CARE HOME ADULTS 18-65
32 Albert Road (Respite Care) Clevedon North Somersat BS21 7RT Lead Inspector
Nicola Hill Unannounced 4 & 7 May 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. 32 Albert Road D53-D02 S20233 32 Albert Road (Respite Care) V223014 310505 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service 32 Albert Road Address Clevedon North Somerset BS21 7RT 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) 01275 341753 0117 9699000 The Brandon Trust Ms Nancy Ruth Kitson Care Home with Nursing 9 Category(ies) of Learning Disability - (9) registration, with number Physical Disability - (9) of places 32 Albert Road D53-D02 S20233 32 Albert Road (Respite Care) V223014 310505 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. May accommodate up to 9 persons aged 18 years and over with learning difficulties and may also have physical disability 2. Staffing notice dated 17 March 1999 Applies 3. Manager must be RN on part 5 or 14 of the NMC register 4. Up to 4 residents may be accommodated for respite care on the ground floor. The maximum duration of respite should be one month. One named permanent resident may continue to reside on the ground floor. This will lapse when the resident leaves the home. 5. An additional bathroom should be provided for use by permanent residents by 1 November 2003 Date of last inspection 2 December 2004 Brief Description of the Service: The Lodge nursing home is part of the Brandon Trust, and offers care and support services for people with learning disabilities and physical disabilities. It is a small home with capacity for nine residents. The service currently provides for six older people who have been resettled from long stay institutions. The home also provides a respite service for up to three younger people in the North Somerset area. 32 Albert Road D53-D02 S20233 32 Albert Road (Respite Care) V223014 310505 Stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection for The Lodge was in two parts to cover both services. On the first visit the inspector spoke with staff and permanent residents, the service representative was Jim Reardon. The second part of the inspection took place on Saturday morning so that the inspector could meet with several respite service users, and speak with Nancy Kitson the manager of the home. Over the course of the inspection, the inspector was able to see and speak to all of the permanent residents at the home, and a total of 5 respite care residents. The residents at the home appeared very settled and happy, however as most have limited communication, an in depth conversation was not possible. The overall atmosphere at the home during both visits was very calm and quiet. The staffing level at the home at this time was very good and included a student nurse who was providing one-to-one support to one of the very dependent respite clients under the supervision of a trained nurse. Two respite service users were present on the first visit, one of whom was receiving day care, and three respite service users were present on the second visit. Two of the service users were taken out to the Helicopter Museum for the day. What the service does well:
The respite residents have well furnished rooms. The manager and staff spoken to during this visit felt that the residents are treated as individuals and their individual characteristics recognised by the staff team. The in-house activities have increased considerably and the residents benefit from aromatherapy on a twice weekly session. The inspector had the opportunity to talk with staff who have been transferred from another home, and they were happy to state that they felt the existing staff team had a good knowledge of residents and that the personal support care plans in place with sufficient to enable them to care successfully for the residents at the home. One of the trained staff who recently transferred to the home stated that he was very impressed by the way in which the home
32 Albert Road D53-D02 S20233 32 Albert Road (Respite Care) V223014 310505 Stage4.doc Version 1.30 Page 6 support workers were prepared to organise amongst themselves the activities for the residents so that they maximised the opportunity for residents to access the community. What has improved since the last inspection? What they could do better: The section was discussed with the manager who recognised that the time allowed for the administration of the home was very limited, and therefore some times things were subject to delay or the manager took them home to complete. The manager also recognised that the communication between staff and residents could be improved by developing proper systems using terms of reference and sign language, photographs etc to promote understanding. This will then allowed home to work towards developing person centred plans, which will identify the choices and aspirations of the residents. The manager would also like to develop in-house team training for basic skills such as feeding residents who have swallowing difficulties, manual handling and particularly using hoists. This idea has been developed through the staff meetings, and the trained staff will able to plan short training programmes for the home support workers, and evidence of this could go toward the continuing
32 Albert Road D53-D02 S20233 32 Albert Road (Respite Care) V223014 310505 Stage4.doc Version 1.30 Page 7 professional development required for registration. 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. 32 Albert Road D53-D02 S20233 32 Albert Road (Respite Care) V223014 310505 Stage4.doc Version 1.30 Page 8 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 32 Albert Road D53-D02 S20233 32 Albert Road (Respite Care) V223014 310505 Stage4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3 & 5 Potential residents to The Lodge have a range of materials available to them on which to make a balanced judgment whether or not to live there. EVIDENCE: The home has produced a DVD that gives a short visual tour narrated by a service user with learning disabilities. In order that the DVD can be viewed they have purchased an individual player which portable and therefore can be taken to potential residents homes for them to view. Currently there are no vacancies for further respite care service users. Since the last visit to the home, there have been eight new referrals to the respite service. The number of service users using the service at the Lodge has been affected by the closure of The Firs. The three places available each day have been booked until the end of August 2005. Some of the residents are completely dependent and require one-to-one supervision, other residents have challenging behaviour and also require one-to-one supervision. This has impacted on staffing numbers, and routinely six staff are rota’d on duty to accommodate the support needs. Prior to using the service the contracting authority provide multi disciplinary care assessments. The manager uses these assessments as the basis for
32 Albert Road D53-D02 S20233 32 Albert Road (Respite Care) V223014 310505 Stage4.doc Version 1.30 Page 10 making the decisions whether or not the support needs of the potential resident can be met. The manager then meets with the parents/carers and discusses what service can be offered, the potential residents visit The Lodge prior to having a respite service. 32 Albert Road D53-D02 S20233 32 Albert Road (Respite Care) V223014 310505 Stage4.doc Version 1.30 Page 11 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 The residents benefit from a staff team who are able to identify needs and are skilled in meeting them. EVIDENCE: The care plan is reviewed through the multidisciplinary team and includes views from the service user, family and carers. Where possible choices and preferred activities are identified by the plan. Risk assessments are made as part of this process to support residents to follow and engage in a lifestyle of their choice. 32 Albert Road D53-D02 S20233 32 Albert Road (Respite Care) V223014 310505 Stage4.doc Version 1.30 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 & 16 The residents have individual goals and aspirations recognized and are supported to achieve them. EVIDENCE: All residents at the home have an individual support plan, which outlines the actions required to be taken to support the residents to be as independent as possible. The support plans are very clear. The residents are offered choices however the comprehension by the residents of more complex choices is difficult. In addition to this the respite service users may not be well known to the staff team and communication may be impaired. Choices are offered on a simplified basis, for example one option may be offered to which a yes or no answer is required, and comprehensive information obtained from the parent/carer about known likes/dislikes. The residents also have opportunities to be part of the local community and access community facilities. In addition to this the residents are taken out either in the car or in wheelchairs to enjoy the local area. Whilst on respite the staff at the home support the residents to attend their
32 Albert Road D53-D02 S20233 32 Albert Road (Respite Care) V223014 310505 Stage4.doc Version 1.30 Page 13 normal daytime activities, this has meant that a driver for 20 hours per week has been appointed. However because of the varied arrangements for each individual i.e. some may need to travel to Weston, others to Nailsea, the 20 hours is insufficient to fully support the service. The budget for the home has also not included an allowance for the fuel used. At the time of the inspection and the cook had resigned for personal reasons, which returned the responsibility for meal preparation to the home support workers. The lunchtime meal appeared to be pleasant and well presented. 32 Albert Road D53-D02 S20233 32 Albert Road (Respite Care) V223014 310505 Stage4.doc Version 1.30 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 & 20 A sensitive and knowledgeable staff team meets residents’ physical and emotional health care needs. EVIDENCE: The residents have plans in place which identify the way in which they preferred to be have their personal support needs met. All the resident access local health care services and are supported for specialist health care services by the community learning disability team. None of the residents at The Lodge are able to administer and take control of their own medication. 32 Albert Road D53-D02 S20233 32 Albert Road (Respite Care) V223014 310505 Stage4.doc Version 1.30 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Resident making complaints and raising concerns are listened to and appropriate action taken. EVIDENCE: The organisation has a rigorous complaints procedure; one complaint has been received since the last inspection. This complaint have been investigated appropriately and a regulation 37 report was sent to the Commission concerning the action taken by the staff at the home to ensure the safety and welfare of a resident in their care. All staff at the home have undertaken training to enable them to recognise abusive practice, and the action to take to report any concerns. 32 Albert Road D53-D02 S20233 32 Albert Road (Respite Care) V223014 310505 Stage4.doc Version 1.30 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,27,29 & 30 The residents at The Lodge have a safe environment which requires regular maintaining to keep it in good order. EVIDENCE: The tour of the building indicated that some work on the environment had been completed since the last inspection. The assistant manager was able to state that certain areas, which had been identified for remedial action, had been notified to the Brandon Trust estate manager for attention, and it was planned that this work would be completed in this financial year. The home has adaptations and equipment suitable to meet the needs of the resident group, it was noted that the hoists were in good working order and had recently been tested by an authorised agent.
32 Albert Road D53-D02 S20233 32 Albert Road (Respite Care) V223014 310505 Stage4.doc Version 1.30 Page 17 The home appeared to be clean and well kept. 32 Albert Road D53-D02 S20233 32 Albert Road (Respite Care) V223014 310505 Stage4.doc Version 1.30 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) 31,32,33 & 35 A competent and qualified staff team supports the residents. EVIDENCE: Since the last inspection the home has been successful in transferring and recruiting new staff to join the team. This has enabled the services offered by the home to be developed to offer a wide range of activities, and for staff to work on a one-to-one individual support basis with the residents. The team as a whole have attended training in Communication with Residents with Learning Disabilities, and to further enhance their skills whilst working with the residents, each of the home support workers have identified training days from the in-house Brandon Trust list. The type of training applied for include areas such as dementia care, working with residents with profound learning abilities. The inspector was able to see evidence of the staff being supervised appropriately by the management; also the regulation 26 visits by the service manager have taken place on a regular basis. The manager stated that the support received from the service manager for the Lodge, Janet , has been exceptional and has allowed the team and the service to develop. 32 Albert Road D53-D02 S20233 32 Albert Road (Respite Care) V223014 310505 Stage4.doc Version 1.30 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 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) 38 & 42 The manager has successfully provided leadership for the staff at home, and provided a safe environment for the residents. EVIDENCE: Additional assistant managers transferring or joining the home have supplemented the management team at the home, and this has allowed the manager to delegate areas of responsibility to these individuals. This has meant that areas of responsibility for the assistant managers have developed such as the monitoring and implementation of health and safety. At the time of the inspection there are no areas of health and safety implementation that are of concern to the inspector. A new assistant manager who had recently joined the team complimented the manager on the team ethos. There appears to be more team cohesion and
32 Albert Road D53-D02 S20233 32 Albert Road (Respite Care) V223014 310505 Stage4.doc Version 1.30 Page 20 willingness to work together to benefit the residents. This may be attributed to the leadership of the management and the continuity from having a full team establishment. 32 Albert Road D53-D02 S20233 32 Albert Road (Respite Care) V223014 310505 Stage4.doc Version 1.30 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 x 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 x 3 x 3 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 x 3 x Standard No 31 32 33 34 35 36 Score 3 3 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
32 Albert Road Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x 3 x x x 3 x D53-D02 S20233 32 Albert Road (Respite Care) V223014 310505 Stage4.doc Version 1.30 Page 22 Are there any outstanding requirements from the last inspection? NO 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 Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations 32 Albert Road D53-D02 S20233 32 Albert Road (Respite Care) V223014 310505 Stage4.doc Version 1.30 Page 23 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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