CARE HOMES FOR OLDER PEOPLE
BOWOOD COURT NURSING & RESIDENTIAL HOME Hewell Road, Enfield Redditch Worcestershire B97 6AT Lead Inspector
Annie OMara Unannounced 7th and 11th August 2005 11.30am 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. BOWOOD COURT NURSING & RESIDENTIAL HOME E52 S4096 Bowood Court V242136 070805.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Bowood Court Residential and Nursing Home Address Hewell Road Enfield Redditch Worcestershire B97 6AT 01527 65115 01527 66645 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) Southern Cross Healthcare Emma Louise Miles Care Home with Nursing 59 Category(ies) of DE(E) Dementia (over 65) - 7 registration, with number OP Old Age - 59 of places PD(E) Physical Disability (over 65) - 59 BOWOOD COURT NURSING & RESIDENTIAL HOME E52 S4096 Bowood Court V242136 070805.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home may accommodate no more than 27 people who require nursing care. Date of last inspection 16 December 2004 Brief Description of the Service: Bowood Court offers both personal and nursing care for up to 59 older people who may have a physical disability. The home is also registered to take up to 7 residents who may have dementia. Nursing care for 27 residents is provided on the ground floor and personal care on the first floor. The home is also registered for up to six service users who may have dementia. 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.There are gardens which are accessible to service users. BOWOOD COURT NURSING & RESIDENTIAL HOME E52 S4096 Bowood Court V242136 070805.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over two separate days, including a Sunday morning and weekday afternoon. Care plans were inspected from both the nursing and personal care floors and staff on each floor were spoken to. Five residents were also spoken to during the visits. In addition, concerns about the management arrangements for the home were discussed with the operations director and project manager. What the service does well: What has improved since the last inspection?
Residents care plans have improved and are being regularly reviewed. Medication is being managed safely with all the requirements from the last inspection being acted upon.
BOWOOD COURT NURSING & RESIDENTIAL HOME E52 S4096 Bowood Court V242136 070805.doc Version 1.40 Page 6 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 E52 S4096 Bowood Court V242136 070805.doc Version 1.40 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 BOWOOD COURT NURSING & RESIDENTIAL HOME E52 S4096 Bowood Court V242136 070805.doc Version 1.40 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, 3, 4 Assessment systems are in place which are comprehensive, but assessments had not been consistently carried out to ensure that all areas of residents needs would be addressed, thereby placing them at risk. EVIDENCE: Information about the home is available for prospective residents. Interim management arrangements were not included in the statement of purpose. Assessments were inspected for newly admitted residents to both floors. On the nursing floor a resident admitted from hospital had an incomplete assessment form filled in. The resident had been admitted with extensive bruising and pressure sores that had been recorded but not photographed or investigated further. This matter was being investigated by the project manager. Assessments from both floors did not provide enough information about the social and emotional care needs of the residents. BOWOOD COURT NURSING & RESIDENTIAL HOME E52 S4096 Bowood Court V242136 070805.doc Version 1.40 Page 9 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 Care plans have improved with regular reviews in place although not all aspects of residents needs have been addressed thereby putting residents’ emotional and social needs at risk of not being met. EVIDENCE: Care plans were in place for residents on both floors and provided good information about residents’ physical needs and how they were to be addressed. There was evidence of regular reviewing. It was noted that there were insufficient details about social and emotional needs of the residents. Daily records indicated the physical care received by residents but gave little information about how they spent their days and what activities they had taken part in. Photographs were missing from some care files. One resident had become distressed and unsettled at night. There was no corresponding care plan to help care staff manage the behaviours in a consistent manner. Risk assessments were in place and the primary healthcare team called in appropriately. Records kept for a resident who was unwell were kept in good detail.
BOWOOD COURT NURSING & RESIDENTIAL HOME E52 S4096 Bowood Court V242136 070805.doc Version 1.40 Page 10 Medication is kept separately for both floors. The requirements from the last inspection had been actioned and there were no concerns on either floor about the management of residents’ medications. Observations made during both inspections indicated that residents on both floors were treated with respect and their dignity was upheld. Residents who were spoken to also confirmed that the staff respected their privacy and put them at ease when undertaking personal care tasks. Other comments about the staff included, “girls are marvellous”, “golden” and “lovely”. BOWOOD COURT NURSING & RESIDENTIAL HOME E52 S4096 Bowood Court V242136 070805.doc Version 1.40 Page 11 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, 13, 15 The relaxed atmosphere and flexible routines allow residents to live their lives as they choose, and the dietary needs of residents are well catered for and allows for them to have choices. EVIDENCE: Residents who were spoken to said that they had enough to do and that there were no set routines. The home does have an activities organiser but there was no list of daily activities on display. Residents said they had been out for walks and enjoyed playing bingo. Visitors are encouraged into the home and where they choose, to remain active as carers. Visitors are welcomed at any time at the home. The residents are given a choice of food and the food observed on the day of the inspection was well presented and looked appetising. Staff stated that the food had improved and residents spoken to said that the food was “lovely”, “very good”, excellent”. BOWOOD COURT NURSING & RESIDENTIAL HOME E52 S4096 Bowood Court V242136 070805.doc Version 1.40 Page 12 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, 18 The management of complaints and arrangements for protecting residents are not satisfactory, placing them at risk of harm or abuse. EVIDENCE: The home has a complaint procedure that contains all the required information. Residents who were spoken to were not all clear about who they would raise concerns with if they needed to. Residents have however contacted the Commission for Social Care Inspection directly with concerns in the past. A visitor who was spoken to was concerned that an item of equipment needed for a resident had taken over 18 weeks to be delivered. It was stated that the issue had been raised with management, but there was no record of this in the complaints log. Staff confirmed that they have received recent training in the protection of vulnerable adults. However it was a concern that issues to do with protection had not been considered in respect of a resident who had been newly admitted with little explanation of their poor condition. BOWOOD COURT NURSING & RESIDENTIAL HOME E52 S4096 Bowood Court V242136 070805.doc Version 1.40 Page 13 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, 20, 21, 23, 24, 25, 26 The maintenance and general standard of the environment ensures that the residents are provided with a safe and comfortable home. EVIDENCE: The home was clean and well maintained on the day of the inspection. The home provides a variety of communal areas for the residents to sit in, and there is also a garden area. Residents bedrooms visited contained the required furniture and were personalised. Residents who were asked said that they liked their rooms and that they were comfortable. Individual bedrooms were being re-painted and carpets were being replaced as necessary. Staff were observed carrying out good hygiene practices during the inspection. Staff raised an issue regarding the anti-bacterial hand wash that they had been given at the home. They were concerned that they had been told they would need to pay for it themselves in the future. When a senior manager was spoken to about this it was apparent that there had been some confusion about the issue that she undertook to address.
BOWOOD COURT NURSING & RESIDENTIAL HOME E52 S4096 Bowood Court V242136 070805.doc Version 1.40 Page 14 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. Staffing levels are being maintained at a level that ensures residents care needs can be met, although the lack of a manager or deputy manager is beginning to have an impact on their morale. EVIDENCE: The numbers and skill mix of the staff was appropriate to the needs of the current resident group and was in line with previously agreed staffing levels. Staff confirmed that they were having regular training and that all staff on the residential floor were up to date with health and safety training. BOWOOD COURT NURSING & RESIDENTIAL HOME E52 S4096 Bowood Court V242136 070805.doc Version 1.40 Page 15 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) 31, 32, 36. Management arrangements have not been adequate to support and maintain the continued development of the home to ensure residents needs continue to be met. EVIDENCE: There were concerns raised at the lack of management at the time of the inspection. Whilst unforeseen circumstances had precipitated the situation, the RGN’s on duty were concerned about the level of support they were receiving. They stated that there were some staff disciplinary matters which were not being addressed. Additionally a concern was raised about a resident who had wandered out of the building which had gone unnoticed and unreported. A resident and a visitor also voiced their concerns about the lack of a manager and that no one seemed to be in charge. Their comments were positive about individual members of staff.
BOWOOD COURT NURSING & RESIDENTIAL HOME E52 S4096 Bowood Court V242136 070805.doc Version 1.40 Page 16 Immediate action was taken by Southern Cross Healthcare when these issues were raised and a projects manager was placed at the home to provide some stability and an assurance was given that all the matters raised would be investigated. Staff stated that they were not receiving regular supervision. BOWOOD COURT NURSING & RESIDENTIAL HOME E52 S4096 Bowood Court V242136 070805.doc Version 1.40 Page 17 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 x 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 3 3 x 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 1 1 x x x 2 x x BOWOOD COURT NURSING & RESIDENTIAL HOME E52 S4096 Bowood Court V242136 070805.doc Version 1.40 Page 18 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. Standard 3 Regulation 14 Requirement All residents being admitted to the home must have all their care needs, including their social and emotional needs assessed prior to admission. Any concerns noted regarding the resident at the point of assessment and admission must be documented and investigated. The social and emotional needs of the residents must be recorded on their care plan and daily records must reflect how they are being met. When residents display distressed and unsettled behaviour this must be reflected in their care plan. Photographs of residents must be kept on their care files. All complaints from residents and relatives must be recorded and any action taken clearly documented. All staff must be made aware of their responsibilities in the protection of vulnerable adults. Arrangements must be in place to ensure that the home is managed appropriately in the absence of the registered Timescale for action From the date of the inspection. From the date of the inspection From the date of the inspection. From the date of the inspection. 31/8/05 From the date of the inspection. From the date of the inspection. From the date of the inspection.
Page 19 2. 3 12,13,15, 18 15 3. 7 4. 7 15 5. 6. 7 16 15 7. 8. 18 31 13 BOWOOD COURT NURSING & RESIDENTIAL HOME E52 S4096 Bowood Court V242136 070805.doc Version 1.40 manager. 9. 10. 36 38 18 13 All staff must receive regular supervision. All incidents relating to residents welfare must be recorded and reported to the Commission for Social Care Inspection. By 30/9/05 From the date of the inspection. 11. 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 1 12 16 Good Practice Recommendations Information about the management arrangements in the absence of the registered manager should be explained in the statement of purpose. A program of weekly activities should be displayed for residents to see. The complaints procedure should be known and made accessible to all residents. BOWOOD COURT NURSING & RESIDENTIAL HOME E52 S4096 Bowood Court V242136 070805.doc Version 1.40 Page 20 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
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