Care Home: Bowmead

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What the care home does well The home gives good quality of health and social care to people whose lives have improved since coming to it. People are kept safe and protected from risk of harm, have lots of choice and are treated with respect. The environment is well kept and maintained. Staff are properly and fully trained to meet peoples` needs and get regular supervision to make sure this continues. People living at the home told us: `Generally they do everything well` (three similar comments), `I think they do everything well and the staff have been wonderful to me`, `As far as I`m concerned everything here is as good as I expected` (one similar comment), `I think the home is generally good and the staff do their best`, `I like the home because it`s quiet and the staff are nice`, `They look after me very well` (two similar comments) and: `They sit and talk to me and take me out`. Staff we surveyed commented: `Cares for residents. it`s very good`, `We provide a stable and social environment`, `The home does well with up to date information about the clients i.e. the care that`s given and welcoming new people into the unit`, `Provides excellent care for elderly service users` and: `I feel residents are quite happy here at Bowmead. You get the odd ones that would like to be in their own home. They are well cared for here, food is excellent. On the whole a happy, clean environment`. What has improved since the last inspection? Two requirements and one good practice recommendation were met: Staff are now being supervised much more frequently. This gives them regular opportunities to discuss their work and learn more about caring for people, Quality assurance surveys are done each year and results sent to the Commission. The next independent survey is due to be done shortly. Complaints are properly recorded in the right file and all concerns are taken seriously. Overall records had improved. However, more work still needs to be done on making sure daily records are written in person-centred and respectful ways, that focus on positives rather than just negative behaviours. All the above shows that people are kept safe by having well supported staff and are able to comment about their lives in the home. What the care home could do better: One requirement about consulting with and providing meaningful activities for people with dementia wasn`t met. There is very little in the way of suitable activities for this group of people, or those with cognitive impairment or mental health problems. However, we did find that the manager has put in place continuing staff training on how to meet this need. Therefore we will not repeat the requirement but will follow it up again at the next visit. We directly recommended to the manager minor improvements in the way of working that are included throughout this report. Two new good practice recommendations were made at this visit. One was to make sure that weight records are kept up where people are of low weight or have been losing weight. Any decision to change the frequency of weighing should be recorded so that the person`s health and fitness can be positively kept up. Efforts should be made to keep all plates and food hotter at mealtimes. This will give people greater enjoyment of each hot meal. We asked people living at the home what they felt could be done better. People told us: `I really don`t think there is anything they could do better` (two similar comments), `I find it adequate here and have nothing to complain about` and: `I don`t think there is anything`. Key inspection report Care homes for older people Name: Address: Bowmead 75 Hollway Road Stockwood Bristol BS14 8PG     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: Juanita Glass     Date: 0 2 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Bowmead 75 Hollway Road Stockwood Bristol BS14 8PG 01179039950 01179039951 brssbow@bristol-city.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Bristol City Council care home 46 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 46. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Bowmead is run by Bristol City Council and registered with the Care Quality Commission. It gives personal care only for older people over the age of 65 years. The home is situated within the residential area of Stockwood in Bristol and is close to a parade of local shops that includes a cafe. These allow easy access for people living in the home and there is a bus stop immediately outside. The home is arranged over two floors with lift access. The total fee payable for local authority care in 2008 is 488.16 pounds. Care Homes for Older People Page 4 of 31 Over 65 46 0 Brief description of the care home People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk The last inspection report was seen displayed in the entrance lobby and in other areas in the home. Care Homes for Older People Page 5 of 31 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: Before the visit, all information the Care Quality Commission (the Commission) has received about the service since the last inspection was looked at. We then drew up an inspection record in preparation for it. This record is used to focus on and plan all our visits so that we concentrate on checking the most important areas. At the visit we looked at four peoples care records, plus complaints, health and safety and staff records among others. We spoke with six people and three staff. We had used our Have Your Say surveys with people using the service and staff to find out what they think about living or working at the home. Twelve people and ten staff filled in the surveys. Their comments are included throughout this report. Care Homes for Older People Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: One requirement about consulting with and providing meaningful activities for people with dementia wasnt met. There is very little in the way of suitable activities for this group of people, or those with cognitive impairment or mental health problems. However, we did find that the manager has put in place continuing staff training on how to meet this need. Therefore we will not repeat the requirement but will follow it up again at the next visit. Care Homes for Older People Page 7 of 31 We directly recommended to the manager minor improvements in the way of working that are included throughout this report. Two new good practice recommendations were made at this visit. One was to make sure that weight records are kept up where people are of low weight or have been losing weight. Any decision to change the frequency of weighing should be recorded so that the persons health and fitness can be positively kept up. Efforts should be made to keep all plates and food hotter at mealtimes. This will give people greater enjoyment of each hot meal. We asked people living at the home what they felt could be done better. People told us: I really dont think there is anything they could do better (two similar comments), I find it adequate here and have nothing to complain about and: I dont think there is anything. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 31 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 9 of 31 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. Clear assessment information means peoples needs are highlighted and met wherever possible. Care staff have the required knowledge and skill to meet peoples diverse needs. Evidence: We looked at three peoples pre-admission assessments. These are done by social workers and the aim is to give a clear picture of the persons background history and need for residential care. We saw assessments that gave information about what had been happening to the person and why they now needed more care. Personal interests and hobbies were included on the assessment together with religious or cultural needs. Basic care plans were attached. From all information given care staff then start to put together a more detailed care plan, so that all needs are picked up and met. This happens throughout the four-week trial period. Care Homes for Older People Page 10 of 31 Evidence: We saw that social workers had visited to do follow up reviews a month or two after people had come to the home. Care records showed that staff at the home had signed to say they can meet individual needs. When people have been in hospital for some time and are fit to return to the home, members of the management team visit to re-assess their fitness to return. Where initial assessments picked up healthcare issues or a liking for different activities these had been transferred into the homes care plan. Staff at the home are trained and experienced in giving care to older people. They are not specialist workers but have the skills and knowledge to meet peoples needs. Training is given in more specialist areas such as dementia care, managing behaviours that challenge and mental health problems. The home isnt specifically registered as a dementia care facility. However, some people do have mild to moderate degrees of dementia and staff are skilled enough to be able to care for them and meet their needs. Of the five staff we sent surveys to before this visit, three said they were always given up to date information about the needs of people they support or care for (for example in the care plan) and two said usually. The home doesnt offer intermediate care (care needed to rehabilitate people with a view to returning home). It does however offer respite care (or short stays to give them or their carers a break) when people need it. Care Homes for Older People Page 11 of 31 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. Changes in peoples physical conditions arent always recorded properly that may mean their needs dont get fully met. Keeping of good and detailed records shows that people are well cared for and can comment regularly on the care they get. Proper management ensures people living at the home are looked after well in respect of medication needs and kept safe from potential errors. Being treated with dignity and respect benefits people living at the home. Evidence: We case-tracked three peoples care in detail. Case-tracking means looking at all records associated with the person and checking care given by talking with both them and staff caring for them. We saw that one person with some degree of cognitive impairment (this means an unclear or undiagnosed condition that could affect their memory and reasoning skills), needed lots of reassurance. Records showed that she or Care Homes for Older People Page 12 of 31 Evidence: he was given this and we saw evidence of staff reassuring her or him at this visit. Care plans are written in person-centred ways. This means looking at a persons whole life, history and needs. It recognises and values them as an individual with rights and choices, rather than just focussing on meeting basic physical care tasks. Care plans were written from the individuals own viewpoint e.g. P likes to and K wishes to. Therefore the plans were clear about the person and what s/he wanted. This approach wasnt carried through to daily records however. From our survey people commented about their care plans and whether staff involve them. Comments were mixed and included: Yes my care plan is discussed with me at length, I dont know much about my care plan, I cant really remember but I can look at it when I want, I never look at it and I dont know what its all about to be honest, Yes my care plan is discussed with me now and again and I am able to add what I want during the discussion and: Yes its discussed with me as and when and also in meetings. Records showed that a persons health and personal care had improved since coming to the home and that her or his fear and anxiety had reduced. We followed up a requirement from the last visit about making sure changes to care or behaviour are recorded. Some of the care records were up to date and showed that care plans are checked regularly and changes recorded. However, some didnt show that they had been looked at since July 09. For one person that had been losing weight, weight records werent being kept up weekly as highlighted on the care plan. We saw that the person eats well and also has food supplements to help gain weight. However, weight records hadnt been done since July 09. If people no longer need weighing as regularly this should be recorded together with clear reasons for the change. Another persons care plan showed no check since August 09. Staff must make sure that they record checks each month so that any change to a persons care can be picked up. We asked people if staff act on what they say they want to happen. Comments included: Yes they do. I might have to wait a short time for things sometimes but yes they do, Yes they always do (two similar comments), Yes but I never ask for anything really and: Yes if its at all possible. We followed up a good practice recommendation from the last visit about putting in place profiles of each person showing background, hobbies and family information. These had been done but werent always consistent. Some were good and gave a Care Homes for Older People Page 13 of 31 Evidence: clear picture of the person and their history, but some werent so good. Work should continue to find out as much as possible about peoples former lives so that they can be treated as individuals and their histories and backgrounds respected. Care plans included activities and leisure interests. Key time records (the time key workers spend with people one to one) showed how these interests were being kept up. Risk assessments were in place for moving and handling, behaviours, smoking and leaving the building among others. Healthcare records were easy to track as a GP visit sheet is kept with details of actions to be taken. Where peoples behaviour suddenly changes and becomes more challenging, staff do tests to see if the person has an infection that could be affecting their behaviour. The GP is called and antibiotics started quickly. Flu jabs are given each winter to every person who wants one. Other healthcare professionals such as chiropodists, audiologists, opticians and staff from the mental health in-reach team regularly visit and these were recorded. We asked people in our survey if they get the medical care they need and all said always to this question. Daily and keytime records gave a good indication of peoples lives in the home and covered emotional needs, activities and their enjoyment of life. However, some records were basic, not particularly person-centred and some focussed on more negative than positive information. This was more often the case where people have behaviour that challenges staff. The manager should keep a regular check on daily records so that staff learn to write in more positive and person-centred ways and people with mental health problems arent discriminated against. We checked medication. We had seen a note in the management message book about gaps in medication records. We checked individual administration sheets but found no gaps. Controlled medication (that which is subject to legal controls) is recorded in a special book kept for the purpose. We checked amounts against those recorded and found them to be accurate. All controlled medication was signed for and witnessed by two members of staff. The returns book (for any medication not taken or no longer needed) was properly filled in and signed by the pharmacist. However, we didnt see a reason for the return of medication recorded and recommend that this is done. We watched medication practice at lunchtime. All was given properly and people were given clear information about taking it. One person chose not to however, so the tablet was put in the returns pot. One person commented in our survey: They give me my medication when I need it. We saw people being treated with respect. The atmosphere on the first day of our visit Care Homes for Older People Page 14 of 31 Evidence: was buzzing and animated. The second day was completely different - much quieter. We asked people if they felt staff treat them with respect and their comments were largely positive: Yes Im treated with respect (two similar comments), Talk to people about knocking on doors, Oh my God yes. They have been wonderful to me, If Im not Id soon let them know. I give respect so I expect to receive it back and: Yes Im treated respectfully at all times by the staff. Care Homes for Older People Page 15 of 31 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. The home continues to give people living at the home opportunities to have a stimulating and varied life where various formal and informal activities happen regularly. Encouragement of contact with the community helps people stay in touch with what is happening outside the home. Few restrictions placed on people living at the home gives them lots of choice in a relaxed atmosphere. A continuing issue with meals may stop people from being fully satisfied with the standard of them. Evidence: We looked at activities records and followed up a requirement from our last visit about consulting with people with dementia and making sure activities that are meaningful to them are put in place. This work is still ongoing. We saw that the occupational therapist from the local mental health in-reach team (that supports care homes) had come in to do a training session on person-centred activities but staff hadnt been told Care Homes for Older People Page 16 of 31 Evidence: about it so it didnt happen. The manager later told us that she had been in again in September and did a session with management team and night staff. A further session is planned for the rest of the staff team in late October. We asked people in our survey - does the home arrange activities that you can take part in if you want? Ten people said always and two said usually. One person commented: They have activities in the unit. They always ask me but I never attend. We saw a programme of activities for September 09. They included: Happy hour (with a glass of sherry, Karaoke, singing and dancing), musical entertainment and quizzes, slide shows, music and movement sessions, craft sessions (e.g. people made photograph frames) and a clothes show. Some of the activities had photographs and one of the finished photo frames was in the activities record file. Lots of photos were displayed on a notice board in the main corridor and showed enjoyment of parties held for different occasions, gardening sessions and trips out. We looked at residents meeting minutes from over the past year. Activities, outings and entertainment are regularly discussed. We saw that a Chocoholics party held in May 09 was enjoyed by all and people said they would like another! Activities records were all properly written up with numbers and names of people and information about their enjoyment of each event. However, staff we surveyed commented: If there were more staff, there would be more social events and service users could have (e.g.) trips and: It would be nice if we had more staff to be able to take some of the residents out e.g. more like pub lunches, on a regular basis. I know they have trips but only 2 to 3 a year. Contact with the local community is kept up by people going across the road to the wide variety of shops and cafes etc. Shopkeepers know people from the home and quickly contact staff if someone falls or is unwell while out. Some people go to the shops or cafe with key workers in key time. People from a local church visit and hold church services once a month that are well attended. The home now has an administrator who helps with management paperwork and has taken on the writing of a regular newsletter called Up on the Hill. This comes out every two months and people were seen reading or carrying the latest edition. The newsletter has lots to interest people and includes, among other things: poems, funny stories and photographs, peoples birthdays, forthcoming events and bits of local news from around the west country. We also saw profiles of both a person living at the home and a member of staff. These are particularly good as they give lots of information about the person concerned that helps others get to know them better. Care Homes for Older People Page 17 of 31 Evidence: The newsletter had been discussed at residents meetings and feedback given was good. People are able to contribute items to it if they wish and people had asked to have articles about themselves put in.The newsletter and its content are therefore commended. We asked people about whether they have enough choice in the home and whether they can get up and go to bed when they want. They told us: I need help to go to bed so if a staff member doesnt turn up by 8pm I use my call bell, There are no rules here at all, I can do what I want, I can do what I choose to do, I can do what I want but I need help as Im not very mobile, especially first thing in the morning and: We are not restricted at all here. People are able to choose what to eat, what to wear, where to sit and whether they want to watch TV or do something else. They can go out, either on their own or with staff. Theyre free to walk about all areas of the home if they wish. People have a choice of menu and diet (e.g. for vegetarians) is respected and catered for. Menus are written up on a blackboard in the dining room so that people can see whats on offer each day. We sampled lunch with people on one of the days of our visit. They had a choice of fish and chips or corned beef and chips with peas or baked beans. Vegetarian meals were specially prepared for those that wanted them. The meal was tasty and people clearly enjoyed it, even those with smaller appetites. There is a wide variety of hot and cold desserts brought round on a trolley and people can choose what they want in whatever combination they like. We asked people do you like the meals at the home? Seven said always, three said usually and two said sometimes. One person did however comment on the timing of meals saying: I think supper time could be a bit earlier. People get breakfast either cooked or just cereals and toast, lunch, a cooked tea and supper with sandwiches, cake and biscuits. They also get fruit thats taken around on the afternoon tea trolley. From minutes of residents meetings we saw that people are consulted on menu choices and are able to say what they like or dont like and other dishes they would like added. Healthy eating options have been discussed as well as over use of things like salt in the meals. We saw that comments about the meals were generally very positive. We did see however from the March meeting, that people said they would like the plates warmed a bit more as sometimes the food can be a bit cold. We agree with this statement as the plates werent warm when we ate with people and the food was lukewarm. As this affects enjoyment of the main meal of the day, the manager should find better ways to make sure food and plates are always kept hot before serving. Care Homes for Older People Page 18 of 31 Evidence: Care Homes for Older People Page 19 of 31 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. Satisfactory complaints management and recording ensures people living at the home can be confident in raising concerns about any aspect of their care. Arrangements for protecting people living at the home makes sure that they are protected from risk or harm as far as possible. Evidence: We followed up a good practice recommendation about making sure complaints are recorded in the file kept for the purpose and in enough detail to show timescales and outcomes are clear. We looked at the homes complaints file and also checked the message book (as concerns are sometimes recorded there instead of in the proper file). All complaints were properly recorded with timescales, action taken and outcomes, in the right file kept for the purpose. Four complaints had been recorded. These were all about care practice. Clear investigation and actions had been put in place and showed communication with the person making the complaint about the result. One complaint was from a relative and this had been dealt with by a team manager from the Elderly Persons (EPH) team that oversees all care homes. An improvement plan had been put in place that included staff training, review of care practices and improvement in communication with people and their relatives. Care Homes for Older People Page 20 of 31 Evidence: People can complain directly to the manager and a more accessible leaflet with pictures has been put in place to help people. Details of how to make a complaint are on notice boards and copies of the leaflet are available. We also saw that the leaflet had been put on audio tape and in braille for people with sight difficulties. This is good practice. We asked people if 1) they know who to speak to if theyre unhappy and 2) how to make a complaint. To the first question all said Yes. To the second question nine said yes and three said no. Any abuse allegations had been properly dealt with by the manager. All allegations are reported to both the Commission and the local authority safeguarding adults from abuse team. Only one incident had been reported in the last twelve months and we had attended protection planning meetings. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a comfortable, clean, safe environment that is well decorated and looked after, physically accessible and meets their needs. Evidence: Bowmead is a 40-bed care home built in the 1960s. Its set out on two floors with a number of lounges on both, plus a smoking room and large dining room on the ground floor. Each bedroom contains a wash basin, single bed, wardrobe and chest of drawers. There are no ensuite facilities in any room although toilets and bathrooms are available on each corridor. Rooms are of different sizes. Some are larger (having been double rooms at one time) and some smaller. Each room is decorated differently and people can bring in pieces of their own furniture if they wish. Each bedroom is furnished following National Minimum Standards guidance. People living at the home are consulted about decor when rooms are being redecorated. Evidence was seen of this at this visit. It includes choosing wallpapers for both their own rooms or communal ones and curtain material for one of the lounges.However one staff member commented in our survey on what could be done better: decorating some of the clients rooms as they would like so that it could be like their home. There is a courtyard garden with flower beds and pots where people can do gardening Care Homes for Older People Page 22 of 31 Evidence: or sit out in fine weather. There is also an area laid to lawn at the back and side of the home. The home has been made as accessible as possible to meet older disabled peoples needs. There is a lift, accessible bathrooms and toilets and some bedrooms are large enough for wheelchair users or those needing medical equipment such as oxygen. Reasonable adjustments are made wherever possible to meet disabled peoples needs. The decor of the home was good at this visit. Several rooms had been redecorated. Peoples bedrooms were homely and they can choose to stay in them or use any of the lounges. The main lounge on the ground floor was full at our visit and one person complained that she had nowhere to sit. However staff took her to another lounge where she settled happily. We spoke to one person who complained about the firmness of her/his mattress that stopped her/him from sleeping. S/he said s/he had told staff but nothing had been done about it. We checked but nothing had been recorded as a complaint or on her/his care records. The duty manager immediately followed it up and arranged for the mattress to temporarily be made more comfortable. We spoke to the person the next day who said that staff had made the bed more comfortable and s/he had had a better nights sleep. The duty manager said the manager was ordering more mattresses but these hadnt arrived. A new one would be ordered as soon as possible. When we spoke with the manager two weeks later she told us the new mattress had been put in place and the person was now feeling much more comfortable. We asked people if the home is kept fresh and clean. Ten people said always and two said usually. The home smelled fresh throughout. Bathrooms and toilets were all very clean and domestic staff were seen working around the home. We saw new signs on all doors that show the use of the particular room. Bathrooms and toilets had pictures on that show their purpose. Each bedroom had a framed picture of a bed with the persons name above it. This is good practice and helps people find the room they need more easily. Care Homes for Older People Page 23 of 31 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. Whilst numbers of permanent staff are low and there is regular reliance on agency staff, good management makes sure the quality of life for people living in the home isnt affected. People living at the home benefit from a well trained and qualified staff group that is able to meet their needs. However, attention to recording training in safeguarding adults will make sure people continue to be kept safe. Evidence: During the two days of our visit we saw that care staff were on duty in such numbers as to meet peoples individual needs properly. However, the majority of the staff working at the time were from an agency. We spoke to two agency staff who had been working regularly at the home for several years and know peoples needs well. They said they like working at Bowmead and would like to work there permanently. However, because of the proposed Residential Futures programme (the plan to close some of the local authority homes and change the way care is provided), a freeze on staff recruitment means that theyre unable to apply. Staff showed good understanding of peoples needs and person-centred care. They told us they would like to spend more quality time with people and talked about the gardening session they did. They confirmed that they get supervision and access to inCare Homes for Older People Page 24 of 31 Evidence: house training plus training from the agency that employs them. They confirmed that they have done safeguarding adults from abuse training and staff files we looked at confirmed this. Agency staff arent able to take advantage of the National Vocational Training (at Level 2) that permanent staff do and that they would like. This is a missed opportunity for both them and people they care for to develop greater skill and knowledge in care practice. We looked at a wide sample of care staff training records. These showed that both permanent and regular agency staff have done dementia awareness and care training. Permanent staff had also done person-centred care training and dealing with challenging behaviour. We followed up a requirement made at the last inspection about making sure all staff do safeguarding adults from abuse training. This was partly met. However, for some staff (particularly night) there was either no training recorded or it was well out of date.The manager should therefore find ways of making sure that safeguarding training is regularly done by all staff, properly recorded and updated. Training records showed evidence of NVQ Level 2 being done, plus fire safety, moving and handling, and other essential training such as emergency aid and health and safety. Care Homes for Older People Page 25 of 31 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. Good management particularly in staff training, supervision and health and safety, makes sure all aspects of running the home meets the needs of people living there and keeps them safe. However, failure by the provider to adequately support the team when there are pressures on management may put people at risk. Suitable ways of making sure people can comment about life in the home helps them to be sure their views and opinions will be taken note of. Peoples finances are well managed that makes sure they are protected from financial abuse. People get consistent care from a staff team that have improved opportunities to regularly discuss and get support for their working practices. Satisfactory management of health and safety in the home makes sure people are kept safe. Care Homes for Older People Page 26 of 31 Evidence: The home manager was on annual leave at the time of this visit. An experienced care assistant who regularly acts as a duty or relief officer, was available during the two days. She was able to supply us with information and was open and welcoming to the inspection. However, she was under a great deal of pressure as other members of the management team were all either on leave or unavoidably absent. This person was due to go on leave the second day but had no one to take over from her. We observed all her efforts to find suitable management cover, but she had little success. On our advice the homes team manager was contacted. We were disappointed that support for this matter wasnt initially forthcoming and the team manager asked the duty officer to continue to try and find cover. As she was, among other things, dealing with staff management, peoples care needs, the giving of medication as well as having to deal with an inspection, our view is that this wasnt supportive and didnt make sure that the home was being run in the best interests of people living there. Eventually we spoke with the team manager who said she had managed to find cover from other homes. We had been sent the quality assurance report that was done in June last year. This showed that satisfaction with the home ranged from 75 (for daily life and activities) to 82 (for management and administration) out of a 100 . An action points sheet had been added so that the manager could take action on less positive comments and issues raised. From our findings at this inspection, the manager and her team have worked hard to improve record keeping and give people a good quality of life in the home. We did a random check of monies held for people. Cash is kept securely and proper balance sheets are kept to show income and expenditure. Separate sheets are kept that staff fill in if they take money to buy things for people. These show amounts taken and returned, a description of items bought and are signed by members of the management team. All balances we checked were right and there were no errors in accounting. People can therefore be sure their money is handled properly. We followed up a requirement made at the last visit about making sure staff get regular supervision. We checked a sample of care staff supervision records and nearly all showed improvement. Many staff averaged over six sessions a year and some had had eight. Staff are able to comment on their work with people and get advice. Theyre also encouraged to read the inspection report so that they can see whats done well and where they could do better. Staff had also had individual yearly reviews and reports of these were in each file. These give staff an opportunity to reflect on the past year and what training they would like to do. Care Homes for Older People Page 27 of 31 Evidence: We looked at health and safety records. Records of weekly checks were all done and signed for. These include fire safety and water temperature checks. Fire training is done regularly for all staff. Fire drills had happened regularly and night staff had had walk through drills that tests their knowledge and shows evidence of what action they would need to take in the event of a fire at night. One staff member raised with us a question of health and safety. This was about peoples walking aids in the dining room. A number of people use the aids and want them kept by their chairs at lunchtime in case they need to leave the room. Staff said they were concerned that this was a health hazard as they carry plates of hot food and try to move trolleys around in a limited space. Also there is a risk to other people falling over them. Keeping the frames all in one area of the room had been tried but this meant people didnt have access to them when they need them. We discussed this with the manager at a later date. The manager should make sure that people have access to their frames when they need them as its in their best interests, but also look at the way the dining room is set out and assess the risk of accidents happening. Care Homes for Older People Page 28 of 31 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 29 of 31 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 1 7 Weight records should continue to be kept regularly when this is an identified need on peoples care plans. Decisions to stop weighing people should be clearly recorded. This will make sure people are kept healthy and safe. Ways should be found to make sure food and plates are always hot enough before serving a main or cooked meal. This will make sure people have proper enjoyment of their food. 2 15 Care Homes for Older People Page 30 of 31 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. 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