Inspection on 29/07/08 for Lower Bowshaw View Nursing Home

This inspection was carried out on 29th July 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lower Bowshaw View Nursing Home 11/09/07

Lower Bowshaw View Nursing Home 09/08/06

Lower Bowshaw View Nursing Home 19/12/05

Lower Bowshaw View Nursing Home 03/05/05

Lower Bowshaw View Nursing Home 13/01/05

Lower Bowshaw View Nursing Home 22/07/04

Lower Bowshaw View Nursing Home 09/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Lower Bowshaw View Nursing Home Low Edges Crescent Sheffield South Yorkshire S8 7LN Lead Inspector Sue Turner Key Unannounced Inspection 07:40 29th July 2008 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 Lower Bowshaw View Nursing Home DS0000021795.V364173.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. Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lower Bowshaw View Nursing Home Address Low Edges Crescent Sheffield South Yorkshire S8 7LN 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) 0114 237 2717 0114 237 5743 none Total West Limited Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One individual who is identified on the application for variation for registration dated 14/05/04 at 4.1 may be accommodated. The minimum age of 55 years must have been attainted by the individual before he can reside at the home. 11th September 2007 Date of last inspection Brief Description of the Service: Lower Bowshaw View is a purpose built nursing home, which provides single bedroom en-suite accommodation for 40 older people. It is located in a residential area of Sheffield with good access to public services and amenities. Accommodation is on two floors; the first floor is accessed by a lift. The home has six lounges and dining rooms, a garden area, and car parking facilities. A copy of the previous inspection report was on display and available for anyone visiting or using the home. Information about how to raise any issues of concern or make a complaint was also on display in the entrance hall. The manager confirmed that the range of fees from 1st April 2008 were £364 £553 per week. Additional charges included hairdressing and private chiropody. Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. This was an unannounced key inspection carried out by Sue Turner, regulation inspector. This site visit took place between the hours of 7.40 am and 3:40 pm. The registered manager is Penny Wilton, who was present during the site visit Shada Rashid is the company director and was also spoken to. Prior to the visit the manager had submitted an Annual Quality Assurance Assessment (AQAA) which detailed what the home was doing well, what had improved since the last inspection and any plans for improving the service in the next twelve months. Information from the AQAA is included in the main body of the report. Questionnaires, regarding the quality of the care and support provided, were sent to people living in the home, their relatives and any professionals involved in peoples care. We received ten from people; eight form relatives, eight from staff and three from health professionals. Comments and feedback from these have been included in this report. On the day of the site visit opportunity was taken to make a partial tour of the premises, inspect a sample of care records, check records relating to the running of the home and check the homes policies and procedures. Time was spent observing and interacting with staff and people. Nine staff, two relatives and seven people living in the home were spoken to. The inspector checked all key standards and the standards relating to the requirements outstanding from the homes last key inspection in September 2007. The progress made has been reported on under the relevant standard in this report. The inspector wishes to thank the people living in the home, staff, and relatives for their time, friendliness and co-operation throughout the inspection process. Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 6 What the service does well: People living in the home made comments such as: “If I ask the staff anything they take notice, I’ve nothing to worry about”. “Staff are always there to help you”. “Everything is always nice and clean”. “I’m quite happy here”. “It’s very pleasant here, everyone is so kind”. “They look after me well”. “The staff do their very best to look after you”. “Nothings too much trouble for them”. Comments received from questionnaires and from talking to relatives included: “My mother in law will always say when asked that she is comfortable and well looked after”. “The home is not perfect but my relative is happy and thinks the staff are lovely. What more do we need”. “I have only ever witnessed staff being caring and considerate to all the people”. “Staff try as far as possible to treat people as individuals, explaining their actions where appropriate”. “Lower Bowshaw is excellent in every way, clean, good food and very caring staff. I feel very happy that mum is among so many nice nurses and staff. The manager is excellent”. “Managers and carers are open and accessible”. “Whilst there will always be room for improvement the care home appears to provide a good level of service”. “Everyone is made to feel welcome. The atmosphere is very good. I personally cannot fault this truly happy nursing home”. “Myself and my family would highly recommend anyone to this nursing home”. Comments received from health professionals included: Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 7 “We have been visiting Lower Bowshaw View for ten years and have a very good working relationship with them”. “The staff generally have a good understanding of peoples medical problems and use our service appropriately”. “Staff are very friendly and helpful when I visit”. What has improved since the last inspection? The manager had been in post for ten months. During this time she had worked hard to make many improvements. Her enthusiasm was commendable and it was evident that the staff team had responded positively to her style of management. At the previous inspection nine requirements were issued. All these had been actioned. The director, managers and staff should be applauded for this. It was clear to see that people’s life’s had been enhanced. People’s health care records were fully completed which ensured that they were receiving the care they had been assessed as needing. Medication Administration Records (MAR) sheets were fully completed and signed at the time of medication administration. This assisted in protecting people’s health and welfare, All window restrictors fitted were in working order. However there was one window that needed immediate attention so that it did not pose a health and safety risk. Action had been taken to eliminate the cause of any unpleasant odour in the home. Further action was needed so that odour was eradicated from one room. Sufficient care staff were on duty at all times which ensured that peoples needs are being met. The staffing levels of the domestics should be increased. The company director was carrying out a monthly monitoring visit and writing her findings in a report. Any actions/improvements identified were then addressed. A maintenance person had been employed, who was ensuring that the fire alarms were tested every week. To ensure peoples health and safety, where instructed by the fire service, fire doors were being kept locked, shut when not in use and all floors were free of slipping hazards. Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 8 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. The summary of this inspection report can be made available in other formats on request. Lower Bowshaw View Nursing Home DS0000021795.V364173.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 Lower Bowshaw View Nursing Home DS0000021795.V364173.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): Standards 1, 3 and 5. Standard 6 is not applicable to this home. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided sufficient information to inform people about their rights and choices. Trial visits were encouraged to enable people to look around the home, meet other people living there and give them the information needed to make informed choices. EVIDENCE: The homes Statement of Purpose and Service User Guide were available, both in the entrance hall, for anyone visiting the home and a copy was also in each persons room. These included useful information about the home and the services offered. Both the Statement of Purpose and Service User Guide were in need of Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 11 updating. The manager said she was in the process of reviewing and updating these. When someone showed an interest in the home social services carried out a full needs assessment. The manager also carried out a pre assessment. This meant that everyone could be assured that the home could meet the person’s needs. Any information collated from the needs assessment would then form the basis for the care plan. The AQAA stated: People are offered the opportunity to visit the home and spend a day to help them decide. Other relatives are encouraged to accompany them. We provide an informative brochure, which contains photographs of the home. People said: “I wasn’t well enough to come and look around so my husband and daughter came, they knew it would be the right place for me”. “I spent a day meeting people and trying the food”. “The community nurse at the local surgery recommended it”. “I came for dinner to help me decide”. This home does not provide intermediate care services. Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people were in the main met. A range of health care professionals visited the home. Medication procedures protected people’s health and welfare. More consideration should be given to people’s privacy and dignity. EVIDENCE: People living in the home had an individualised plan of care. Three peoples plans of care were checked. Care plans contained a wide range of information on many aspects of personal, social and health care needs. The care plan was developed at the time of the person’s admission. Care plans seen focused more on the tasks necessary to care for the person. There was little information about what the person themselves felt their care needs were and how they wanted their specific needs to be met. Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 13 Staff completed daily records. These were done at the end of each shift. There was good quality information in the daily records, which linked with the information in peoples care plans. Staff said that they reviewed and updated care plans each month or as necessary. Care plans seen had been reviewed. There was evidence in the care plans seen that relatives had been involved with them. Two relatives spoken to said that they had been involved in reviews or updates of their relatives care plan. Staff were regularly reviewing and updating individual risk assessments. Of the ten people who returned surveys, nine said that staff did listen and act on what they said and that they did receive the care and support they needed. Care plans identified that a range of health professionals visited the home to assist in maintaining peoples health care needs. People said that GP’s, dentist, opticians and chiropodists visited the home as requested. One person was seen being assisted to eat their lunch in bed. The person was laid flat with just the support of a pillow. This was brought to the attention of the staff member and manager as the person’s position could have inhibited their swallowing and caused a risk of choking. The person was in a profile bed that enabled them to sit upright. The persons care plan acknowledged there were risks around eating and swallowing. Relatives said: “Mum always looks clean and happy, so I feel the personal care is very good”. “The senior staff have always kept us informed of changes in my mothers health and been helpful and supportive”. “The staff always take time to inform me of my fathers well being, for example doctor and hospital appointments and changes to his medication”. “My father is always showered, shaved etc and staff constantly remind him to call for help should he need it”. “We have regular reviews of my mothers care”. Medicines were securely stored around the home in locked trolleys within cupboards. Medicine Administration Records (MAR) checked were completed with staffs’ signatures. Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 14 Controlled drugs (CD) were kept in a clinical room and within a double locking cabinet. A CD register was available. People spoken to said that staff administered their medication at appropriate times and one person who had chosen to self administer had been provided with a lockable drawer to keep their medications safe. There was evidence that the manager, deputy manager and trained staff were closely auditing medication administration procedures. The AQAA stated: People’s privacy and dignity is respected by all staff and ways to promote this are taught in our induction course. We operate a policy of knocking before entering a person’s room. People and relatives spoken with, and via their questionnaires, said that the carers treated them with respect and provided personal care and support in a way that maintained their dignity and privacy and was sensitive to their individual needs and wishes. We observed that most ladies were not wearing stockings or tights. People were put on aprons to eat their meals. People were left sat in wheelchairs in the lounges and not transferred to easy chairs. Some people had been assessed as high risk of developing pressure areas. Charts that recorded when staff had ‘turned’ people to alleviate pressure were seen in people’s rooms. Charts seen were up to date, however they were left strewn around peoples rooms, not in folders and not in any order. These practises did not promote people’s privacy and dignity. Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 15 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): Standards 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had a choice of lifestyle within the home and were able to maintain contact with family and friends ensuring that they continued to be involved in community life. A range of activities was on offer, further activities would promote choice and maintain peoples interests. Meals served at the home offered choice and ensured people received a healthy balanced diet. EVIDENCE: People said they were able to get up and go to bed when they chose, and were seen to walk freely around the home, if able. Relatives spoken to said they were able to visit at any time and were made to feel very welcome. The inspector saw that everyone coming to the home was offered hospitality and staff took time to make sure friends and family were made to feel comfortable whilst visiting their loved one. Some people said they preferred to stay in their room at certain times of the day and that the staff respected their decision. Relatives said: Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 16 “My mother has been a resident for over two years and we have been very pleased with her care and always made to feel welcome when we visit”. “Staff always offer us a cup of tea when we arrive as they know we’ve travelled along way and we’re ready for a drink”. “The reception staff are very welcoming and efficient. The carers are polite and friendly who earn every penny”. People said that they enjoyed taking part in social activities within the home. Particular favourites were chair aerobics and quizzes. The activities coordinator had left and not been replaced. People said that they would like to do even more activities. There was a brochure printed each month, which was given to everyone. It described the activities available at the home for the month. Activities and outings were varied and the brochure was colourful, informative and valued by the people living in the home. Activities took place each afternoon and evening. Carers were expected to carry out activities. Relatives said: “They ought to be a little more adventurous with the activities in the afternoon. They send out a programme for the month and it’s a little repetitive. I know it is difficult but a few new ideas could stimulate people”. “Staff endeavour to provide stimulation through the daily afternoon activities”. These include visiting entertainers, simple games and quizzes”. “Attempts are made to stimulate people through activity involvement, entertainment and open days”. We observed breakfast and lunch being served in two dining rooms. The tables were set with cloths, cutlery and condiments. The dining rooms were quite small and had a pleasant relaxed ambience. Staff were seen assisting people to eat in a supportive way. Some people were on special diets, these were provided. There were menu boards in the dining rooms. One menu board was displaying the meal options for 25.07.08 and not what was available that day. When asked “do you like the meals at the home?” Two surveys said “always”, four said “usually” and four said “sometimes”. People said: Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 17 “If I don’t like it I tell them”. “There’s always a choice, we had a nice meal yesterday”. “The food isn’t bad, a lot of it is quite enjoyable”. “The food is lovely, I like the toast in a morning”. One relative said: “When someone is reluctant to eat staff will encourage them with patience and care, offering alternatives so that they are hydrated and well fed”. Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 18 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): Standards 16 and 18. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints procedures were in place and people and their relatives felt confident that any concerns they voiced will be listened to. Staff had an understanding of the procedures to be followed should they suspect any abuse at the home, so helping to ensure that people were protected from abuse. EVIDENCE: People and their families had been provided with a copy of the homes complaints procedure, which was also on display in the entrance hall and bedrooms. This contained details of who to speak to at the home and who to contact outside of the home to make a complaint should they wish to do so. Relatives spoken to said that they felt very comfortable in going to any member of the staff or the manager, knowing that any concerns they may have would be addressed without delay. When people were asked, “do you know who to speak to if you are unhappy?” Eight surveys said “always” and two said “usually”. Relatives said: Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 19 “I speak to the manager or deputy if I have any concerns. They have sorted out minor issues I have raised with them.” “If I had a complaint I would not hesitate to talk to the manager, but I have no complaints.” “I am aware of how to make a complaint but I have never needed to use this route”. Eight staff surveys were returned. When staff were asked, “Do you know what to do if a person/relative/advocate or friend has concerns about the home? All the staff said “yes”. The home kept a record of complaints, which detailed the action taken and outcomes. The home had not received any complaints since the last inspection. We had not received any complaints about the home. Staff spoken to were clear how to respond and record any complaints received. The AQAA stated: All staff are trained in the Protection Of Vulnerable Adults (POVA) and work to these regulations. We have a clear POVA policy and procedure. We have a whistle blowing policy. Staff spoken to said that they would report any allegations of abuse to their manager. Staff said they had received formal training in adult protection procedures and were able to describe types of abuse that people could be susceptible to. In conversation with staff, we noted that they had a good understanding of safeguarding adults and whistle blowing policies, procedures and practices. Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 20 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): Standards 19, 24 and 26. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main people live in a well-maintained environment. Repair, refurbishment and hygiene work is necessary to ensure people live in safe, comfortable and hygienic surroundings. EVIDENCE: The AQAA stated: We ensure the environment is well maintained and offers people a pleasant homely place to live in. Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 21 The home has outdoor space, which is accessible to all people including those with mobility problems. We have a new sensory garden designed for people with cognitive and sensory deficit. People said they enjoyed sitting out and walking around the new garden. It could be seen from the conservatory and people that couldn’t get outside enjoyed looking out into the garden. A tour of the building identified that some areas of the home were in need of minor repair. A new maintenance person had been employed. The manager said he was working hard to catch up on the jobs that had accumulated. On arrival at the home early morning there was an odour but this lifted during the day. The home was tidy, but certain areas needed some thorough cleaning. The domestic said that there were usually two cleaners on each day between 9am and 3pm. However one cleaner had the role of laundry person, so this meant there was normally only one person cleaning. We believe that this is not sufficient considering the size of the home and the dependency levels of the people living there. There were few homely touches around the home. Chairs in the lounges were all placed around the edges and there were no cushions on them. Side tables in lounges were not domestic. Picture lights were on the corridors, however there were no pictures under them. There were posters on walls that gave medical advice and notices on doors giving staff instructions. These didn’t help to give the home a comfortable feel. One bedroom seen was odorous. The manager said they were aware of this and were going to replace the carpet. Following the last inspection work was underway to refurbish the bathrooms so that they would be more homely and privacy curtains were being fitted to bathroom windows. When people were asked is the home clean and fresh, ten people said “always”. Controls of infection procedures were in place. Staff were observed using protective aprons and gloves. Staff said they had received training in infection control. Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 22 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): Standards 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main, sufficient staff were provided to meet the needs of people. The recruitment information obtained for staff was sufficient to adequately protect the welfare of people. Staff had completed training that ensured they had the competences to meet people’s individual needs. EVIDENCE: The homes rota indicated that agreed levels of staff were being maintained to meet the needs of people. Staff were willing to cover any holidays and sickness. The manager said that they had recruited a number of bank workers who could be called upon at short notice to cover shifts. The manager had undertaken a review of staff training and had identified the shortfalls. Mandatory training had been booked and further training in specialised topics for example diabetes and falls prevention was being delivered by the Sheffield Partnerships for Older Peoples Projects (POPP’s) team. Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 23 Staff interviewed said that when they started work they received induction training in the first three months of their employment. Three staff files checked identified that the member of staff had received induction training when they commenced work. Staff were able to talk about the various training courses that they had attended, which included all of the mandatory training, for example, Moving and Handling, Food Hygiene, First Aid and Fire. 33 of the care staff had achieved NVQ Level 2 or above in Health and Social Care. A number of care staff had also commenced the training. This did not meet the required minimum of 50 of the staff team trained to NVQ Level 2 in Care. Eight staff surveys were returned, when asked are you being given training, which is relevant to your role? All eight said, “yes”. Staff said: “We have been provided with all the essential training”. “I have never done this work before and found the induction training very useful”. Relatives said: “Sometimes my mother has difficulty in understanding what some staff are saying. She is hard of hearing and if a member of staff does not speak English as a first language it can be difficult for her”. “The home could improve by having more staff on the day shift so that they would have more time to spend with people on a one to one basis”. “Staff can be under pressure at times”. “Staff appear to be trained and motivated”. “The home appears to be well organised and adequately staffed with designated nurses and carers allocated on a one to one basis”. Three records of employment were checked. These included all of the required information including interview assessment, verification of identity, references, certificates of training, health checks and evidence of Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) check. Application forms fully recorded previous employment. Two of the three files seen did not hold a recent photograph. Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 24 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): Standards 31, 33, 35, 36 and 38. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The managers’ leadership approach benefited people and staff. Quality assurance systems meant that the home was run in the best interests of everyone. In the main people’s monies were safely handled and people’s health and safety had been promoted and protected. EVIDENCE: The manager at the home had recently registered with us. She was a qualified nurse and had completed the Registered managers Award (RMA). Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 25 Since the last inspection the manager, with the support of the company director, had worked hard to action the requirements made and this was evidenced by the many developments made within the service. The manager was hard working, competent and carried out her role to a very high standard. She was clearly very committed to ensuring that people living in the home were consistently well cared for, safe and happy. Everyone spoken to and information from questionnaires confirmed that people, staff and relatives were all happy to approach the manager at any time for advice, guidance or to look at any issues. They all said that they were confident that she would respond to them appropriately and swiftly. Shada Rashid is the company director. She worked from an office at the home. She spent time speaking to people, staff and relatives. Each month she completed a report about the quality of the service provided. These reports were seen. They were thorough and informative. The AQAA stated: We have recently changed our resident and relatives quality assurance questionnaire as the same one has been used for several years. We have introduced questions which ask fir views on possible changes and ask specific questions which can be acted upon to ensure continued satisfaction and improvement. In February 2008 the manager had sent out surveys to people and their relatives, asking them their opinions of the home. The information returned had been collated into a report. The results were in the main very positive. Following this the manager and company director had complied an action plan that was being addressed. The manager said that regular resident and relative meetings were not being held as they had historically been poorly attended. The manager had written to all relatives asking them what their day and time preference would be for meetings. She was in the process of collating people’s responses so that attendance at these meetings would be improved. Staff meetings were held regularly. Nurses met with the managers each month and other staff met bi monthly. Minutes from these were seen. There was evidence that appropriate actions had been taken following staffs comments at these meetings. The home handles money on behalf of some people. This was checked for three people. Account sheets were kept, receipts were seen for all transactions and monies kept balanced with what was recorded on the account sheet. One person’s balance was significantly high. This money should have been put into Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 26 the bank before it had reached this amount. The administrator and director said they would go to the bank and deposit the money immediately. Formal staff supervision, to develop, inform and support staff took place at regular intervals and staff said that they found this useful and beneficial. Fire records evidenced that fire alarm checks took place each week. Staff said that they had received fire training and fire drills. A fire risk assessment had been completed. The manager said that no further actions were necessary. Environmental Health had awarded the home a very good four-star rating following their last inspection visit. Whilst undertaking a tour of the home we saw that a window was broken. The window had a sign asking people not to open it. So that people’s health and safety was not put at risk it was important that the window was repaired or replaced quickly. The manager said that a number of new windows had been ordered. They were being made and were due to be fitted the following week. Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 27 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 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 12 Timescale for action So that people are not put at risk 29/07/08 of choking when being assisted to feed, staff must make sure that people are supported in a comfortable and upright position. There must be a recent 11/08/08 photograph on each staff file. To ensure peoples safety, the 11/08/08 broken window must be repaired or replaced promptly. Requirement 2. 3. OP29 OP38 19 13 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. 4. Refer to Standard OP1 OP7 OP10 OP30 Good Practice Recommendations The Statement of Purpose and Service User Guide should be reviewed and updated. Care plans should be written in a more person centred way. Suitable arrangements and appropriate action should be taken to ensure that people’s privacy and dignity is respected. Staff should be provided with training in assisting people DS0000021795.V364173.R01.S.doc Version 5.2 Page 29 Lower Bowshaw View Nursing Home 5. 6. 7. 8. 9. 10. OP12 OP15 OP19 OP26 OP28 OP35 to eat in a safe way. An activities worker should be recruited so that the programme of outings and activities is enhanced. So that people living in and visiting the home are aware of the meals on offer the menu board on display should be kept up to date. Domestic staffing levels should be increased. To ensure people health and well being the cause of unpleasant odour in the home should be found and action taken to eliminate this. 50 of care staff should be trained to NVQ level 2 in care. Money kept at the home for people should be kept to a minimum. Lower Bowshaw View Nursing Home DS0000021795.V364173.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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