Inspection on 14/02/07 for 26 Cheddar Grove

This inspection was carried out on 14th February 2007.

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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

26 Cheddar Grove 29/10/07

26 Cheddar Grove 07/02/06

26 Cheddar Grove 21/11/05

26 Cheddar Grove 18/02/05

26 Cheddar Grove 29/09/04

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 Cheddar Grove 26 Cheddar Grove Bedminster Bristol BS13 7EN Lead Inspector Paula Cordell Key Unannounced Inspection 14th February 2007 10:00 Cheddar Grove DS0000020273.V329823.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 Cheddar Grove DS0000020273.V329823.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. Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cheddar Grove Address 26 Cheddar Grove Bedminster Bristol BS13 7EN 0117 9077214 0117 9077214 colin.westwood@brandontrust.org www.brandontrust.org The Brandon Trust 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) Mr Colin Richard Westwood Care Home 7 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (7) of places Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Staffing Notice dated 28/03/1994 applies Manager must be a RN on parts 5 or 14 of the NMC register May accommodate up to 7 persons aged 40 years or over, with Learning disabilities. 7th February 2006 Date of last inspection Brief Description of the Service: Cheddar Grove is a large (ex Vicarage) house set in a quiet area of Bedminster Down on the outskirts of Bristol. It has good links with local amenities, shops, pubs and a post office, which are all within walking distance. The church is next door. The house has seven bedrooms, four of which are on the ground floor. There is a large back garden overlooking a school field. The home has qualified nurses on duty at all times and caters for adults with learning difficulties and mildly challenging behaviour. The aim of the home is to provide total support for residents in all aspects of their lives. Residents are encouraged to develop self-confidence and life skills. Residents are taken on various holidays, outings and have links with local colleges and day centres. The home caters for ambulant and non-ambulant residents and has mobility aids so all parts of the home are accessible. The fees for the home are £1231 per week. Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection. The purpose of the visit was to review the requirements and recommendations from the inspection in February 2006 and to monitor the quality of the care provided to the residents living at Cheddar Grove. The home has received no additional visits during this period. There has been an allegation of abuse of which the home has investigated through the appropriate channels and procedures. The allegation was not upheld. The home has been keeping the Commission for Social Care Inspection informed of incidents that affect the wellbeing of the individuals living at Cheddar Grove and the provider has sent monthly appraisals of the service. This information was used to plan the inspection process. The inspection was conducted over a total of 5.5 hours. The inspector had an opportunity to meet with a number of the residents and three members of staff. The home has no vacancies at present. The methodology used during this inspection included viewing care records and other relevant documents required of a care home and a tour of the home. The inspector received responses from one visiting professional, four relatives and one of the residents (supported by their key worker) living at Cheddar Grove to questionnaires sent prior to the inspection. A pre-inspection questionnaire was completed by the registered manager was also received and this information assisted with the planning of the site visit. What the service does well: What has improved since the last inspection? Residents now benefit from care documentation being dated in response to the previous recommendation. Cheddar Grove DS0000020273.V329823.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. Cheddar Grove DS0000020273.V329823.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 Cheddar Grove DS0000020273.V329823.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): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents’ needs are assessed and a plan put in place to ensure they are met. Residents are encouraged to ‘test drive’ the service to ensure all parties are happy with the placement. Resident’s contracts are not service user friendly. EVIDENCE: The home has a statement of purpose and a service user guide. These were not seen on this inspection as these were assessed as meeting the standard at previous inspections. There are policies and procedures for the staff to follow in the event of a resident vacancy arising in the home. Presently the home is fully occupied. It was evident that the home encourages prospective residents to visit the home prior to making a decision to move. Relatives, the resident and their placing social workers visit the home prior to making a decision to move. Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 Page 9 Visits are arranged to suit the individual gradually building up to an overnight stay. There was clear and informative assessments in place including copies of the placing authorities assessment of need and care plan. From evidence provided at the last inspection it was evident that the admission process was seen as core process to ensure that the home is satisfied that they can meet the assessed needs of the individual and that the current resident group and the new resident are compatible. There is also a trial period of 3 months. Residents’ contracts were available in residents bedrooms these are not ‘user friendly’. This remains a recommendation from the previous inspection that contracts be made user friendly and individualised to meet the communication needs of each person. Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 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. 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. The home is failing one individual due to the lack of documentation in supporting and minimising challenging behaviour; consequently other residents and staff are at risk of harm. Whilst residents care needs are being met this would be better evidenced if formal reviews were in place. EVIDENCE: Care plans examined were detailed and person centred. However, three out of the four care plans seen had not been formally reviewed in the last six months. Staff stated that the reviews are regular and residents are involved in the planning of their care. Residents make day-to-day decisions on how they want to spend their time. Residents are offered a variety of choices to enable them to make informed decisions. Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 Page 11 From reading the person centred plan for one individual it was not evident that the resident had obsessive behaviours that affected their every day living. However, this came to light during conversations with staff and from reading medical assessments from the psychiatrist. The plan of care must be reviewed and reflect the individual which may assist in reducing behaviours that challenge. Risk assessments were detailed but lacked a formal review. Risk documentation covered a wide range of activities including manual handling, transferring from chair to bed etc, choking, access to the bedroom, use of hydrotherapy and general activities. One risk assessment made reference to a resident having a lock fitted to their bedroom door. However, there was no lock in place. This was to prevent another resident accessing the individual’s room. Staff stated that the individual would not be able to use a key due to the level of physical disability. This requires amending and other measures taken to ensure the safety of the resident’s personal space. From talking with staff and observation there was concerns about one of the individuals in relation to challenging behaviour towards both staff and other residents. There was no care plan detailing the support needs for the individual and concerns were raised that staff were dealing with the individual in different ways and offering no consistency. The home is recording incidents of aggression however; it is evident that this information was not informing the plan of care. An incident was observed where the resident hit another. The perpetrator was asked to sit back in the lounge and the victim was only asked if they were “all right”. Where residents are being attacked the home must follow the Protection of Vulnerable Adults Protocol enabling a strategy to be developed involving a multi-agency approach. Generally, staff had a good understanding of residents care needs and evidently had built good relationships. Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents lead very active lifestyles based on their preferences. Residents are encouraged to maintain contact with friends and relatives. Residents have a healthy diet. EVIDENCE: Each resident has a structured timetable of activities, which is varied to suit the needs of the residents. One resident receives additional funding for one to one support. Evidence was provided that this was in place with an additional member of staff rostered to provide the support. Activities varied to suit the individuals living at Cheddar Grove and included attendance at day centres, hydrotherapy, college and activities with the staff. Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 Page 13 Records provided evidence that residents had regular social outings with staff including trips to the pub, cinema, ten pin bowling, shopping trips, out for meals and places of interest. Residents confirmed that they were supported to go out in the home’s vehicle. A member of staff stated that one of the reasons they enjoyed working in the home was that the residents were encouraged to lead very full and active lifestyles. From conversations with staff residents were supported with a wide spectrum of activities and were not discriminated against due to their physical or learning disability. This is good practice. On the day of the visit, two of the residents were being supported to go out shopping and for a visit to a café, two residents were out at college and one resident was at their day centre. Staff stated that it takes some organisation in relation to staffing and ensuring adequate drivers are available to ensure that residents attend all their activities. It was evident that the staff were committed and this was seen as a strong value of the home for residents to lead active lifestyles based on their individual preferences. Residents’ rights are respected and responsibilities recognised in their daily lives. One staff member said, “this home is relaxed and welcoming and run by the residents rather than the staff”. House meetings evidence that residents are asked their opinions about various aspects of life in the home. The minutes of the last meeting show that the topic of relationships was discussed and how people should treat each other. The home has a policy on bullying and harassment. This was not seen on this occasion. The manager confirmed at the last inspection that residents were asked if they would like a key to their bedroom. Two residents currently have their own key. No residents have a front door key, as they do not go out unsupported. All residents are supported to have an annual holiday. Staff described how residents were supported to choose their holiday. Pictures were seen of the residents on holiday last year. One resident stated that they had been to Spain with a fellow resident last year and they had liked it. Holidays this year include a short break to the New Forest, a one to one holiday to Pembroke for one individual and a barge holiday. One resident prefers short breaks and finds this preferable to a longer holiday. Residents’ contact with relatives and friends was clearly documented in the plan of care. Residents were supported to maintain contact and visitors are encouraged to the home. One relative stated that they are always “cheerfully received by staff and that they relative is well care for, and they have no concerns whatsoever about the care provided”. Another relative stated that the home meets the care needs of the resident, and they are kept informed of important issues affecting their relative. Another relative stated, “ The home and the staff provides a good quality life”. Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 Page 14 The menu was varied and appealing and it was evidenced that residents have input into the planning and preparation of food. Resident’s preferences in relation to food were recorded and staff had a good knowledge of individual’s likes and dislikes. The lunchtime meal was unrushed and residents appeared to enjoy their meal. A staff member and a resident confirmed that residents are encouraged and supported to use the kitchen, making snacks and helping with the preparation of a main meal. Risk assessments were seen supporting this. A resident stated that they liked to spend time with staff in the kitchen. Another resident stated that the food was good. Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. Resident’s personal and health care needs are responded to appropriately. Residents are safe guarded by the home’s medication practices. Residents are assured that their dignity would be maintained during illness and death. EVIDENCE: It was noted that the healthcare needs of the residents are assessed and met and the appropriate healthcare specialist accessed where necessary. There was evidence of visiting professionals including the dentist, optician, physiotherapist and occupational therapist. Residents have a Health action plan detailing their support needs. This was comprehensive and demonstrated that residents health care needs were being responded to. Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 Page 16 Resident’s personal care needs were clearly described in the person centred plan on how each person would like to be supported. A relative praised the staff on the care that is taken with their relative in relation to personal care and the individuality that is maintained in clothes and presentation. Three relative questionnaires stated that the home keeps them informed of important matters relating to the care of their relative. One relative stated that staff are always willing to listen if one has any concerns about health and are very reassured that the home takes the appropriate action. It was noted that some residents have access to a psychiatrist and are regularly reviewed for their emotional and mental health needs. The home must ensure that where residents challenge that their plan of care is reviewed holistically rather than the focus of being treated with medication. The Medication Administration Sheets (MARS) were seen. These were clearly written and contained signatures of the staff administering the medication. It was noted that there were guidelines in place for as and when required medication. There were medication profiles in place including the uses and side effects of each medication. Policies and procedures were in place for the safe administration of medication as seen at the last inspection. Medication balances were checked at random and found to be correct. Stock checks take place on a weekly basis and all medication is signed in and dated. Medication is stored in accordance to the Royal Pharmaceutical guidelines. Staff who are responsible for administering medication have attended training in the monitored dosage system as evidenced via discussion with the qualified nurses on duty during the site visit and via training records. Staff training records evidenced that all staff have a first aid certificate and have attended training in manual handling. Some staff have attended further training in epilepsy, dementia and supporting residents that are getting older. From talking with staff the home has experienced a death of a resident and the individual is still missed. It was evident that the staff and the residents were supported through this time. A number of staff have attended training in ‘death and dying’ and ‘supporting people through loss and bereavement’. Cheddar Grove DS0000020273.V329823.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. Residents are protected by the Organisation’s procedures in the event of an allegation of abuse, however one individual’s protocol relating to allegations could lead to confusion on the procedure. Residents and relatives can be confident that their concerns would be responded to appropriately. Residents can be confident that they views would be listened to. Residents would be better protected in the event of an allegation of abuse if all staff attend training on protection. EVIDENCE: As seen at the last inspection there were adequate policies in place regarding the protection of vulnerable adults. Staff were aware of the whistle blowing policy and policies were discussed at team meetings. The local authorities guidance on ‘No Secrets’ was available to all staff alongside the General Social Care Council (GSCC) codes of conduct. Staff confirmed their knowledge of the policies. Relative feedback demonstrated that they were aware of the complaints procedure. Copies of the complaint procedure were available to residents in their bedrooms and this was in a resident friendly format. Residents’ views and concerns were sought at resident meetings. Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 Page 18 The home’s record demonstrated that there has been one complaint since the last inspection, which related to an allegation of abuse by a member of staff to a resident. The home responded appropriately and followed the Protection of Vulnerable Adults Policy and the police were involved. The allegation was unfounded. The home has devised a local protocol for the resident concerned in the event of further allegations. Concerns were raised that whilst the home would take an allegation seriously it fails to follow the “No Secrets” guidance and the home will conduct an investigation including interviewing the resident and staff. This must be amended to reflect the Department of Health’s No Secrets. Staff had been targeted and it was evident from conversations that some staff were frightened of the individual. Consequently some staff’s immediate reaction by their own admission was to shout at this individual to prevent the initial aggression. This is a form of abuse and staff, the individual concerned and the other residents are being failed by the lack of guidance and training in supporting this individual. In addition residents who are being targeted are suffering abuse and deserve to feel safe in their home. A random check on staff training records provided evidence that three out of seven staff had not attended training on Protection of Vulnerable Adults. This must be addressed. A member of staff stated that they were planning to attend this course shortly. Safe practices are in place relating to resident’s finances with the appropriate checks and balances in place. Finances were checked daily by the staff and monthly during the provider visit in respect of regulation 26. Cheddar Grove DS0000020273.V329823.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 good This judgement has been made using available evidence including a visit to this service. 26 Cheddar Grove provides residents with a homely, safe and clean environment, which is meeting their care needs. EVIDENCE: 26 Cheddar Grove is situated in a residential area to the South of the city of Bristol. The home is in keeping with the local neighbourhood and has good access to public transport. The home is accessible to residents who have a physical disability with a slope to the front door. Each resident has a single bedroom, which has been personalised by the individual. There are four ground floor bedrooms. There is a stair lift to access the first floor bedrooms. Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 Page 20 Residents have available to them two lounges that are homely and decorated to a good standard. These areas have been recently redecorated. In addition residents have access to a dining area and kitchen. From talking with the person in charge there is a refurbishment plan for the forthcoming year, which includes both bathrooms and the dining area and some of the carpets throughout the house. These areas were noted to need some decoration and modernisation, however no requirement has been made as this is being addressed via the home’s refurbishment plan. Routine maintenance records demonstrated that repairs were responded to in a timely fashion. The home has a number of aids to assist residents with personal care and their mobility including hoists. Certificates were seen demonstrating that these are routinely maintained. Radiators are fitted with guards, the water is temperature controlled and windows are fitted with restrictors ensuring the residents safety. A relative stated that when they visit the home, it is always clean. During the inspection it was noted that the home was clean and free from odour. Care staff are completing the cleaning and the catering tasks as observed during this visit. The home has a small sluice and laundry room. Staff stated that these are adequate to the needs of the care home. Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,35,36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient and competent staff supports residents. However, there is a lack of training to support staff to deal with episodes of challenging behaviour. Staff feel otherwise supported in their role but there is a lack of formal supervision. EVIDENCE: The home has an effective staff team with sufficient numbers and complementary skills to support residents assessed needs, however there is a lack of training to support residents that challenge. Residents are supported by a minimum of three staff in the morning and afternoon and two staff at night (one waking and one sleeping in member of staff). In addition from Monday to Friday there is a fourth member of staff during the morning to ensure that social activities can take place. The duty rota provided evidence that a qualified nurse registered with the Nursing and Midwifery Council manages each shift. Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 Page 22 Staff records confirmed that they undertook an induction (the Learning Disability Award Framework) and attended mandatory courses in health and safety and the organisation’s values for supporting individuals with a learning disability. Staff then are supported to progress on to a National Vocational Award in care. According to the pre-inspection questionnaire the home has 77 of the workforce having completed an NVQ, which exceeds the government targets of 50 . Training records further evidenced that staff have attended courses in makaton (communication in signing), understanding epilepsy, understanding multiple disabilities, person centred planning, supporting residents who are getting older, dementia and recruitment and selection. All of the mandatory training has also been accessed. From reviewing the staff training files and speaking with staff, only one member of staff has had training to supporting individuals that exhibit challenging behaviour. In light of the present behaviours that challenge staff must be given support and guidance in supporting the individual. The staffing records are not kept on the premises but held at the Brandon Trust HQ. The Commission for Social Care Inspection will be completing an inspection of the personnel department to view staffing records. It was noted that there are appropriate policies and procedures in place regarding recruitment and equal opportunities etc. At the last inspection it was confirmed that where possible residents were invited to take part in the interview process this was not revisited at this inspection. The supervision timetable was displayed in the office. Signatures were gained from staff when they had received their supervision session. This evidenced that whilst staff are having periodic supervision this is not at the prescribed intervals, in accordance with the National Minimum Standard. A member of staff stated that the manager has been managing two homes and supervision may have been an area that has slipped, however they stated that they felt supported both by the manager and the staff team. A member of staff stated that the manager supervised the qualified nurses, and then they in turn would supervise the home support workers (unqualified staff). A significant number of the home support workers have only had three supervisions in the last twelve months. Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 Page 23 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 good This judgement has been made using available evidence including a visit to this service. Resident’s benefit from an open approach to the management of the home. EVIDENCE: The registered manager is Mr Colin Westwood. Mr Westwood has recently had the responsibility of managing this home and another within in close proximity of Cheddar Grove also owned by Brandon Trust. Mr Westwood is on a period of extended leave and one of the assistant managers is acting as the manager in his absence. The organisation has been keeping the Commission for Social Care Inspection informed of the changes in management. Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 Page 24 Staff comments about the management of the home were generally positive. However, three staff stated that it has been an unsettling time whilst the registered manager has been working in the other home and at times staff morale has been low. Staff stated that this was not reflective of the manager but his dual responsibility of managing the other home. It is evident that the home has an open approach with regular resident and staff meetings where topics relating to the running of the home are discussed. Staff comments about the team dynamics were positive confirming the open approach and that views and concerns were openly discussed to move the service forward. The home has a quality assurance tool, which is completed by all staff within the home and an external assessor. Quality assurance was noted to be a topic of the last staff meeting and the delegating of responsibilities. The fire logbook evidenced that the appropriate fire equipment checks were taking place and that all staff also undertook fire drills and training. There was written evidence of a recent drill and training carried out at the home. Equipment checks take place appropriately including the annual portable appliance testing. The Health and Safety at Work Act poster is clearly displayed in the office and the staff were observed carrying out tasks that had been risk assessed appropriately i.e. shopping and cooking. The certificate of employer’s liability was clearly displayed alongside the registration certificate. There are sound systems in place to ensure financial planning and budgeting within the home, recruitment and selection and appraisal of managers is carried out by the Service Development Manager who also carried out monthly unannounced visits to ascertain sound service provision. There are clear lines of accountability within the home and a chart in the office details which nurse qualified staff member supports which Support Worker. Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 2 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 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 X 33 3 34 X 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 X X X 3 X Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 Page 26 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 YA6 Regulation 15 (1) Requirement The registered person shall after consultation with the service user or a representative prepare a written plan as to how the service user’s needs in respect of health and welfare are to be met. Ensure the plan is reflective of the individual and develop guidance on how the staff are to be support an individual with their challenging behaviour. The registered person shall keep the service users plan of care under review a minimum of six monthly intervals. Risk assessments must be reviewed at periodic intervals. The registered provider shall make arrangements by training or by other measures to present service users being harmed or suffering abuse or being placed at risk of harm or abuse. Timescale for action 13/03/07 2. YA6 15 (2) 13/04/07 3. 4. YA9 YA23 13 (4) 13 (6) 13/04/07 13/03/07 Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 Page 27 5. YA23 13 (6) Review the local protocol for one individual on the event of an allegation - to ensure that it is compliant with the Department of Health’s guidance on protection. The registered provider shall make arrangements by training or by other measures to present service users being harmed or suffering abuse or being placed at risk of harm or abuse. 15/02/07 6. YA35 18 (1) (c) (i) To make a referral to Bristol City Council as part of a protection strategy in respect of one individual and their challenging behaviour to develop a strategy of support, involving other professionals. Ensuring the safety of others. Ensure that the persons 13/05/07 employed by the registered person to work at the care home receive (i) training appropriate to the work they are to perform. Staff to receive training in supporting residents that challenge and protection of vulnerable adults. 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 YA5 YA36 Good Practice Recommendations Ensure residents’ contracts are user friendly. (Outstanding since Feb 06) All staff to receive at least six supervisions (one to one) per year. Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Cheddar Grove DS0000020273.V329823.R01.S.doc Version 5.2 Page 29 - 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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