Care Home: Bowerfield House Private Nursing Home

What the care home does well Thorough assessments were carried out for each person before they came to live at the home, to make sure that their needs could be met. Having found out during the assessment what peoples` needs and abilities were, detailed care plans had been written so staff had the information about the care they needed to deliver. We saw that staff were kind and patient with people they were caring for and whilst we were at the home the atmosphere was calm and relaxed, with people free to walk around the hallways and communal areas. Everyone we spoke to said the staff were very good, friendly and approachable. Comments included, "Always caring and understanding - pay attention to detail - very cheerful and helpful staff" and "I am particularly impressed by the number of health plans and their detailed contents, drawn up to promote X`s comfort and wellbeing. I am most pleased with Bowerfield House". The manager was working hard to establish a staff team with the right skills, experience and attitude to work with people with dementia and staff were being recruited through a robust vetting process to make sure they were suitable to work in a care setting. Since the home reopened the manager has been registered with us and people expressed confidence in the way he was running the home. Comments included "The home is run in a very professional manner. All the staff are approachable, particularly the manager who obviously has the welfare of the residents at heart", "The manager is available - knows all the residents and their immediate relatives by name - visits the communal areas a lot and talks to the residents" and " I am impressed by this home. X has been in one residential home and 2 nursing homes prior to this. This is the best". What has improved since the last inspection? We could not compare what we found at this inspection against what we found at the last inspection because since then the home has been closed and refurbished and has reopened with a new client group, new manager and new staff team. What the care home could do better: Staff need to make sure that care plans and risk assessments are reviewed regularly and are accurate by taking into account any changes or events that have affected the person. Although there was a commitment to providing opportunities for recreation and social stimulation, people that returned surveys said this was an area that could be improved. An activities organiser had recently been employed for 2 days per week and the manager said this would increase as more people came to live at the home. Development of the key worker system should also be considered to help staff work with people in identifying pastimes and social pursuits that meet their individual needs and abilities. People said they liked the food provided at the home and the meal we saw looked appetising and tasty. However, choice at each mealtime was limited and it was not clear how people living at the home were supported to voice preferences. Staff training needs to be prioritised especially in the topics of health and safety such as fire safety and moving and handling. It is also recommended that training via Stockport council is accessed for safeguarding adults and the manager needs to identify staff that are trained in first aid. Quality assurance and monitoring processes were in place but it was not always clear that where shortfalls were highlighted, the actions that were identified as being needed to address them were actually carried out. For the quality assurance systems to be really effective and useful in developing a continuous cycle of improvement this final step needs to be more robust. Staff had not had the opportunity to participate in fire drills, which they need so they are clear about the procedures to follow in the event of a fire. Health and safety checks of the building and equipment were not always carried out at the appropriate intervals. These checks must be made and recorded to ensure the safety of staff and people living at the home. Key inspection report Care homes for older people Name: Address: Bowerfield House Private Nursing Home 1 Broadwood Close Disley Stockport Cheshire SK12 2NJ     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: Fiona Bryan     Date: 0 1 1 2 2 0 0 9 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 Older People Page 2 of 28 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 Older People 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 Older People Page 3 of 28 Information about the care home Name of care home: Address: Bowerfield House Private Nursing Home 1 Broadwood Close Disley Stockport Cheshire SK12 2NJ 01663764291 01663764356 bowerfield.mmnh@gmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Bowerfield House Ltd Name of registered manager (if applicable) Mr Ian Parker Moore Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The regisered person may provide the following category of service only; Care home with nursing - Code N, to people of the following gender: either. Whose primary care needs on admision to the home are within the following category dementia - Code DE The maximum number of service users who can be accommodated is: 26 Date of last inspection Brief description of the care home Bowerfield House has recently been closed for refurbishment and reopened in May 2009. Following some environmental changes to make the home suitable for the provision of dementia care it now provides 24 hour nursing and personal care and accommodation for up to 26 people with dementia. The home is part of the Maria Mallaband Care Group. The home is situated in High Lane, Disley, and is fairly close to the borough of Macclesfield. Access to the open countryside and Lyme Park are minutes away. Local amenities and access to local bus services are readily Care Homes for Older People Page 4 of 28 Over 65 0 26 Brief description of the care home available. Bowerfield House is a purpose built home which was built a number of years ago, situated in a leafy suburb with attractive garden areas at the front of the home. Car parking facilities are provided at the side of the main entrance. Accommodation is provided over 2 floors served by a passenger lift. The first floor has 17 single bedrooms 8 with an en-suite facility, 2 bathrooms and a shower facility. The ground floor has 9 bedrooms, 6 with an en-suite facility a shower room and a bathroom. An extension and a conservatory have been built to create additional single bedrooms and more communal space. The current weekly fees range from £725 - £830. Further details and the homes statement of purpose and service user guide are available from the manager. Care Homes for Older People Page 5 of 28 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection, which included a visit to the home took place on Tuesday 1st December 2009. The staff at the home did not know that this visit was going to take place. All the key standards were assessed at the site visit and information was taken from various sources, which included observing care practices and talking with people that live at the home, visitors, the manager and other members of the staff team. Key standards refers to those standards we feel are particularly important in ensuring the health, safety, welfare and quality of life of people living at the home. The care and services provided to two people were looked at in detail, looking at their experience of the home from their admission to the present day. A selection of staff and care records was examined, including care files, medication Care Homes for Older People Page 6 of 28 records, training records and staff duty rotas. Before the inspection, we asked for surveys to be sent out to people living at the home. Eight people returned surveys and their comments have been included in this report. We also asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we see the service. The manager completed the form quite well and during the inspection we discussed the type of information that would be useful in future AQAAs. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Staff need to make sure that care plans and risk assessments are reviewed regularly and are accurate by taking into account any changes or events that have affected the person. Although there was a commitment to providing opportunities for recreation and social stimulation, people that returned surveys said this was an area that could be improved. An activities organiser had recently been employed for 2 days per week and the manager said this would increase as more people came to live at the home. Development of the key worker system should also be considered to help staff work with people in identifying pastimes and social pursuits that meet their individual needs and abilities. People said they liked the food provided at the home and the meal we saw looked appetising and tasty. However, choice at each mealtime was limited and it was not Care Homes for Older People Page 8 of 28 clear how people living at the home were supported to voice preferences. Staff training needs to be prioritised especially in the topics of health and safety such as fire safety and moving and handling. It is also recommended that training via Stockport council is accessed for safeguarding adults and the manager needs to identify staff that are trained in first aid. Quality assurance and monitoring processes were in place but it was not always clear that where shortfalls were highlighted, the actions that were identified as being needed to address them were actually carried out. For the quality assurance systems to be really effective and useful in developing a continuous cycle of improvement this final step needs to be more robust. Staff had not had the opportunity to participate in fire drills, which they need so they are clear about the procedures to follow in the event of a fire. Health and safety checks of the building and equipment were not always carried out at the appropriate intervals. These checks must be made and recorded to ensure the safety of staff and people living at the home. 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 Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. Peoples needs are assessed before they move into the home to ensure that their care needs can be met. Evidence: Information is available for people about the services provided at the home, in a service user guide and a statement of purpose. Maria Mallaband Care Group also have a website proving information about all the homes within the group. The information about Bowerfield House needed to be amended slightly, as it was not entirely clear, seeming to indicate that nursing care could be provided for people with physical disabilities, where in fact the home is only registered to accommodate people with dementia needing nursing or personal care. We looked in detail at the care provided to 2 people living at the home. Assessments had been undertaken for both of them before they came to live at the home. Care Homes for Older People Page 11 of 28 Evidence: Staff told us that when someone was newly admitted they were told by the manager or the nurse in charge about their care needs and the reasons for their admission. Eight people living at the home returned surveys and all of them said they had received enough information about the home to help them decide if the home would be suitable for them. Care Homes for Older People Page 12 of 28 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. People who live at Bowerfield House have their needs met and their care is provided in a manner that protects their privacy and dignity. Evidence: We looked in detail at the care provided to 2 people. Each person had care plans and risk assessments that addressed the needs identified during their assessment. Care plans were detailed and gave information about peoples preferences, daily routines and abilities. Care plans had not always been reviewed monthly but where there were changes to someones care needs these did seem to have been recorded, for example where one person had developed sore skin, there were regular updates about how this was being managed. Staff need to make sure that risk assessments are always updated to reflect changes; one person had fallen several times but their risk assessment was not reviewed after each fall and when it was reviewed the fact that they had fallen was not taken into account. Care Homes for Older People Page 13 of 28 Evidence: Records showed that people had been seen by other health care professionals such as their GP, opticians, speech and language therapists (SALT) and consultant psychiatrists. For the most part staff were aware of current advice and treatment advised by other professionals but do need to ensure that requests are always followed up. In one persons file, a letter from the consultant to the GP requested that the person had a blood test but this had not been done - the nurse responsible for reviewing that persons care should have made sure this was carried out. We looked at how medicines were managed for a small number of people. Systems were generally safe and protected people from errors. The instructions for one medicine had been hand written by a member of staff. It is recommended that where staff handwrite instructions these are checked and countersigned by a second person to make sure they are transcribed correctly. We spoke to several visitors to the home who told us they were happy with the care their relatives were receiving. People told us staff were very kind and one person told us their relative always looked clean and well cared for when they visited. One person said that there had been some initial problems for their relative in settling into the home but they were much better now and their condition had improved and was stable. Another person said staff kept him up to date with how his relative was - he was pleased that he did not have to seek staff out to ask them but they were proactive in coming to talk to him. Of the 8 people that returned surveys 7 said they always or usually got the care and support they needed and that staff always or usually listened and acted on what they said. In answer to the question What does the care home do well? comments from relatives that had helped people living at the home complete the surveys included, Always caring and understanding - pay attention to detail - very cheerful and helpful staff, I am particularly impressed by the number of health plans and their detailed contents, drawn up to promote Xs comfort and wellbeing. I am most pleased with Bowerfield House and Good care - personal and nursing. Care Homes for Older People Page 14 of 28 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. 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. Social activities and meal options were fairly limited so people did not have opportunities to exercise much choice. Evidence: An activities organiser had been appointed who was working 2 days a week. It was reported that when the home was fully occupied the activities organiser would be working 5 days per week. Of the 8 people that returned surveys, 3 people said there was always or usually activities taking place that they could take part in, whilst the rest said there were only sometimes activities or that activities were not yet given a high priority. In answer to the question What could the home do better? comments included, Entertainment and activities and It will be better when they start with the odd outing in the mini bus and get activities going. Some of the care files contained useful details about peoples previous jobs, interests and hobbies. This type of information is important in order for staff to understand people as individuals and meet their diverse needs and staff need to build on this work and develop the key worker system so that people can engage in socially stimulating Care Homes for Older People Page 15 of 28 Evidence: activities that match their abilities. One person wrote in the survey that their relative had been allowed to bring their cat into the home and was very appreciative of this writing This humanitarian gesture was of the utmost importance in his settling in at Bowerfield House. I know he would not be content or happy without his pet. During the inspection we saw people having lunch. The meal was fish pie and mixed vegetables and it looked appetising and tasty. People were eating well and one person said it was nice. No choice of meal was offered, although the chef said this was because the last time fish pie had been served everyone had wanted it. Menus showed that a range of meals were provided such as casseroles, roasts and pies. Photographs of the food being served were included in the menu to help people understand and recognise what was being offered. However, it was not clear how the menus were used and how choice for people was promoted in a practical sense, as we did not see anyone being offered any alternatives, for example we noticed that although tables were laid with cloths and cutlery no condiments or sauces were provided. If it is not practicable to place these on the tables staff should offer them to each person as they serve their meal. Staff told us that the tea time meal was usually either soup and bread and butter or sandwiches. No hot option was routinely provided although we were told that the chef was aware of and able to cater for individual needs and special likes and dislikes. However, as more people are admitted to the home further consideration may be needed as to how peoples preferences can be identified and more choice made available. The chef currently only works until 1pm so this impacts on what food can be served. The manager said that once the home was full he would be looking again at the times and content of the meals and would be listening to the views of people living at the home and their relatives about this. Care Homes for Older People Page 16 of 28 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. People were protected by the complaints and safeguarding procedures, which were generally understood by staff. Evidence: A copy of the homes complaints procedure was displayed in the entrance to the home and was also provided in the service user guide. However 4 of the 8 people that returned surveys said that they did not know how to make a formal complaint should they need to. The manager was advised to explain the complaints procedure to people at the next resident/relatives meeting to make sure that everyone had the information. No complaints had been received by the manager since the home was reopened. People described the manager as approachable and said they could speak to him if they had any concerns. Most staff had undertaken training in safeguarding adults, although the staff member we spoke to was unsure about the external agencies that could be contacted if they felt that any concerns about the safety of people living at the home were not being addressed properly by the manager or senior managers within the company. It is recommended that further training in safeguarding is accessed through Stockport council as this training covers the Stockport interagency policy and procedures. Care Homes for Older People Page 17 of 28 Evidence: Since the home reopened there had been several incidents where people living at the home had been at risk of injury or had been injured by other people living there. The manager had taken appropriate steps on each occasion to safeguard everyone and had contacted the relevant agencies. The mental capacity of people had been assessed prior to decisions being made about their health care, to ensure that if possible they were included in decision making. For example several people required medicine to be given covertly (disguised in food or drink) because they did not want to take it but they needed it to manage their health issues. Where this occurred a mental capacity assessment had been carried out and the consultant psychiatrist had authorised the use of covert medication. This was good practice, as it ensured decisions were made in the best interests of the person. Care Homes for Older People Page 18 of 28 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, 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. 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. People live in clean, comfortable and pleasant surroundings. Evidence: Prior to the home being reopened a site visit was carried out on the 21st April 2009 to assess the suitability of the home to provide dementia care. Some changes had been made to the premises to make it suitable. An extension and a conservatory had been built to create additional bedrooms and more communal space. Although additional bedrooms were created the total number of bedrooms was reduced from 27 to 26 because some of the existing shared rooms were converted to single rooms. Digital locks had been fitted to entrances and exit doors and some of the interlocking internal doors. The doors were linked to the fire alarm system so that they could be opened in the event of a fire. At this inspection a partial tour was undertaken. The bedrooms seen were personalised with peoples own possessions and the decoration and furnishings were of a good standard. Each bedroom had been fitted with a nurse call system, smoke detector and window restrictors. Care Homes for Older People Page 19 of 28 Evidence: The home was clean and tidy and there were no bad smells. All the 8 people that returned surveys said the home was always clean and fresh, one person commenting that there were the highest standards of cleanliness. A safe, enclosed garden area with a patio, lawn and outdoor seating was accessed via the conservatory. However the conservatory was unusable as the manager said the heating was not sufficient and it was too cold for people to sit. Additionally, although we pointed out at the site visit in April that anti-glare blinds were needed so that people could use the area, these had not been provided; blinds would also help to keep the heat in. As the windows in the lounge/dining room on the ground floor were quite small, people would really benefit from being able to use the conservatory as it was very bright and airy, in contrast to the lounge where the lighting was a bit dim. Some adaptations to the environment had been made with reference to current best practice in dementia care. For example the toilet doors had been painted yellow and there were clear signs to direct and orientate people to them, and picture frames were attached to each persons bedroom door so they could display photographs of themselves, family, pets etc., again to help people find their way around the home. This work should continue as there were still many improvements that could be made to enhance peoples mood and promote their independence. Care Homes for Older People Page 20 of 28 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. 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 staff team is still being developed and staff have not had all the necessary training to ensure they can meet peoples needs safely. Evidence: On the day of the inspection there were 15 people living at the home. It was reported that there was usually 1 nurse and 2 carers throughout the day and night to care for them. We looked at the staff duty rotas for the weeks commencing 23/11/09 and 30/11/09, which confirmed this. On the day we visited another 2 staff were working at the home as part of their induction training, and were supernumerary to the usual staff. Of the 8 people that returned surveys 7 said there was always or usually staff available when they were needed and one person said there sometimes was. People we spoke to on the day of the inspection said that staffing had improved from when the home first reopened. We were told that there had been a lot of agency and bank staff, which had caused some problems in getting to know the people living at the home and provide continuity of care. More permanent staff had been recruited and the use of agency staff had reduced. People told us the staff were extremely caring and kind and the manager was recruiting a good staff team. Care Homes for Older People Page 21 of 28 Evidence: Because additional staff were on duty when we were at the home it was not possible to form an opinion of how the home would operate with the normal staffing levels. However, staff on the first floor told us there were several people that needed help to eat and also needed 2 staff to help them move. It was reported that a further 2 people were expected to be admitted later in the week. The manager needs to ensure that the dependency of people living in the home is taken into account when staffing levels are determined and was aware that staffing would need to be increased in line with future admissions. We looked at 2 staff personnel files to see how people had been recruited. Both files contained all the necessary information and documents to demonstrate that appropriate checks had been made to assess their suitability to work in a care setting. One of the staff that was working at the home on induction confirmed she had been asked to provide references and had obtained a criminal record disclosure prior to staring to work at the home. In the AQAA the manager said 2 of the 4 permanent care staff had successfully completed NVQ level 2 training. We looked at the training records for staff, which showed ongoing training for staff in dementia care, safeguarding adults and pressure area care. A few staff had undertaken training in infection control, food hygiene and health and safety but the majority had not. From the records it appeared that the majority of staff had also not received moving and handling training or fire safety training. There was no record of any member of staff having done first aid training, or training about the Mental Capacity Act or Deprivation of Liberty Safeguards. It was reported that training in dealing with challenging behaviour was booked for January 2010. The manager said that some staff had undertaken training in moving and handling, fire safety and first aid at their previous employment but acknowledged that he needed to confirm this and identify people who had up to date first aid training to act as designated first aiders. All staff must have mandatory training in health and safety topics as a matter of priority. Care Homes for Older People Page 22 of 28 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 manager is deevloping good systems to ensure that the home is run in the best interests of the people living there. Evidence: The manager was registered with us after demonstrating fitness to undertake this role. The manager is a Registered Mental Nurse with many years experience and he has almost completed the Leadership and Skills qualification. We received some very good feedback about the manager and how the home was being run from people that returned surveys. Comments included The home is run in a very professional manner. All the staff are approachable, particularly the manager who obviously has the welfare of the residents at heart, I love it here, The manager is available - he knows all the residents and their immediate relatives by name - he visits the communal areas a lot and talks to the residents and I am impressed by this home. X has been in one residential home and 2 nursing homes prior to this. This is the best. Care Homes for Older People Page 23 of 28 Evidence: It was reported that the company had conducted a satisfaction survey, with surveys being returned to the company head office. The manager was waiting for feedback about the results of this. There had been one resident/relatives meeting since the home reopened. Visitors told us the plan was to hold the meetings every 3 months so the next one was due. There was a system in place to review the quality of the service delivered to people. Audits (checks) were made across a range of areas and staff practices, such as the recruitment process, staff training, care planning, medicines management and the environment. The quality monitoring mechanisms in place fell down slightly, in that it was not always clear that where shortfalls were highlighted, the actions that were identified as being needed to address them were actually carried out. For the quality assurance systems to be really effective and useful in developing a continuous cycle of improvement this final step needs to be more robust. Small amounts of money are kept in safe keeping for people living at the home. We were told that a ledger sheet was kept for each person with details and receipts for all transactions. We did not view these records at this inspection. We looked at the records of the checks that were made of the building and equipment in respect of health and safety. Some of the checks had not been carried out as often as they should have been. The manager said that the maintenance person who was responsible for doing this worked between Bowerfield House and the neighbouring Bowerfield Court and he did not always spend the full designated time at Bowerfield House. The maintenance person must work sufficient hours at the home to ensure that all the health and safety checks of the building are carried out within appropriate timescales. There had been no fire drills at the home since it was reopened. All staff must be given the opportunity to participate in fire drills to ensure they understand the procedures that need to be followed to maintain the safety of themselves and people living in the home in the event of a fire. Care Homes for Older People Page 24 of 28 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 Older People Page 25 of 28 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 1 30 18 Staff must receive training 20/01/2010 appropriate to the work they are to perform including training in fire safety, moving and handling and health and safety. This will ensure staff are competent to deliver care and will ensure the health and safety of both staff and people living at the home. 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 12 Further consultation should take place and the key worker system should be developed to help staff work with people living at the home to engage in social activities and events that meet their needs and abilities. The options at mealtimes should be reviewed and the system for enabling people to exercise more choice about what they eat shoud be developed. Staff should attend training run by Stockport MBC in 2 15 3 18 Care Homes for Older People Page 26 of 28 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 safeguarding adults so they have a full understanding of reporting procedures and contacts. 4 20 The heating should be fixed in the conservatory so people can make use of it in winter and get the benefit of the light, airy space which will enhance their mood. The manager should develop the quality monitoring system one stage further so that it provides evidence of how feedback is used and acted on to improve the service. This will make it more robust and progress will be more measurable. Regular checks of the building and equipment should be made and recorded in line with relevant health and safety legislation. 5 33 6 38 Care Homes for Older People Page 27 of 28 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. 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