Care Home: Bowden Derra Park

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What the care home does well Bowden Derra Park can accommodate 46 people, 31 of whom live in Bowden Derra House. In spite of the size of the service we believe that it is able to offer homely and comfortable accommodation. Living in a large group will not suit every person, however we found that the people who do live there were happy. We believe that the mix of people means that there is always some one to talk to and get on with, and that there was enough space to avoid other people. The Expert by Experience commented: "The home feels like a large family home not like a residential home. If I lived there I would recommend it to anyone looking for this type of home". Staff commented in a survey: "Provides a family feeling for service users, that is happy and stable providing a sense of belonging". Visiting professionals had concerns that the size and the nature of the service meant that people were not treated as individual and were isolated from the wider community, we found that the people at Bowden Derra experienced some of the benefits of living in a larger group, that the Management took steps to try ensure that there was contact with the wider community and that people were treated as individuals. One of the relatives who responded to a survey said "They integrate people to enable them to live together as a group e.g. Having meals etc together, but they treat them as individuals helping them to make their own friends with the group and pursuing their own interests". The house is situated in a rural area, and access to shops and other facilities in involves the use of a vehicle. We found that people at Bowden Derra did go out, and were able to use the same community resources as other people. We also found that the rural location meant that people were able to walk freely in the grounds of the houses, something that might not have been possible in other accommodation. We were told that there were plans to open a village shop so that people would have a chance to develop skills and to take an active role in the village. Staff comments in surveys included "Service Users tend to have a good access to the community with a variety of activity for every age", "Encourages staff and service users to develop and try new things..." and "Offers a relaxed and settled home offering choice activities and structure for individuals that need it." We found the accommodation to be spacious and comfortable, and generally suited to the needs of the people accommodated. We found that people did have the opportunity to make their bedrooms their own space. The Manager of Bowden Derra Park told us he is looking at the accommodation that is currently provided and considering how improvements may be made, including in relation to reducing the number of shared rooms. We found that care that is provided is generally very good; staff know what help people need and treat them with respect. The Expert by Experience told us "The staff I saw treated the residents with respect and were not patronising to them. Everyone treats everybody as one big happy family. The residents I met said that get on very well with the staff and I could see this from watchingthem." Staff told us "Service Users and staff members are being valued as individuals". The care plans are generally thorough thought could contain more detail so that they better reflect individual needs and choices. We found that staff knew what they were doing and were aware of what was in plans. Staff are well trained, competent and well supported. Comments form staff included "Good relationships with all the managerial people makes it easy to work here", "New training is always being reviewed and offered", and "Lots of team meetings and informal meetings. The door is always open". When we spoke with staff we found that they were very happy in their role: "I have never worked in a care role before and I love my time at Bowden Derra", "I have only been her 8 weeks and so that it has been a pleasant place to work and the staff are excellent and the clients all seem really happy and care for" and from someone who had 26 years experience of social care "The homely atmosphere and the core group of staff are some of the best I have ever worked with". We found that the home is well managed and that organised. There are good systems in place to ensure people are kept safe. We found that staff and the people who live at Bowden Derra seemed very confident approaching the managers and raising any wants or concerns. What has improved since the last inspection? A new Hydrotherapy pool has been opened on site. This means that people do not have to travel to Truro to use such a facility. Individual bank accounts have now been opened for each person who lives at the home. The Manager also identified that they had investigated and sourced some courses on promoting independence and independence skills for service users and that they have improved training for staff, 50% of staff have now completed their Learning Disability Qualification. CARE HOME ADULTS 18-65 Bowden Derra Park Polyphant Launceston Cornwall PL15 7PU Lead Inspector Helen Tworkowski Unannounced Inspection 1st September 2008 8:30 Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 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 Bowden Derra Park DS0000008982.V368477.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 Adults 18-65. 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. Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bowden Derra Park Address Polyphant Launceston Cornwall PL15 7PU 01566 86230 01566 86230 jonathan@bowdenderra.co.uk 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) Bowden Derra Park Limited Mr Maurice Clement d`Entrecasteaux Care Home 46 Category(ies) of Learning disability (46) registration, with number of places Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Total numbers not to exceed 46 of whom up to 20 may have an associated physical disability Service users to include up to 31 adults with a learning disability (LD) to be accommodated in Bowden Derra House (Main House) Service users to include up to 5 adults with a learning disability (LD) to be accommodated in Medrow House Service users to include up to 10 adults with a learning disability (LD) to be accommodated in Orchard House 20th February 2007 Date of last inspection Brief Description of the Service: Bowden Derra Park Ltd is a privately owned company that provides care and accommodation for up to 46 people with a learning disability in one of three houses. Bowden Derra House has rooms on the first floor and ground floor where there are also three communal sitting rooms and a large dining room. Orchard House provides care and accommodation for people who may present with challenging behaviour. The accommodation is divided into three flats, each with their own dining room and lounge. Medrow House is situated on the limits of the campus and is home to service users who have been identified as people who would benefit from a more independent life style where they could participate in the running and organisation of their home. There are large grounds surrounding the home, which is situated on the outskirts of a village approximately seven miles from Launceston. The Statement of Purpose and Service User Guide, which provide information about what the service provides, are available from the office. The fee range at the time of the inspection is from £256 to £2500 depending on the level of support needed, the fees includes transport on local trips, and trips to doctors and appointments, and basic toiletries. Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced Key Inspection was brought forward from the planned date because of concerns that had been raised by visiting professionals. This inspection was not to investigate these concerns, however we were aware of the concerns during the visit. Following this inspection the quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection took place over three days: 1/9/08 2/9/08 3/9/08 8:30am – 6:00pm Helen Tworkowski Regulatory Inspector 8:30am – 4:00pm Alan Pitts, Regulatory Inspector 9:00am - 5:30pm Helen Tworkowski Regulatory Inspector 9:00am – 1.00pm Alan Pitts, Regulatory Inspector 3:00pm - 5:30pm Expert by Experience 9:00am - 2:00pm Helen Tworkowski Regulatory Inspector 9:00am - 10: 30am Alan Pitts, Regulatory Inspector 10:00am - 2:00pm Brian Brown, Pharmacy Inspector As part of this inspection we looked at the care and support provided to six individuals who live at the home. We talked with people who at Bowden Derra Park, ate meals in the dining room and looked around the three houses that make up Bowden Derra Park. We also talked with staff in private about their experiences. We looked at various records and systems including those relating to care, staffing, medication, and health and safety. We also talked with two professionals who were visiting the home during the period of our visits. The Inspection included a visit by an “Expert by Experience”, who is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The Pharmacy Inspector carried out the inspection of the medication system. In addition to this the Manager provide us with information in the form of an Annual Quality Assurance Assessment. We sent out 40 surveys to staff and received, 19 were returned. We also sent surveys to each of the 46 people who live at the home, 31 were returned. Surveys were also sent to visiting professionals, two were returned. In addition surveys were sent to relatives of the people who live at Bowden Derra, at the time of writing this report ten have been returned. Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 6 What the service does well: Bowden Derra Park can accommodate 46 people, 31 of whom live in Bowden Derra House. In spite of the size of the service we believe that it is able to offer homely and comfortable accommodation. Living in a large group will not suit every person, however we found that the people who do live there were happy. We believe that the mix of people means that there is always some one to talk to and get on with, and that there was enough space to avoid other people. The Expert by Experience commented: “The home feels like a large family home not like a residential home. If I lived there I would recommend it to anyone looking for this type of home”. Staff commented in a survey: “Provides a family feeling for service users, that is happy and stable providing a sense of belonging”. Visiting professionals had concerns that the size and the nature of the service meant that people were not treated as individual and were isolated from the wider community, we found that the people at Bowden Derra experienced some of the benefits of living in a larger group, that the Management took steps to try ensure that there was contact with the wider community and that people were treated as individuals. One of the relatives who responded to a survey said “They integrate people to enable them to live together as a group e.g. Having meals etc together, but they treat them as individuals helping them to make their own friends with the group and pursuing their own interests”. The house is situated in a rural area, and access to shops and other facilities in involves the use of a vehicle. We found that people at Bowden Derra did go out, and were able to use the same community resources as other people. We also found that the rural location meant that people were able to walk freely in the grounds of the houses, something that might not have been possible in other accommodation. We were told that there were plans to open a village shop so that people would have a chance to develop skills and to take an active role in the village. Staff comments in surveys included “Service Users tend to have a good access to the community with a variety of activity for every age”, “Encourages staff and service users to develop and try new things…” and “Offers a relaxed and settled home offering choice activities and structure for individuals that need it.” We found the accommodation to be spacious and comfortable, and generally suited to the needs of the people accommodated. We found that people did have the opportunity to make their bedrooms their own space. The Manager of Bowden Derra Park told us he is looking at the accommodation that is currently provided and considering how improvements may be made, including in relation to reducing the number of shared rooms. We found that care that is provided is generally very good; staff know what help people need and treat them with respect. The Expert by Experience told us “The staff I saw treated the residents with respect and were not patronising to them. Everyone treats everybody as one big happy family. The residents I met said that get on very well with the staff and I could see this from watching Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 7 them.” Staff told us “Service Users and staff members are being valued as individuals”. The care plans are generally thorough thought could contain more detail so that they better reflect individual needs and choices. We found that staff knew what they were doing and were aware of what was in plans. Staff are well trained, competent and well supported. Comments form staff included “Good relationships with all the managerial people makes it easy to work here”, “New training is always being reviewed and offered”, and “Lots of team meetings and informal meetings. The door is always open”. When we spoke with staff we found that they were very happy in their role: “I have never worked in a care role before and I love my time at Bowden Derra”, “I have only been her 8 weeks and so that it has been a pleasant place to work and the staff are excellent and the clients all seem really happy and care for” and from someone who had 26 years experience of social care “The homely atmosphere and the core group of staff are some of the best I have ever worked with”. We found that the home is well managed and that organised. There are good systems in place to ensure people are kept safe. We found that staff and the people who live at Bowden Derra seemed very confident approaching the managers and raising any wants or concerns. What has improved since the last inspection? What they could do better: The Statement of Purpose and Service User Guide need to be reviewed, so that they provide more precise information about exactly what sort of service can be offered at Bowden Derra Park and the sorts of needs that can be catered for and met. Care Plans would benefit from including more detail; this would help ensure that they are focused on individual wants and preferences. We also believe that the way they are currently stored needs to be reviewed, so that they are Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 8 both secure and respect confidentiality. We found that some of the records such as those relating to fluid intake and challenging behaviour were not being analysed, and actions taken where appropriate. We found that locks had been placed on some wardrobe doors, to protect people’s property. This practice must be reviewed, and appropriate means found to give people the confidence that their property will be safe and access to it themselves. We also found that where some people had bedroom door locks fitted, so that they could lock their doors, these locks could not always be over-ridden in an emergency. Each person now has their own bank account, but benefits are still being paid into the company account. We had no concerns that money was being misappropriated however money belonging to the individual must be paid to the individual’s account (or one of their choosing), and where appropriate charges may be made by the home on the individual for services provided. The recording system for medicines received into the home and for medicines being taken out for both holidays and other visits needs to be revised. Some aspects of the storage of medicine needs attention to comply with current regulations. 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. Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who are moving to Bowden Derra Park benefit from a service that will get to know their needs and will respond to them when they move. Information is available about what is offered at Bowden Derra Park, however this would benefit from being more detailed. EVIDENCE: Prior to this inspection the Commission had received a revised copy of the “Statement of Purpose” and “Service User Guide”, these documents should provide people who are thinking about moving to Bowden Derra Park with information about what they can expect. These documents had previously been agreed with the Commission, however we discussed with the Manager how these document could be improved so that they provide more precise information about the service. We discussed with the Manager the importance of being clear with both people purchasing and people using the service what they can expect for Bowden Derra Park. We looked at the information that had been received or collected prior to two people moving to the home. We were told that both individuals had moved to Bowden Derra in an emergency, which had meant that the usual assessment process had not been used. We saw that the home had been provided with Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 11 various documents with information about the individuals and was told that visits had been made to assess the individuals and where possible the individual had visited Bowden Derra. We discussed with the Manager the importance of ensuring that not only are people properly assessed but also that there was a proper record of that assessment. We also discussed issues around emergency placements and ensuring that the home remains in control of their admission process, fulfilling their responsibilities and duties. We talked with one of the Social Workers who had been involved in one of the emergency admissions. She said that she believed that the Bowden Derra had worked very well with the individual. The person had arrived at Bowden Derra after being very unsettled at the last place she had lived. She had settled in very quickly at Bowden Derra, staff had provided her with the close boundaries and structure that she needed, and she had responded very positively to this. Another Social Worker, responding to a survey said that with one exception the home does ensure that accurate information is gathered. Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7, 9, and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who live at Bowden Derra Park benefit from clear plans of care that provide staff with information about what they need to do. The plans would benefit from more detail, reflecting better the needs and preferences of the individual. People are kept safe by a risk assessment process. There are systems in place to ensure that where needed people receive help to manage their money, though the management of benefits needs to be reviewed. EVIDENCE: We looked at the surveys that the people who live at Bowden Derra who completed. When asked if carers treated them well 21 people said always, whilst 7 people said sometimes. When asked if carers listened and acted upon what they said 21 people said always whilst 9 people said sometimes. We looked at the information on six people at Bowden Derra and how staff meet their needs. Each person has a “Care Plan” document that contains information about how needs are to be met by staff, it also contained information about how risks are managed. All of the Care Plans seen were up Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 13 to date and had been reviewed. The information in these documents varied in the amount of detail they contained. Some documents gave clear and precise details about individuals needs. The information for one person who had behaviours that challenged was very detailed. However some of the information was not specific- for example some plans contained instructions to staff such as helping individuals to make appropriate choices. It was not clear what staff were actually meant to do or what an appropriate choice was. Care Plans need to give staff clear guidance about the support they are to offer. This level of detail should also then reflect the individual’s preferences and wishes better. The plan would then become more focused on the person. We were told that in addition to the home’s Care Plan each person also has his or her own Life Plan document. We asked the staff in a survey if they were given up to date information about needs of the people you support or care for, in the care plan: 17 staff said that they always were whilst one person said that they usually were. We discussed with the Manager that they had previously been advised to keep Care Plans in individual’s bedrooms. We were concerned about confidentiality and that these documents could easily be destroyed if left lying around. Care Plans belong to the service, and whilst it is our expectation that these are accessible to the individual to whom they relate, and that the individual is involved in drawing up the document, it is the property of the home. The Care Plan is there to ensure that staff provide the right support. Care Plans should be kept in a secure manner and be readily available to staff who need to refer to these documents, both day and night. The Commission requires that all such records be kept for three years following the date of the last entry. All of the Care Plans seen had a signing chart where staff sign to say that they have read the document. All staff spoken with as part of this inspection were aware of the documents and the information they contained. Some of the people who live at Bowden Derra Park have behaviours that challenge. We found that some people had detailed plans about how to manage these needs. Other people had less detailed plans, and guidance that had been provided by visiting professionals was out of date. We discussed with the manager that the out of date guidance indicated that physical intervention was to be used. We were told that this guidance was no longer used. We were told that there is no planned physical intervention. Where guidance is out of date, this should be clearly indicated as such. We asked the Manager if he had a copy of the Department of Health Guidance on Physical Intervention for people with a Learning Disability or Autistic Spectrum Disorder. Mr d`Entrecasteaux confirmed that they were familiar with this guidance. We discussed with the Manager whether the home offered support to people who needed to be restrained. He confirmed that they do not offer support to people who needed to have such interventions on a planned basis. However, Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 14 there could be rare situations when this might be needed, and he said that they were looking at ensuring that some staff received general training in this area. We saw that “antecedent, behaviour and consequence charts” were completed for individuals where there had been incidents, however these were not always being analysed on a regular or frequent basis. Such an analysis helps staff understand why behaviours are occurring and to understand the best responses. Recording should be purposeful, and if it is not used then it has little value. Staff spoken with told us that a small group of staff would be working closely with a visiting health care professional to help assist an individual with some difficulties he was experiencing. Staff are highly motivated and committed to this work and to helping the individual. One visiting professional commented that she thought that staff responded to her ideas with enthusiasm, although she had concerns that there was an emphasis on doing for rather than with. As part of this inspection we looked around the house, and saw that some of the people who lived at Bowden Derra had fluid input and output charts. We found that sometimes two or three different charts were in use, and that at the end of the day totals were not being completed. We asked staff about the point at which they would seek the advice of a health care professional; there was no specific guidance. If there are sufficient concerns about an individual to require that fluids charts are kept, then there should be clear guidance, drawn up with the relevant professionals, about what actions are to be taken under what circumstances. There were good records of health care visits such as visits to the GP or to specialists to discuss epilepsy. In looking around the home we noticed that some of the wardrobes were locked. The staff explained that this was because of concerns that other residents would take items. Given that there are lots of items around the room that could still be taken, this strategy did not seem to be appropriate and in locking the wardrobe people were denied access to their belongings. We discussed with the Manager fitting suitable door locks to each bedroom, so that individuals could lock their own doors if they so choose. We talked with some of the people who live at Bowden Derra Park about the decisions they make about their lives. People told us that they are able to decide the times they get up and go to bed, what they do with their time and the holidays they go on. We saw that, in one of the houses that make up Bowden Derra Park, there are communication boards- so people can see what is happening that day. We spoke with a visiting speech and language therapist about the support people got to communicate and she confirmed that the staff did follow guidance offered. However she said that it could be difficult to maintain the consistency that is required in larger staff teams. She said that Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 15 she had not observed that staff talk over the people who live at Bowden Derra Park. Other visiting professionals raised concerns in their surveys that they thought that the model of care at Bowden Derra Park is not person centred, reflecting an individuals wishes about how they wish to live their lives, and that at times people may have limited control. From the evidence we saw at this inspection we found there were occasions when people’s control was unnecessarily limited, however overall people were able to make decisions about their lives on a day-to-day basis. The Manager explained that they held some cash for people who were not able to manage their own money. We saw that each person had a bank account in his or her name. We were told that some people were able to have a pin number and to use it appropriately. Others however did not have this ability. We saw that money taken out of the bank appeared as a cash entry in the records held at Bowden Derra Park, and that where money was spent there were receipts. We noted that individual’s benefits were being paid directly to the Company account and then money was paid into the individual accounts. We discussed with the manager that the benefits need to be paid to the individual accounts, and where charges are to be paid to Bowden Derra these payments can be transferred. These payments or charges should be specified in the contract/ terms and conditions. The Manager discussed with us issues concerning the need to support individuals with their finances. We discussed including financial planning and support as part of the Care Plan process. This would help ensure that an individual’s aspirations, priorities and choices could be taken into account when looking at the support they might need to manage their money. It would also ensure that the individual’s representatives, where appropriate, are involved in this planning, and any capacity issues identified. Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at Bowden Derra Park are provided with a good standard of meals. They are able to make choices about their lives and are treated with respect by the people who support them. EVIDENCE: We asked an “Expert by Experience” to look the lifestyle of people who live at Bowden Derra House. An Expert by Experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The expert by experience made the following report based on this visit: I spoke to a number of the residents from the main house. Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 17 Some of the residents go during the day to day centres. A day centre called Westgate or Molly Tanner Lodge. One resident I spoke to said he goes to the Westgate Day Centre and does jigsaws and puzzles. Another resident said she goes to a day centre twice a week and while there answers the telephones on a voluntary basis. She said I used to be paid but not now. But they are looking into her being paid again. Another lady I spoke to goes to Molly Tanner Day Centre. She goes there Thursdays and Fridays. But she would like to do something else. So that is being looked into. The age range of the home is 17 to 78 years old. There is no problem with this as the older residents motive the younger ones. The residents I spoke to said there is plenty to do at the home. There is a hydrotherapy pool which all the residents like using. A lot of the residents go in the village, towns near to go shopping all the residents are well known. Some of them also go to the pub where they meet the locals. They go to the theatre to see shows. The home also put on things Halloween, November 5th Bonfire night, birthday parties for the residents and there was a very big party to celebrate the homes 25th anniversary where people from the village and surrounding area and the press attended. The residents can have holidays they can go on there own with support or in a group. Every year a group from the home goes to Butlins. But if the group wanted to go somewhere else it can be arranged. As regards relationships the residents can have friends visit and go into their rooms. They can close their door so people will have to knock to be let in. All the rooms have a TV in them. They have access to a telephone so they can ring their family free of charge if they need to it can be done in private. Send letters, birthday, and Christmas cards. Some of the residents have family visit them. One of the residents I spoke to has got a girlfriend. They have been together for 12 years. His girlfriend lives at a nearby farm and goes to the home. She is moving from the farm shortly not to far but will still be able to see her boyfriend. Regarding relationships the manger is getting accessible booklets on relationships. Will also get someone to come and talk to the residents about it. One resident I chatted to help in the kitchen peeling potatoes, carrots etc and preparing food for the home. He gets paid for this. Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 18 Regarding meals and mealtimes all the food is got locally. All the food is natural as possible. Residents with special food needs, i.e. diabetics are catered for. You can also have non-meat meals if you prefer a veggie option. Some residents do not like green things on their plate so the food can be dyed using natural food colouring. If a resident wants something different than on the menu they ask the staff and it is sorted out for them. The residents can choose their meals by looking at a chart with 3 food options to choose from. The manager did a survey to see what the most popular foods were. Photos of all those foods are going to be put into a book to help the residents choose their meals. The mealtimes are not structured. Everyone finds that works. They all can have fruit and drinks hot or cold anytime during the day. Other things the home does they have coffee mornings for staff who buy things. The money goes into buying things for the home. They have a greenhouse – growing grapes but they want to grow more things in it. It is hoped very soon to start an allotment and sell the produce. They are also seeking planning permission to open a shop and café at the home and have the residents helping to run them. If the residents want to do it. The staff I saw treated the residents with respect and were not patronising to them. Everyone treats everybody as one big happy family. The residents I met said they get on very well with the staff and I could see this from watching them. The home feels like a large family home not like a residential home. If I lived there I would recommend it to anyone looking for this type of home. We ate two meals at Bowden Derra, one in Bowden Derra House and one in Orchard House. At Orchard House we sat and saw how staff helped some one eat. Staff intervened and gave help when it was appropriate and let the individual feed herself when she was able to. Staff were considerate and sensitive to the needs of this individual, who clearly trusted them. The Speech and Language therapist told us that staff did follow the advice given in relation to helping people to eat and drink. We were told that meals are brought over from the main kitchen, but that there was always food in house so that if people got hungry between meals or wanted something different there was another option. We looked in the fridge and the cupboard and checked that this was the case. Staff told us that they were part the way through the Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 19 process of photographing all of the meals. These pictures would be used to help people choose meals. At Bowden Derra House both staff and the people who live there ate in the large dining room. People sat in small groups and talked and chatted in a relaxed manner. The meal was not hurried, and people seemed to use the opportunity to catch up with what had been happening. In spite of the size of the room and the number of people around, the mealtime was not institutional. We were told that people from Bowden Derra House are involved in preparing their own packed lunch if they are going out to a day centre. We asked about whether people can make their own drinks and we were told that where individuals can do this safely then they could. We saw that this was the case. We discussed with the manager the possibility of ensuring that any future developments include giving people the opportunity to use facilities that are more domestic in scale. When we visited Medrow House at a mealtime there was only one resident plus a member of staff. Lunch again was a relaxed informal meal. We were told that the people who live in the house have the opportunity to go shopping for the food for the house each week. We asked the Manager and other staff about why some people went out for a haircut and why others had the hairdresser come to them. We were told that was based entirely on what suited the individual. The hairdresser who came to the home was ran one of the shops that most people went to. We were told by a number of different staff when we asked that most people did go out to the shops, however some people did not like shopping. We were shown clothes catalogues that some people had used to make their choice of clothes to buy. Most of the relatives who responded to the survey told us that the home helped their the person who lived at Bowden Derra to keep in touch however three of the ten relatives thought they were only sometimes informed about important issues that affected their friend or relative. Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 20 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Whilst people, who live at Bowden Derra Park are generally well supported, and their wants and preferences are taken into account some aspects of the medication system may not always protect them. EVIDENCE: We talked to staff about the changing needs of people at Bowden Derra Park and looked at the care of one particular individual whose ongoing illness meant she could do much less now than in the past. Staff spoke about her with respect and whilst they acknowledged her illness, they still saw the person and not the illness. They emphasised what she could still do and enjoy, and not the problems. We observed staff working with this individual, when the sun shone in her eyes they moved her chair, they checked her hands to see if she was cold and fetched a rug. They spoke to her and encouraged her to respond to them. This was good quality person centred care. We observed one of the people who lives at Bowden Derra Park discussing with the manager a trip to the village to withdraw money. This was dealt with in an adult and respectful manner, and the individual was able to choose who Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 21 accompanied him. We observed many interactions where people were not only were making choices, but also telling staff what they wanted. During the time we spent in all three of the houses, we noticed that people were well dressed in clean clothes that suited their personality and needs. Staff discussed with us that some individual enjoyed playing with toys, and whilst they were aware that this might not be appropriate to their age, they were also aware of how much enjoyment that individual go out of the activity. One of the professionals who responded to a survey said that she believed that people people’s basic health care needs were met however felt that she was less clear if their wider psychological needs were met. We found that the home sought advice and guidance from professionals, and where given the advice was taken on. Eight out of the ten relatives responding to the survey said that the home always gave the support or care that was expected or agreed, whilst the other two people said that this was usually or sometimes the case. One relative commented, “Put his needs first and if there is something he really doesn’t want to do they work around it so that he is happy with what he’s doing”. We found that for people leaving the home both for holidays and visits that whilst a record is made that they have taken medicines with them that this record does not always include the quantity of medicine taken or the quantity returned. Also some of the records do not comply with best practice as they contain many people’s information. We found that whilst the receipt of all monthly supplies of medicine were recorded this was not always the case for those medicines received at other times. This may mean it is more difficult to monitor the use of medicines and ensure that people have received the amount of medicine prescribed for them. For people living at the home that need medicines administered by specialist procedures there is evidence that training has been arranged and sufficient people are available to carry this out at all times. Some people were prescribed medicines to be administered “when required”, from talking to members of staff they were aware that they knew how they would administer these, however there were no clear directions on how these decisions were to be made available within the individual plans of care. We found that medicines subject to control under Misuse of Drugs regulations were being stored at the home and that provision had not been made to store these in accordance with the regulations as they had been amended in 2007. During the inspection we agreed that with the Manager that he would order a cupboard compliant with the new regulations. It was also agreed that he would Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 22 provide us with conformation that the cupboard had been ordered and further provide confirmation when the cupboard had been fitted. We also found that whilst most other medicines were kept securely, the cupboard used for the storage of the medicines fridge and in use external products was accessible to all members of staff and not just those people who had received training in the administration of medicines. This increases the risk of medicines being diverted. Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 23 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an open ethos in this home that is likely to ensure that an issues or concerns are dealt with quickly by the management. EVIDENCE: A number of safeguarding alerts have been made because of concerns about the well being of certain individuals at Bowden Derra. We found that the manager and staff had passed on information as appropriate, and had cooperated with all investigations. All 18 of the staff who responded to the survey said that they knew what to do if they were told by someone about a concern about the home, one member of staff commented “No secrets/safeguarding training is a very high priority”. Information supplied by Bowden Derra Park as part of their annual quality assurance assessment indicates that no formal complaints had been received in the last twelve months. The home has a record of complaints received. About half (13) of the people who responded to the survey who live at Bowden Derra Park said that they knew how to make a complaint, however 22 out of 26 people said that knew who to speak to if they were not happy. Four of the ten relatives responding to the survey said that they did not know how to make a complaint. We would therefore suggest that relatives are provided with this information. Seven of the relatives said that the home had always responded appropriately when they had raised a concern, two other people said that this was usually the case, with one person saying sometimes. Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 24 Staff told us about the style of management in the home, we were told that if any was doing something that was not quite right it was discussed with them immediately. There was an open and direct style of communicating what was expected of staff. All the staff we spoke with when asked if they would be able to voice concerns said yes without hesitations. We were told that some of the staff were related to other members of staff, we were told that that personal relationships were put on one side at work. Staff said that managers were very approachable with any issues or concerns. We were aware throughout the course of this inspection of people: both staff and residents talking with the Registered Manager. There was no hesitation in their approach. Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 25 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Bowden Derra Park provides a good standard of clean and comfortable accommodation. Bowden Derra House is large but suites the needs of the people who live there, and despite the size is not institutional. EVIDENCE: We were shown around each of the three houses that make up Bowden Derra Park. Bowden Derra House is a large building. It has three different lounges, and a large dining room. People clearly had preferences about which room they used, and some people had their own chairs. As has already been noted when we ate in the dining room, despite the size of the room we found it to be comfortable and not institutional. The size of the house means that it at no point felt crowded, there was enough space for people to move around comfortably, including on the staircase. We noted that some of the people who live at Bowden Derra Park have a visual impairment, we were told that professionals from the visual impairment team had visited and advised on how to make adaptations so that the house better suited the needs of people with this disability. Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 26 We looked around private areas of the home, bathrooms and bedrooms. The bedrooms that we saw were all very different. Some were clean and tidy, others less so, reflecting individual tastes and preferences. Some individuals had had their rooms decorated in colours that they liked. We spoke with one of the residents about the colour she had chosen for her room, and she was clearly very proud of the room. The Manager told us that when individuals first moved to the home the rooms would have been decorated in a neutral colour, however as they settled in then the room could be decorated to their taste. We notice that one individual had a poster with their name on their bedroom door, making a clear statement about whose room it was. We discussed with staff how this could be encouraged, not only so that rooms were clearly identified as belonging to that individual, but also so it broke the monotony of a long corridor. We discussed the provision of door locks with staff. A few of the bedrooms had door locks and we were told that individual residents did have keys. However we noted that these Yale locks could be locked from the inside and when the snib was put down the lock could not be over ridden in an emergency. Other bedroom doors had “star key” locks, which could be used to lock a room if a resident was not in it. We discussed with the Manager the provision of door locks that could be used by individuals so that they could each lock their room if they felt that it was necessary. The rooms were well furnished and where rooms were shared, screens were available. We discussed with the manager the appropriateness of double rooms, and he acknowledged that this was a concern, and said that they were looking at options to reduce the number of shared rooms in future. We asked why there were no bedside lamps, and we were told that this was because staff had been told that they were a health and safety risk. We discussed this with the Manager and asked for bedside lamps to be provided to everyone, except where based on a risk assessment that it could be shown that such a lamp would pose an unreasonable risk. The house was clean, and there were no unpleasant odours. There is a large laundry that does all of the washing for the three houses. The laundry was hot and we discussed with staff who worked there the need for the provision of a fly screen that would enable them to keep the door open. We asked staff at Orchard House about dealing with foul laundry, and found that they were not using appropriate procedures. We discussed this with the Manager, and the need for staff not only to understand what to do, but the principles that underlie it. Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 35, and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at Bowden Derra Park benefit from motivated, well managed and competent staff. EVIDENCE: We interviewed five of the care staff and spoke with many others during the course of this inspection. We found that staff were very satisfied with their work. They knew what they were doing, they felt well supported and they felt valued. People spoke about loving their work, and some explained that they might have found better paid work elsewhere but enjoyed the work so much they stayed. It is unusual to find this degree of commitment and satisfaction in a care home. We observed the way staff talked and acted around the people who lived at Bowden Derra, and we saw that people were treated with respect. No one was spoken down to. We discussed with the Manager the importance of ensuring that staff understood that sometimes terms of address could be seen by visitors as inappropriate or patronising. Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 28 We looked at the recruitment and training files relating six staff and found that appropriate checks were made before people started work at Bowden Derra. The home uses it’s own in house induction in addition to the nationally accepted standard induction produced by “Skills for Care”. Inductions were completed, however sometimes a number of areas were signed as completed on the one day. The Manager explained that whilst the induction was completed over a period of time the signing had taken place on the same day. We discussed with the Manager signing of each section of the induction. Staff comments in the surveys about their inductions included “It as a very thorough induction and was given a lot of support nothing was too much trouble”, and “I had a 2 week period in the 3 different houses and was closely supervised at all times”. Staff spoken to said that they were well supported, there was a record of supervisions that had taken place, and this showed that in a few cases that they were not taking place as frequently as they should have been. Comments from staff included “Lots of team meetings and informal meetings. The door is always open”, “Good relationships with managerial people make it easy to work here”, and I feel happy to ask my manager anything anytime I need advice or help. The records of staff training showed that staff had received a range of training appropriate to their work. This included generic training such as in relation to food safety and the safe handling of medicines, but also in relation to Autism. Information provided as part by the home indicated that 31 of the 69 staff had NVQ2 or above, whilst a further 17 were working towards this award. Staff comments about training included “New training always being reviewed and offered” and “I can apply for any course I wish to attend and there are always plenty to choose from”. The majority of staff who respond to surveys said that there were always or usually enough staff, comments from staff included “Sometimes due to holidays or sickness can be short staffed” and “Everyone here at Bowden Derra work as a collective team to ensure there is always enough staff”. The rota shows that at Bowden Derra House that some of the staff are allocated to work with individuals and that whilst others are working with groups of people who needed less support. We saw handover sheets that showed that staff were assigned specific responsibilities to support individuals. From what we observed around the house there were sufficient staff on duty. There was no indication that the people at Bowden Derra were not occupied, that they were unkempt or uncared for. We were provided with rotas, and discussed with the Manager including the family or surnames of staff, as well as their first names. We noted from the rota that the home does use some Agency staff; we discussed with the Manager any agreements that were in place with agency to ensure that these staff were suited to the work. The Manager said that there were no such written agreements. We would recommend that such agreements Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 29 be in place, so that the home can be assured that the agency has done the appropriate recruitment checks and that the worker is appropriately trained. We would also recommend that it is clear what responsibilities any agency staff has within the home. We looked at staff turnover using information provided by the Manager. We calculated that 22 staff left in 2007 out of a total of 69 staff. When we looked at how long these staff had worked at the home we saw that a proportion had left quite quickly. This reinforced what staff told us, that staff who were not suited to the work did not stay. A staff turnover of 35 is not unreasonable for the care industry, particularly where people have to work unsocial hours and where the work can be very demanding. Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 30 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Bowden Derra Park is well-managed service where the wants and wishes of the people who live in the home are taken into account. EVIDENCE: The Registered Manager Mr Reece D`Entrecasteaux confirmed that he had completed his Registered Managers Award. Through out the time we spent at the home we observed that staff and residents were happy to approach him and to raise issues. Staff told us that there was no “us and them” with the managers at Bowden Derra. Concerns have been raised in surveys from visiting professionals regarding the ethos of the home and style of management. From the surveys we have received from relatives and staff, and from the interactions observed during Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 31 the three days of the visit, we found that there was an open and approachable management style. We discussed with the Manager concerns regarding that the nature of Bowden Derra meant there was limited contact with the local community, and we were told of the various ways that the service has encouraged links with the local community and the plans to open a shop that would further enhance this. We found that records were generally well organised and up to date. As a company runs Bowden Derra Park the Commission requires that a representative of the company visit each month to see that the home is being properly run. We found that these visits had occurred and that there was a record of these visits. An environmental risk assessment had been carried out earlier in the year by the home’s insurers, however they had not received a copy of the relevant documents. We recommended that this should be followed up. We saw that the risk assessments in relation to the preparation of food were in place and that there were records of staff training to ensure the safe handling of equipment. Chemicals and cleaning fluids were safely stored and that the relevant assessments had been carried out. We also checked and found that there agreements in place for the maintenance and servicing of hoists and other equipment. When we looked around the home we saw that hoists were available for use and staff told us that each person had their own slings. We were told there is a fire warden on site, who is supported by 5 fire officers. We found that there were detailed training records including the names of the people who attended and the content of the training. We asked about quality assurance at Bowden Derra Park and was told that questionnaires had been sent out to the people who live at Bowden Derra and others who have contact with the service such as GPs and relatives, this had been done in 2007 though was yet to be done in 2008. We discussed with the Manager publishing a summary of the results and any actions that are to be taken. We were told that the people who live at Bowden Derra have their say about what happens in the home via a Forum, and minutes of these meeting are kept, in both a symbol and large print format. Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 2 27 x 28 3 29 3 30 2 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 3 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 3 3 x 3 x x 3 x Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 33 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA7 Regulation 12(2) Requirement Timescale for action 01/12/08 2 YA7 20 3 YA20 13(2) 4 YA20 13(2) 5 YA26 13 (4) a People who live at Bowden Derra must be given the opportunity to keep their belongings safe, to have their privacy respected and that wardrobe doors must only be locked where it can be shown to be in the best interests of someone who lacks the capacity to make their own decision to do this. Benefits paid to individual 31/12/08 service users must not be paid into the company’s bank account. However the company can make charges and require payments that are contractually due. Order a cupboard for the storage 31/12/08 of Controlled Drugs compliant with the new regulations by 08/09/2008 and that you would then have this cupboard fitted by 31/12/2008. All medicines must be stored 31/12/08 securely to prevent unauthorised access which may lead to them not being available for the person to whom they have been prescribed Bedroom door locks, where 01/11/08 DS0000008982.V368477.R01.S.doc Version 5.2 Bowden Derra Park Page 34 provided, must be capable of being overridden in an emergency. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations The Statement of Purpose and Service User Guide should be revised so that it gives more precise detail as to the nature of the service provide and to the sorts of needs that can be met. Information gathered, as part of the assessment process, should be fully recorded. Records, including those relating to fluid intake and difficult behaviours, should be monitored, analysed and actions taken should be based on agreed protocols. Care Plans should contain more detail so they better reflect the wishes and preferences of the individual. Care Plans and other information should be kept secure and in a manner that protects their confidence. It is recommended that the home review the way in which they record the movement of medicines in and out of the home for visits, appointments and holidays. Staff should have a good understanding of the principles that underlie control of infection procedures so that they can appropriately manage foul laundry. There should be a clear written agreement between the home and any agency providing staff, as to the preemployment checks and competence of any staff. 2 3 4 5 6 7 8 YA2 YA6 YA6 YA10 YA20 YA30 YA34 Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. Extracts may not be used or reproduced without the express permission of CSCI Bowden Derra Park DS0000008982.V368477.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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