Care Home: Bowlacre

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• Chirnside House
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What the care home does well During this visit there was a relaxed and informal atmosphere, and people living in the home appeared settled and at home in their environment. Although there were shortfalls in the general maintenance of the physical building, this did not seem to concern residents or their relatives.People who were spoken to said they felt comfortable with the staff team and that they could approach them with any concerns. Staff were observed as they engaged in meaningful conversations with residents and where appropriate, they offered support and reassurance in a sensitive and caring manner. Comments included: " I like it here, it`s very friendly with caring staff". "Staff are very caring and nothing is too much trouble". "Staff are fantastic, you can ask for anything and they will get it for you". One visitor said she thought that the staff provided good support to the residents. She said that staff are warm and open, "There`s a calm atmosphere here, and everyone is so kind. The staff are lovely and will do anything for you. If there are any changes in care needs the staff ring me. I couldn`t wish for a more caring place". Encouragement is given to people to develop and maintain relationships with family and friends, and to participate in the local community. Residents were complimentary about the meals served in the home, and the mealtime arrangements provided a relaxed social occasion. What has improved since the last inspection? The home continually places emphasis on developing the care plans so that staff have the important information they need to meet care needs. Some refurbishment has taken place which includes re-placing carpet in corridors. CARE HOMES FOR OLDER PEOPLE Bowlacre Elson Drive, Stockport Road Gee Cross Hyde Tameside SK14 5EZ Lead Inspector Ann Connolly Unannounced Inspection 20th June 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bowlacre Address Elson Drive, Stockport Road Gee Cross Hyde Tameside SK14 5EZ 0161 368 2615 0161 368 6015 bowlacre@yahoo.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) Bowlacre Home Janette Frances Wilson Care Home 37 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (37), of places Physical disability over 65 years of age (4) Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users up to 37 OP up to 6 DE (E) and 4 PD (E) Date of last inspection 25th June 2007 Brief Description of the Service: Bowlacre is a large, detached building set back from the main road within its own grounds. The building has been extended and adapted over the years to provide accommodation for 37 older people with physical disabilities and dementia type conditions. The home is owned and managed by a voluntary housing association. The bedrooms are located over two floors. In total there are 33 single rooms, 31 of which have en-suite facilities, and a further two shared rooms, both with en-suites. On the ground floor there are two sitting rooms, one dining room and a large conservatory. Aids and adaptations are in place to meet the assessed needs of the service users. Bowlacre is located in a residential area of Gee Cross. The grounds are well maintained and fully accessible to the service users. Car parking is to the front of the property. Fees for accommodation and care at the home range from £331.75 to £376.25. Additional charges are also made for hairdressing and chiropody services, newspapers and some personal toiletries. Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes This was a key inspection that included a site visit to the home. The manager was not told beforehand that we were coming to inspect, this is called an unannounced inspection. This inspection looked at all the key standards and included a review of all available information received by the Commission for Social Care (CSCI) about the service provided at the home since the last inspection. During the site visit a selection of records, care plans, policies and procedures were examined. Discussions took place with the manager, staff working in the home, and some relatives who were visiting. Prior to the inspection, questionnaires were sent out to the people who live in the home, asking them to comment on how the home is run and managed, and for their views about how the staff supported them. Six of these were returned and the comments are included in this report. A tour of the home was undertaken and residents were asked for their comments and views about the environment. Several residents living in the home were spoken to in private during the visit, and discussions took place with them to find out what they thought about the home and what they felt about how the staff supported them. Before the inspection, we also asked the manager of the service 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 is one of the ways that we get information from the manager of the service about how they are meeting outcomes for people using their service. Since the last inspection visit, which took place on 25th June 2007 , the Commission for Social Care Inspection has not received any concerns about this service. Information in the AQAA shows that the service received one complaint direct and that this was resolved within 28 days. What the service does well: During this visit there was a relaxed and informal atmosphere, and people living in the home appeared settled and at home in their environment. Although there were shortfalls in the general maintenance of the physical building, this did not seem to concern residents or their relatives. Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 6 People who were spoken to said they felt comfortable with the staff team and that they could approach them with any concerns. Staff were observed as they engaged in meaningful conversations with residents and where appropriate, they offered support and reassurance in a sensitive and caring manner. Comments included: “ I like it here, it’s very friendly with caring staff”. “Staff are very caring and nothing is too much trouble”. “Staff are fantastic, you can ask for anything and they will get it for you”. One visitor said she thought that the staff provided good support to the residents. She said that staff are warm and open, “There’s a calm atmosphere here, and everyone is so kind. The staff are lovely and will do anything for you. If there are any changes in care needs the staff ring me. I couldn’t wish for a more caring place”. Encouragement is given to people to develop and maintain relationships with family and friends, and to participate in the local community. Residents were complimentary about the meals served in the home, and the mealtime arrangements provided a relaxed social occasion. What has improved since the last inspection? What they could do better: Although there was evidence that some staff were developing care plans, this work needs to be consistent so that staff have the necessary information they need in order to provide care and support to residents in an appropriate manner. The requirements made in this report in relation to medication must be addressed so that residents receive their medication in a safe way. The manager must provide the Commission with confirmation that the passenger lift is fit for purpose and provide a copy of the latest lift inspection report. Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 7 There should be a programme of refurbishment and development in place so that residents and their relatives can be confident that the home is maintained to a satisfactory level and provides a safe environment. The external grounds must be safe and accessible to residents. A system should be in place so that the training and development needs of staff are monitored, and so that training can be arranged where appropriate. Residents should be consulted on their interests so that their social, cultural, religious and recreational needs are met. An appropriate leisure activity programme should be in place to meet these needs. 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. Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are assessed prior to admission into the home and trial visits are arranged to help prospective residents make an informed choice about their future care arrangements EVIDENCE: Three care plans were looked at during this visit. All of them had an assessment of care needs on the file. The quality of assessments varied, with some having more information than others. Some of the assessment documentation that was looked at had sections that were incomplete or not dated and signed correctly. The staff team said that they were aware of this and working to improve assessment documentation. Overall, it was evident from discussion with the staff team that they recognised the importance of having sufficient information about the prospective resident, so that they can ensure that the staff skill mix is appropriate to meet the needs of the individual person. Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 10 There was evidence that the home took time to help prospective residents adjust to residential care. Prospective residents are encouraged to visit the home prior to arranging their admission and are given the opportunity to meet other residents, staff and to sample life in the home. Standard 6 was not assessed as intermediate care is not provided. . Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users health and personal care needs were being met and personal care and support was offered in such a way as to promote and protect residents’ privacy, dignity and independence. EVIDENCE: Three care plans were looked at during this visit. The quality of the care plans varied according to which member of staff had written them, and this meant that there was a lack of consistency in the quality of information provided to staff. There was evidence that some care needs, which had been identified in the assessment, had not been included in the current working care plan. For example, the assessment identified a problem with urine retention resulting in catheterisation, however, none of this information was in the care plan. There were examples of staff identifying new care needs, and again these had not been added to the care plan. This means that staff do not always have the important information that is needed when providing care and support to residents. Care plans must be reviewed and audited so that the information on all care plans is consistent in quality and detail. Care plans must be regularly Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 12 updated so that staff have appropriate information to support residents and so that residents can be confident of receiving good quality care and support. Information in the AQAA shows that the manager and staff had already identified some shortfalls in the care plans. As a result of this they have implemented a new care planning system and have plans to increase the involvement of residents and their families in the care plan review process. Most relatives who were spoken to during this visit said they felt that the staff in the home were very good at keeping them involved and up to date with any changes in care needs. One relative said, “The care is very good here. The staff are always there and the care has been particularly good during periods of illness when my mother has needed more care and support”. Records and discussion with residents showed that a variety of health workers visit the home to assist with residents care. These are people such as dentists, opticians and dieticians. Examination of residents’ medication administration records showed that all medicines provided by the supplying pharmacist were administered satisfactorily. A senior member of staff checks all medication when it is received by the home. It was found that medication stock levels balanced with the MAR sheets, and there were good recording systems in place to record the receipt and disposal of medication. There was no documentation of specimen signatures of the staff responsible for the administration of medication. This should be addressed so that any tracking of administration can be undertaken. There were occasions where hand written entries of medication had not been countersigned by a second member of staff to ensure accuracy in the detail. Observations were made of the administration of medication. Medication was administered from a monitored dosage system in blister packs. This means the individual medication is put into a sealed bubble of plastic by the local supplying pharmacist. The medication was multiply dispensed by the pharmacist, and as such must have a description on the blister pack identifying each medication, colour and shape etc. The supplying pharmacist had not done this, and the manager must discuss this and arrange for medication delivered by him to have this supporting information. Staff responsible for the administration of medication demonstrated a good knowledge of the different medication. Mediation was administered appropriately and records signed immediately after administration. It was noted that there was a dosette box in use for the administration of medication to one resident. Staff said that this was used for a resident who was admitted regularly for respite care. The family brought in the medication in bottles and the staff then put this into the dosette box. This practice is called ‘secondary dispensing’ and is not good practice because if the care worker giving the medicines does not have the container with the label they cannot be sure that each person receives the right dose of Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 13 the right medicine at the right time, as prescribed. The manager must look at alternative ways of administering medication to this resident. Controlled drugs and associated records were examined and found to be in order. The current storage arrangement for controlled drugs does not meet the requirements of current legislation. Appropriate safe storage for controlled medication must be in place and must meet current legislation. Staff were observed engaging in meaningful conversations with residents, and at all times, communication appeared respectful. Residents spoke highly of staff. One resident said, “I am very happy here, the staff are so lovely with everyone”. One relative said, “The staff are lovely and the carers will do anything for you. If there are changes in care needs they ring me. I have got an easier mind and I couldn’t ask for a more caring place.” Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities were offered, but these need to be expanded to ensure that the social, cultural and recreational needs of residents are met. Residents were encouraged to take control over their own lifestyle and encouraged to maintain contact with family and friends. Meals served to residents were of a high quality providing a well presented and nutritionally balanced meal EVIDENCE: Visitors were seen coming and going throughout the day. Residents and relative commented on how they felt staff made them welcome. Residents said they were encouraged and supported to keep in contact with family and friends. All residents spoken to were complementary about the quality of food in the home. The main meal during this visit was a choice of meatballs with fresh vegetables or poached salmon. The meal was well presented and looked Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 15 appetizing. Relatives are offered a meal for a token cost. This means they can dine with their relative and join in the social occasion. The mealtime occasion was a relaxed and social occasion. The dining room was well presented and staff were available to give appropriate, sensitive and discreet support when it was needed. The home does not have an activities organiser, and it is left to care staff to try and organise the activity programme in the home. The activities book was not available to look at during this visit, as the staff could not locate it. All comments from resident’s relatives and staff raised concerns over the lack of a structured activity programme and that activities were not offered on a regular basis. One resident said, “ There’s not many activities here” Other comments included: “I like it here but there’s no activities”. One of the comments in the survey forms, which are completed by residents and their families, said ‘ I feel that there should be more activities and entertainment’. There needs to be a pro-active approach in consulting with residents about their interests so that their social, cultural, religious and recreational interest are met. A smoking room has been provided to meet the non smoking legislation that came into force on 1st July 2007. Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place to ensure that residents are protected, and systems are there to support residents to make their concerns known. EVIDENCE: There is a comprehensive complaints policy in place. This is located in reception areas and in the statement of purpose and service user guide. A copy of the service user guide in located in each bedroom. Responses from surveys sent out to residents and their families indicated that on the whole, people knew how to voice their concerns and complaints. It was evident from some of the responses that families felt confident in raising their concerns. One family member said that she felt confident and able to go to see the manager or staff with any issues of concern. Since the last inspection visit, one complaint had been made directly to the manager at the home in January 2008. There was documentary evidence to demonstrate that the manager had instigated the procedures for investigating the complaint, however, there was no documentary evidence to show how the complaint was investigated, the outcome of the investigation, whether it had been resolved, and no copy of any correspondence to the complainant. A copy of all action taken in relation to complaints must be kept on file. The Commission for Social Care Inspection have not received any complaints about this service since the last inspection visit. Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 17 There has been one safeguarding referral made in the last twelve months and an appropriate referral was made to the social services for investigation. A number of staff were spoken to about their understanding of adult protection issues. Most staff were able to demonstrate a sound understanding of the procedures for adult protection, and were aware that any allegations of abuse must be reported to social services and the Commission for Social Care Inspection. Most staff said they had not received updated training in safeguarding adults, and information provided by the manager in the AQAA stated that this was an area for improvement and that they need to continue to train staff in policies and procedures. It was recommended that training in safeguarding adults should be included on the staff training matrix so that the manager can be confident that staff have the appropriate skills and knowledge to protect the safety and well being of residents in the home. The manager has put an information file in place which provides staff with useful information on issues surrounding abuse. This also included the safeguarding adult’s procedures, and the forms which staff are required to complete in the event of any allegation of abuse. This provides staff with a useful overview on local procedures and the systems in place for holding strategy meetings. Some progress had been made in meeting the previous requirement for all staff to receive training in adult protection. In March 2007, three staff attended a course in safeguarding adults, the manager attended training in May 2007 and training has been scheduled for additional staff in December. The manager said that December was the earliest date that she could obtain in securing this training for staff. As an interim arrangement, and until all staff have been enrolled on this training, the remaining staff team have watched a DVD on safeguarding adults and completed a questionnaire which enabled the manager to assess staff awareness and understanding of the training material. The manager was aware that this type of training should not be used as a substitute for formal training. There was evidence in the supervision programme that the one to one supervision sessions were used to re-in force good practice in care related topics, which included safeguarding adults. Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable environment, however, the general maintenance programme for the home tends to be reactive rather than proactive and has resulted in a gradual deterioration of many areas of the physical environment. This approach has the potential to compromise the safety and comfort of residents living in the home. EVIDENCE: The home provides a number of areas for residents to access and enjoy being with other people, or relaxing on their own. There are several pleasant communal spaces. During this visit the home was clean and tidy and free from offensive areas. Most of the residents and relatives who were spoken to were aware of the decline in the physical standards of the building, but said that this did not unduly worry them as they were more interested in the quality of care and Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 19 support provided. However, most thought that there had been an under spending of the budget in carrying out home improvements and renovation work over the years. They felt they were willing to compromise on these issues, as they were aware that the home was run as a registered charity. Although relatives said they had made allowances about the decoration and general maintenance, the recent malfunctioning of the passenger lift had caused them considerable concern. On the 23rd of February 2008 and 24 of February 2008, the home notified the Commission that the passenger lift had broken down and the fire service was called to rescue a resident who had to be seen by the paramedics. Some residents had to sleep downstairs when this incident occurred. Relatives said that the issue of the lift has been on the agenda at relative’s meetings for a few years, and concern was expressed that there was still no movement forward in addressing this concern or updating this vital piece of equipment. Some of the documentation for the lift was not available for inspection during this visit. A requirement has been made for the documentation to be made available to the Commission to confirm that the lift is suitable for purpose. Information in the AQAA states that the lift was last serviced in December 2007. Since this date the lift has been inoperable on two occasions as described above. During the tour of the building there was evidence of poor decorative standards in corridor areas. Walls were scuffed and wallpaper borders were coming away from the wall. Most of the window frames were single glazed with old frames, which were In need of painting or re-placing. Furniture in bedrooms was varied, and a mix of old and new. Many items of worn furniture need to be re-placed. Many of the exterior windows were in urgent need of painting to prevent further deterioration and possible rotting of woodwork or damage to metal window frames. One bedroom had a broken toilet seat, in another room inappropriate carpeting was fitted in a toilet area. It was noted that all toilet and bathroom areas were fitted with soap dispensers and paper towels. Staff confirmed that there were sufficient supplies of protective clothing, aprons and gloves to promote good infection control procedures. There was no staff training matrix in place, so it was not possible to determine how many staff had received training in infection control. This has been discussed further in standards 27 to 30. A chairman of the committee said that some of the ongoing maintenance problems were as a result of the long tern illness of the handyman. However, steps have been taken to address this and the chairman hopes that the appointment of a temporary handyman will improve the general maintenance programme in the home. Pleasant garden areas surround the home, and new gates have been installed in the garden to improve security. There are a number of benches surrounding the lawn area and these are located on a gravel path. This footpath was an Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 20 uneven surface, and could be potentially hazardous to residents wishing to access these areas. This path must be risk assessed and appropriate action taken following the findings. The home benefits from an old, but well used conservatory, however problems arise in extreme weather conditions. For example, during this visit, the heat from the sun made it very uncomfortable to spend a long period of time in this area. Appropriate shade or alternative accommodation needs to be provided in these circumstances so that residents are comfortable in their environment at all times. The manager of the home needs to ensure that the physical environment meets the needs of the people living there. To do this there needs to be a programme in place to improve decoration, fixtures and fittings. Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents using the service can be confident that staff receive some support and training to help them to develop the right skills to meet the needs of the people they provide care and support to. EVIDENCE: During this visit, there were sufficient staff on duty to meet the needs of the residents in the home. Staff were observed engaging in meaningful conversations, and seemed to respond quickly to any resident asking for support. Three staff files were examined. These contained most of the documentation required by legislation. Some of the information was unclear, and one file did not confirm if a reference was from the last employer. All files which were looked at provided confirmation that Criminal Record Bureau Checks (CRB) had been carried out. Staff who were spoken to were enthusiastic about their caring role, and all of them confirmed that they were in receipt of supervision. There was evidence on files that staff had accessed training relevant to their roles. Recent emails Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 22 to the manager provided evidence that a number of courses had been made available to staff. Information in the AQAA states that 18 staff have attained NVQ level 2 or above. There was no training matrix in place, and it was recommended that this was developed so that the manager had an overview of training needs and an accurate overview of how the home was performing in ensuring that staff and the relevant qualifications to meet the needs of residents in the home. Residents and their relatives were very complimentary about the standard of care and support provided by staff in the home. Many of the comments made reference to the warm, sensitive caring personalities of the carers. Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in the best interest of residents living in the home. EVIDENCE: The manager is suitable qualified to manage the home and has completed NVQ Level 4 Registered Managers Award. The manager was not available during this visit as she was attending training. However, we spoke to the Chairman of the Committee, and later spoke with the manager via the telephone. There were mixed views from staff about the support they received from the manager, and it was evident that staff felt there was a lack of clarity about individual roles and responsibilities of staff. Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 24 The Committee said that both they and the manager recognised that there were some managerial issues that required addressing. In order to support the manager, they had recruited the services of a management consultant who was going to work with and support the manager to develop a business plan and look at roles and responsibilities in the home. This will help the manager to continuously improve the service, and develop an open and transparent approach in the way the home is run. Information in the AQAA showed that the health and safety of residents and staff was promoted. The information showed that equipment was regularly checked and maintained. However, as previously discussed, over recent months there has been incidents where the lift has broken down, and one relative said that this was a recurrent problem and that they had been told that a new lift would be installed, but to date this had not happened. The up to date lift servicing record could not be found during this visit, and a requirement has been made for the manager to forward a copy of this document to the Commission. Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 3 Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (2) (b) Timescale for action Care plans must be reviewed and 21/08/08 audited so that the information on all care plans is consistent in quality and detail. Care plans must be regularly updated so that staff have appropriate information to support residents and so that residents can be confident of receiving good quality care and support. Appropriate safe storage that 21/08/08 meets current legislation must be in place for controlled drugs. This will ensure that medication is managed safely by the home. Secondary dispensing must not be used. Alternative methods of administering medication to people in short stay must be in place with supporting policies and procedures. The supplying pharmacist must be asked to arrange for medication which is multiply dispensed to be accompanied by a description on the blister pack identifying each medication, colour and shape etc DS0000005562.V366185.R01.S.doc Requirement 2. OP9 13 3 OP9 13 21/08/08 4 OP9 13 21/08/08 Bowlacre Version 5.2 Page 27 5 OP22 13(4) 6 7 OP25 OP16 13 22 Confirmation must be sent to the Commission confirming that the passenger lift is fit for purpose and forward a copy of the latest lift inspection report. The footpath surrounding the lawn area must be made safe and accessible to residents. A copy of all action taken in relation to complaints must be kept on file 30/06/08 12/09/08 21/08/08 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 OP9 Good Practice Recommendations Sample signatures of staff responsible for administering medication should be in place for audit and tracking purposes. Hand written entries should be countersigned to check for accuracy of prescribed details. In order to prevent the risks from cross infection the staff should be reminded to wear protective clothing whilst supporting the residents with their meals. Residents should be consulted on their interests so that their social, cultural, religious and recreational interest are met. Training in safeguarding adults should be included on the staff training matrix so that the manager can be confident that staff have the appropriate skills and knowledge to protect the safety and well being of residents in the home. Appropriate shade or alternative accommodation should be provided in the conservatory so that residents are comfortable in their environment at all times. The manager needs to ensure that the physical environment meets the needs of the people living there. To do this there needs to be a programme in place to improve decoration, fixtures and fittings. 2. OP28 3. 4. OP12 OP18 5. 6. OP20 OP25 Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Bowlacre DS0000005562.V366185.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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