Inspection on 29/09/05 for 20 Queens Road

This inspection was carried out on 29th September 2005.

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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

20 Queens Road 23/06/08

20 Queens Road 03/01/08

20 Queens Road 08/03/07

20 Queens Road 17/05/05

20 Queens Road 22/12/04

20 Queens Road 03/06/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 20 Queens Road 20 Queens Road Bishopsworth Bristol BS13 8LB Lead Inspector Karen Walker Unannounced Inspection 29th September 2005 09:30 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 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 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 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. 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 20 Queens Road Address 20 Queens Road Bishopsworth Bristol BS13 8LB 0117 9077224 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) The Brandon Trust Mr. Glyn Edward Massey Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (6) of places 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Staffing Notice dated 02/10/1996 applies Manager must be a RN on parts 5 or 14 of the NMC register May accommodate 6 persons aged 45 years and over. Date of last inspection 16th May 2005 Brief Description of the Service: The Brandon Trust operates 20 Queens Road. The home is registered with the Commission for Social Care Inspection to provide personal care and nursing care to six people with a learning disability. The home provides registered nurse cover at all times. The home is situated in a busy residential area, close to major transport routes. There are local amenities including shops, social venues and a nearby public house. The home is a converted bungalow providing single rooms and communal space in two areas including an art/activity room for service user’s personal use. The home has a clear philosophy of care, which can be found in the statement of purpose. 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector met with staff and residents and discussed the support provided. Case tracking took place for two residents, which included examining records speaking to key-workers and meeting with family members. Records relating to the home including health and safety were also examined. A Tour of the property was undertaken. What the service does well: What has improved since the last inspection? All of the requirements from the last inspection have been met. The manager has put together a checklist to monitor recruitment practices. This includes Enhanced Criminal Record Bureau (CRB) checks and professional identification numbers (PIN) of qualified nursing staff. To further enhance the safety and well being of the residents the manager has planned ‘Protection from abuse’ training for the staff team and ensures all new staff cover the topic as part of the Learning Disability Award Framework (LADAF). 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 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. 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 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 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 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 the following standard(s): 1-5 Residents are given the opportunity to ‘test drive’ the home prior to moving in and individual needs and aspirations are assessed. Contracts are in place detailing the terms and conditions of the home. EVIDENCE: Through case tracking it was noted that contracts were in place, which were signed, by the resident or their representative. These documents although detailed were however not accessible to the individuals they were designed for. At the last inspection the inspector saw that the home had merged the Statement of Purpose and Service user Guide into one folder. The folder contained the information required by the relevant Regulation. The inspector was told that the last person to move into the home had a graduated admission process before deciding on the placement. It was noted that assessments and care plans were in place completed by the relevant placing authority. 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6-9 Residents care plans and risk assessments do not always reflect their assessed needs. Residents are consulted on aspects of running the home and are empowered to make everyday choices. EVIDENCE: The inspector examined at length two ‘Planning for Life’ packs including care plans and risk assessments. It was noted that although the pre-assessments had been carried out the care plan did not relate to it. One care plan lacked the relevant information needed to adequately support the resident and requires a review. Information needed in the plan of care includes, support with hearing and visual impairment including blephitis, mobility, dementia, continence and reoccurring chest infections. Records also indicate that this person can become quite anxious and agitated, again this is not reflected in the care plan. The plan would benefit from recording ‘triggers’ of behaviour as well as management. 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 Page 10 Another care plan lacked information relating to foot care and chiropody, continence, support with agitation, oedema management, anaemia and continence issues. It was noted that whilst there were some risk assessments in place relevant to individuals, these required review to ensure they include all areas of daily living where there could be significant risk. Risk assessments are needed for the use of bedrails and advice must be sought from the occupational therapist where bedrails are not designed for a specific bed. Residents were observed being offered choices in areas of personal support, meal choices and activities. The home manager confirmed that the residents’ views were collected during communal activities such as meal times. Residents meetings were also held and one staff member explained that input was gained from residents whose communication preference is non-verbal by means of observation. 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-17 Residents have appropriate personal and family contact and are supported to maintain family links. Residents are a part of their local and wider community. EVIDENCE: The inspector noted through case tracking that family plays a big part of one residents life. Visitors are encouraged to visit at any reasonable time and are made to feel welcome. Two relatives met with the inspector and were full of praise for the staff team and for the manager. Comments included ‘we couldn’t be happier with the home, the care is fantastic’. It was noted that there was an in house policy available regarding respecting residents’ rights. There was a confidentiality policy in place as well as a policy regarding choices made with personal care. 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 Page 12 Residents were encouraged to carry out their hobbies with support. The manager confirmed that daytime activities had improved although there was still room for improvement. All of the residents had a planned holiday and one resident is going on a ‘one to one’ holiday with the manager. The theme of the holiday was transport as this is of particular interest to the resident. Other holidays also reflected residents’ choices and preferences. Breakfast and lunch times were observed and it was noted that residents were given choices regarding menu, amounts of food, and support if necessary. they received. Residents confirmed the food was ‘nice’. The meals were unhurried and the atmosphere relaxed. Those requiring support received it in a pleasant friendly way. The menus were not examined on this occasion. 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 18-20 Staff provide sensitive and flexible personal support and nursing care to maximise residents privacy, dignity and independence. Although medication policies and procedures are in place, these are not strictly adhered to, and a requirement has been made to ensure resident and staff safety. EVIDENCE: Records show that specialist support is gained where necessary although it has been recommended that ‘dementia voice’ be contacted to offer advice regarding the support of one person with a diagnosis of dementia. It was also noted through case tracking that there was no record of an optician visit for one person, the manager will investigate this and ensure all residents receive the necessary healthcare checks within appropriate timescales. It is further recommended that ‘quick view’ healthcare sheets be completed so that visits can be easily monitored. 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 Page 14 The manager demonstrated an understanding of the need to respect the residents’ privacy and dignity. He was aware of gender issues and the areas of the service, which included the need to respect residents’ privacy. Residents’ were observed to be dressed in a style that reflects their personality. Times for getting up and going to bed are flexible and suit the individual. The opportunity was taken to examine medication practices and storage. It was noted that medication balances kept were not always accurate. This was discussed with the manager who in turn will discuss issues with team members responsible for the administration and storage of medication. A requirement is made. All other issues relating to medication were satisfactory. 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 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 the following standard(s): 22-23 Residents’ views are sought and they are protected from harm. EVIDENCE: The inspector took the opportunity to examine the financial records for the 2 residents that the inspector ‘case tracked’. Both balances were correct at the time of the inspection and financial processes were explained by one of the care staff. There was a complaints book in place to record any complaints received from residents and staff. There were no recorded complaints since 2003. The complaints procedure is in a format that some of the residents find accessible. Staff confirmed that they seek the views of the residents at informal times of the day especially over a meal in the evening. Staff said they are aware of residents differing communication needs and are able to translate their wishes and feelings. Records show that staff attend awareness of abuse training and the inspector suggests that this training become part of the annual rolling programme. 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 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 the following standard(s): 24-30 Shared spaces compliment residents personal bedrooms. The home is suited to its stated purpose however requires some attention to ensure it remains comfortable and safe. EVIDENCE: The inspector was invited into residents’ bedrooms and found them to be personal and individualised. It was noted in one bedroom that bedrails are used to support a person of risk at falling out of bed. It is required that a risk assessment be put in place for their use and the Occupational Therapist be contacted for advice on the type of bedrails that can safely be used. See standard 9. A tour of the environment was undertaken with the manager and it was noted that there were some areas requiring attention. 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 Page 17 Black patches and flaking paintwork were on the walls in the quiet room this requires investigation. Water in one bedroom was too hot to hold a hand under; this also requires investigation. The small toilet has a fixed frame over but this has become rusted and worn. It is strongly recommended that this be replaced with the drop down arm facility. It was noted that the base plate on the hoist in the small bathroom has become rusty. The manager said this would be replaced with a walk in shower. There are adequate bathroom and toilet facilities to meet the needs of the resident group. The hallway carpet is also due to be replaced. 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31-36 There are appropriate staffing numbers and skill mix employed at the home to ensure the assessed needs of residents are met. Residents are protected by the homes recruitment policies although the documentation required by legislation is not kept on the premises. EVIDENCE: The manager explained the staffing structure and confirmed there were the appropriate staffing numbers and skill mix employed at the home. One staff member confirmed she had undertaken training relevant to the needs of the residents as well as statutory training. She was aware of her job description and was able to describe her role and responsibilities within the home. She said ‘Supervision takes place 4-6 weekly’. The home manager confirmed this. Records show that the manager has checked the personal identification documents of his staff members. Personal identification numbers for all of the qualified nurses are recorded alongside reference contacts. The documents themselves are stored a the Brandon Trust HQ and legislation currently requires all such documentation relating to staff employment to be kept on the premises. The CSCI and the Brandon Trust are currently in negotiation over this requirement and a long timescale has been given. 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37-40,42 Residents’ benefit from a positive team with a sound management approach. Residents’ best interests are safeguarded by the Organisational policies and procedures. EVIDENCE: The fire logbook was examined and it was noted that all necessary checks of the fire alarm system and equipment takes place within the timescales prescribed by the Avon Fire Brigade. The fire risk assessment was written in 2002 and would benefit from being updated. It is strongly recommended that the fire risk assessment be checked and agreed by the relevant fire specialist either through Brandon Trust or the Avon Fire Brigade. 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 Page 20 A member of staff said ‘I feel empowered and am able to make my own decisions. The management approach is good and we are all part of the team’. The manager said residents meetings take place every other month and these are more of a social get together than a formal meeting. Other staff members said that views were also sought from residents at bath times, and one to one times throughout the day. The home has a number of policies and procedures designed to protect and enhance the lives of the residents and staff team. 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 Page 21 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 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 20 Queens Road Score 3 2 2 X Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X 2 X DS0000020284.V253753.R01.S.doc Version 5.0 Page 22 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 YA6 Regulation 15(2)B Requirement Care plans lack the relevant information needed to adequately support the residents and requires a review. Timescale for action 01/11/05 Schedule3(3)m Information needed in one particular plan of care includes, support with hearing and visual impairment including blephitis, mobility, dementia, continence, anxiety and agitation and reoccurring chest infections. 2 YA9 13(1)(b)(4) Risk assessments are needed for the use of bedrails and advice must be sought from the occupational therapist where bedrails are not designed for a specific bed. Risk assessments must be reviewed to ensure they encompass all identified risks associated with daily living. 3 YA19 13(1)(b) Ensure all residents receive the necessary healthcare DS0000020284.V253753.R01.S.doc 01/11/05 01/11/05 20 Queens Road Version 5.0 Page 23 checks within appropriate timescales including dentist and opticians. 4 YA20 17(3)(a) Ensure all medication records are kept up to date including PRN balances. Walls in the quiet room to be investigated. Water temperatures to be monitored. 6 YA34 Schedule 4(6)(a-f) Legislation currently requires all documentation relating to staff employment to be kept on the premises. The fire risk assessment to be reviewed and updated. 01/11/06 10/10/05 5 YA24 23(2)(b) 01/11/05 7 YA42 13(4)(c) 01/11/05 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 2 3 4 5 Refer to Standard YA5 YA6 YA19 YA24 YA42 Good Practice Recommendations Where necessary make contracts accessible to residents. Contact dementia voice to seek support for one resident with a diagnosis of dementia. Put in place ‘quick view’ healthcare sheets. Replace the toilet frame with the drop down arm facility. The fire risk assessment to be checked and agreed by the relevant fire specialist either through Brandon Trust or Avon Fire Brigade. 20 Queens Road DS0000020284.V253753.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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. 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