Inspection on 13/09/05 for 261 Passage Road

This inspection was carried out on 13th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 but made no statutory requirements on the home.

Other inspections for this house

261 Passage Road 12/09/07

261 Passage Road 10/10/06

261 Passage Road 26/02/06

261 Passage Road 01/02/05

261 Passage Road 13/07/04

261 Passage Road 13/03/04

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 18-65 261 Passage Road Brentry Bristol BS10 7JA Lead Inspector Karen Walker Unannounced 13 September 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 261 Passage Road Address 261 Passage Road Brentry Bristol BS10 7JA 0117 9593223 0117 9699000 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Brandon Trust Mrs Susan Alexandra Massey Care Home Only 5 Category(ies) of LD Learning disability, for 5 registration, with number of places 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate persons aged from 40 years upwards. Date of last inspection 1 February 2005 Unannounced Brief Description of the Service: 261 Passage Road is operated by the Brandon Trust to provide residential care for up to five residents all of whom are currently female with a learning disability aged 40 years and over. The home is registered with the Commission for Social Care Inspection. The manager is Mrs Susan Massey who has a wealth of experience supporting residents with learning disabilities and with the current resident group. She is a qualified Learning Disability nurse as is the Deputy Manager Joyce Montague. This home blends in well with its neighbouring properties and is close to many local community facilities. There is the shopping area of Crow Lane within walking distance; Henleaze and Westbury village are a short car or bus ride away. The home has access to major bus routes and is a short ride away from the Mall Shopping precinct and the facilities it has to offer. The home has the added benefit of a large wellmaintained garden that is accessible to all residents. The garden provides a safe environment in that it is well fenced off and the home is not on a main road. 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of this inspection was to review the support being provided to one resident who is currently unwell and requires specialist input. The inspector met with this resident and viewed documentation relating to her. The resident commented that she was ‘ok and comfortable’. Requirements of the last inspection were also reviewed with the deputy manager. What the service does well: What has improved since the last inspection? Progress has been made towards complying with a requirement made at the last inspection to ensure certain risk assessments were in place. However where there have been significant changes in identified need this must be reflected in the risk assessments and care documentation. Unless mentioned throughout this report the requirements and recommendations made at the last inspection have been met. 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 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. 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1-4 Prospective residents have adequate information needed to make an informed choice on service provision. They have the opportunity to ‘test drive’ the placement prior to admission. EVIDENCE: The statement of purpose was seen at the last inspection and since there have been no changes within the home it has not been reviewed. The service user guide is in place and residents have been given a copy. When a vacancy arises Residents are invited to complete a ‘staggered’ admissions process. The assessment document viewed by the inspector and completed by the relevant social services prior to the residents’ admission into the home covered all aspects of personal care and daily living, personal safety and social interaction, mobility, health and financial arrangements. This linked closely to the care plans and includes the residents’ preferred form of address and how they communicate. 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 Page 9 The inspector examined one plan of care and through case tracking noted some evidence to show that the assessed needs of the resident were being met. The inspector spoke with another resident who said she was ‘ok and comfortable’. This plan of care however requires attention and will be further discussed in standard 6. A Staff member spoken with on the day of the inspection confirmed that the staff team supported residents to attend various health appointments. The inspector saw staff members communicating effectively with residents. There was evidence of appropriate contact with the general practitioner, dentist, chiropodist and opticians services. Various reports were made available to the inspector. There were detailed physiotherapy reports and the appropriate equipment was on order. 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9 Changing needs and personal goals are not identified in a residents care plan and risk assessments do not reflect appropriate risks. EVIDENCE: One resident who remains unwell was spoken with and documentation examined in respect of her. The new ‘planning for life’ folder had not been adequately completed and therefore essential information was left out. Her care plan or risk assessments did not reflect her current needs. Requirements are therefore made to ensure that her assessed needs are adequately recorded and the appropriate risk assessments are in place. Examples of risk assessments and care plans needed include mobility and transferring from the bed to the chair etc, refusing food and fluids, refusing medication, pressure area care, mouth care, continence etc. It was evident however that this resident received a lot of love and support throughout the day and night. 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 Page 11 The inspector is aware that there is a quality assurance system in the home where residents are asked for their views. This was not examined on this occasion. As a result of a requirement made a the last inspection there are now clear guidelines in place for staff to follow in the event of one resident having a seizure. This includes when to call the emergency services. 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15,17 Residents are offered a healthy balanced diet and enjoy their meals. Residents take part in age appropriate activitities supported by the home and by various day care staff. Family links are encouraged and supported. EVIDENCE: Residents are integrated into the community through using local shops, hairdressing and health care facilities. The leisure centre is sometimes accessed along with the Baptist church. Staff support residents to use the community by providing transport in the form of staff cars, a motobility car and public transport. The home blends well with its neighbouring properties, it is well decorated and homely in appearance. 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 Page 13 Residents are supported to visit local pubs for lunch or dinner and often support local fetes and sales. At the last inspection the manager said choices regarding activities and outings could be made through the residents meetings held approximately every 2 months. One staff member confirmed information was also made available to residents in the form of leaflets or catalogues. One staff member explained how she involved family members in the decision making process. It was explained that friends and relatives are encouraged to visit the home and residents are supported to visit their relatives. The inspector examined the menu book and noted menus were planned on a daily basis. The inspector heard staff members offering lunch choices and these were all recorded. Staff and residents confirmed that choices were met whenever possible and staff were aware of the likes and dislikes of the current resident group. One resident when asked if the food was nice said ‘its ok nice’. 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18-21 Residents are supported in a way they prefer with regards personal care and are assured of positive attention and love. Physical and healthcare needs are met although this is often not recorded. Residents cannot be assured of safe medication practices and procedures for the storage and recording of medications must be adhered too. EVIDENCE: It was noted that one resident had input from the St Peters Hospice nursing team. The district nurse and general practitioner has regular input and liaise with the home about the care provided. Mouth care sponges were available although the inspector observed the resident in question taking fluids. It was confirmed that fluid intake was not yet a problem. This must be included in the plan of care for future reference as previously discussed in this report. The district nurses have carried out a ‘waterlow’ assessment, which revealed a currently low risk of pressure areas developing. This must be regularly reviewed. 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 Page 15 The appropriate equipment has been provided including an ‘electric’ bed which the resident said is ‘ok’. Staff were observed supporting this person in a gentle and empowering way, always offering assurance and providing various choices. Dealing with ‘death and dying’ policies are in place and the deputy ensured they were readily available to staff. Although she was able to tell the inspector of one persons requirements after death and wishes of the family members this had not been recorded. A requirement was made on the day of this inspection to ensure the section in the planning for life folder entitled ‘my wishes in the event of my death’ are adequately recorded. The medication administration record sheets were examined and it was noted that the home now stock ‘controlled drugs’ available for appropriately assessed pain relief. It was noted that there was no controlled drug register in place and advice was sought from Sue Fuller the pharmacy inspector from the CSCI. An immediate requirement was left in respect of drug recording and the pharmacy inspector will carry out a full medication review on Thursday 15th September 05. The home has a walk in shower facility to meet the needs of those residents who are growing older and whose mobility needs are changing. The home has a stair lift in place to enable residents’ easy access to personal bedrooms. Its use has now been risk assessed. Records show that additional specialist support is accessed where necessary, this includes input from the physiotherapist, speech therapist and occupational therapist. Staff members told the inspector that individuals are supported to chose and buy their own clothes and visit the hairdressers, the inspector saw that the residents’ appearance reflects their personality. 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Residents are protected from abuse and harm and know their views will be listened to. EVIDENCE: The complaints book now takes the following format: Date, nature of complaint, action taken and timescale, outcome and signature. The inspector saw that the complaints procedure was available in the service user guide this includes details of how to contact the CSCI. How to make a complaint was also detailed on the notice board in the kitchen. The staff member spoken with said the staff team and residents were supported to complain. There were 2-recorded complaints since the last inspection and these were both acted upon. Staff act as advocates. A staff member spoken with at the last inspection told the inspector that a member of the staff team attends a monthly ‘communication’ meeting. These meetings are used as a forum to discuss concerns, managerial and organisational issues. Although the staff member spoken with was aware of the ‘no secrets’ document and the varying types of abuse, the inspector recommends that all staff have annual refreshers on the subject of the protection of vulnerable adults. At the last inspection the manager confirmed that ‘restraint’ is not used at this home although lap straps and the appropriate belts are used for safety on the stair lift and in the wheelchair and car. The inspector was pleased to note at this inspection that the appropriate risk assessments had been put in place. 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,27,28,29,30 The home is suited to its stated purpose and the residents enjoy living there. EVIDENCE: It was noted that Residents’ bedrooms are homely and individualised. One bedroom had the necessary equipment to support a resident who remains in bed. The home was clean and tidy on the day of the inspection. Living space is of an adequate size and both comfortable and homely. There is a large wellmaintained garden with adequate seating. At the last inspection it was noted that one bedroom smelt strongly of urine. This was not apparent on the day of this unannounced inspection and there were no unpleasant odours throughout the home. There are adequate toileting and bathing facilities for the resident group and where appropriate equipment has been provided for those requiring extra support. 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,34,35, Staff are aware of their roles and responsibilities and residents are supported by a competent staff team. EVIDENCE: The inspector examined the duty rota and it was noted that the staffing levels were sufficient to cater for the needs of the current resident group. The staff training folder was discussed with the deputy manager and it was noted that some of the staff team had taken advantage of the loss and bereavement training offered. Other training accessed was the medication system and the history of learning disability. One staff member is attending a racial abuse and discrimination training day in order to support her in dealing with one resident who uses racially unacceptable language. This has been discussed with the resident in question. Staff said they felt confident in meeting the needs of the current resident group. 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 Page 19 Records regarding staffing and employment continue to be held at the Brandon Trust HQ. There is an ongoing requirement that all records be kept at the home. This is being considered by the CSCI. The manager has confirmed that she has viewed all the necessary records and Criminal Record Bureau checks have been undertaken in respect of all staff. Key workers were clear about the care plans set within the home and said much of their role was supporting residents with general healthcare needs, social needs and encouraging independence. A Staff member spoken with said she was familiar with the General Social Care Councils Codes Of Conduct (GSCC). 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37-40,42,43 The residents’ benefit from a stable management tier and a well run establishment. The health, safety and welfare of residents are of priority and their best interests are safeguarded. EVIDENCE: The manager holds a nursing qualification (RNMH) and has had at least twenty-three years experience in a managerial role. She holds a national vocational qualification (D32/33) as an assessor as well as the national vocational qualification level 4 in management. She has just completed the registered managers award. 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 Page 21 The manager has evidenced that she undertakes periodic training including, team development, person centred planning, recruitment and selection and national vocational qualification standardisation. Additional courses are planned and undertaken as necessary. The fire logbook was examined and it was noted that a fire risk assessment was in place relating to the home. It is strongly recommended that an appropriate fire safety officer approve the fire risk assessment. Records show and the deputy manager confirmed that 6 monthly fire training for all staff was not taking place. This is a requirement. The inspector saw a number of policies and procedures put in place by the organisation and staff are expected to sign up to these policies. There was a specific policy for ‘service user involvement’ that was in an accessible style and encouraged resident involvement in service user forums. The inspector saw the bullying and harassment policy; whistle blowing and other staff related policies as well as generic policies and procedures needed to comply with current legislation. An emergency and crisis policy has been put in place June 2004. The Brandon Trust is a large organisation with overall responsibility for the home. There is a business plan in place that is produced annually; this then feeds into the homes annual plan. Monthly regulation 26 visits take place carried out by the service development manager. The inspector saw the liability insurance document was displayed along with the registration certificate. There are clear lines of accountability throughout the Trust that the staff are aware of. 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 Page 22 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 x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 3 x 1 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x 3 3 3 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score 3 2 x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 261 Passage Road Score x x 1 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x 3 3 D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 Page 23 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 6 Regulation Requirement Timescale for action 13/09/05 15(1)(2)( care plans and risk asessments b)13(4)(c) must be updated to ensure they relect current assessed needs. Examples of risk assessments and care plans needed are; mobility and transferring from the bed to the chair etc, refusing food and fluids, refusing medication, pressure area care, mouth care etc. the plans must be reviwed in priority order as discussed on the day of inspection. 13(2) 2. 20 a controlled drugs register must 13/09/05 be put in place and all controlled drugs recieved into the home must be adequately recorded. AN IMMEDIATE Requirement notice WAS LEFT ON THE DAY OF THE INSPECTION. fire training must take place on a 30/09/05 6 monthly basis as prescribed by the Avon Fire Brigade . all records relating to the ongoing recruitment of staff must be kept on the premises. This requirement has been repeated . Version 1.40 Page 24 3. 42 23(4)(d) 4. 34 Schedule 4 6 (a)-(f) 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc 5. 21 12(3) A requirement was made on the day of this inspection to ensure the section in the planning for life folder entitled ‘my wishes in the event of my death’ are adequately recorded . 13/09/05 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. Refer to Standard 42 23 Good Practice Recommendations It is strongly recommended that an appropriate fire safety officer approve the fire risk assessment. all staff to have annual refreshers on the subject of the protection of vulnerable adults. 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 Page 25 Commission for Social Care Inspection 300 Aztec West Almondsbury South Gloucestershire 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 261 Passage Road D56_D05_S26544_261PassageRd_V248681_130905_Stage4.doc Version 1.40 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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