Inspection on 15/01/08 for Bradbury Court

This is the latest available inspection report for this service, carried out on 15th January 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Similar services:

Ashlong House

Spring Lane Care Home

Avenues (The) (Neave Crescent)

Barrington Lodge Nursing Home

Beacon House Nursing Home

St Mary`s Convent & Nursing Home

1-3 Frederick Gardens

The Royal Star and Garter Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Bradbury Court 65-77 Welldon Crescent Harrow Middlesex HA1 1QW Lead Inspector Clive Heidrich Key Unannounced Inspection 15 and 16th January 2008 08:15 th DS0000070245.V351710.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000070245.V351710.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000070245.V351710.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bradbury Court Address 65-77 Welldon Crescent Harrow Middlesex HA1 1QW 020 8901 2990 020 8901 2998 manharrow@v2net.co.uk www.grooms-shaftesbury.org.uk Grooms-Shaftesbury Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Janet Marilyn Hill Care Home 21 Category(ies) of Physical disability (21) registration, with number of places DS0000070245.V351710.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Physical Disability - Code PD The maximum number of service users who can be accommodated is: 21 The home, under a previous provider organization, was last inspected on 29/9/06. Date of last inspection Brief Description of the Service: Bradbury Court is owned and run by the Grooms-Shaftesbury organisation, a national voluntary-sector organisation that specialises in care services for people who have disabilities. The home itself provides residential care for up to 21 adults who have physical disabilities. The home is situated on a residential road, close to Harrow’s main shopping centre. It is a modern, purpose-built building providing spacious accommodation on three floors and has been designed to complement the local houses. The home has two wheelchair-accessible passenger lifts that have controls in Braille and voice announcements to assist people with visual impairment. Residents each have large bedrooms with en-suite bathrooms and kitchenettes. There is a range of fully accessible community facilities. The home has offstreet parking area for about ten cars. At the time of the inspection there were two resident vacancies. The manager stated that the current scale of charges is from £1320 to £1550 a week. The Service User Guide is available on request, and is given out when people come to look around. DS0000070245.V351710.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The service was requested to complete an Annual Quality Assurance Assessment (AQAA) well in advance of the inspection. This provides the service with the chance to explain how it meets the National Minimum Standards. The AQAA was duly returned to the CSCI in good time. Surveys were sent to the home after receipt of the AQAA. These were distributed by the manager. Surveys specifically for residents were however delivered directly by the inspector to one resident, for them to distribute to other residents. Their help with this is much appreciated. Surveys were overall returned from ten staff, one relative, one health professional and one resident. Their views have been incorporated throughout the report. The unannounced inspection itself took place across two consecutive days, lasting a total of twelve hours. During this period, the inspector met with residents, staff, the manager, and visiting healthcare professionals. Key areas of the environment were checked. Specific records were viewed. Half an hour was spent directly observing the care being provided to some of the residents in communal areas. The manager was provided with feedback at the end of the visit. The inspector thanks all involved in the home for their patience and helpfulness before, during, and after the inspection. What the service does well: Most feedback received about the home was positive. Feedback from residents included, “it’s a very good home” and “it’s the best home I’ve lived in.” Comments from health professionals included, “it’s a fantastic home” and “the service respects residents as individuals.” The home exceeds environmental standards. It was purpose built eight years ago, and remains a leading example of how to design facilities to meet the needs of people who have physical disabilities. Residents receive good support to lead independent lifestyles of their choice, both through the environment and through the attitude and support of staff. They are consulted on many aspects of how the home operates. The home provides residents with excellent standards of support with community presence. Residents have a strong say in what is organised. Two staff members are employed as activities co-ordinators to lead activities. The DS0000070245.V351710.R01.S.doc Version 5.2 Page 6 home has two vehicles that can safely transport a number of people in wheelchairs. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by DS0000070245.V351710.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000070245.V351710.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000070245.V351710.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents are met with to discuss their needs and preferences. Information about the home is provided to them, and they are encouraged to visit the home. All of this helps the prospective resident with decisions about moving in, and the service with ensuring that it can meet the new person’s needs. EVIDENCE: Three people have moved into the home since the last inspection. The movingin process for two of them was considered, including meeting these two people. Both reported satisfaction with the process, which included visiting the home in advance. One person said that the deputy manager “showed me around the home.” It was confirmed that this process included the opportunity to meet other residents, and to have a meal. Paperwork on individuals’ files showed that other aspects of an appropriate moving-in process were followed. The home provided the prospective resident with a form to fill in about their needs and preferences, and a similar form for their social worker where applicable. Formal needs assessments were acquired from the social worker. A visit was also made to the prospective resident DS0000070245.V351710.R01.S.doc Version 5.2 Page 10 where they lived at that time, so that management at the home could meet them and their representatives (e.g. family) and discuss the person’s needs. Records of this were kept. All of this was undertaken in a timely manner. Once people decided to move into the home, it was apparent that a moving-in checklist was followed to help them with getting to know the home and settling in. Needs assessments were also undertaken within a day, to help form an initial picture of the support that the person needs. Formal review meetings with the funding authority, between one and two months later, then checked that the placement was working. There have been no decisions to move back out at this stage, and those review meeting records checked found confirmation of the placement working. As one resident stated to the inspector, it is “the best home I’ve been in.” One of the people spoken with stated that they did receive a handbook about the home when moving-in. The manager confirmed that these are given out to new residents, and to anyone who visits to look around. The handbook (‘Service User Guide’) has been updated by the manager to reflect that Grooms-Shaftesbury now runs the home. DS0000070245.V351710.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. Residents make decisions about how to live their lives. Different lifestyles are respected by the service. Support with decisions is provided where needed. Independence is appropriately enabled. Each resident has an individual plan, which they are consulted about, and which is followed by the service. Residents are consulted about how the home operates. EVIDENCE: There was a strong standard of residents being able to make decisions about their lives. Feedback from residents spoken with confirmed that they choose what to do in the home, for instance about when to get up, and with what activities to pursue. They also confirmed that they have a choice of keyworker. Residents were seen to have freedom of movement around the home. Observations of care practices showed that staff provide support where needed at mealtimes and that residents are routinely asked what they would like. Meal choices are displayed in advance of meals. Complaint records upheld points DS0000070245.V351710.R01.S.doc Version 5.2 Page 12 where residents’ choices were not respected. Records about residents included about people making choices and refusing particular services. Residents’ meetings are held every month. Records of these showed for instance about discussions on how to vote at the next set of elections, which resulted in three people deciding to register for postal votes. The minutes also showed discussion on who wanted to attend which Christmas activities, and about changes in staff. Meetings were seen to be informative and consultative. There was no significant change to the care-planning process since the last inspection. Three residents’ care-plans were checked in detail. The Standex system is used. This provides for good details of residents’ individual needs and wishes as it makes prompts in many key areas. The system includes a section on the particular support needs that the individual resident has, for instance detailed descriptions of PEG-feed support, the person’s preferred morning and evening routines, and about leg care for one person when hoisting them. In two cases, the records were signed by the resident, which indicates consultation and agreement. One resident was able to confirm this consultation. The files were reasonably up-to-date and generally matched feedback from residents about the care they expected. Three residents confirmed that the support they get from staff matches their expectations, one noting “good support” in particular. One resident noted that they would like to have a copy of their care plan. The manager confirmed that residents can view care plans at any time. Consideration should be given to enabling each resident, unless an individual objects, to own a copy of their care plan in a format that they can most easily use. This for instance could mean re-writing plans in larger print, using pictures and photos, and/or making summaries. The needs and wishes of the individual resident would be the guiding factor. The risk assessment file had up-to-date and individual assessments in place for some residents, including signatures of the resident in some cases. These included for instance about the risk management of falling, spilling drinks, and of not using footplates on their wheelchair as per the resident’s wishes. For newer residents, the file was not being used. Instead, their care assessments included details of pertinent risks and their management, for instance about falls from the bed and the wheelchair, and about nutrition and hydration. Care files also generally included manual handling assessments. Feedback and records found that those residents checked on have had formal review meetings about their placements in the home within the last six months. These have involved the residents and their social worker, along with representatives from the home and any invited family members. This is appropriate. Feedback and records confirmed that action points from these meetings are addressed by the service at the home where applicable, which is encouraging. DS0000070245.V351710.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. People who use this service experience an excellent outcome in this area. This judgement has been made using available evidence including a visit to this service. Residents are provided with excellent standards of community support to attend places of their choice, backed with good standards of activity provision in the service overall. There are excellent standards of upholding residents’ rights and preferences, and good standards of providing support with relationships. Residents are provided with good standards of nutritional food based on their choices. EVIDENCE: The home has two people specifically employed to provide activity support, whose hours are flexible enough to enable for instance regular support in the evening. Residents confirmed that they are consulted about what they would like to do, and are provided with a wide variety of options. The home has two adapted vehicles, able to take four and three wheelchairs respectively, and DS0000070245.V351710.R01.S.doc Version 5.2 Page 14 there was feedback about staff being aware of which train stations locally and in London are best adapted for easy wheelchair use. Residents’ feedback about activities included “there is always something going on”, “there is a new yoga class”, and “there’s more here than where I used to live.” A number of residents said that there is a lot going on. Residents confirmed that advertised activities always take place. During the visit, the inspector observed residents playing pool, using a computer, making a phone call in the private phone area, receiving aromatherapy from a specialist, chatting with staff in the dining area, and going out. On the first day of the inspection, three people were going to an evening performance of ‘The Sound of Music’ in the West End. Reports the next day included that the show was loud, and that everyone coped with the rain. One resident noted that a local school would be making their weekly visit that afternoon, which they were looking forward to. Management confirmed that two schools visit, to provide companionship and play music, which some residents enjoy and others actively avoid. Records and feedback found that the range of recent community activities include going to Premiership football matches, going to the local cinema, going to various music concerts such as for Rod Stewart, visiting family and friends, ice-skating, and day trips to such places as Southend during the summer. A number of residents also go on holiday with support from the home, for instance through transportation to and from the venue. The manager noted that there was clear emphasis by the activity team on including everyone within their plans, including those who do not speak up and those who do not like going out, so providing in-house activities instead. In terms of religion, the manager noted that some residents are supported to attend church. There were records and care plans about some people being involved in church groups. Records showed that one person with a different belief was being supported to attend a college course about the belief. A number of residents stated that they have their own phone in their room, which allows private calls in and out of the home. Another stated that if they want to make a call, they go into the office to ask, and that staff both support and provide privacy. Staff were seen to consult with one resident about their phone bill, looking at ways of supporting them to cut down on the cost by using different connection options. A few residents also positively stated that mail is given to them unopened, which one resident noted is “important.” Mail by a resident was seen to be taken for posting by staff. Residents confirmed that their visitors are welcomed into the home. One resident stated that they receive support to visit family. The one relative survey noted that the home always helps their relative to keep in touch. Care plans were seen to reflect the resident’s family involvement. DS0000070245.V351710.R01.S.doc Version 5.2 Page 15 There were varying opinions expressed about the food. Some residents stated that they like it, whilst others were less impressed. A common theme was about wanting more variety. An example given was that it is always fish on Friday, for which one person stated, “twice a month is enough.” Another noted that both options for that meal are fish. Checks of the recent menus found that there are two different hot dishes provided for the main meal, along with a hot and a cold option for the second meal of the day. There was no significant repetition of these meals across the three weeks sampled. However, it was always fish on Fridays, with the two options appearing to vary only in terms of one being a ‘healthy-living’ version. The regular Friday fish options on the menu should be further considered, to see if any alterations could meet residents’ collective preferences better. Management noted that they go through the menus every three months via residents meetings, and that all residents received a copy of the optional menu. This menu can provide for different dishes to the two advertised meals if ordered at least an hour in advance. One resident confirmed that the options are always put on a board near the kitchen in advance, and that they like these alternatives. The manager also noted that requests made by residents can result in one of the cooks going out to the local supermarket to get the ingredients. Individual diets such as for vegetarians are also catered for. Observations at lunch found that adapted cutlery was available where needed, residents’ choices were respected, staff provided good support to residents that needed it, and that most residents ate the meal provided to them. A check of the kitchen found it to be clean and well-stocked, with two designated people working there before and during lunchtime. DS0000070245.V351710.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. The service at the home provides residents with good standards of individualised personal support and medication support. The service capably supports residents with health needs and there is appropriate liaison with health professionals. EVIDENCE: Feedback from residents about personal support was positive, people for instance stating that they feel well-cared for and that staff know about their individual needs. The relative’s survey stated that support is usually provided as expected. A health professional survey stated that the service “looks after the residents really well, cares for them appropriately, and seeks help from medical teams appropriately.” There was evidence that the care plan preferences of one resident in terms of clothing were seen to be followed in practice. It was also positive to note that two recorded complaints about disliking having to wait for staff support were upheld and resulted in apologies to the involved residents. DS0000070245.V351710.R01.S.doc Version 5.2 Page 17 Feedback from residents was positive about acquiring health support. One relative noted that one of the things the home does well is “making appointments.” One resident agreed with this, whilst another noted that a couple of recent appointments had been mismanaged. The inspector observed a similar case during the second day of inspection, where a planned appointment for one resident to a Central London hospital had to be cancelled. However, diary entries, letters from the hospital, and feedback from staff strongly suggested that people working at the home had done their very best to enable the appointment to happen. There was for instance an extra staff member working just to provide support at the appointment, and a number of staff were seen to make great efforts to try to address the sudden issue that had caused the ultimate cancellation of the appointment. It is therefore judged that the service makes more than reasonable efforts to enable planned health appointments to happen. Records and feedback showed that residents are supported where needed to access a broad range of healthcare professionals. Records showed for instance about accessing the GP, dentist, optician, chiropodist, wheelchair services, specialist clinics in hospitals, and district nurses. It was possible to establish that where concerns about health arose for an individual resident, prompt action was taken. Feedback from a couple of health professionals indicated very good support from staff, for instance, that health care needs are always properly monitored. It was not easily possible to track the outcomes of planned appointments for some residents in a couple of cases. This was because updates in the relevant section of the resident’s health records were not found. Greater care should be taken to update this section, to more easily enable consistent care. Feedback from three residents about how medication is handled was positive. Comments included “I got medication for a cold”, and “staff don’t forget.” A health professional confirmed that the service always supports people to administer their own medication where possible. A few residents self-medicate. A check for one person found that the process had been risk-assessed by the service. There was additionally a record of the GP stating that they have no concerns about these particular people self-medicating. The home has a separate room for medication storage, if people are not looking after their own medications individually. The room was found to be clean and tidy, with a medication fridge being used where needed. A blisterpack dosage system that is pre-packed by the supplying pharmacist is used. Any interim changes are recorded about in a communication book available in that room. Checks of three residents’ medications against the administration records found all expected medicines in stock and all records up-to-date. There were DS0000070245.V351710.R01.S.doc Version 5.2 Page 18 also individual records of quantities of medications coming into the home, and of any returns to the pharmacist, which enables straightforward auditing where needed. Those staff that administer medication have received formal training in that respect from the pharmacy. The manager noted that some staff were internally checked for capability around administering medication. There have been no medication errors notified to the inspecting authority since the last inspection. DS0000070245.V351710.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Both of them. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. Residents can be confident that any concerns raised will be acted on by the home’s management, with feedback being provided to them. The home has systems in place at the home to reasonably protect residents from the risks of abuse. EVIDENCE: Feedback from residents, and the resident survey received, found that residents know how to make complaints. One person for instance stated that they “would speak to manager if there was a problem.” It was noted that past residents’ meeting have included reminders on how to make complaints and about what would happen. One resident noted that the complaints process is in their copy of the handbook about the service. The staff surveys received also found that everyone felt that they know what to do if someone raises concerns about the home. The complaint book had records of eight complaints in 2007. One was being investigated in a timely manner, others had been addressed within appropriate timescales. All bar one were from residents, about issues such as having to wait for care, staff doing things without asking, and the taste of specific food. The other was from a relative. The majority were upheld, with proportionate actions being taken to address the issues. This fully addresses shortfalls found at the previous inspection. There have been no complaints made directly to the inspecting body since the last inspection. DS0000070245.V351710.R01.S.doc Version 5.2 Page 20 Those residents spoken with generally confirmed that they feel safe in the home. One person spoke about not being introduced to new people working in an official capacity there, citing students present during the visit as example. Management took this onboard, confirming that information hadn’t been provided properly to residents about the students. Suggestions of a visitors’ board for residents to be aware of who is present, and of ensuring as far as possible that all official visitors display identification, should be considered. The home has an updated policy on abuse prevention. Staff were made aware of it at a recent staff meeting. There are also appropriate guidance brochures from local authorities available for consultation, should an allegation of abuse be made. One allegation was made since the last inspection, of verbal abuse. It was reported to relevant organisations, with agreement for internal investigation. Checks of a sample of recent incident forms found nothing that should have been referred externally as a safeguarding issue. Examples of incidents reported about to the home’s management included a resident slipping during a transfer between seats, and of a resident momentarily choking whilst eating. The manager and a few staff have attended extensive training on abuseprevention. They are qualified to provide this training to other staff in the home. The manager noted that staff are up-to-date in this respect. It was found that the newest staff member received this training shortly after starting work in the home, and another randomly-chosen person had had the training in early 2007. DS0000070245.V351710.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 28, 29 and 30. People who use this service experience an excellent outcome in this area. This judgement has been made using available evidence including a visit to this service. The home is purpose-built to enable people who have physical disabilities to maximize their independence. There is much equipment and space in support of this. There are also excellent standards of upholding cleanliness, and good standards of comfort and homeliness. EVIDENCE: The home was purpose-built to provide a spacious and independenceenabling environment to people who have physical disabilities. There are many facilities in place in this respect, which enables some of these standards to be judged as exceeded. Residents have equipment around the home, such as automatic doors and curtain openers, to support their independence. There are enough hoists including bath chairs. Each bedroom has an en-suite shower, and a small kitchenette. DS0000070245.V351710.R01.S.doc Version 5.2 Page 22 Most residents spoken with had no concerns about the environment. One noted a preference for overhead-tracking hoists, which the home does not have, and another said that one of the lifts was stuck on the top floor recently. Staff confirmed this, noting that there has been much professional work undertaken in the last year to upgrade it. The manager confirmed this, and showed a recently-sent fax that agreed to further improvement work. One resident was asked about getting around. They confirmed that this is fine and that they have all the adaptations they need. Another resident stated that past issues with large objects being occasionally left in the way in corridors have stayed resolved. There was feedback from residents that staff respond quickly enough to activations of the alarm system within their rooms. There was new carpeting throughout dining and lounge areas. The manager noted that furniture there has been replaced, and several bedrooms have been redecorated since the last inspection. This is encouraging. The manager noted about an ongoing damp investigation. There are areas of the wall that are marked and blistered, but with no smell, around the corner from the lifts downstairs. Whilst unsightly, the area is still accessible by residents if needed, and management are attempting to find the cause and remedy the issue. The environment was seen to be clean, bright, and well-maintained. Residents spoken with confirmed that the home is kept clean. There is a designated team of established cleaners in this respect. The home continues to have a designated laundry worker and an area for residents to specifically launder clothes themselves. There are two industrial washing machines and tumble driers for general laundering purposes. The red-bag system of handling soiled laundry was seen to be in use, to help uphold hygiene standards. The manager noted that she and a staff member are due to attend training on infection control that will enable them to teach others in the home. Staff have previously had infection control training, but this will enable updates. DS0000070245.V351710.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. People who use this service experience an excellent outcome in this area. This judgement has been made using available evidence including a visit to this service. Residents are supported by a strongly-qualified staff team that has low turnover and for whom there was much positive feedback. Staffing levels meet the collective needs of residents. Recruitment practices protect residents. Staff supervision practices are a little infrequent, however regular training enables staff to support residents appropriately and consistently. EVIDENCE: Strong feedback was received about the staff team overall. Comments from residents included “staff are kind” and that staff treat them well. A number of residents confirmed that staff listen to them. Feedback from relatives and health professionals included that staff have the right skills and experience to look after people properly. Observations during the inspection confirmed these positive comments. Rosters from January showed that there are usually seven care staff working during the day with residents, along with other people in non-care roles. Four care staff work during the night. Typically there would be one of the seven DS0000070245.V351710.R01.S.doc Version 5.2 Page 24 shifts being covered by bank or agency staff. The manager stated that there were 2.5 staff vacancies at the time of the inspection. These are mainly covered by three bank staff who have much experience of the home and with whom residents are very familiar. Agency staffing was needed in December to cover sickness. Four out of five residents spoken with about staffing levels felt that there are enough staff working in the home, including at night. The fifth person was concerned about sickness levels. Staff surveys found people saying that there are usually or always enough staff to meet residents’ needs. There were no clear observations of care shortfalls during the visit, hence staffing levels are judged as appropriate to the needs of current residents. Staff surveys fedback positively about training overall. For instance, all ten noted that they are given training which is relevant to their role. The manager noted that 23 out of 28 care staff have completed the NVQ qualification in care. This is undertaken at a local college. This approximately doubles the number at the previous inspection, which is encouraging, and clearly exceeds the expectation under the National Minimum Standards of 50 . Sample checks of staff files found appropriate certificates in place. Further staff are working towards the qualification. There was prompt training in place for the newest staff member in the areas of manual handling, emergency first aid, health & safety, and abuse-prevention. Checks of a couple of other staff members’ files found updates for health & safety in 2007, which addresses a requirement from the last inspection, and evidence of other refresher training. The manager could explain about further training plans for the team. Five of the ten staff surveys received noted that their manager sometimes provides enough support and meets with them to discuss their work. Other replies were more positive. Supervision records for five staff were checked. They showed that people received supervision meetings with their line manager, however the frequency tended to be once every three to four months. The expectation under the National Minimum Standards is a meeting every two months. The lack of regular supervisions for staff could affect staff morale and could allow inappropriate work practices to develop. Supervisions meetings must take place at least every two months under normal circumstances. The manager stated that there was only one new staff member since the last inspection, and that a strength of the home is the low staff turnover. There were indeed many familiar faces amongst staff relative to previous inspections. The recruitment files of the newest person were checked. There was an application form, an employment history, appropriate identification checks, DS0000070245.V351710.R01.S.doc Version 5.2 Page 25 three written references, and an appropriate Criminal Record Bureau check. These were all acquired in a timely manner relative to the start date on the person’s contract. DS0000070245.V351710.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People who use this service experience a good outcome in this area. This judgement has been made using available evidence including a visit to this service. The service provides residents with an appropriately-managed home. Residents are involved in quality monitoring of the service. Health & safety systems protect people in the home sufficiently. EVIDENCE: The registered manager has managed the home for over ten years, including at its previous location. She noted that she retains her registration as a qualified nurse. She has completed the Registered Managers Award. Some residents were spoken with about the change or provider following a merger in the summer of the previous provider John Grooms with another DS0000070245.V351710.R01.S.doc Version 5.2 Page 27 provider The Shaftesbury Society. No one had noticed any changes in the services provided. A couple of residents said that “no-one visits” in respect of the new organization. This should be considered, in terms of meeting interested residents directly. The service at the home was last formally audited by external people in July 2006. The report of this was made available to the inspector at the previous inspection. The manager noted that a further audit, involving opinions from residents and other stakeholders, was due. As mentioned under standard 8, the home also holds monthly residents’ meetings. These are used to provide residents with information about the home, to plan for events, and to acquire their views about aspects of the service. One recent meeting included a resident running through the fire procedure for everyone’s benefit. There were no unmanaged health and safety concerns arising at the inspection. Internal health & safety checks including fire checks were seen to be up-to-date. The last fire drill was in November 2007, which is appropriately recent. There were up-to-date professional checks of the fire systems, the mobile hoists, and of the water systems against legionella risks. The gas systems were out-of-date by a few months but were booked during the inspection. The manager noted that she sees all accident and incident forms, with copies provided to the organization’s health and safety expert. Accident records had appropriate details of what happened, and the actions to take to minimise the risk of repeats. DS0000070245.V351710.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 4 27 X 28 4 29 3 30 4 STAFFING Standard No Score 31 X 32 4 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 3 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X DS0000070245.V351710.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA36 Regulation 18(2)(a) Requirement Supervisions meetings must take place for each staff member at least every two months under normal circumstances, to help provide consistent and appropriate support to residents. Timescale for action 01/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA7 Good Practice Recommendations Consideration should be given to enabling each resident, unless an individual objects, to own a copy of their care plan in a format that they can most easily use. This for instance could mean re-writing plans in larger print, using pictures and photos, and/or making summaries. The needs and wishes of the individual resident would be the guiding factor. The regular Friday fish options on the menu should be further considered, to see if any alterations could meet residents’ collective preferences better. Greater care should be taken to appropriately update individual residents’ health sections within their care files, to more easily enable consistent care. Records were DS0000070245.V351710.R01.S.doc Version 5.2 Page 30 2 3 YA17 YA19 4 YA23 5 YA37 missing in a few cases. Consideration should be given to making residents better aware of people who are visiting or working in an official capacity. This could be through a visitors’ board for residents to be aware of who is present, and/or of ensuring as far as possible that all official visitors display identification at all times when in the home. Consideration should be given to the feedback from some residents that no-one from the new provider organization visits residents. DS0000070245.V351710.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000070245.V351710.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!