Inspection on 21/02/06 for 218 Kingsway

This inspection was carried out on 21st February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

218 Kingsway 14/11/07

218 Kingsway 03/10/06

218 Kingsway 31/08/05

218 Kingsway 25/02/05

218 Kingsway 03/06/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME ADULTS 18-65 218 Kingsway St George Bristol BS5 8NS Lead Inspector Sandra Jones Unannounced Inspection 21 February 2006 09:30 st 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 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 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 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. 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 218 Kingsway Address St George Bristol BS5 8NS 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) 0117 9476315 0117 9709301 admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Ms Nicola Jane Josefowicz Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 5 persons aged between 18 and 64 years with Mental Disorder. 31st August 2005 Date of last inspection Brief Description of the Service: 218 Kingsway is a care home for five younger adults with mental health care needs of both sexes. It is operated by Aspects and Milestones Trust and managed by Ms. N. Jozefowicz. The property is semi-detached, with an appearance of a domestic dwelling, which blends well with its local environment. It is adjacent to a shopping precinct and major bus routes. 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second unannounced inspection for the home in the year 2005/06 To gain a full overview of the home both reports must be read in conjunction. Members of staff on duty and residents at the home during the inspection were consulted. Documentation held at the home was reviewed and feedback from residents and staff was used to confirm practices at the home. The findings from the tour of the premises were used to make judgements on the environmental outcomes for residents. What the service does well: What has improved since the last inspection? What they could do better: 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 Page 6 There are three requirements arising from this inspection, which are based on evidencing that restrictions imposed are based on good practice guidelines. Records of medications administered must list each medication and staff must sign for each medication administered. From discussions with the staff, the venues and time allocated for staff meetings must be considered particularly as staff are lone workers. 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. 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 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 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 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): These standards were not assessed at this inspection. EVIDENCE: 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 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 A framework of the key principles that represent person centred care has been established for residents to influence the manner in which their care is to be provided. Where restrictions are imposed, risk assessments must detail agencies informed and the good practice followed in making the decisions. EVIDENCE: Since the last inspection, residents needs were reviewed and Person Centred Plans developed. Personal profiles describe each aspect of the persons needs, with a description of the manner the need is to be met. It is evident that the likes, dislikes and preferred routines of the person are incorporated into the action plans. From the profiles care plans are developed listing the aims of the person and the staff. For residents with current mental health needs, triggers and warning signs of deterioration are clearly described. Actions to be taken with safety net advice are included into the care plans. Additional to the home’s care plans are the Care Planning Approach (CPA) review meetings 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 Page 10 convened by the care coordinator. The psychiatrist, any outside agency, the resident and relatives participate in the annual reviews. Restrictions are imposed on smoking, number of drinks consumed at night, water is turned off in one bedroom at night and time one residents spend in their bedroom during the day. The stock of mugs is locked leaving residents with two mugs each for their day’s use. For one resident to have six hours quality sleep at night, a structure to develop healthy sleep patterns has been devised. The resident has agreed not to retire before 7:00 pm and for staff to limit the time that the person can sleep during the day. Members of staff manage the number of cigarettes that two residents smoke during the day. The profiles for these individuals briefly describe the quantity, the times and the reasons for the restrictions. A separate agreement is in place with one resident for hourly drinks and for staff to monitor the intake. Another resident that requires a healthy sleeping pattern, restrictions on choice are detailed in the action plan. The resident has agreed not to have any drinks from 8:00pm onwards, cups will not be taken into bedroom, and on each shift staff will check for empty receptacles. At night staff will remove the stereo equipment and the water supply to the bedroom to be switched off. However, the risk assessments are not clear on the agencies consulted before imposing the restrictions and the good practice guidelines followed. Risk assessments must include the agencies informed about the restrictions imposed along with the good practice guidelines used to make the decisions. Specific care plans are in place for residents that at times exhibit inappropriate behaviour towards others. Name-calling, infantile behaviour and shouting in other people’s faces are listed as inappropriate. Action plans describe the steps to be taken by the staff to achieve positive behaviour. The resident at the home during the inspection agreed to comment on the standards of care at the home. The resident understood that the staff maintain records about residents. Residents, relatives and keyworkers attend reviews. In terms of influencing decisions, the resident stated that “in a way” there are opportunities, during the reviews, to disagree with decisions. Keyworkers are appointed and during the discussion the resident felt more comfortable to have the keyworker present. This individual is clear on the role of the keyworker. Reports of significant events describe outcomes of visits, activities, behaviours exhibited and observations by staff. The information is factual and objective, with each entry signed and dated. 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 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 opportunities to experience meaningful community-based activities. Meals served at the home are varied and nutritious. The home caters for specific diets. EVIDENCE: Residents attend a combination of day care services; college courses and three are also employed. One resident is currently on the waiting list for a college course to learn office skills. Members of staff currently assist two residents with budgeting. The others have skills and abilities in budgeting. Dial-a-Ride and concessionary bus passes are sought for residents to support residents with maintaining education and occupation. 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 Page 12 The resident consulted confirmed their awareness of the house rules and expectation of residents. Damage to property and inappropriate behaviour were two examples given by the resident. The home currently caters for vegetarian and diabetic diets and staff endeavour to provide healthy diets. Currently four residents can participate in food preparation and it’s an expectation that residents assist with meals. The record of food provided lists meals provided at each mealtime with any alternatives. The range of fruit, fresh vegetables, tinned and frozen foods confirmed that residents have a varied and nutritious diet. The resident giving feedback stated that the food was good and sufficient quantities are served. A record of fridge, freezer and cooked meat temperatures is maintained and complies with Food Safety Act. 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 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, 19 & 20 Individual Person Centred Plans specify the manner in which personal care is to be provided. Residents health and emotional health care are assessed, recognised and procedures are in place to address them from specialist support. Medication administration procedures do not adequately protect residents because staff do not sign for each medication administered. EVIDENCE: One resident requires assistance with personal care, another with specific areas and others with prompting from staff. The care plans for the person that requires support with daily living is specific and detailed. Other care plans briefly describe the steps to be taken by the staff. For example, hair washing and reminders to change. Individual profiles list the individuals preferred routines in terms of sleeping patterns and personal hygiene. Within the personal hygiene schedules the person’s abilities to dress and attend to their hair are clarified. 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 Page 14 One resident visits the Health Centre independently for injections and staff accompany residents on GP’s visits and hospital appointments. One resident has input from the continence advisor. Another resident that is diabetic visits the nurse at the health centre for check-ups The residents do not require aids to move around the home, equipment or therapists. Psychiatrists from the Central Bristol Rehab. team visit residents at home to review their mental health needs every six months. One resident recently had a cataract removed and three residents have regular hospital appointments. It was understood from the staff on duty that Community Psychiatrist Nurse are to be appointed for each person funded by the Local Authority. Female residents are invited for routine screening. One person has refused and the others attend routine checks. Residents access NHS community facilities. Residents recently visited the optician for check-ups, and regular visits are arranged to the chiropodist and dentist. Paracetamol, cough mixture and laxatives are administered from a stock supply when required and the records of administration are accurate and well managed. Four residents currently self administer their medication from a monitored dosage system, which is checked by the staff to ensure safe administration. Members of staff administer medication to one person from a monitored dosage system. The records are not consistent with the medication and members of staff must sign after administering each medication. It was understood from the staff that the pharmacist countersigns the records of medication received to evidence receipt of the medication for disposal. 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 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, taken seriously and acted upon by the staff. Through polices, procedures and training a commitment towards safeguarding residents from abuse is established. EVIDENCE: Four complaints were received at the home from residents and the records describe the actions taken to resolve the complaints to a satisfactory outcome. Residents meetings are forums where the group can express views and express concerns. Five residents meetings were organised last year and staff on duty explained that additional meetings can be convened where topical issues arise. From the minutes of the meetings, residents are informed of any changes, told about outcomes of visits and their views sought on the day-today running of the home. Residents consulted during the inspection confirmed that residents meetings take place and generally policies and routines are discussed. It was also stated that members of staff would be approached with complaints. Confidence that staff would take their concerns seriously was expressed. Members of staff stated that POVA training is provided and all staff have attended the training. There were no POVA incidents at the home. 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 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, 26, 27 & 30 The environment for the residents is comfortable and is decorated to a reasonable standard. Personal space is arranged to meet the individuals needs and to maintain their lifestyle. The home has enough toilets and bathrooms enabling to enable residents to have personal privacy. There is sufficient communal space for residents to share activities and for private use. The home was found to be clean and free from unpleasant smells. EVIDENCE: 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 Page 17 218 Kingsway is a semi-detached property located in a residential environment, next to a small shopping precinct and close to bus routes. The property is arranged over two floors, with shared space on ground floor and bedrooms on the both floors. Generally the property is maintained to an adequate standard. The carpet in the corridors was replaced and repainted since the last inspection. It was understood that the lounge will be repainted in the future. Bedrooms are single occupancy and lockable furnished with a combination of the home’s furniture and the person’s personal possessions. Each bedroom reflects the individuals personality and is suitable to meet the individuals lifestyle. In one upstairs bedroom there were cracks in the wall and ceiling, it was understood that action to repair the damage is being taken. One bedroom is fully en-suite with toilet, shower and hand basin. The home operates above the NMS of no more that three people sharing toilets and bathrooms. Current ratio of residents sharing bathroom and toilet is two people sharing. There is a lounge/dining room, smoking lounge and kitchen shared by the residents. The lounge/dining room offers sufficient seating for resident group to sit together and watch television and dining space to eat their meals together. It was understood from the member of staff on duty that generally, residents eat their meals in the dining space but gather in the smoking room. The smoking room has a large sofa, easy chair and desk for residents. It is well ventilated and can be used by non-smokers. The kitchen is large enough for three people to sit and at the dining table. The home provides sufficient communal space for shared activities and for private use. An en-suite facility was provided for one resident to maintain their independence. The other residents do not require aids and adaptations to move around the home. The laundry is sited away from the kitchen. The walls are painted and there is vinyl flooring for ease with cleaning. There is a domestic washing machine and tumble dryer with hand washing facilities. One resident is occasionally doubly incontinent and foul linen can be put through the washing machine. 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 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): 36 There are opportunities for staff to increase their skills and capabilities to meet residents changing needs. EVIDENCE: As the manager was not on duty personnel records were not available. Members of staff gave feedback on the arrangements for training and supervision. It was reported that during 1:1 staff have opportunities to discuss issues with the manager. Personal Development Plans are set with the manager and focus on training needs and accessibility to staff. 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 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): 38 & 41 The manager must consider the venues and time allocated for staff meetings to maintain consistency of care at the home. Records kept at the home on behalf of the residents are up to date and well maintained. EVIDENCE: The staff at the home are lone workers and stated that there is peer support from the team. As lone workers, it was commented that there are times that they are left to make decisions when residents require urgent support form outside professional. Clinical advice from on-call support is poor. In terms of consistency of care, staff meetings are arranged monthly and individual supervision six weekly with the manager. The agenda for staff meetings allows for suggestion and the end of the meeting during any other business. Staff’s comments suggest that in depth discussions cannot always 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 Page 20 take place because of time constraints. The manager must consider venues and time allocated for staff meetings to ensure that staff have opportunities to raise issues particularly as they are lone workers. The rota in place indicates that generally one person is rostered throughout the day and at night one-person sleeps in the premises at night. Additional staff are rostered during the day to provide transport whenever the manager is covering evening and night shifts. It is evident through the inspection that one resident is becoming frailer. While this individual is away from the home three times a staffing levels must be monitored to ensure that residents changing needs are met. Facilities for the safekeeping of cash and valuables exist at the home and the records were consistent with the balances held. The records of fire safety checks and practices are examined, which indicated that checks and practices are conducted at the stipulated frequencies. 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 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 Standard No Score 1 x 2 x 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 3 ENVIRONMENT Standard No Score 24 3 25 x 26 3 27 3 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 x 33 x 34 x 35 x 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 x x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 x 14 x 15 x 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x X 2 X X 3 X X 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 Page 22 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 YA9 Regulation 13(4) Requirement Timescale for action 30/04/06 2 YA20 13(2) 3 YA38 21(1) For restriction imposed, risk assessments must incorporate the agencies informed and the decision-making process including good practice guidelines used. Medication record sheets must 30/03/06 detail each medication administered and staff must sign for each medication administered to residents The manager must consider the 30/04/06 venue and time allocated for staff meetings RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 Page 23 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. Extracts may not be used or reproduced without the express permission of CSCI 218 Kingsway DS0000026582.V283501.R01.S.doc Version 5.1 Page 24 - 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. 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