Care Home: Bowles Lodge

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What the care home does well Residents live in a home run in their best interests. They benefit from a competent, qualified and experienced Registered Manager. Individuals enjoy living in a clean and comfortable environment, although they may benefit from minor repair. People who are thinking about moving in are assessed to make sure that the home can meet their wishes and needs. Residents are treated with dignity and respect. They are recognised as individuals and are able to exercise choice over their lives. Individuals changing personal, health and social care needs are met and reflected in care plans. There are systems in place for the administration of medication which aim to protect residents. Residents benefit from sufficient numbers of appropriately recruited, supervised, qualified and trained staff who care for, understand and anticipate their needs and wishes. The views of residents and their representatives are listened to and receive appropriate consideration. People are protected from potential abuse and by the systems in place to protect their finances and health and safety. Residents feel suitably occupied and can choose to take part in group activities or pursue their individual interests; they enjoy keeping in contact with their relatives and friends. Residents benefit from a good quality varied diet. What has improved since the last inspection? Since the last Key Inspection and following a Random Pharmacy Inspection, residents are better protected by improvements to the systems for the administration of medication. Care plans now contain more personal information which helps staff to get to know a resident better, and offers a chance to familiarise themselves with the person concerned. Residents have benefited from improvements to the environment and some areas have been re carpeted. Some facilities and equipment have been renewed or replaced such as the staff call system, some furniture and televisions, beds, some bath hoists and baths. Residents enjoy a reminiscence area in the home including reading material, pictures and a piano. What the care home could do better: Residents are protected by a safe environment, although the covering of two exposed radiators would enhance this. The Registered Manager explained that they would replace the storage facility for care plans to improve confidentiality.There are systems in place for the administration of medication which aim to protect residents, although this may be improved by the provision of a lockable medication fridge. The best interests of residents may be enhanced by reviewing the frequency of some aspects of the quality assurance system. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bowles Lodge All Saints Road Hawkhurst Kent TN18 4HT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Martin     Date: 0 9 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 24 Information about the care home Name of care home: Address: Bowles Lodge All Saints Road Hawkhurst Kent TN18 4HT 01580752775 01580754622 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Kent County Council care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 36 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Bowles Lodge is a Linked Service Centre owned and operated by Kent County Council. It offers residential care for 36 older people and there is a day centre on the site. The Home is a detached, purpose built, premises on one level with 34 single bedrooms and one shared bedroom. There are staff call points and television points in all bedrooms. There are telephone points in some bedrooms and at other places around the Home. There is a large garden to the rear of the building and car parking to the front. Bowles Care Homes for Older People Page 4 of 24 Over 65 36 0 2 4 0 9 2 0 0 8 Brief description of the care home Lodge is located near to the centre of Hawkhurst village with easy access to bus services. The nearest shops and other amenities including churches, library, chemist, post office and public houses are within half a mile.The Homes senior staffing team comprises the Manager, a Senior Team Leader and Team Leaders. The Home employs Care Workers who work a roster that gives 24-hour cover and additional staff for catering, domestic and administration duties. Full information about the fees and costs payable, the service provided and the homes Statement of Purpose are available from the Registered Manager. Care Homes for Older People Page 5 of 24 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: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This Key Unannounced Inspection included a visit to the home in Hawkhurst on 9th April 2009, where the Registered Manager, two Team Leaders, two Carers, the Administrator, the Handyman, three Service Users and two relatives were spoken with. In addition, subsequent information was received from the Registered Manager on 17th April 2009. Some judgements about the quality of the service provided were taken from observations and conversation. Some records and documents were looked at together with the premises and facilities of the home. The last Key Inspection was undertaken on 11th April 2007, an Annual Service Review was completed on 24th April 2008 and a Random Pharmacy Inspection was undertaken Care Homes for Older People Page 6 of 24 on 24th September 2009. An Annual Quality Assurance Assessment, AQAA, has been received from the home. Any other information received since the previous Key Inspection has been reviewed. All of the above have been included within this inspection process and some of the gathered evidence is mentioned in this report where appropriate. What the care home does well: What has improved since the last inspection? What they could do better: Residents are protected by a safe environment, although the covering of two exposed radiators would enhance this. The Registered Manager explained that they would replace the storage facility for care plans to improve confidentiality. Care Homes for Older People Page 8 of 24 There are systems in place for the administration of medication which aim to protect residents, although this may be improved by the provision of a lockable medication fridge. The best interests of residents may be enhanced by reviewing the frequency of some aspects of the quality assurance system. 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 set out 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 24 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 24 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. Residents benefit from assessment before they move in, which ensures that the home can meet their needs. Evidence: The Registered manager said that people who are thinking about moving in to the home are assessed beforehand to ensure that their needs can be met. This can also be done by the local authority. Information is recorded and care plans for the help that people need are developed from this. The Registered Manager explained that the home does not provide any intermediate care, although people can be accommodated in the short term for respite. Care Homes for Older People Page 11 of 24 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. Residents are treated with dignity and respect. Residents changing personal, health and social care needs are met and reflected in care plans; although changes to storage facilities would enhance confidentiality. There are systems in place for the administration of medication which aim to protect residents, although this may be improved by the provision of a lockable medication fridge. Evidence: Individual plans of care for each resident are developed from assessments undertaken prior to their admission to the home. These aim to identify the action required from staff to meet residents personal, social and health care needs. Three care plans were looked at. These are clear with detailed up to date information, which reflects the changing needs of individuals. Care plans now contain more personal information which helps staff to get to know a resident better, and offers a chance to familiarise themselves with the person concerned. Any risks to residents are assessed and Care Homes for Older People Page 12 of 24 Evidence: records show the actions needed to reduce these. The Registered Manager assured the inspector that the storage facility for care plans would shortly be replaced to improve confidentiality. The Provider is recommended to complete their stated intention to provide new lockable storage for care plans as soon as possible. Residents health care needs are met. These are monitored and recorded in care plans. Records also show that a range of health and social care professionals are accessed to support staff to meet residents needs including consultation and referral to medical professionals. Since the last Key Inspection and following a previous Random Pharmacy Inspection, residents are better protected by improvements to the systems for the administration of medication. Although a few residents manage their own medication, most benefit from support from staff to do so. Although medication is stored in a secure room in designated cupboards, the medication fridge was not lockable. The Provider is strongly recommended to provide a lockable medication fridge. Administration records are completed appropriately and audited by senior staff regularly. The Registered Manager said that individual guidelines for medication taken on a when required basis are contained within care plans. Residents are treated with dignity and respect. During the visit, staff were observed to be kind and helpful, attend to residents needs in privacy and respond quickly when needed. Staff spoken with demonstrated a good understanding of individuals needs and described their roles well. Comments from residents spoken with included, I get the help I need with bathing and everything else; on the whole its all very good, the staff are normally polite and helpful; if I need to use the buzzer, they come quickly; I do my own medication, its locked away, the GP agreed to me doing it. Care Homes for Older People Page 13 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are recognised as individuals and are able to exercise choice over their lives. Residents feel suitably occupied and can choose to take part in group activities or pursue their individual interests; they enjoy keeping in contact with their relatives and friends. Residents benefit from a good quality varied diet. Evidence: People move into Bowles Lodge knowing the nature of the service. Residents are free to choose what to do each day. The pace of daily life is relaxed. They are encouraged to be as independent as possible. People can choose whether to spend time in their rooms or in the communal areas and the routines of the home are generally flexible. Residents spoken with said they could get up and go to bed when they wanted to. Residents can choose to pursue their own individual pastimes or to join in with group activities and events. Those organised by the home are requested by residents. Recently there has been an Easter bonnet making competition with prizes given and Care Homes for Older People Page 14 of 24 Evidence: photographs taken by a local newspaper. Examples of other activities and events include organ recital, day trips, outing to the coast, a visit from the local museum, bingo, trip to a pantomime, visiting schools and music groups and raffles; there is a summer fete. In addition residents have the opportunity to attend the day centre nearby, which offers a range of activities. Staff spoken with confirmed a range of activities provided for residents. There is a reminiscence area with items such as music, books, magazines, a piano and pictures. Comments from residents spoken with included, there is something happening on Easter Sunday; I know all about the Easter bonnet competition, I made one; the gardens are very nice; my relative visits me regularly; Ive been to the hairdresser today. Residents are encouraged to keep in contact with their relatives and friends if they wish. Visitors are welcome in the home at any reasonable hour. Those spoken with confirmed this and said that they are very happy with the home. Residents can choose whether to eat in their bedrooms or the communal dining areas. There are hot and cold options for breakfast, lunch and tea and people are able to choose what they want in advance. Staff are aware of residents special dietary needs, likes and dislikes and any allergies. Each wing of the home has a kitchenette area where snacks and drink making facilities are available. Residents are able to invite their friends or relatives for a meal in the home, which they can have in private or in the communal dining areas. Comments from residents spoken with included, the food is always very good; its always nice; you always get a choice; they come today to ask me for choices for tomorrow; there is a choice for all meals. Care Homes for Older People Page 15 of 24 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. The views of residents and their representatives are listened to and receive appropriate consideration. Procedures are in place, which aim to protect residents from potential abuse. Evidence: At the time of this visit, it was observed that residents were at ease talking with staff and the Registered Manager who listened to their views. Staff demonstrated a good understanding of residents. A positive relationship between both staff and residents with a good balance between professionalism and friendliness was observed. There is a written complaints procedure and leaflets available for residents and their relatives. There are regular meetings for residents and their relatives. Residents and relatives spoken with did not voice any complaints and none have been received by the home recently. Comments made by those spoken with included, I know how to complain; I get on alright with staff; on the whole its all very good; the staff are normally polite and helpful; I am very happy with the home and my relative is happy here. Procedures are in place, which aim to protect residents from potential abuse. The Registered Manager discussed action taken regarding the safeguarding of a vulnerable adult. They demonstrated a good understanding of the procedures involved. Care Homes for Older People Page 16 of 24 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. Residents enjoy living in a clean and comfortable environment, although they may benefit from minor repair. Residents are protected by a safe environment, although the covering of two exposed radiators would enhance this. Evidence: Residents enjoy living in a comfortable environment. All areas of the home are clean and tidy. Since the last inspection, residents have benefited from improvements to the environment and some areas have been re carpeted. Some facilities and equipment have been renewed or replaced such as the staff call system, some furniture and televisions, beds, some bath hoists and baths. Communal toilet floors would benefit from repainting. The Provider is recommended to renew the flooring surface in communal toilets. The gardens surrounding the house are well maintained and attractive. The home is divided into separate wings; each with a sitting and dining area and a kitchenette. The home provides a conservatory, activities room and hairdressing salon. Residents rooms are comfortable and personalised. Rooms are all for single occupancy except two, which can be used for people who are related or choose to share. Care Homes for Older People Page 17 of 24 Evidence: Adaptations and specialist equipment is provided to assist people with their mobility and bathing if necessary. Accommodation and facilities for residents are provided on the ground floor. The home is warm and light. In order to protect residents, hot water temperatures are tested regularly. The majority of radiators are either covered or have low surface temperatures, although two, one in the activities room and one in the hairdressing salon are not. Although residents are supervised by staff in these areas, the Provider is strongly recommended to either cover or provide guaranteed low surface temperatures for all pipe work and radiators in the activity and hairdressing rooms. The kitchen and laundry areas are maintained in a hygienic manner. There are plans for an extension of the laundry room. Residents spoken with said, the gardens are very nice; I could bring my belongings with me when I came; if I need to use the buzzer, they come quickly. Care Homes for Older People Page 18 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from sufficient numbers of appropriately recruited, qualified and trained staff who care for, understand and anticipate their needs and wishes. Evidence: It was observed that there were enough staff on duty to meet residents needs at the time of this visit; this was confirmed by records seen and staff spoken with. Bowles Lodge is staffed by a Registered manager, senior team leaders, team leaders, care staff and domestic, catering, administration and maintenance staff. Many people have worked in the home for some years. Staff spoken with confirmed they had worked in the home for over ten years. The home has a procedure in place which aims to recruit suitable staff who can meet the needs of residents. Records seen showed that residents are protected by appropriate pre employment checks. The home provides an ongoing programme of training for staff, which is designed to further develop and update their skills. Records show that appropriate courses and qualifications are undertaken. Staff spoken with confirmed this as including moving and handling, the protection of vulnerable adults, medication, first aid, food hygiene, dementia, fire, diversity, mental capacity, infection control and National Vocational Qualifications at level 2. Care Homes for Older People Page 19 of 24 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. Residents benefit from a competent, qualified and experienced Registered Manager. The home is aimed to run in the best interests of residents, although this may be enhanced by reviewing the frequency of some aspects of the quality assurance system. Residents are protected by the system in place for safeguarding their finances. Residents benefit from well supported and supervised staff. The health and safety of residents is promoted by the testing and maintenance of systems and equipment in the home. Evidence: The Registered Manager has many years experience of working with older people. They have a good knowledge of how the Service runs and have obtained an NVQ level Care Homes for Older People Page 20 of 24 Evidence: 4 qualification and completed the Registered Managers Award. The home has a system in place to assure the quality of the service provided. Residents are relaxed and at ease when speaking to staff and the Registered Manager. Regular meetings are held both for residents and their relatives. Audits are undertaken and the home receives monthly visits from a representative of the owners. The Registered Manager described a more formal system, which included using questionnaires; it was said that this would be undertaken shortly as it had not taken place for some time. The Provider is strongly recommended to complete their stated intention to ensure that quality assurance surveys and analysis are undertaken with appropriate frequency. The Administrator described how the home only keeps small amounts of cash on behalf of a few residents; most deal with their own finances or relatives do this for them. It was mentioned that people have lockable facilities available. The Registered Manager ensures that staff are supported to undertake their roles through both informal discussion and formal recorded supervision sessions. This was confirmed by records seen and by staff spoken with. Records of accidents and incidents are recorded appropriately. There are a range of detailed and comprehensive written policies and procedures designed to help carers complete their duties in an effective and consistent manner. Other records looked at as part of this visit have been mentioned elsewhere within this report where appropriate. Records generally indicate the testing and maintenance of systems and equipment within the home. The Registered Manager monitors the premises and the accommodation. This is done so that potential hazards to health and safety can be identified and addressed. Care Homes for Older People Page 21 of 24 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 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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