CARE HOME ADULTS 18-65
182 Bromham Road 182 Bromham Road Bedford Bedfordshire MK40 4BP Lead Inspector
Katrina Derbyshire Unannounced 14th June 2005 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 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 Stationary 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. 182 Bromham Road I51 S14886 182 Bromham Road V213108 140605 - Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service 182 Bromham Road Address 182 Bromham Road Bedford Bedfordshire MK40 4BP 01234 357238 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Lansdowne Care Services Mrs M Hoath CRH Care Home 6 Category(ies) of LD registration, with number PD of places 182 Bromham Road I51 S14886 182 Bromham Road V213108 140605 - Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25th October 2004 Brief Description of the Service: 182 Bromham Road is a large Victorian House situated on the west side of Bedford. It was registered in 1996 to provide residential care for 6 adults with learning disabilities. There are six single bedrooms on two floors and toilet and bathing facilities on both floors. The communal space, comprising of a lounge, dining room and activity room are on the ground floor as is the domestic style kitchen and utility room. There is a spacious garden to the rear. The home is conveniently situated for access to Bedford with all its amenities and bus and rail services. 182 Bromham Road I51 S14886 182 Bromham Road V213108 140605 - Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on 14th June 2004. The Home Manager, Mrs Marion Hoath was present for part of the visit. During the inspection several areas of the home were visited and the inspector spent time with many of the residents in the lounge and dining area of the home. The care of three residents was examined in depth by looking at their records and interviewing the residents and staff who look after them. What the service does well: What has improved since the last inspection?
There has been a change to the staff team and several new staff are now working at the home. The staff work very well together and this means that the atmosphere in the home is welcoming and relaxed. Residents have also been encouraged and supported recently to increase their independence. Staff have been working together as a team to make sure each resident can achieve their individual goals, for some residents this means being able to wash and dress themselves. This has been very important to the residents who enjoy taking part in the daily life of the home through light household chores for example. 182 Bromham Road I51 S14886 182 Bromham Road V213108 140605 - Stage 4.doc Version 1.30 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. 182 Bromham Road I51 S14886 182 Bromham Road V213108 140605 - Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection 182 Bromham Road I51 S14886 182 Bromham Road V213108 140605 - Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 and 4. The homes statement of purpose and service user guide are good at providing residents and prospective residents with details of the services the home provides, enabling an informed decision about admission to the home. EVIDENCE: The admission procedure at the home was very clear, and residents had received an assessment prior to being admitted into the home. Although there had been no recent admissions at the home, staff confirmed that all admissions would be planned where possible. Residents would have the opportunity to visit the home and stay for tea and stay overnight, before making a decision on whether to move into the home. Assessments had been completed prior to any admission and then reviewed and amended every 6 months. These assessments are kept in the residents care notes, and are also used as one of the care planning documents by the home. They were comprehensive and included the sensory, educational and emotional needs of the residents. The statement of purpose and service user guide also contained all the required information. Staff had signed a sheet to confirm that they had read and understood the documents. The services available at the home had been clearly described these included; room sizes, how the privacy and dignity of residents’ was to be maintained, staff training and activities available.
182 Bromham Road I51 S14886 182 Bromham Road V213108 140605 - Stage 4.doc Version 1.30 Page 9 182 Bromham Road I51 S14886 182 Bromham Road V213108 140605 - Stage 4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9. The planning of care is good and provides a good amount of information so staff know the needs of residents, and they receive the care that they need. EVIDENCE: Each resident has a comprehensive plan of care within his or her individual records. Each plan is reviewed every 6 months when the care of the resident is reviewed by the home, resident and residents’ representative. The information is sufficient to guide and direct staff in supporting them in achieving their personal goals and aspirations. Staff, through discussion, demonstrated that they were clear on the content of the residents’ care plans and were able to describe the individual needs of the resident. However daily notes within the individual files of residents on several occasions contained the opinion of the member of staff instead of their observations. One example was an entry, which stated “ moody and badly behaved today”, only factual information must be recorded. Risk assessments relating to possible risks that residents may encounter had been undertaken, and these were also kept in the residents’ individual files. These documents made clear how staff were to support the resident in carrying out varying tasks that may involve some risk. One example was one resident
182 Bromham Road I51 S14886 182 Bromham Road V213108 140605 - Stage 4.doc Version 1.30 Page 11 had a risk assessment on their file relating to carrying out laundry in the home, the resident was seen to assist staff in this and the guidance within the document was also seen to be followed by staff. 182 Bromham Road I51 S14886 182 Bromham Road V213108 140605 - Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 and 17. The amount and variety of activities available to the residents is good and results in them receiving a consistent and fulfilling social life. EVIDENCE: At the time of this inspection two residents were away on holiday in Yorkshire and the other residents in the home were preparing for their holiday, the following week. Transport is available to the home and is used to take residents out on a variety of trips; recent excursions included shopping trips and a visit to the Zoo. Also residents and records confirmed that residents attended a variety of day placements. Programmes of learning and development undertaken by the resident at their placement were kept in their individual file, and showed that they participated in music and art classes for example. Meals at the home are prepared by the staff who have undertaken their food hygiene certificate. The kitchen was very clean and organised with up to date records showing that cleaning schedules were in place, fridge and freezer temperatures were recorded and menus were planned. Residents were seen to
182 Bromham Road I51 S14886 182 Bromham Road V213108 140605 - Stage 4.doc Version 1.30 Page 13 enjoy their tea and several commented on how much they enjoyed it, portion size was large and fresh fruit was available to all the residents. 182 Bromham Road I51 S14886 182 Bromham Road V213108 140605 - Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 20. The health needs of residents are well met and residents receive fast and effective healthcare support to meet their needs. EVIDENCE: Residents’ files contained a variety of correspondence to show the healthcare support received by the residents. Residents had access to a Consultant, Chiropodist, Dentist and optician if needed. Regular healthcare check ups are arranged by the home and residents are supported in carrying out the advice of health care professionals by staff, this was reflected in the care plans of residents. The home sought advice if needed very quickly, one example seen was a resident had complained of stomach pains at breakfast time, records showed a Doctors appointment had been secured by the home within minutes. The home uses a monitored dosage system for medication. The stocks that were checked were correct as was the medication records for administration. A system was also in place for returning unused medication and one staff member had responsibility for the ordering of monthly prescriptions. However the training staff have received in administering rectal diazepam needs to be approved, and confirmed that it is sufficient and safe. The home is required to seek the approval in writing from the Doctor prescribing this medication.
182 Bromham Road I51 S14886 182 Bromham Road V213108 140605 - Stage 4.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards will be assessed at the next inspection. EVIDENCE: 182 Bromham Road I51 S14886 182 Bromham Road V213108 140605 - Stage 4.doc Version 1.30 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28 and 30. The standard of the environment within the home is good providing residents with an attractive and homely place to live in. EVIDENCE: All the communal areas of the home were visited and the garden at the rear of the home. The sitting room had domestic style furniture of a good standard and the décor was clean and bright. Throughout the home the décor is in good condition and a routine maintenance programme is in place. The use of ornaments and pictures assists in creating a homely environment. The large rear garden has seating for the residents and is secured through the use of a fence, the garden is well maintained and was seen to be used by the residents throughout the inspection. All areas of the home visited, were very clean and tidy. There were no odours in the home, and organised cleaning systems were in place. Staff when carrying out food preparation followed food hygiene guidance, and basic health and hygiene practices were followed when carrying out support to the residents and other tasks in the home.
182 Bromham Road I51 S14886 182 Bromham Road V213108 140605 - Stage 4.doc Version 1.30 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 35. Staff morale is high resulting in an enthusiastic workforce that works positively with residents to improve their quality of life. EVIDENCE: Through the interviewing of staff it was evident that they were clear on the limitations and scope of their individual roles and responsibilities. Staff spoke of the importance of team working and how recent changes in the staff team had resulted in the improvement of the promotion of independence, for the residents. Communication between the staff and residents was very supportive and encouraging, interaction remained constant and staff used the use of both verbal and non-verbal communication methods. Staff receive a structured induction when employed by the home, that meets national standards. One member of staff employed by the home five months ago stated “ l have received lots of training since l worked here, l have been taught all about the residents as well as going on training courses”. Certificates of attendance were on display in the home, for example the Home Managers Registered Managers Award was on display in the office and the food hygiene certificates were on display in the kitchen. Staff confirmed that through individual supervision training needs were identified and the company would arrange for this need to be met.
182 Bromham Road I51 S14886 182 Bromham Road V213108 140605 - Stage 4.doc Version 1.30 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 and 42. The management of the home is effective and supportive and staff receive appropriate supervision to meet the needs of the residents. EVIDENCE: The Home Manager has been in post for several years and has undertaken her National Vocational Qualification at level 3 and 4 alongside her Registered Managers Award. Systems in the home ensure that the home is organised, staff are trained and the residents receive individual care as management undertakes reviews of all the areas in the home. A representative of the company also visits the home once a month to review the home looking at the management, staff and building and a report of this is available. Staff spoke positively about the manager, one member of staff said “ she is knowledgeable, supportive and very organised the staff and residents have confidence in her”. Health and Safety training is available for staff and this includes fire awareness, moving and handling and food hygiene. Required checks are also
182 Bromham Road I51 S14886 182 Bromham Road V213108 140605 - Stage 4.doc Version 1.30 Page 19 undertaken on gas or electrical equipment in the home and records of these are kept. Risk assessments were also in place to minimise the risk of harm to residents’, and staff through interviewing demonstrated that they had a good level of knowledge on their responsibilities in health and safety. 182 Bromham Road I51 S14886 182 Bromham Road V213108 140605 - Stage 4.doc Version 1.30 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x 3 x Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 x x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score x x x x 3 x 3 Standard No 11 12 13 14 15 16 17 x 3 4 x x x 3 Standard No 31 32 33 34 35 36 Score 3 x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
182 Bromham Road Score x 4 3 x Standard No 37 38 39 40 41 42 43 Score 4 x x x x 3 x I51 S14886 182 Bromham Road V213108 140605 - Stage 4.doc Version 1.30 Page 21 NO 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 YA20 Regulation 12(1)(a) & 13 Requirement Consent from Residents General Practitioners must be in place, to confirm if the training by staff in the administration of rectal diazepam is sufficent and safe. Records concerning the residents must only contain factual information, and must not contain the opinion of the staff member. Timescale for action 31/07/05 2. YA6 12 & 15 31/07/05 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 Good Practice Recommendations 182 Bromham Road I51 S14886 182 Bromham Road V213108 140605 - Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Clifton House Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 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 182 Bromham Road I51 S14886 182 Bromham Road V213108 140605 - Stage 4.doc Version 1.30 Page 23 - 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!
