Care Home: Bowmans Lodge

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What the care home does well Bowmans Lodge provides the support and supervision people, who may have changing needs, require to live as independently as they are able within the community. People have been encouraged to follow individual interests that provide the opportunity for personal development and stimulation. People tell us they are happy with the service provided and are supported to keep in contact with their relatives. People are prompted to have the regular health checks they need. People are supported by a stable team of staff that they know. What has improved since the last inspection? A more person centred approach to recording people`s individual needs, goals and preferences has been introduced. The house has been redecorated and new furnishings provided so people have a bright fresh home to live in. The manager / provider has introduced an extensive programme of training and review of management, medication and quality assurance systems to make sure staff are up to date with current practice and changing regulations. What the care home could do better: The manager/provider needs to continue with the developments that have taken place to make sure the quality of the service and service user involvement in planning and reviewing their individual health & social care needs is maintained over time. We have advised the manager to get two people to countersign the hand written entries on the medication administration records, to confirm their accuracy, where these are not pre-printed by the pharmacist. Also to check with the dispensing pharmacist on the best way to record doses of medicines that are made up from different strength tablets so there are clear instructions for staff and stocks can be audited. Key inspection report Care homes for adults (18-65 years) Name: Address: Bowmans Lodge 46 Coombes Road London Colney Hertfordshire AL2 1ND     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: Sheila Knopp     Date: 1 2 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Bowmans Lodge 46 Coombes Road London Colney Hertfordshire AL2 1ND 01727823273 01727823273FP bowmanslodge@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr V Pyneandee,Mrs M Pyneandee Name of registered manager (if applicable) Mr V Pyneandee Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 3 The registered person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Bowmans Lodge is a privately owned and run care home, registered to provide care and accommodation for up to three younger adults with a learning disability or with a mental health disorder. The home aims to offer a supportive environment, to enable service users to gain or regain skills and to recover the confidence necessary for them to be able to move on Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 0 3 3 1 4 1 2 2 0 0 9 Brief description of the care home and live independently within the community. The home is a semi-detached house, situated in a residential area of London Colney. The accommodation is on two floors and includes communal areas and office/sleep-in provision for staff. The home operates a no smoking policy although a covered area is provided adjacent to the garden, where residents may smoke if they choose to. The front garden has hard standing for car parking; the rear garden provides additional seating areas for residents. Information regarding the service is available in the Statement of Purpose and Service User Guide, these and a copy of the most recent CSCI inspection report and current fee levels are available on request from the service provider. Care Homes for Adults (18-65 years) Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The information in this report is based on a visit to Bowmans Lodge by one inspector on 12th April 2010. Where this report refers to we it recognises that it is written on behalf of the Care Quality Commission (CQC). The visit was in the late afternoon to enable us to meet with the people who live there. We gave the manager short notice of our visit as we needed access to specific records that would not be available to other staff. As well as meeting individual service users we reviewed relevant care, personnel and health and safety records. We have reviewed the information we have received about this service since our last key inspection on 13th August 2009. This includes a random inspection on 14th December 2009 to look at the management of medication and staff training. The visit Care Homes for Adults (18-65 years) Page 6 of 25 confirmed the manager had taken the action we required. We made survey forms available to residents and staff so the views of a wider group of people could be included in our assessment of the service. Responses were received from 3 service users and 9 staff. We have not received any complaints about this service during the last year. We have also looked at the managers Annual Quality Assurance Assessment (AQAA). The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also provides us with numerical data. The assessment was detailed and provided on time. Care Homes for Adults (18-65 years) Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 25 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will be involved in an assessment of their needs, involving other people who know them, before they come to stay, to make sure Bowmans Lodge is the rights place for them to be. Evidence: To look at how people are involved in choosing to live at Bowmans Lodge we had conversations with the three people who live there and reviewed relevant records. The people living at Bowmans Lodge have previously confirmed they were able to visit the home and meet other residents before making their decision to stay. Before people come to stay the manager receives information from other health & social care professionals who are able to provide detailed information on the health, social and psychological care needs of the person concerned. The manager then carries out their own assessment to make sure Bowmans Lodge can offer a suitable service. Care Homes for Adults (18-65 years) Page 10 of 25 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Bowmans Lodge are involved in deciding how they wish to organise their lives and receive support to make decisions and manage any identified risks. Evidence: Service users told us I like this home as I can come and go when I like. It is a very relaxing place and I like it very much and I very much like being here and hope to spend my time fruitfully over the next few years. Each person living at Bowmans Lodge has a plan of care that they have agreed and is kept up to date. The format of the information has changed since our last visit and now reflects a person centred approach that sets out how people are involved in decisions about their lives and the support they need. The manager makes sure the annual reviews (CPA) involving service users and the community health & social care professionals who support them take place. Care Homes for Adults (18-65 years) Page 11 of 25 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to make decisions about their lives that enable them to use their talents and skills according to their individual circumstances. Evidence: We had discussions with three of the residents who live at Bowmans Lodge to find out whether they are encouraged to lead fulfilling lives that support their personal and cultural expectations. We found people had individual and flexible routines. People told us they are able to choose what to do and gave examples of decisions they had made. Individuals are able to make use of community facilities independently and follow their own interests. This includes opportunities for continuing with adult education courses and maintaining contact with relatives. Care Homes for Adults (18-65 years) Page 12 of 25 Evidence: People are able to come and go from their home as they wish and have their own key. Residents are involved in organising the food they wish to eat. They confirmed they are served good meals and spoke about favourite dishes individual staff members cook. Care Homes for Adults (18-65 years) Page 13 of 25 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in decisions about managing their health and are given support to maintain their dignity and take their prescribed medicines. Evidence: To confirm people are receiving the personal care and support they need we had discussions with the people living at Bowmans Lodge, reviewed relevant care records, polices and procedures and the systems for making sure people have their prescribed medicines. Personal support and prompting is provided according to the individual needs of the person concerned. This includes helping people to manage their own appointments and regular health checks. Each individual has a person centred plan of care that they have signed. The care plans set out how each person wishes specific needs to be met. They provide information to staff on specific triggers or changes that may indicate further support is needed or a different approach is required. Service users have an annual CPA review and health check with the relevant health & social care professionals. Care Homes for Adults (18-65 years) Page 14 of 25 Evidence: Our last key inspection identified specific issues with medication procedures. We reviewed these at a further inspection on 14th December 2009 and these had been addressed. The manager is making further changes to the systems and reported the dispensing pharmacist was due to visit the day after our inspection to provide further guidance. We have advised the manager to follow the good practice of getting two people to sign the administration chart when hand written directions are being added. This is to provide a further check that the correct information has been recorded. We also advised the manager to have a discussion with the pharmacist about the best way to record medicines on the administration record where doses are made up from tablets of varying strength. This is to make sure staff have clear instructions. Service users have signed a consent form agreeing to staff administering their medicines. The medicine procedure and staff training has been updated. There is a procedure for people to manage their own medicines subject to an assessment of risk if this is appropriate. Guidance on the use of medicines given as required (PRN) has been put in place alongside information about indications for use and other strategies to try. This is to ensure a consistent and appropriate response from staff and peoples rights are protected. Care Homes for Adults (18-65 years) Page 15 of 25 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that there are opportunities to raise any concerns they have with the staff and manager at Bowmans Lodge or during the regular contact people have with the other services and professionals who support them. Evidence: People living at Bowmans Lodge tell us they know who to speak to if they have any concerns and feel secure and comfortable. We have not received any complaints about the service provided at Bowmans Lodge between our visits and are not aware of any incidents, which would raise concerns about peoples safety and well-being. Recent training for the manager and staff has included the implications of the Mental Capacity Act, safeguarding vulnerable adults and re ponding to challenging situations. Service users look after their own finances and external advice and support is available to enable people to manage this area of their lives. Care Homes for Adults (18-65 years) Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Bowmans Lodge provides the people with a comfortable domestic style home to live in that gives them good access to the local community and bus routes. Evidence: Each person living at Bowmans Lodge has their own room with wash hand basin. They are able to add their own belongings to make their rooms more personal. There is a shared kitchen-diner, lounge with television and bathrooms. Steps lead down from the back of the house to a well screened garden, which has a lawn, patio and greenhouse. There is a covered annexe outside the kitchen where residents can smoke. Since our last visit there has been an extensive programme of redecoration and refurbishment. The house now has a fresh, bright modern feel. People told us they were invited to choose colour schemes and are encouraged to take part in the running of their home. The manager advised that the hot water temperatures in the bathroom are regulated at the tank. We advised that records of regular temperature checks are kept as part of a risk based approach to making sure the safety systems in place continue to be effective. Care Homes for Adults (18-65 years) Page 17 of 25 Evidence: The domestic style laundry arrangements are suitable to meet the needs of independent people. Staff have received recent infection control training so they understand any issues, which may arise. Care Homes for Adults (18-65 years) Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Bowmans Lodge can be confident in the staff who support them because checks are carried out before staff are employed, they see regular staff and staff training and supervision systems have been updated. Evidence: The manager has responded positively to the action we required him to take following our key inspection on 13th August 2009. A training programme has been put in place to make sure staff have the regular updates they need. Training certificates were available in staff files indicating the courses they had attended and the manager has an overall training programme to plan future activity. The people who live at Bowmans Lodge said they had good relationships with the staff who are available when they are at home. There is a mobile contact number so people are able to contact the manager/provider if their plans change. The records in the home confirm staff are receiving regular supervision and have the opportunity to attend meetings with other staff to discuss the running of the service. The staff who responded to our survey confirmed details of the training, supervision and management support they receive. Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: There is a long standing team of regular staff who know the residents. One new member of staff has been recruited since out last visit. We looked at the recruitment records and found that the required checks on their back ground and experience had been completed. All staff have recently had their criminal records checks renewed. The manager / provider has recently attended training on staff recruitment and selection to ensure he has up to date knowledge of the requirements in this area. Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Bowmans Lodge can be confident that the manager is keeping up to date with the professional knowledge required to provide appropriate support and maintain their safety. Evidence: The manager / provider of Bowmans Lodge has provided information about the range of courses attended since our last key inspection to ensure that he is up to date with the current management practices to provide an effective and safe service. This has included equality and diversity training so peoples individuality and rights are understood and promoted in light of current practice. We have been told that an external consultant has been commissioned to review the policies, procedures and quality assurance systems against the standards providers need to demonstrate compliance with from October 2010. This is a positive response to the regulatory changes taking place Clear records of safety checks are kept and individual risks are recorded as part of Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: each persons plan of care.The manager has attended a course on managing risk in the care sector and staff have attended relevant health & safety courses, including first aid and infection control. The people who live at Bowmans Lodge maintain their independence and no accidents or incidents have been reported to us. Care Homes for Adults (18-65 years) Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 25 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 Adults (18-65 years) Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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