in respect of signing and review of care plans was met. Confidential health care records were recorded on different coloured sheets and documented appropriate healthcare visits and treatments. For a resident with mental health needs there was clear documentation about management of her/his needs and regular contact with the community psychiatric nurse and hospital. However it wasn’t clear that the home could meet this resident’s complex assessed needs because of her/his mental health. The deputy manager said she had spoken at length to the psychiatrist that day Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 11 and it was hoped that the resident would be able to move to a more suitable placement shortly. Medication records showed gaps in signatures on different days and at different times. It was apparent that medication was not always signed for as soon as it was given. Medications had not always been given and no reason for this recorded on individual sheets. It was observed that residents are able to maintain privacy in their rooms and can lock their doors. However an incident in the dining room was observed when a staff member carried out a care task without asking or telling the resident who was startled by the action. A good practice recommendation is made in respect of treating residents with dignity and respect. The resident had also asked for more food but was ‘persuaded’ not to have it. The manager said she would address this immediately. Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 &15 Residents are able to take part in activities and entertainments are provided. Key time is available and they can go out in the local community. Residents are consulted on a variety of choices, particularly about meals. They are able to maintain independence and choice where possible. EVIDENCE: The deputy manager had chaired a residents meeting shortly before the inspector arrived. Residents confirmed the issues discussed at the meeting and were able to give examples of choice available to them e.g. entertainments, activities, outings and meals. Recent activities had included ballroom dancing that 20 residents had attended, gardening, sitting in the garden on sunny days and a coffee morning with raffle. However little progress has been made on recording how residents enjoy these activities that was subject to a requirement at the last inspection. A new requirement is therefore made in respect of this. A resident said s/he was happy because s/he was now able to smoke in her/his room that s/he felt had previously not been ‘allowed’. A trolley shop – to be taken around the home, was in the process of being set up for residents. From this residents can buy personal items such as soap and tights, plus sweets and crossword books. Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 13 Requirements in respect of choice and consultation made at the last inspection had been met. Progress has been made in choice and delivery of meals. Residents were complimentary about meals and said that the food is getting better. They had given the deputy manager suggestions about meals and how they wanted them to be provided. It was noted that the menu revealed two choices of main dish, three choices of dessert and lots of choice and variety at tea-time. One resident said that staff ask residents about meals and try and provide whatever they want. Staff assist residents with dietary choices in respect of healthcare e.g. diets suitable for diabetics and people with irritable bowel syndrome. Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 17 Complaints are taken seriously and recorded appropriately. There is an open atmosphere in the home. Residents are able to take part in the civic process of voting, thereby retaining involvement in the local community. EVIDENCE: The home’s complaints record was examined and one new complaint noted. The complaint, about a resident’s clothing, had been recorded with clear details of the complaint itself and investigation. However the record of outcome was unclear. The deputy manager said she would amend this to make it clearer. A requirement made at the last inspection in respect of this had been met. Residents spoke openly to the inspector about what it was like to live at the home and were not afraid to air their views. The manager takes any complaint seriously and strives to make sure of positive outcomes for residents involved. The inspection happened on polling day for the General Election. The manager said that almost all residents had registered for postal votes, following a visit by the Electoral Officer. A large number of residents had voted this way and only one had chosen to go out to a polling station. Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,24 & 25 Many improvements have been made to the building and décor throughout the home and residents benefit from a homely and comfortable environment. Improvement in respect of maintaining appropriate water temperatures in resident’ bedrooms is needed, to bring them up to acceptable levels. EVIDENCE: Opportunity was taken to inspect the whole premises. Much redecoration and refurbishment of communal areas has taken place and there are plans to continue with this programme of works. The premises were clean and hygienic with no offensive odours. Residents’ bedrooms are personalised and reflect their individual tastes – indicating that choice and independence are promoted. Residents said that they are fully involved in choosing colours. It was noted in one room that a notice was pinned up on the wall (in respect of a hearing aid) that made the room look institutional and could be interpreted as disrespectful to the resident. Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 16 Water temperatures were checked randomly in a number of bedrooms as requirements in respect of low temperatures had been made at previous inspections. The gardener/handyperson was observed carrying out weekly checks of temperatures. At this visit, temperatures were found to be still much lower in some rooms than that recommended under the National Minimum Standards. Water was tepid and may not meet residents’ needs. The manager contacted the contractor responsible for the heating and water system and it was arranged that a visit would be made and water supply/temperature would be checked in each bedroom. Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 & 29 Permanent staffing remains an issue and residents are not always confident that there are enough staff to meet their needs at all times. Staff are well supported by the management team in working towards developing NVQ qualifications in care. Monitoring of recruitment and keeping of personnel records must improve to make sure residents are fully protected. EVIDENCE: Appropriate levels of staffing were seen at this visit. Four care staff were on duty in the morning and 3-4 on duty in the afternoon. The manager said that sometimes more staff are on duty when activities or entertainments happen. It was clear that making sure there are enough staff on at each shift is of paramount importance to managers. However agency staff still have to be used, although wherever possible the same staff are regularly used. A resident said that s/he thinks the home may still be a little short-staffed at times. Some progress is being made with NVQ Level 2 training. Five staff already have the qualification and assistant managers are working with two staff each. Further an external assessor is working with another two. This is good practice. A requirement in respect of keeping staff personnel records at the home available for inspection had not been met. Negotiations are taking place with the local authority to ensure this is done quickly. However newly developed individual staff files were seen. A previously used checklist that is now obsolete was kept in each file. This demonstrated that the manager had seen essential Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 18 records. However this doesn’t meet the regulation. Further, although proof of identity that included photocopied photographs of staff was seen in the files, some photos were almost entirely unrecognisable and many years out of date. A new requirement is therefore made to make sure the home keeps recent photographs of each staff member in their files. Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 37 & 38 The manager demonstrates an open and inclusive approach in her relationships with residents and staff. New, external quality assurance surveys are about to be introduced. Record keeping systems are in place but further improvement is needed in respect of care records that are not satisfactory. Health and safety issues are monitored regularly and residents are protected from harm or risk of harm. EVIDENCE: The manager Ms Loveta Allison was welcoming and open to the inspection process. Residents spoke highly of her style of management and her quick responses to any issues they may raise. The deputy manager was also on duty having returned from a lengthy period of unavoidable absence. She too demonstrated clear consultative approaches to residents’ issues. Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 20 A new system of external quality assurance is being put in place for all local authority care homes. Bowmead has not yet taken part in this and the Standard will be inspected at the next visit. Although some daily records were positive and documented residents’ wishes, the majority were mainly about personal care. Some were negatively written. Limited progress has been made despite staff training in writing of care records and requirements being made at the last two inspections. Care records didn’t show how residents enjoy their lives in the home and didn’t match with residents’ own comments and views. There are clear systems in place for the maintenance of health and safety. A number of polices were available and the fire logbook indicated that the relevant tests and checks are being made of the system at the regular intervals. In addition to this up to date health and safety risk assessments were in place. Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x 2 2 x STAFFING Standard No Score 27 3 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x x 3 3 x x x 2 3 Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP1 OP2 Regulation 6 (a) 4(1)(b)(c) Requirement The statement of purpose must be reviewed and amended where necessary Contracts must be amended to ensure each resident is aware of the fees payable and methods of payment (not met from the 7 December 04 inspection) All medication must be signed for immediately it is given Water temperatures in each residents bedroom must be delivered close to 43 degrees centigrade (not met from the 7 December 04 inspection) Photographs of each staff member must be kept at the home (not met from the 7 December 04) inspection) All care records for each resident must be written in a positive way that focusses on abilities and enjoyment of life in the home (not met from the 7 December 04 inspection) Timescale for action 31 July 05 1 August 05 3. 4. OP9 OP25 13(2) 13(4)(c) From 5 May 05 31 July 05 5. OP29 19(1)(b)(i )Sch 2 12(4)(a) 31 July 05 6. OP37 31 July 05 Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 23 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 OP10 Good Practice Recommendations Residents should be treated with dignity and respect at all times Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 24 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bowmead D56_36948_Bowmead_224740_Stage4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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