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Care Home: Bonhomie House

  • Dodwell Lane Bursledon Southampton Hampshire SO31 1DJ
  • Tel: 02380402168
  • Fax:

Bonhomie is a home for adults from the age of 18 and offers a service to meet the needs of physically and sensory impaired service users and those with mental health disorders. The home also provides care for people with acquired brain injury. 78 7830012009 The service is offered in various units throughout the grounds including nine purpose built bungalows, existing bungalows and satelite units and the main house. Currently the house is in the process of being extended and fully refurbished in a staged programme and as a consequence only seventeen rooms in the house were being occupied at the time of this visit. There is a large hall in the grounds, which offers facilities for activities and entertainment, and is being used as the main dining room and communal area whilst the buildling works are in progress. The activity hall building also accommodates a sensory room and a hydrotherapy pool. The service users are encouraged and enabled to access facilities in the community. The home is situated in its own grounds with easy access to the M27 and is in close proximity to Eastleigh shopping centre and Hedge End village. For fee enquiries contact the home.

  • Latitude: 50.901000976562
    Longitude: -1.3099999427795
  • Manager: Mrs Karen Patricia Richards
  • Price p/w: £2086
  • UK
  • Total Capacity: 78
  • Type: Care home with nursing
  • Provider: Mrs Malek D Lakhani,Dr Azim D Lakhani,Mr Amin Lakhani
  • Ownership: Private
  • Care Home ID: 3182
Residents Needs:
Sensory impairment, mental health, excluding learning disability or dementia, Physical disability

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Bonhomie House.

Key inspection report Care homes for adults (18-65 years) Name: Address: Bonhomie House Dodwell Lane Bursledon Southampton Hampshire SO31 1DJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janette Everitt     Date: 2 0 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 37 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: Bonhomie House Dodwell Lane Bursledon Southampton Hampshire SO31 1DJ 02380402168 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Malek D Lakhani,Dr Azim D Lakhani,Mr Amin Lakhani care home 78 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia physical disability sensory impairment Additional conditions: The maximum number of service users to be accommodated is 78. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) Physical disability (PD) Sensory impairment (SI). Date of last inspection Brief description of the care home Bonhomie is a home for adults from the age of 18 and offers a service to meet the needs of physically and sensory impaired service users and those with mental health disorders. The home also provides care for people with acquired brain injury. Care Homes for Adults (18-65 years) Page 4 of 37 Over 65 0 0 0 78 78 78 3 0 0 1 2 0 0 9 Brief description of the care home The service is offered in various units throughout the grounds including nine purpose built bungalows, existing bungalows and satelite units and the main house. Currently the house is in the process of being extended and fully refurbished in a staged programme and as a consequence only seventeen rooms in the house were being occupied at the time of this visit. There is a large hall in the grounds, which offers facilities for activities and entertainment, and is being used as the main dining room and communal area whilst the buildling works are in progress. The activity hall building also accommodates a sensory room and a hydrotherapy pool. The service users are encouraged and enabled to access facilities in the community. The home is situated in its own grounds with easy access to the M27 and is in close proximity to Eastleigh shopping centre and Hedge End village. For fee enquiries contact the home. Care Homes for Adults (18-65 years) Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The visit to Bonhomie House took place on the 20th January 2010 and formed part of the process of the inspection of the service to assess the service against the key national minimum standards. The evidence to support the assessed outcomes for people who use the service was gathered from the Annual Quality Assurance Assessment (AQAA), which the manager returned to us and this gave us the information we asked for. Information received since the last key inspection of January 2009 was also taken into account. Prior to the visit surveys were sent to service users, staff, visiting professionals and GPs. We gathered information in surveys returned to CQC from people living in the home, a GP , 2 relatives and 2 staff. We also spoke to a number of service users and staff at the time of this visit. The outcome of the surveys indicated that there was a high level of satisfaction with Care Homes for Adults (18-65 years) Page 6 of 37 the service and that generally residents were happy living at the home and the service they received. Evidence was also gathered from reading and inspecting records, touring the site and from observing the interaction between staff and users of the service. At the time of this visit there were 48 people in residence. The home is registered to accommodate 78 people but owing to the disruption of the home whilst building works are in progress, admissions have been halted. The home was accommodating a mixed gender and one service user was from another cultural background. The registered manager assisted us with the inspection, Care Homes for Adults (18-65 years) Page 7 of 37 What the care home does well: What has improved since the last inspection? The Statement of Purpose, service users guide and the complaints procedure is now available in different formats, Makaton, Widget and large font. The care planning system is now electronic and is detailed and is reviewed appropriately with the involvement of the service user. Care Homes for Adults (18-65 years) Page 8 of 37 The first phase of the refurbishment has been completed and the home is starting to look bright and modern in the areas completed. For those service users who have moved into their new rooms they are very happy with them. New equipment has also been purchased and profile beds have been provided in all the new bedrooms. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 37 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users needs are fully assessed and they are given the Statement of Purpose and Service User Guide at the time of the assessment to ensure the home can meet their needs and they are fully informed about the home before they reach a decision about going to live there. Evidence: A sample of service users pre-admission assessments was viewed. The files demonstrated that assessments are undertaken by the manager with the deputy manager or another trained nurse, using a needs assessment form that covers all areas of assessed needs and includes information on medical history, personal history, any known risks, relationships, health and physical abilities, washing, dressing, bathing, showering, medication, behaviour, day routine, night routine, likes and dislikes, diet, sight, hearing and continence. The home also receives comprehensive social care needs and health care assessments from other professionals involved in the placement and these were also seen on the Care Homes for Adults (18-65 years) Page 11 of 37 Evidence: service users files. The manager told us that the home was about to admit a person from another area in the country and that this person had visited the home for an assessment and has been down to visit the home on a number of occasions since, lengthening their stay each time. This had given the person and their relative the opportunity to meet other service users, become familiar with the lay-out of the home and enabled them to choose which room they wish to move into. There was evidence of a full multi-professional assessment having taken place and the person will be moving into the home as soon as funding is agreed. Once the person has moved into the home they will be allocated to a member of staff who will ensure they feel welcome and identify any problems or concerns they may have as soon as possible. The Statement of Purpose, the service user guide and the complaints procedure are now available in different formats and are given to the service user and their family when they enquire about the home. Care Homes for Adults (18-65 years) Page 12 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users know their assessed needs are reflected in person centred plans of care. They are also involved in the development of the plans to ensure they receive the care they need in the way they wish it to be carried out. Service users are supported to make decisions about their lives. Risks are identified in the care plans that inform staff about how these risks are to be managed. Evidence: A sample of four care plans was examined. The service has now adapted the new care planning system to all service users records. The care planning is electronic but is also available in a hard copy. The electronic system is detailed and covers all aspects of the service users physical, mental, emotional and social care needs. The care plans describe the level of care the person needs in detail. All service users have been assessed for their mental capacity and therefore if there Care Homes for Adults (18-65 years) Page 13 of 37 Evidence: are any decisions to be made for a service user who has been assessed as not having capacity, a best interest meeting will be held. These meetings are attended by the relevant staff involved in the persons care, a social worker, the multidisciplinary team, family and the service user. These meetings are held in order to give information and support to service users to help them make decisions about their lives within their mental capacity. The records demonstrate risk assessments for behaviour, bathing, moving and handling, nutritional, waterlow, smoking, medication, cognitive behaviour, personal hygiene and other specific risk assessments. Care plans were in place to describe how the risks would be managed. There is a great deal of service user involvement and discussion about how risks are to be managed and care plans are person centred and are around how the service users wish their needs to be met and set out any restrictions on choice and freedom which has been agreed with the service user and family and others involved in their care. For one service user a decision had to be made about them undergoing major surgery and this was discussed at the best interest meeting involving all the relevant people as to whether the surgery should be carried out. Records of the meeting recorded that the service user had the capacity to make their own decision, with the full facts explained to them and with support from the team they were able to make an informatvie decision. Another example recorded was a service user choosing to sleep in his wheelchair. A best interests meeting was held and was attended by the service user, the social worker and everyone involved in the persons care. It was decided that the person had capacity to make this decision, having had the risks explained to them. This decision is being respected and is now fully documented in their care plans. The home has three registered nurses on duty each day and they are responsible for a designated area of the home. A group of care workers are allocated to that nurse and they report back at the end of the shift to the registered nurse about how the service user has spent the day and how their needs have been met. This is then recorded in the daily notes by the registered nurse who then evaluates the care plans appropriately. It was observed that daily charts are kept in the rooms of the service users who are nursed in bed or who choose to stay in their rooms. The charts record when they were visited and the task that was undertaken or care given when the carers were present. Food and fluid intake is recorded together with the level of contact the carer has had Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: with that person at the time of that visit. These charts were seen to be recorded appropriately every hour. The charts are checked daily by the registered nurse and a sample of these charts is audited by the manager monthly. The home has purchased more new equipment for hoisting and moving and handling purposes. These were seen around the home. It was observed that some of the equipment was in need of cleaning and that there were no records of when equipment like the weighing scales were cleaned. If a service user has been assessed as needing to be hoisted and has special needs, a specific sling for their sole use will be stored in their room and used exclusively by them. These were seen in some service users rooms. The surveys received from service users and those spoken to on the day of this visit told us that they are involve with the care planning process and that they are happy with their care. The surveys also told us that they are able to make their own decisions about what they want in their daily lives and where they wish to go. Risk assessments have been undertaken for the ongoing building works that are in progress. The site has been risk assessed and clearly defined areas have been closed off. Care Homes for Adults (18-65 years) Page 15 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this 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 ensures the people who use the service are supported to maintain an active lifestyle that suits their needs and individual interests. The home ensures the people who use the service maintain contact with family and friends and socially engage with their peers and the local community. Service users independence and individual choices are promoted within their daily routines. Service users are offered a nutritious and varied diet Evidence: The AQAA says that all service users are encouraged to utilise the opportunities to develop their social, emotional, communication and independent living skills as much as possible. The physio and occupational therapist are available to assist service users with all these activities throughout the week. The home does not employ an activities organiser specifically for that job, but staff and the deputy manager are familiar with the service users social and recreational needs and ensures that a variety of activities Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: are available for the residents. Many of the residents have lived at Bonhomie for some years and have a routine of activities they prefer to participate in and this is documented in the care plans. The home has a range of individual group and community based activities provided for the service users, such as shopping, visiting the the theatre, cinema, swimming pool, pubs and places of worship. The home encourages open visiting and freedom of choice within the individual assessed risk taking. A tour of the site and observation throughout the visit confirmed that the home does provide a range of activities to suit each service users needs and choices. The care plans document a good social history for each service user and what their preferred recreational activities are. The home has tried to put together booklets for each service user titled This is your Life This booklet gives information about the persons past life which can be shared with staff and others, if they wish, and may enhance interaction between them. The home has a large activities hall on site, which is also temporarily being used as a dining area whilst the building works are in progress. The kitchen area in the hall is used as the servery for meals, which are transported over in hot trolleys from the main kitchen. However, this area remains the hub of any activities, where large gatherings are held such as discos, parties and sporting activities. When visiting this area it was observed that several activities were taking place with individual service users and a number of staff were in attendance. For those unable to participate in group activities, one to one activities were taking place with carers and service users. Some service users were sitting around the table ready for their lunch. Service users spoken to at this time said they were happy and enjoyed being together and doing the activities. Another service user had a communication aid and was able to respond quickly to questions and comments and told us that he is the chair of the residents association and consults with the manager about any issues that are raised at the residents meetings and is consulted on any changes in the home. He told us that the residents have been regularly informed of the progress of the building works and this is presented to the service users as a film update at their meetings. The notice board displayed a number of photographs of past events and outings. The home is fortunate to have a mini bus that is available most of the time to take service users into the community to attend various outside activities or to attend other appointments. The home has a hydrotherapy pool which cannot be used fully until the building works Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: are complete but the manager told us that the home hires a pool in the community for the service users to use. The activities centre houses a sensory room, where service users cognitive and sensory needs can be stimulated and where they can take time to relax if they wish. A record is kept of those who attended each activity and the outcome of the activity for the individual and the group. A diary in the large hall recorded past and planned activities. The home appeared a busy place with a great deal of activity going on throughout the day. The manager told us that there are no service users attending a college currently Several service users have their own computers. One was spoken with and he informed us that he has the latest computer equipment and that he is connected to broadband, which is available throughout the home for all IT users. It was observed when looking around the building, that all rooms have television and many of the service users have their own entertainment and music centres. Several service users attend day centre a number of days a week. The manager told us that two service users go on holiday and the home will arrange holidays if they are requested. Surveys returned from service users indicated that they always make the decision about what they do each day and they do as they choose during the day and evenings every day of the week. The home has an open visiting policy and visitors are made welcome to the home at any time. Service users can meet their relatives in their rooms or in the communal areas. Service users are supported to maintain contact with their friends and families. The home has built relationships with relatives and friends of the service users, some of whom have been resident for a number of years and some relatives attend the home regularly. The AQAA states that the home has specialist guidance available for personal relationships if required. Two of the service users have formed a special relationship. The manager told us that the home is part of the Romsey Nursing Home Innovation project for nutrition. A dietitian visits the home to give staff training on diets and good nutrition. Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: The kitchen was visited and the kitchen staff spoken to. The kitchen was observed to be clean but surrounded by building works. The chef told us that the kitchen is being refurbished but is the last area to be completed. The chef told us that he had attended recent training and was about to refresh the menus so that service users have more choice and have snacks available throughout the 24 hour period. The chef told us that he worked at the home for some considerable time and is familiar with all the service users likes and dislikes and will produce whatever they want. The menu was displayed in the activities hall and this evidenced a choice of meals with alternatives available. The lunch time meal was observed to be wholesome and nutritious. Service user spoken to told us that they enjoyed the food. It was observed that those meals that were pureed were done so in separate portions in order that the service user could see the colours and taste the different textures of the food. There were a number of service users who needed help with their food and this was observed to be given with respect whilst talking to the service user about their meal. For those service users who are fed artificially this is undertaken with as much involvement with the service user as possible. Service users are nutritionally assessed on admission to the home and if a risk is identified a care plan is written to manage this risk. Weights are monitored regularly and any risk identified the service user will be given advise and referred to the GP. Care Homes for Adults (18-65 years) Page 19 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 has a person centred approach in supporting the people who use the service with their personal, emotional and general health care needs in a way they prefer. The home supports the people who use the service with their medication and comply with the procedures for the safe management of medication. Evidence: The AQAA states that the care is provided in a flexible and sensitive way and the homes aim is to maximise the service users core rights. The care plans describe in detail the level of care needed and staff are made aware through the care plans of the service users preferences, likes and dislikes, their choice of clothing, hair styles and their personal routines. The home employs a mixed gender of staff and service users are given the choice of which gender they would prefer to support them with their personal care and this is documented on the care plans and respected. The on-site laundry ensures that service users clean clothes are returned to them Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: promptly. The manager told us that the home has good links with the primary care trust and specialist heath care teams such as the mental health team, learning disability team, diabetic nurse and wound care specialist who will all visit the home when requested. Care plans describe the health care needs of the service user which are reviewed monthly and more frequently if necessary. All visiting health professionals are recorded in the care plans. The home employs an occupational therapist and a physiotherapist who attend the home weekly to assist service users and staff with moving and handling, posture, positioning and the ordering and maintaining of equipment. The occupational therapist will work with service users helping them to become more independent with their daily living skills. The physiotherapist said that she will train staff to use the hydrotherapy pool when it is commissioned. The physiotherapist and occupational therapist write care plans to guide staff practice. The service users have the availability of a visiting chiropodist, a dental clinic locally or one who will visit the home if required to do so. A number of service users visit the community dentist and optician. The home is currently being visited by the community matron who is overseeing and giving advice and guidance on wound care for one particular service user. This has been agreed within a multidisciplinary forum as being the best way for the service user to have their tissue viability assessed and reviewed regularly. The GP visits the home weekly to review medication and see any service users who need to be reviewed or have requested to see the doctor. The GP attended the home during this visit and commented that he has good relationships with the home and considers the home cares for people with complicated problems very well and that he is happy with his patients care. Surveys returned from service users and relatives said: My sister has complex needs and the home look after her very well. The home give superb care, give information when needed and give the right care and consideration to keep the family involved Staff are very friendly and giving in all aspects of their role. It is lovely here. The home give a good standard of care. The home has systems in place for the administration of medication. It has policies Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: and procedures to guide practice and these were viewed by us and noted to have been reviewed recently. The home uses a monitored dosage system (MDS) for the management of medication, which is supplied by a large pharmacy. The nurse who coordinates the ordering of the medication told us that this system is much safer for the person administering it. The medication trolley and other medication is kept in a room designated for this in the refurbished part of the main house and it is kept locked at all times. The bungalows and satellite rooms each have a locked environment that medication is stored in and the medication is administered and managed by the registered nurse who is in charge of that area each shift. The medications are administered only by registered nurses, who has received training from Boots on the MDS system. The medication administrating sheets (MAR) were viewed and had been documented appropriately. There was evidence that care plans had been written to describe the trigger factor to observe for when as needed (PRN) medication should be offered. The medication trolley stored individual (PRN) medication for each person it had been prescribed for. It was observed on the MAR sheets that if a person was prescribed a variable dose of medication, the actual dose administered was not being recorded on the MAR and it would be difficult to identify the true amount of medication taken over a twenty four hour period. A recommendation will be made. Controlled drugs were stored appropriately and safely. The controlled drug register was viewed and checked and the balance documented in the register matched that of the stock held. The medication fridge was clean and temperatures were monitored and recorded daily. Medication storage cupboards were observed and were clean and tidy. There was evidence in one cupboard of a large quantity of one particular medication for a service user who was prescribed it on a PRN basis. It was discussed with the nurse that some of the stock should be returned before it was out of date and that more detail should be given to stock rotation when re-ordering medication. We observed the medication being administered and this demonstrated safe practice. The nurse told us there were no service users choosing to self-medicate at the time of this visit. The home has a contract for the disposal of waste medication and this was seen by us with the records of the medication disposed of and the signature of the person taking the medication away. Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: Care Homes for Adults (18-65 years) Page 23 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 general service users feel their views are listened to and acted upon and that they are protected from abuse. Evidence: The home has a complaints procedure that is displayed in the home in different formats. This was seen by us to be in a graphic format for service users to follow. The manager and deputy manager actively encourage service users to discuss any issues and have an open door policy if people wish to talk to one of them when they are in the home. It was observed during this visit that service users feel free to walk into the managers office to talk to her. The manager believes that issues can be defused by talking and discussion and she openly encourages this. The complaints log did not record any complaints since the last inspection and CQC have not received any complaints. The manager also liaises closely with the service user who is chairman of the residents meetings and he will discuss any issues with the manager if they have arisen during a residents meeting. The home has a whistle blowing policy and staff are issued with information should an occasion arise when they have concerns. The home has policies and procedures in place in respect of safeguarding service users from risk of harm. Staff receive training and are required to read the local authority procedures for the safe guarding of Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: vulnerable adults at the time of their induction and this is followed up by further training, which the manager is trained to deliver. The induction programme records and staff training matrix provided evidenced that this training has taken place. The AQAA records that two safeguarding issues have been investigated in the last year. The outcome from one investigation has now been closed with an action plan in place. The manager told us that the outcome from this investigation was that lessons had been learned by all professionals involved with the investigation and that it had also highlighted to professionals outside the home, the complexity of the care needs of some of the service users in residence. The manager told us that staff in general are now more confident in handling any concerns made known to them and they now have a more positive attitude to complaints and see them as a way of identifying shortfalls and a way to improve practice. Staff spoken to understood the procedures for reporting safeguarding issues and surveys returned from staff and service users indicated that they would know who to talk to if they had any concerns or issues. Care Homes for Adults (18-65 years) Page 25 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a clean, safe environment that has been tailored to meet the needs, wishes and preferences of the residents. Evidence: The site of Bonhomie House consists of the large house, bungalows and satellite rooms next to a large activities hall that houses the hydrotherapy pool and the sensory room. The AQAA states that the service wishes to provide a home from home environment as far as is possible whilst the refurbishment of the home is taking place. The whole site has been disrupted during the extensive building works and refurbishment programme, therefore there are no areas of the home that have not been affected in some way. Subsequently the home has not admitted any new residents for some time because of the extensive building works and currently there are 48 service users in residence. The large house is in the process of being refurbished and extended. One half of the house is affected whilst the other half remains occupied. The AQAA tells us that the first phase of the refurbishment has been completed and work continues to complete the next phase. Some residents from the house, whose chosen rooms are in the Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: second phase of the refurbishment programme, have moved to the bungalows and are sharing accommodation with one other service user. The manager told us that this has been done in full consultation with the service users and their significant others and that they have ensured that the service users have been in full agreement with whom they are sharing. A service user spoken to told us that the building works and alterations to the home are discussed at most of the service users meetings and that the service users are well informed about the progress of the works. The manager said that she considers the service users and relatives have been constantly informed about the changes and comments from them have been considered. We looked around the part of the house completed and other areas on the site. The home will be divided into smaller groups with a dining room and lounge to service a number of rooms in specific areas of the home. The plans and vision for the home predict a transformation of the site with more of a small community village feel to the home. The new area, that is now occupied and includes seventeen bedrooms, are bright and modern and have been fully refurbished with furniture, carpets, curtains, equipment, bedding, lighting, heating and ventilation. Profiling beds have been provided in the new bedrooms along with pressure relieving mattresses and more moving and handling equipment has been purchased. All rooms have locks and lockable storage space. Service user have been consulted on how they wish their rooms to be arranged and have installed their personal belongings, making all rooms look different. Service users spoken to told us they are very happy with their rooms and they have been able to choose what they want in them. One service user did point out that the air conditioning/heating vent was above the bed and did disturb him. The manager quickly relayed this to the maintenance person for investigation. The project has been being planned for some years and therefore every aspect of the programme has been considered. Risk assessments are in place for the whole site and a Hampshire Fire and Rescue officer visits the site once a month to monitor safety. The home has appointed their own fire officer who is also monitoring the site regularly. The service users continue to have access to the parts of the site they would need to go and the building works does not appear to inhibit their movements around the home. Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: The laundry is a separate building in the grounds and was visited. The old laundry has been extended to enable the home to launder all bedding and personal clothing on site and new industrial machines have been purchased. The bungalows that are situated in the grounds of the house accommodate one or two people. The surrounding gardens of the bungalows have been landscaped with a water feature in the courtyard. This area is used in the summer as the BBQ area and the manager told us that the service user enjoy these occasions. The home has a maintenance team who are responsible for the day to day repairs to the home and ensure that all fire alarms and equipment are tested at appropriate intervals. At the time of this visit the maintenance person was in the home doing the day to day repairs that needed doing. The areas of the home were observed to be as clean as possible in the main house considering the dust that must circulate in the air. The bungalows were visited and were clean. A group of cleaning staff were observed to be in this area. Surveys returned from service users indicate that they consider their environment to be clean and fresh. The home has policies and procedures regarding infection control. Infection control training is part of the induction and annual mandatory training and this was evidenced on the training matrix. Hand washing facilities and protective aprons and rubber gloves were observed to be available in appropriate areas. It was observed by us that some of the equipment like the weighing scales and some of the wheelchairs were in need of cleaning and this was discussed with the manager who said that she would ensure that policy and procedures were put in place to ensure these were cleaned regularly. Care Homes for Adults (18-65 years) Page 28 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this 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 ensures the residents are supported by sufficient numbers of skilled and competent staff who have undergone training in appropriate subjects. The service users are supported and protected by the homes recruitment policy and practices. Evidence: The AQAA told us that the home maintains good staffing levels throughout the 24 hour period. On the day of this visit the numbers of staff on duty were sufficient to meet the service users needs. The rota indicated that three registered nurses were on duty throughout the 24 hours period with 22 carers on the morning shift, 20 the afternoon shift and 13 during the night with 3 extra during twilight hours until 1100 p.m. These numbers of staff do include those that have been funded for one to one care and some who have two to one care. The site is divided into three areas, the house, the bungalows and the satellite accommodation so that one registered nurse is always allocated to one of these areas throughout the twenty four hour period. The staff have developed into teams in these areas to ensure information is communicated well between the changing shifts. Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: The home employs separate housekeeping staff, a cook, kitchen assistant, a laundry assistant and a maintenance team. The registered manager and deputy manager are also on duty five days a week. The manager told us that agency staff are used every day but they are supplied by a regular agency and they have been seconded to the home for a considerable amount of time and are familiar with the service users care and integrate well into the staff team. The manager said the home does provide training for the agency staff and some are encouraged to undertake their national vocational qualification (NVQ) level 2. Observations of the relationships and interaction service users have with the staff was observed throughout the visit. It was obvious the service users feel relaxed and able to chat to staff in a friendly manner and staff were observed to be knowledgeable with their care needs and how they wished to be interacted with. Surveys returned to CQC indicated that staff usually listen to what they say and are treated well. The organisation is on a continual recruitment drive to recruit more permanent local staff into the homes and the manager showed us the current advert in the local newspaper for recruitment of staff. The AQAA informed us that all staff commencing work at Bonhomie House receive a job description and are inducted within their roles using the skills for care induction. National Vocational Qualification (NVQ) training is ongoing. All staff undertake an induction programme based on the Skills for Care induction programme and a completed induction programme booklet was evidenced in a staff personnel file. Newly recruited staff are also issued with pamphlets that give information and practical steps on such things as nutrition, hydration, activities etc. The home has a recruitment procedure in place and all new staff are employed according to legislation regarding references, Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (POVA) checks. A sample of three staff records were viewed and demonstrated that the CRB, POVA and two references were received before the person commences employment. The AQAA told us that the home has expanded the training programme from last year and all staff receive induction training and regular staff supervision. Senior staff have initiated staff training sessions with chosen subjects and work alongside the care staff to help maintain and increase their skills. Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: Staff are issued with training packs on specific subjects and this takes approximately 6 weeks to work through after which the staff member completes a questionnaire and this is sent to head office for marking and a certificate is issued if the outcome indicates that sufficient knowledge on the subject had been gained. These were evidenced in staff files. The company training programme covers a wide variety of subjects such as challenging behaviours, first aid, mental health awareness, food hygiene, diabetes, dementia awareness, activities and infection control. The manager told us that the home have key trainers for the mental capacity act (MCA) and deprivation of liberty safeguards (DOLS) and staff receive training on these subjects and are also issued with an information booklet to give them a better understanding of the how this can impact onto the service users. The manager showed us the training matrix on the computer. Staff training needs are identified during the supervision sessions and yearly appraisals and this is scheduled into staffs individual training programme. A staff nurse spoken to told us that she receives regular supervision from the manager and training is made available to support her in her role and also her professional portfolio. The manager said she monitors on the training matrix that all mandatory training is up to date for each member of staff. Staff spoken to and surveys returned told us that staff receive training that is relevant to their roles and which enables them to meet the individual needs of the service users. The AQAA states that 6 of the 28 staff have achieved their NVQ level 2 and this continues to represent less than 50 per cent of care staff qualified to that level. The manager said that currently a further 6 staff are undertaking the NVQ level 2 and that staff are supported and encouraged to undertake this training. Care Homes for Adults (18-65 years) Page 31 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this 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 ensures the residents live in a home that is well managed, which is open and inclusive and safe to live in. Evidence: The registered manager is a registered general nurse and a registered mental health nurse and has completed her Registered Managers Award (RMA). She has previous experience of working with people with nursing needs, mental health needs and learning disabilities. The manager has appointed a deputy manager to support her in her role, who has had many years experience working at the home and has gained the registered managers award. The manager continues to update her knowledge and delivers all the mental capacity act training to her staff and is also a moving and handling trainer. The manager told us she is about to promote one of the registered nurses to a senior clinical post to strengthen the management structure in the clinical areas. Staff spoken to feel they are well supported by the manager and the organization and Care Homes for Adults (18-65 years) Page 32 of 37 Evidence: that the manager and deputy manager are always available if they wish to see them. Observations throughout the day evidenced that the manager is respected in her role and has good relationships with all the staff. Surveys returned from staff and relatives told us: The manager and deputy are very supportive and receptive to new ideas. The care in this home is good and I look forward to coming to work. The manager and deputy are always willing to help at all times. Observing the relationships and interaction between the manager and the service users, it was evident that she is very familiar with their special needs and has good relationships with them. She demonstrated good communication skills with those who had communication problems. One service user was eager to show us how his communication system worked and this enabled him to communicate and respond to our questions. He told us he was happy living at the home and that he liked his new room. The manager and deputy have an open door policy and service users are aware of this. The manager told us that the service users feel confident to come to the office to voice their approval or disapproval of something and it gives them the opportunity to discuss any other issues. At the time of this visit several service users wandered into the office to speak to the manager. The home undertakes an annual service audit that is an annual review based on the AQAA with systems and records being audited at stipulated intervals. The manager is distributing questionnaires to service users, in a pictorial format, and to other stakeholders in February. They had been distributed a year ago and the results were seen by us at the inspection visit in January 2009. They told us that generally there was a high level of satisfaction with the service. The service users have a residents meeting 4-6 weekly and the chairman of this group had distributed questionnaires to other service users to do their own survey. The last one involved catering at the home. The other QA survey by the residents was in respect of staff. Both surveys were favourable and the chairman made available pie charts with the results and these were seen by us to be held in the quality assurance file in the office. The manager told us that the outcome from the survey was that the menus are to be changed in consultation with the service users. The manager told us that the residents meetings are well attended and that the chair person communicates with her over any issues that may be discussed at the time. Care Homes for Adults (18-65 years) Page 33 of 37 Evidence: The manager undertakes a series of monthly audits on care plans, medication charts and charts that are kept for daily records. There were records of the wheelchair audit that included safety and repairs but not the cleanliness. This will be included in future audits. All the audits are based on the annual quality assurance assessment and a specific area is audited at a specified time. Any improvements that are identified as being needed are put into the three monthly action plan. The home has a six monthly finance audit of all service users monies. The accident records were viewed and these are completed appropriately. All incidents are reported to the CQC on Regulation 37 reports. The accident book is audited monthly and if there is an emerging theme of falls the manager will refer the person to the falls clinic to try to find out why the falls are occurring and what strategy can be put in place to prevent and manage any risks. The operational manager visits the home regularly and once a month writes a general report which is kept in the home and seen by us. Staff meetings are held monthly and minutes recorded. A sample of servicing certificates for systems and equipment were viewed. These were observed to be current. The fire log was viewed and evidenced that the fire system is tested at appropriate intervals and that an updated fire risk assessment is in place. Care Homes for Adults (18-65 years) Page 34 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 35 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 Medication that is prescribed with a variable dose, the dose administered should be recorded on the MAR chart each time it is given. Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 37 of 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!

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