Inspection on 29/10/07 for 1 & 2 Hunts Lane

This inspection was carried out on 29th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1 & 2 Hunts Lane 13/10/08

1 & 2 Hunts Lane 16/01/07

1 & 2 Hunts Lane 13/12/05

1 & 2 Hunts Lane 10/05/05

1 & 2 Hunts Lane 16/12/04

1 & 2 Hunts Lane 03/08/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 1 & 2 Hunts Lane Wellington Hill Horfield Bristol BS7 8UW Lead Inspector Kath Houson Key Unannounced Inspection 29 & 30th October 2007 09:30 th 1 & 2 Hunts Lane DS0000020340.V351231.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 1 & 2 Hunts Lane DS0000020340.V351231.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. 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1 & 2 Hunts Lane Address Wellington Hill Horfield Bristol BS7 8UW 0117 9354310 0117 9699000 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) www.brandontrust.org The Brandon Trust Mrs Dolores May Smart Care Home 10 Category(ies) of Learning disability (10) registration, with number of places 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Staffing Notice dated 17/03/1999 applies Manager must be a RN on parts 5 or 14 of the NMC register May accommodate up to 10 persons, aged 35 years and over, requiring personal care. May accommodate 1 named person aged 65 years and over. Date of last inspection 16th January 2007 Brief Description of the Service: Hunts Lane is arranged in two separate bungalows that are joined by a link corridor. This provides accommodation for ten adults with a learning and physical disability. The bungalow has specialist equipment and adaptations to assist nursing care. The home is located behind a residential road in the area of Horfield in Bristol. The home is close to Gloucester Road and local amenities that are on the main bus routes into the city centre. It is also within walking distance of pubs, churches, shops, sports centre and open parkland. In October 2007 the fees for this service are charged at £1,300 per week. There are additional charges for extra activities such as hairdressing, music sessions and mini bus hire. Western Challenge who are responsible for all the repairs and décor within the home owns the building. The building is leased to Brandon Trust who provides and manages the care. 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection. This unannounced inspection was conducted over two successive days, which involved a visit to the service The registered manager assisted on the first day of the inspection and the assistant manager was available on the second day. We inspected nineteen of what the Commission (CSCI) considers the key standards that show how the service is performing. We did this by: • • • • • Looking at the homes written records Tracking the care of three people living at the home to see how well their needs are being met. Looking at the premises Talking with the manager and staff Getting the views of relatives of people living in the home and professionals such as GP and the Community Learning Disability Team (CDT) through surveys. What the service does well: What has improved since the last inspection? The system for recording medication has improved since the last inspection. Some risk assessments have been written and this helps people to take risks more safely. 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 6 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 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 7 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 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 8 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 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People are given enough information about the home to decide if they want to live there. The procedure for admitting new people has not ensured that their needs and that of others can be fully met. EVIDENCE: The Statement of Purpose (SOP) contains information about the home that would give people the information they need about what to expect if they decide to live there. There had been one new admission since the last inspection. Correspondence from the placing authority was available in the care file. The manager described the admissions process and the assessment procedure. However, the evidence shows that an inappropriate placement had taken place that put people at risk from harm (this is described in more detail later in the report). This meant that action had to be taken by staff to keep everyone safe from harm. The admission procedure needs to be reviewed so that the needs of people already living in the home are taken into account and new people can be sure their needs will be met. 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 9 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, & 9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There may be a risk that people’s needs are not fully met as they are not always addressed in the care plan. Staff communicate well with people and are aware of their requirements. EVIDENCE: A requirement to improve care plans and include risk assessments was made at the last inspection. This time three care plans were looked at in detail. They were on a new format, individualised and contained information about the person’s care needs. The care plans were well recorded and gave guidelines to staff providing support to people. They contained review dates so that changes to the care plan can be made as necessary. The manager said that some of the care plans were incomplete and were being changed over to the new format. This was evident as one of the care plans was 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 10 up to date and contained all the information in the correct sections. The sample care plan was of improved standard and person centred. The new care plans also show that risk assessments are in place and were written with input from other health professionals. For example, there are guidelines for staff to help keep people safe if they are prone to falling. Despite improvements to some of the care plans guidelines for specialised needs for, example eating disorders, for one person, were not followed. This is discussed in the Personal Care section of the report. Although some of the care plans had been improved since the last inspection the previous requirement had not been fully met. Staff said that they do follow care plans. However, the manager must make sure care plans fully cover people’s needs, clear guidelines are followed through properly and recorded, to ensure people’s needs are consistently met. The staff were observed talking with the people in a respectful manner. They know the people living in the home well and appeared to respond to what they were communicating. To improve this, the home’s future plan is to develop a communication passport for each person. The manager would be seeking help and guidance from the speech and language department who will have the majority of the input. The communication framework will be based on people’s non-verbal communication, facial expression, sounds, gestures and any visual interaction. This will help staff recognise what people are communicating and give individuals more opportunity for making decisions about their lives. The standard on the topic of resident’s confidentiality was not fully assessed on this occasion. However all personal records were kept in a secure place in the home. 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 11 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 15 16 17 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents’ are encouraged to take part in activities that meet with their interests. Increased stimulation for people living in the lower house would ensure that they are given equal amount of leisure time. The home provides a varied and specialised diet for resident’s who have complex needs. EVIDENCE: People living in the home are encouraged to take part in a variety of activities at home and in the community. On the day of the inspection music was being played for the people in the upper house. In the Lower house most people were out on a day trip with relatives or at day centres. An activities coordinator has been employed by the home to give support to people with their chosen activities and hobbies. 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 12 The day care rota confirmed that some people were out with care staff. Activities range from, aromatherapy and reflexology, driving to Weston, 1:1 time, snoozelum, abseiling, and arts and crafts and are dependent on the homes resources. During the inspection people showed their artwork that was then pinned up on their bedroom wall. The manager said that sometime in the near future the home would be given some sensory equipment that can be used in people’s bedrooms. This would be a positive outcome giving stimulation on an increased and flexible basis. The manager said “people have holidays at least twice a year.” Recent photographs showed them on holiday at Euro Disney. Some of the photographs can be seen in people’s bedrooms. The manager also said “steps were being taken to increase the social aspects for the everyone”. She discussed the use of a community map for each person. This would provide additional information about services that are available in the local community. The aim is for individuals to be more involved in the local community. The home has started to put this programme into place. In the upper house, some people were home and there was time for the staff to join in with some of the activities. People seemed to be enjoying the visiting musician. However, the assistant manager had said “its often difficult to organise social activities as they are dependant of staffing levels.” There were people in the lower house that were not getting much stimulation. Providing physical care takes up a fair amount of time in the lower house and demands were high. Staff were also having to take extra steps to protect people due to a particular situation. The manager said that she planned to discuss how to increase activities and stimulation for people in the lower house with the activities coordinator. The home encourages contact with people’s relatives. The number of survey responses that were returned to the Commission (CSCI) confirmed this. Relatives said “ everything my relative needs they get”. Family contact is frequent and inclusive. The findings suggest that families are involved in people’s care and that the home keeps the families involved with any changes that may occur. One relative said “ I’m always kept up to date with important issues” On several occasions staff spoke respectfully to and about residents, addressing residents’ by their preferred names. The relative’s feedback forms commented on “how caring the environment is at Hunts Lane.” The home provides a balanced specialist and varied diet for those people with complex needs. On close examination of the food diary it was evident that people are offered varied and balanced meals. Special instructions on food preparation were seen for example if someone needs to have their food prepared to a certain consistency to avoid choking. However, advice from a 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 13 health care professional about the food for a particular person did not appear to have been included (see the Personal and Healthcare section). Mealtimes were observed to be relaxed and calm and at the pace of the residents’. 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 14 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 & 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The service does not satisfactorily record complex and specialist health needs. People who use the service have regular access to healthcare services but there may be a risk to wellbeing when health matters are not properly monitored and recorded in the home. There has been an improvement to all residents’ medication records that were in order and up to date. EVIDENCE: Staff were giving immediate attention to people. At the time of the inspection the local GP made a visit to the home. The GP was able to provide both verbal and written feedback about the service. The GP said “ that the staff are doing an excellent job.” 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 15 However one care plan showed that someone had to be regularly weighed and it was clear from the records that this had not been done for some weeks. Although the person concerned appeared well cared for, this places them at risk as their progress is not being properly monitored. A dietary plan was also provided, which would assist with weight gain based on likes and dislikes of certain food but this had not been included in the menu. The local Community Learning Disabilities Team (CLDT) had raised concerns that their messages about resident’s needs were not always passed on to the correct person. The manager has taken steps to ensure that any messages about care needs are written in the home’s communication book so that they can be acted upon. The manager said that the service have regular contact with other health professionals such as the District Nurses (DN). Resident’s healthcare files evidence this and showed the number of times the DN would visit and the nature of that visit. Some of the residents are also prone to more hospital visits due to their complex health needs. The manager and her team provided regular support during resident’s hospital visits. The manger said that they would go to see to the hospital to ensure that the residents’ was not left isolated whist in hospital. The service has now adopted the Boots medication system and much of the medicines are in peoples’ individual containers. All the resident’s medication administration records (MAR) were looked at. The system appears to work for the service and no drug errors were detected. Any allergies were well recorded. Only the qualified nurses are allowed to administer the medication within the home. The epilepsy management plan is well documented. The service has contact with the Joint Epilepsy Council and approaches the council for any extra information. This was evident in the care file. Detail of input from other health consultants and the community nurse were recorded. The home has a good recording system for diabetics. For instance, people using insulin by injection are monitored and their blood sugar levels are recorded regularly. Homely remedies or medication taken when necessary (PRN) were also recorded as well as health status and the blood pressure levels. The PRN protocol was seen as evidence at the time of the inspection. It was noted that some of the PRN external ointments and creams were out of date. The manager must ensure that PRN medication has the date of opening written onto the containers. This is to make sure that the medicines are rotated in the correct order so that they are used before the expiry date. A pot of ointment was found to have expired; the manager removed the ointment immediately. 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 16 Some of the medication records did not include a photograph of the person the medication was prescribed for. The manager should make sure that photographs are with the records. This is to ensure that the correct medication is administered to the correct person. The standard for end of life was not assessed on this occasion. However, the end of life programme was evident in people’s care files. As part of this process the manager considered the needs of people who have no next of kin. This is based on people’s wishes about how they want to be cared for at the end of their lives. It would be good practice to involve an advocate to obtain objective support that would be of benefit to the people using the service. 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 17 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): 22 & 23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure that is accessible to relatives and residents’ the home keeps a full record of any investigations. Staff understand and act on protection but people would be more fully protected if the admission procedure was better. EVIDENCE: The home has a complaints procedure that is both written and pictorial. It is attached to the SOP. The procedure is clearly written and accessible to people living at the home and relatives’ on request. The complaints record book is well documented with written accounts about how the complaints have been resolved. There have been a number of complaints, which the manager has dealt with in-house. There is currently an ongoing complaint that is still being addressed. The service has received a number of compliments through relative’s surveys sent into the Commission (CSCI). Comments include “… A sincere thank you for all the help and care”, “ the service always gives support to my relative”, “I do know how to make a complaint, I have not had any reason to question the care my relative gets over the years”, “ the service always supports residents to choose”, “ I always feel that the care home meets the needs of my relative”. 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 18 Records showed that most staff had been trained in the protection of vulnerable adults in 2006. One staff member had trained in 2003. Staff understood protection issues. They were acting on instructions from the manager to keep people safe when we inspected. However, it is recommended that staff have update training so that they remain clear about what to do when situations arise. The home was experiencing a problem with behaviour that could result in abuse of people living in the home. Records showed that safeguarding measures had been put in place to protect people. The measures were clearly written in the communication book and the monitoring of people’s wellbeing was written in their care plan. The manager said that suitable arrangements are being made to resolve the safeguarding issue. During the inspection staff did not leave vulnerable residents on their own where there was the possibility that physical abuse could take place. Notifications to the Commission evidence that the manager is addressing this issue to ensure that people are protected from abuse. 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 19 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): 24,25, 26, 27,28,29 & 30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home does not provide an environment that is comfortable, homely and encourages independence. The residents’ live in an environment that is not very homely. Privacy and dignity are compromised in some areas of the home. EVIDENCE: Hunts Lane is a nursing home that consists of two five-bedded bungalows, which have a link corridor. The bungalows are situated at the back of a private residential road in the Horfield area of Bristol. The home is in close proximity to the main Gloucester Road where many facilities can be found. These include shops, church groups, pubs and a sports complex which is in easy access for people living in the home. The home has recently been adapted to assist people who have complex needs and require the use of specialist equipment to aid their independence. 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 20 The home has good access for people who are wheelchair users. For instance the home has large doorways and corridors with a well-adapted lift at the front entrance to the house. The house has ten bedrooms five on each side. Two of the bedrooms have en suite facilities. Both houses have a well-equipped kitchen, large bathrooms which have specialist equipment such as a ‘hi and lo’ bath and toilet. There is a wheel-in shower room. The communal areas such as the lounge/dining rooms are large enough for wheelchairs and other specialist equipment necessary to promote independence and encourage freedom of movement. There are two sluice rooms and a utility room that caters for laundry for both sides of the house. There is a sleeping in room for staff who are on call during the night. Although recent refurbishment and alterations have been carried out on the building the physical environment does not fully meet the specialist needs of residents’ who use the service. During the inspection a number of issues were highlighted: • Space is inadequate for the physical care and does not allow the people to use the rooms comfortably. For example, when providing personal care staff have to remove specialist equipment from the bathrooms before the bathing procedure can take place. Other equipment has to be kept in the garage and cannot be used due to the lack of space. The manager hopes that the garage can be adapted to provide additional space for this service. The positioning of the sluice areas is intrusive. The doors of the sluice infringe on a bedroom door and corridor. This restricts people’s movement as they have to wait until the doors close and the corridor is a “safe” place for wheelchairs users or those with restricted mobility. The noise from the sluice that is next to the bedrooms is unsatisfactory. Many of the bedrooms had large cracks in the walls. There were sharp nails that had been painted over and were sticking out of the walls. Some of the paintwork was also chipped. The walk in shower-room has a drainage problem. The smell from the room is unacceptable and needs attention. This room is currently used only for storage when it could be better used for the resident’s personal care. Bedrooms throughout the house with the exception of one are painted the same colour so that bedrooms are not very personalised and homely. DS0000020340.V351231.R01.S.doc Version 5.2 Page 21 • • • • • • 1 & 2 Hunts Lane Unfinished, poorly completed paintwork was seen in the hallways. The same ceramic tiles were seen in all bathrooms and en-suites. The décor reflects the preference of the contractors rather than the people who use the service. • The garden in the upper house is not accessible to people living in the home. The pooling and collection of rainwater has not been addressed from the previous inspection and may cause a damp problem in the lounge. The garden to the upper house is open to a neighbour’s garden. People living in the home have full view of their neighbour’s garden and their outside toilet. This must be addressed in order to maintain boundaries and privacy. There were no toilet rolls and towels in the bathrooms and ensuites. The manager said that it was shopping day suggesting that they had run out of toilet rolls. This should not happen and does not explain why there were no towels. There was no toilet seat in one of the bathrooms. At the last inspection concerns were raised about the lack of privacy for people using a dining room that had no proper curtains at the window. This has been addressed but there are still a number of windows in bathrooms and the link corridor particularly where the windows are not covered or only covered with net curtains. People passing by the windows would be able to see in. The manager must ensure that the privacy and dignity of all people living in the home is maintained at all times. The manager and staff said that the fire system has insufficient power to add more magnetic closures. This means that many of the doors had to be frequently wedged open which could be hazardous should there be a fire. Door handles need to be replaced in one of the bedrooms as this was broken at the time of inspection. The staff sleeping–in room does not have a toilet. Although the staff were given a choice of whether to have a shower or a toilet the staff team chose to have a shower. This means that staff on sleep-in shifts would have to walk through the home during the night. The assistant manager said that the combination boiler also has problems: the pressure drops and the water can be too hot to the point of scalding which is a hazard in the kitchen. The water can also be too cold with the potential to lose heating. However, the water temperatures in the resident’s bedrooms are controlled. • • • • • • 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 22 • There were a number of toiletries on display around the bathrooms and bedrooms. These items could be hazardous to people’s health if misused. A risk assessment must be put in place to make sure people are not at risk of harm. The quality of life for the people using this service is made worse by the environment they are living in and fails to be a homely and comfortable place to live. The condition of the premises does not reflect well on the management of the home or the Trust. Recent alterations to the building have not properly met the needs of the people living there and hampers staff in their work. It is acknowledged that the Trust is not responsible for the maintenance of the premises. However, as the registered provider, the Trust must address the problems highlighted in this report. There was a marked difference in the atmosphere in the two sides of the home. In response from a complaint by neighbours about noise people had been moved around so that quieter people occupied the upper house. This meant that the lower house was very noisy. A member of staff said that this was made worse as the relationship between some people living n the home was causing anxiety. The home manages the risk of infection well. During the inspection it was evident that the manager had taken steps to keep the spread of infection to a minimum. The home had numerous bacterial alcohol gel for hand washing throughout the two bungalows. Latex gloves were placed in bedrooms and especially in the rooms of those with an active infection. Plastic aprons were made available for all staff use and easily accessible. The protocol for the handling of soiled laundry keeps infection control to a minimum. People have use of their own specialist equipment that promotes an independent life. The equipment is maintained and cleaned and the appropriate aids and adaptations meet the needs of people who use the service. At the time of inspection, the home was clean but there was a very offensive smell from the unused shower room as previously mentioned. 1 & 2 Hunts Lane DS0000020340.V351231.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): 31, 32 & 33 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The Trust recognises the importance of staff development and mandatory training. Staffing levels are not always adequate to meet people’s needs particularly in the lower house. EVIDENCE: The Commission (CSCI) and Brandon Trust have an arrangement that staff records be kept at the trust’s head quarters so staff and recruitment documentation were not seen on this occasion. It was very clear that staff are fond of people living in the home and treat them well. They spoke to people in a friendly but respectful way. The staff are long- standing and committed to their jobs and the people they care for. Three members of staff and a member from a care agency were spoken with. One staff member in the lower house said there were not enough staff on duty to accommodate activities. Others members of staff said there are enough staff 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 24 to cover resident’s activities. It was clear that there was a difference between staffing needs on the two sides of the house. The upper house was quiet and serene. Staff clearly had time to talk with people and be present during the afternoon activities. In the lower house there was a lot of noise and staff were very busy giving care to people. There was also a safeguarding issue in the lower house and staff had to continually make sure people were safe. The nurse who was on duty in the lower house said that she had to leave the lower house to give medication and complete any nursing tasks in the upper house as well. A staff member said that although staffs working long shifts are entitled to an hour’s break they frequently do not take breaks due to the demands on their time and staffing levels on the day. Staff are allocated days to do specific administrative tasks but daily admin can be difficult because staff can be too busy. Supporting a person to bathe can take more than an hour and equipment has to be moved from the bathrooms first putting more demands on staff time. Staff again said that this was more specific to the lower house. The rotas confirmed that staffing levels vary to accommodate resident’s activities. The manager said that she is planning to address the staffing levels in the lower house with the activities coordinator so that activities can take place more often. Given the conflicting messages from staff in the upper and lower houses a requirement is made to review staffing levels. The provider’s monthly report shows that there is a staff vacancy for one hundred and ten point five hours. This has been at that level for several months. The manager said that some staff will be redeployed from other locations. In the meantime the vacant hours are being covered. The Brandon Trust training matrix was seen during inspection and the topics include Manual Handling, Health and Safety, Food Hygiene, First Aid. Some specialist topics were also seen and range from Understanding Autism, Understanding epilepsy, understanding Mental Health. The provider’s monthly report states that some staff had mandatory training and updates. The manager said that the Brandon Trust was arranging a number of training days. The staff team said that they had good opportunities for personal development and are able to take periods of secondment for experience. They said that training is available and they are expected to cover everything on the training plan, but can choose when to do various elements. 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 25 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 & 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home is generally well managed but attention needs to be given to the admission procedure, the condition of the premises and staffing levels to improve the service for the people who live there. EVIDENCE: The home’s manager is a qualified nurse for people with learning disabilities and has completed the Registered manager’s Award. 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 26 The home conducts regular health and safety checks and the home’s records confirmed this. Specialist equipment checks were seen during the tour of the buildings. However records of tests for equipment for the upper house is included in the lower house records and the systems such as the lights and fire panel is for both bungalows. The manager said that since the bungalows were joined the upper and lower house operates as one unit. The home has a fire risk assessment in place and a disaster plan. According the manager and the SOP this incorporates the emergency procedures and risk assessments for the home. All staff have regular fire training and regular fire drills take place. The manager has regular meetings with the staff team. Notes from the meetings were seen and discussed during the inspection. The most recent meeting notes were yet to be written up. The agendas include; reallocation of bedrooms, holidays, menus, maintenance of the home, skills for care and staff working towards National Vocational Qualification (NVQ). Some of the comments we received from the CLDT raised concerns about communication between CLDT and the home. However the manager was confident that the new system for recording messages would resolve the problem. The Brandon Trust has a set of core quality assurance standards and the home has produced a questionnaire that is sent out to relatives annually. However the last time a quality assurance audit was conducted for the home was in June 2006. Completed surveys were not available during the inspection but we saw a blank copy. The manager said that they had not had a very good response from the questionnaires but she does obtain verbal responses. Consideration must be given to devising a meaningful quality assurance system that helps the manager and staff to develop the service in the best interests of people living in the home. The responses returned to us before the inspection were very positive about the quality of the service and it was clear that people living in home are generally well cared for. The manager clearly knows the people who live there well and cares very much for their wellbeing. However the manager must review the admission procedure to make sure that people are not admitted who may be a risk to others and whose own needs can’t be properly met. It also causes some concern that simple issues such as window coverings have not been addressed. 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 27 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 1 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 2 26 2 27 1 28 2 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 X 16 X 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 2 X X 2 X 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 28 Yes Are there any outstanding requirements from the last inspection? 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 YA2 & 23 Regulation 14 (1) Timescale for action People already living in the home 05/12/07 are protected and that new people’s needs can be met. The manager must not admit a new person to the service until an appropriate assessment of need is carried out. People’s needs are properly met 31/12/07 the registered manager must make sure care plans are fully completed for all people using the service. (Previous requirement partly met 30/04/07) The activity needs of people, particularly in the lower house, can be met; staffing levels must be reviewed. To improve the facilities for people living in the home a plan to address issues in the report that relate to the premises must be received by the Commission. So that people are safe from harm the manager must undertake a risk assessment for toiletries that are left in bathrooms and accessible to people living in the home. DS0000020340.V351231.R01.S.doc Requirement 2. YA6 15(1) 3. YA12, & 33 18(a) 17/12/07 4. YA24 - 28 16 & 23 31/12/07 5. YA24 16(4) 05/12/07 1 & 2 Hunts Lane Version 5.2 Page 29 6. YA20 13 (2) 7. YA24 23 (4,a) 8. YA24 16(1) The registered manager shall 05/12/07 ensure that ointments and external creams are discarded by the expiry date. To improve fire safety the 31/12/07 manager must consult the fire service about bedroom doors that are not linked to the alarm system. The manager must make sure 31/12/07 that the privacy and dignity of people is maintained by putting curtains or blinds up. (This requirement is partly met from the last inspection) The registered manager must establish and maintain a system for reviewing at appropriate intervals the quality of care provided so that the service can continue to be improved and developed. 9. YA39 24 (1) 01/03/08 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. 2. Refer to Standard YA17 Good Practice Recommendations Consider including advice from health care professionals in the menu for a particular person as giving what the person prefers to eat could help weight gain. People’s photographs should be kept with medication records so that they are easily identified YA6 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 1 & 2 Hunts Lane DS0000020340.V351231.R01.S.doc Version 5.2 Page 31 - 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. 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