Inspection on 05/09/06 for Bowood Court Nursing & Residential Home

This inspection was carried out on 5th September 2006.

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

Bowood Court Nursing &... 04/11/08

Bowood Court Nursing &... 27/11/07

Bowood Court Nursing &... 21/02/06

Bowood Court Nursing &... 07/08/05

Bowood Court Nursing &... 16/12/04

Bowood Court Nursing &... 27/07/04

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

CARE HOMES FOR OLDER PEOPLE Bowood Court Nursing & Residential Home Hewell Road Enfield Redditch Worcestershire B97 6AT Lead Inspector Chris Potter Unannounced Inspection 10:00 5 September 2006 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 Bowood Court Nursing & Residential Home DS0000004096.V304734.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. Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bowood Court Nursing & Residential Home Address Hewell Road Enfield Redditch Worcestershire B97 6AT 01527 65115 01527 66645 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) www.schealthcare.co.uk Southern Cross Healthcare Services Limited Emma Louise Miles Care Home 59 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (59), of places Physical disability over 65 years of age (59) Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home may accommodate no more than 27 people who require nursing care. 21st February 2006 Date of last inspection Brief Description of the Service: Bowood Court offers both personal and nursing care for up to a maximum of 59 older people who may have physical disabilities and/or needs associated with old age. Nursing care for 27 residents is provided on the ground floor and personal care for 32 residents on the first floor. A maximum of six residents may have dementia illnesses. The home is located close to Redditch town centre, which has good amenities. Bowood Court was first registered in 1998 and is purpose built. It offers single, en-suite accommodation for all service users on both floors and has a passenger lift. Communal lounges, dining rooms, toilets and bathroom facilities are available on both floors. There are gardens which are accessible to service users. Southern Cross Health Care Ltd owns the home. The acting manager is Sharon Cox. The fees for the home range between £446.50 and £568.50, additional costs for hairdressing and chiropody are requested when the service is used. Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was Bowood Court’s key unannounced inspection, and was undertaken over two days totalling 10 hours of inspection time. The last inspection of Bowood Court took place in February 2006. At the time of the inspection the home was caring for 55 residents. This inspection focused on the environment, the residents’ care delivery through case tracking their care documentation, staffing levels, training and recruitment. The views of the residents, relatives and staff were sought at the time of the visit and prior to the inspection from comment cards. Since the last inspection the manager had left, and no formal notification had been received by the CSCI. The inspector was informed that the manager had left Friday 1st of September to manage another home for Southern Cross. The deputy manager had been asked to cover for the manager. The comments received from General Practitioners prior to the inspection was positive, one commented that they sometimes have to wait for a member of staff to be available, as they are attending to residents’ needs. What the service does well: The acting manager and staff were able to demonstrate the care needs of the residents. Some residents were most complimentary about the home, and the care provided for them. Comments included; “No complaints about the home”, “All the staff are smashing” and “I can’t fault anything”. Relatives spoken to commented; “… staff treat you like a member of the family”. The owners provide good training opportunities for staff. Staff confirmed this when asked during the inspection. Many of the residents’ bedrooms have been personalised by the resident, which gives a more homely environment and reflects their personality. The home is well maintained and in good decorative order throughout. Maintenance records were available and up-to-date. Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 Page 6 Medication management was well organised. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 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 the following standard(s): 1,2,3,4,and 5 The quality outcome for this area is good. This judgement has been made using available evidence including visits to this service. Residents’ individual needs are assessed prior to them moving into the home in order to establish the homes ability to meet those needs, and to help ensure appropriate care is provided. Potential residents are provided with the appropriate information to assist them with their choice of home. EVIDENCE: The home provides prospective residents and relatives with the appropriate information to assist them in choosing the home. A copy of the relevant documents and last inspection report were available in the reception area of the home. Obviously the Statement of Purpose and Service User Guide will have to be updated to reflect the recent management changes. Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 Page 9 Relative’s feedback received prior to the inspection confirmed that they had been provided with the appropriate information to assist them with their choice of home. It was confirmed they had also been invited to visit the home prior to confirming their choice. A contract detailing the home’s terms and conditions are provided on admission to the home, a copy is retained by the home. A registered nurse visits potential residents prior to admission and completes a pre-admission assessment to ensure the home is able to meet their needs. Three residents’ care records reviewed confirmed that a pre-admission assessment had been completed. Comments from residents included: “No complaints about the home.” All the staff are smashing” “I can’t fault anything” Comments from General Practitioners raised an issue that at times they are kept waiting for a member of staff to assist them. Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9,10 and 11 The quality outcome for this area is good. This judgement has been made using the available evidence including site visits to this service. Care plans were sufficient and provided the necessary detail regarding the residents’ care needs to ensure that care staff are able to provide the level of input required. EVIDENCE: The home provides care for residents requiring nursing on the ground floor and residential care on the first floor. Staff were able to demonstrate the needs for the residents on both units. All staff were observed delivering care to the residents in a respectful manner. The care records for three residents were reviewed at the time of the inspection; these were reflective of the residents’ care needs. Appropriate risk assessments had been completed and were evident of monthly review. From discussions with relatives, it was confirmed that they were consulted about their relatives’ care. One relative commented that on occasions communication Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 Page 11 was not always clearly conveyed to them. An example of this related to what the general practitioner had said when visiting. One resident who had recently returned from hospital had not had the care plan updated to reflect the change in their condition. The deputy manager agreed to address this with the nurse on duty when they returned from hospital. A resident with challenging behaviour was causing problems and disruption for the staff trying to care for this lady. It was recommended that the home notify social services and the family, and a more appropriate placement sought. The home provides a good range of pressure-relieving equipment, and aids to assist staff to safely move residents. It was recommended that a hoist be provided for the first floor, in case of emergency. Apparently the staff go down to the ground floor to use their hoist, but in practice staff tend to lift manually to save time. Management of medication was reviewed on both floors and found to be well organised. It was recommended that allergies are recorded for all residents or “none known” should be recorded on the medication administration chart. The relatives of a resident who was very poorly at the time of the inspection were most complimentary about the quality of care being provided by the nurses and care staff. Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 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 the following standard(s): 12,13,14 and 15 The outcome for this area is adequate; this judgement has been made using available evidence including visits to this service. Activities are limited, and not suitable for all the residents. The dietary needs of the residents are restricted and therefore they do not have full choice over their meals. EVIDENCE: On both days of the inspection the residents were observed in the lounges, dining areas and their bedrooms. Residents appeared content and those asked confirmed it was their choice to be in either the lounges or bedrooms. The home employs an activities organiser, and staff and residents stated that the activities had improved recently following the appointment of a new person for the position. On the second day of the inspection some residents had joined in a game of bingo and had enjoyed this. It was pleasing to see the residents’ artwork on display in the activity room. The home needs to expand the available activities, and consider the more dependant residents. Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 Page 13 The catering provision for the residents was reviewed. The kitchen provides cover for both Bowood Court and Bowood Mews providing 90 plus meals a day. The earlier inspection in July 2006 to Bowood Mews raised comments that the quality and choice of food was poor. The chef has been trying to address the concerns about the food, and has undertaken a food audit with the residents. He has also developing new menus and is trying to cater for their likes and dislikes. The menu provides a limited choice for the residents to choose from. If they do not like the choices available on the menu, the chef is limited to what they can offer for an alternative. Two residents informed the inspector that they provide some of their own food because they do not like the brands, which the home uses. The chef explained that having to work to an allocated budget, food is bulk purchased. So it is therefore difficult to accommodate a bacon sandwich at short notice. The chef tends to go for the cheaper brands to try and work within the budget. It was recommended that Southern Cross should review the budget to ensure that residents’ choice can be facilitated. Comments received in respect of the food varied: “It has got a little better with the new chef” “Can’t expect any better given the number of people being catered for” “The food is good, depending on your appetite” “I have no problems with the quality of food provided it suits me” The chef is going to review the food survey in 6 months to see if the residents’ satisfaction had improved. Staff were observed assisting residents with their meals appropriately. Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 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 the following standard(s): 16 and 18 The outcome for this area is adequate. This judgement has been made using available evidence including visits to this service. There is a complaints policy in place to fully safeguard the residents this must be followed. EVIDENCE: The complaints records were reviewed during the inspection. The record must clearly demonstrate the investigation undertaken and the outcome of the investigation. This could not be evidenced from the records provided at the inspection. From further discussion with relatives and residents it was evident that the home was failing to record all complaints. Some relatives stated that they felt their complaint had not been taken seriously by the manager. They were confident that the deputy manager would and had addressed their concerns. From the time of the last inspection the home had made three referrals for allegations to be investigated under Worcestershire’s multi-agency adult protection procedure. The home co-operated fully with the investigations. Staff spoken with were aware of the adult protection procedure and confirmed that they felt confident to report any concern that they may have. Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 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 the following standard(s): 19,20,21,22,23,24,25 and 26 The outcome for this area is good. This judgement has been made using available evidence including visits to this service. The home provides a well maintained, and comfortable home for the residents. EVIDENCE: The home provides accommodation for 59 residents on two floors in single ensuite rooms. All areas of the home are in good decorative order providing a pleasant environment for residents. Many of the residents have personalised their bedrooms, which reflects their personality. Residents spoken to confirmed they were very happy with their bedrooms and liked spending time in them. A maintenance person is employed who deals with many of the safety checks, and minor repairs. All records observed were well organised and up to date. Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 Page 16 A couple of ceiling leaks were observed during the tour of the home, the maintenance person was aware of these and was in the process of addressing the issues. All areas of the home were observed clean and tidy, and no odours were evident from walking around the home. Generally comments received from relatives about the cleanliness of the home was good. One relative stated at the time of the inspection that at weekends, the home does not provide domestic cover. The deputy manager confirmed that cleaning staff work seven days-a-week. Specialist baths are fitted and are appropriate to meet the needs of the residents on both the first and second floor. The bathrooms are spacious to allow staff good access when bathing residents. All windows on the first floor were restricted as required. The temperature on this floor was extremely hot and residents and staff were complaining about the uncomfortable temperatures. The windows appeared to be restricted too narrowly and it was recommended that this be reviewed. One resident with breathing difficulties had a letter from her doctor requesting that this window should be open. It was recommended that the home complete a risk assessment so that when the resident is not in the room the window restrictor is replaced. Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The outcome for this area is good; this judgement has been made using available evidence including visits to this service. Appropriate numbers of staff are on duty to meet the needs of the residents. EVIDENCE: The duty rota was reviewed at this inspection this showed that the home provides staff on both floors within the recommended minimal requirements. A relative advised the inspector that the home had operated with shortfalls during the summer holidays; this was also confirmed by some staff. The home must ensure that where possible agency staff are used to ensure a safe number of staff are available to provide the level of care required. Staff generally felt that when all staff were on shift the numbers were appropriate to meet the needs of the residents. Three recently employed staff files were examined. These evidenced that the home was complying with their recruitment procedure. One file showed that a reference had not been provided by the most recent employer. Where this is not possible a record should be recorded on their application. Staff training records evidenced that not all staff were up to date with their mandatory training. Gaps were evident for moving and handling and fire training. Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 Page 18 The home has almost achieved 50 of care staff with NVQ level 2 qualifications. Staff spoken with confirmed that the company are very keen on them attending the training courses. It was recommended that the home review specialist training for both nurses and care staff, for example, nutrition, wound care and diabetic management. Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37 and 38 The outcome for this area is adequate. This judgement has been made using available evidence including visits to this service. EVIDENCE: The registered manager had left the home on Friday prior to the inspection. The CSCI should have been provided with formal notification about this and who would be managing the home in the interim. The deputy manager advised the inspector that she had been asked to manage the home on the Friday of the previous week. All staff, residents and relatives interviewed spoke very well of her and felt she would be more than able to manage the home effectively. The home has service and maintenance contracts for all equipment in the home. All records were available and up to date at the time of the inspection. Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 Page 20 The home has no responsibility for residents’ finances. These are managed by relatives. The home requests that relatives open an account for personal allowances, and all receipts are kept for any outgoings. The home is able to audit the amounts. Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 3 3 3 3 3 Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 Page 22 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 OP31 Regulation 37 Requirement The registered providers must notify the CSCI of any management changes without delay. The home must ensure when a resident returns from hospital or leave that their care plan and risk assessment are updated to reflect any changes in their condition. A first aider (four day First Aid at Work Qualification) must be on duty at all times. This remains outstanding from the last inspection. Timescale for action 05/09/06 2. OP7 15 05/09/06 3. OP38 13 30/11/06 4. 5. OP12 OP16 15 15 Activities should be reviewed to offer more choice for the more dependant residents. The home must review the complaints policy to ensure all complaints are recorded and an outcome is evident. 31/10/06 31/10/06 Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 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. 2. 3. Refer to Standard OP38 OP15 OP38 Good Practice Recommendations It is recommended that a hoist be provided on the first floor for use in emergencies. The registered providers review the catering budget so residents can be accommodated with their choice. The opening on the window restrictors should be reviewed to ensure the are set to the appropriate width. It was also recommended that the home monitor the temperatures on the first floor to ensure a comfortable temperature is maintained for both residents and staff. Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Bowood Court Nursing & Residential Home DS0000004096.V304734.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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