Inspection on 13/04/05 for 33a Hampstead Road

This inspection was carried out on 13th April 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

33a Hampstead Road 05/10/06

33a Hampstead Road 22/09/05

33a Hampstead Road 24/11/04

33a Hampstead Road 28/06/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME ADULTS 18-65 33a Hampstead Road Brislington Bristol BS4 3HL Lead Inspector Andrew Pollard Announced 13 April 2005 09:45 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. 33a Hampstead Road Version 1.10 Page 3 SERVICE INFORMATION Name of service 33a Hampstead Road Address 33a Hampstead Road Brislington Bristol BS4 3HL 0117 9077219 0117 9709301 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) Aspects and Milestones Trust Mrs Hilary Frances Edwards CRH N 8 Category(ies) of MD Mental Disorder,8 registration, with number of places 33a Hampstead Road Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 8 Adult patients suffering from Mental disorder excluding those detained under the Mental Health Act 1983 Staffing Notice dated 28/03/2002 applies Manager must be a RN on parts 3 or 13 of the NMC register Date of last inspection 24-Nov-2004 Brief Description of the Service: The home is operated by Milestones a branch of the Aspects and Milestones Trust, a publicly funded charity.The home is registered to provide nursing care for 8 adults with continuing mental health needs but has limited scope for dealing with physical or age related health problems leading to physical disability.The home is located a short walk from local shops and a main bus route allows easy access to Broadmead.The aim is to create a person centred home which is relaxed and homely as well as maintaining residents life skills and providing therapeutic support where needed. 33a Hampstead Road Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The following methods of evidence gathering has been used In the production of this report; observation, pre-inspection questionnaire, discussion with residents and staff, relative and residents comment cards, tour of the home and sampling policies, records, care plans, meals. The emphasis of the service remains continuing care and where appropriate the long-term aim is to lead people toward a more independent lifestyle in the community. In addition staff strive to enhance the quality of life for the residents. Hampstead Rd is a person centred home which is relaxed and homely as well as maintaining residents life skills and providing therapeutic support where needed. The majority of residents have little interest in the management of the home other than their attendance at the house meetings. Residents actively engage with the menu planning sessions. Seven of the eight comment card stated residents did not wish to be more involved with decision making in the home. Other comments on the cards were positive and residents stated they felt well cared for and that staff treated them well. All felt that sutable activities were provided. No one wished to speak to the inspector however some general conversation did take place during the inspection and no complaints were made. Four relative comment cards were submitted; all gave positive comments or praise to the staff and home. The staff interactions with residents witnessed by the inspector were positive and people were treated with respect and dignity. The staff team are experienced with the needs of the resident group. The skill mix and level of Registered Nurse input is appropriate for the resident group. The manager considers morale and motivation to be improving. The home was clean and in good general order. The home is suitable to meet the current needs of the residents who are all. What the service does well: The manager and staff are operating the home in an increasingly person cantered way and seek to empower and motivate the residents to engage more fully with life in and out of the home. When needed the staff have the skills and experience to identify and provide therapeutic interventions and manage the clinical care needs of the residents. 33a Hampstead Road Version 1.10 Page 6 There are a wide range of activities and opportunities made available to the residents. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 33a Hampstead Road Version 1.10 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 33a Hampstead Road Version 1.10 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) 1,2,3,4,5 The staff have been successful in creating a person centred home which is relaxed and homely as well as maintaining residents life skills and providing therapeutic support where needed based upon their assessed needs and aspirations. EVIDENCE: 33a Hampstead Road Version 1.10 Page 9 The statement of purpose and service user guide has been written in accord with the regulations and schedules. Residents were asked if they wished to be involved with reviewing the guide but no one wished to contribute. In general all admissions are publicly funded. There are no vacancies and there have been no new admissions since the last inspection. No short-term placements or emergency admissions are accepted. All admissions are managed through the community mental health team and social services that carry out full assessments of peoples needs. The prospective resident and or relatives are consulted where appropriate. The manager or deputy assess all referred clients prior to admission and introduce to them to the care staff that are to be the key-workers. People are offered a half-day visit followed by an overnight stay. The views of the existing residents are taken in to account regarding any admission. A summary of the assessed needs and a letter confirming the home’s ability to meet the needs is sent to all prospective residents. All residents have a licence agreement setting out their terms and conditions. All residents can read and most have signed the agreement. 33a Hampstead Road Version 1.10 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) 6,7,8,9 There was good evidence of needs and risk assessments being carried out and reviews of such taking place. Residents are involved with decision-making and consulted about the running of the home within the limits of their willingness or ability to take part. EVIDENCE: 33a Hampstead Road Version 1.10 Page 11 All residents have a person centred care plan, which they were encouraged to take an active part in developing. Some residents require staff support in this process and some play a very limited part. A thumbnail biography called “about me” is written, along with “things you need to know about me what is essential, important and what I do and don’t like”. There are six monthly multidisciplinary reviews used to generate the enhanced care plans titled “my needs, my goals and my actions.” A number of residents choose not to attend these reviews. The inspector suggested that the person centred plan and enhanced care plan should be better integrated rather than stand as two separate documents. All residents have a named Registered Nurse and Care Assistant key worker. Each care plan element is evaluated at least every two months by the resident (where possible) the Nurse and key worker. The staff writes daily shift notes. Individualised risk assessments have been written and are held in each person’s case file along with skills assessments and competences. The main areas of risk identified are: falling, bathing, smoking, alcohol and previous mental health history and medication compliance. The home has a missing person policy. Any restrictions on personal freedoms were documented in care plans. The majority of residents show little interest in the management of the home other than their attendance at the residents meetings, which are generally well attended. 33a Hampstead Road Version 1.10 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) 12,13,15,16,17 It was evident from the range of social and occupational activities taking place that the staff strive to enhance the quality of life for the residents. Residents regularly make use of community facilities and services. From speaking to residents and reviewing records it was evident that the food provided is to peoples liking and offers a healthy diet. EVIDENCE: 33a Hampstead Road Version 1.10 Page 13 The emphasis of the service remains continuing care and to maintain the existing life skills that people have. Where appropriate the long-term aim is to lead people toward a more independent lifestyle in the community. None of the residents is able to take employment. The long -standing mental health needs of the residents often militate against the likelihood of future employment or further education. Most of the residents make use of community services and facilities. Residents attend various venues including Merrywood Road (arts and crafts) City of Bristol college and the city farm. A number of residents also go to the social/drop in centre at St Johns each week. Three or four residents currently attend church from time to time. An activity organiser, Mr Jessup has been employed for 22.5hrs a week over three days engaging residents with in and out of house occupation and recreation. In the main these activities are arranged on a one to one basis based around the residents choice. Mr Jessup chairs the residents meetings. A more flexible arrangement of working hours is being introduced to support evening social activities and days set aside to take people out. Activities are fully addressed in the person centred care plans. Holidays or short breaks have been arranged this year including a trip to France and Butlins in Bognor Regis. A number of residents have regular contact with family members or friends, however in some cases residents have lost contact with family or do not wish to have contact. Family and friends are welcome to visit the home at the invitation of the resident. The menus are varied and offer a balanced diet. Records of food served are kept for a month. There are no special cultural needs at present. There is no one with special dietary needs other than a diet controlled diabetic person. There is active involvement of the residents in choice of meals and requests for individual likes are discussed at the weekly meetings or catered for on a day-byday basis. Three residents do prepare snacks with varying levels of support. There are three meals a day and the times are flexible. The residents spoken to all said they enjoyed the food. 33a Hampstead Road Version 1.10 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 The medication policy of the home is being complied with. There are effective arrangements in place to meet residents mental and physical healthcare needs. The home has all the specialist equipment required to meet the resident’s needs. EVIDENCE: Only two residents are assessed as safe to self medicate albeit to a limited degree this is closely monitored and as yet they do not have fully custody of their drugs. Competence assessments and a supporting policy for selfmedication were available. Registered nurses administer all other medication. All residents have a medication profile. The home has a file containing drug alerts. The receipt and administration and disposal records were in order. Weekly stock checking takes place. Temazepam is the only the Controlled Drugs in use and is properly stored. There is a local medication policy as an adjunct to the Trust document. 33a Hampstead Road Version 1.10 Page 15 All Registered Nurses are RMN apart from one EN (M). All residents remain under the care of a consultant and the SHO visits at least monthly. All residents are registered with a local GP practice that makes any referrals for paramedical services required. Dental checks are arranged for those who wish for such. Three people are able to be independent in accessing medical services the others require general support. All residents need some degree of prompting or support in managing personal care. Two residents have depot drugs and one person has a catheter. There are two people who have limited mobility and use a bath seat. One person uses a pressure-relieving mattress and a wheelchair for outdoor use. All residents are under the care of a consultant. The SHO visits at least monthly. All residents are registered with a local GP practice that makes any referrals for paramedical services required. Dental checks are arranged for those who wish for such as a re eye tests. Three people are able to be independent in accessing medical services the others require general support. 33a Hampstead Road Version 1.10 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 The staff are aware of the Trusts complaints and POVA policies and are trained in putting them into practice to protect residents from abuse. The residents are aware of the complaints procedure and have regular meetings to give their views on the running of the home. EVIDENCE: The complaint procedure meets CSCI requirements and is available to residents and families where appropriate. In four comment cards residents indicated they were aware of whom to complain to if they were unhappy with their care. Each resident has been given a copy of the complaint procedure and a flow chart is pinned to the notice board to raise people’s awareness. The four relative comment cards indicated they were aware of the procedure but had never had cause to complain. There is a complaint log and suggestion book in place no complaints have been made. The residents spoken with had no complaints. The Bristol “No Secrets” guidance was available as was the whistle blowing and a POVA policy. Most of the staff have attended alerter level POVA training and further updates are planned. The manager has attended training and updating in POVA through the Local Authority. Copies of the GSCC code of practice have been issued individually to the care staff. All residents have a balance sheet for any monies held for safekeeping and receipts supporting expenditure. All money is checked daily and double signed. All residents have a bank account, some of who require varying levels of staff support with managing their money. Only one person is able to fully manage 33a Hampstead Road Version 1.10 Page 17 their own finances a number handle their own personal allowance. Four residents countersign cheques along with specific nurses. Each resident has a specific case file relating to his or her finances. An internal Trust audit and independent audit have taken place last autumn, which identified no irregularities. 33a Hampstead Road Version 1.10 Page 18 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) 24,25,26,27,28,29,30. The house is a clean, comfortable and safe environment for the current residents. The bedrooms and communal rooms and facilities are suitable for their purpose and meet the resident’s needs. Residents have any specialist equipment they presently require to promote their independence. EVIDENCE: The home is suitable to meet the current needs of the residents who are all ambulant, however two residents are becoming increasingly frail and their placements are under review. The home was clean and in good general order. The fittings and furnishings are of a domestic nature and are in good order. The heating, lighting and ventilation are satisfactory. Appropriate arrangements are in place for maintenance and servicing of plant and equipment, for which records are kept. Bedrooms are decorated and furnished in accord with resident’s wishes. In general bedrooms are plain but this reflects to some extent the residents lack of motivation and the fact that people do not generally spend much times 33a Hampstead Road Version 1.10 Page 19 in their rooms. Residents take some responsibility for maintaining their own rooms. At present one person has been considered unsafe to smoke in their bedroom. Rooms are lockable and residents have access to keys if they wish. There are two bathrooms and they are suitable for the residents needs. One bathroom contains a shower. The bathroom on the ground floor has a handrail and hydraulic bath seat installed. A communal WC on the top floor services the two upper bedrooms. Communal areas include a dining room, lounge and smoking lounge. Laundry and kitchen facilities are of an appropriate type and scale. The food hygiene award was given by the EHO in 2004. The kitchen has been completely refurbished and refitted. Department of Health guidelines on infection control are available. Proper arrangements are in place to dispose of clinical waste. 33a Hampstead Road Version 1.10 Page 20 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) 32,33 35 36 The staff are experienced and trained to meet the individual and joint needs of the residents. The staff skill mix and staffing levels are conducive to maintaining and enhancing the resident’s quality of life. The manager demonstrated a clear commitment and focus on training. EVIDENCE: 33a Hampstead Road Version 1.10 Page 21 Staffing levels are in accordance with the existing staffing notice. The manager works supernumerary five days per week. The staff team are experienced with the needs of the resident group and are client centred. Resident dependency is quite variable depending upon people’s mental state. The skill mix and level of RN input are appropriate for the resident group. Three new care staff have recently been appointed and there are no remaining vacancies. A housekeeper works three hours five days per week and an activity organiser twenty-two hours per week. Staff turnover and the level of sick leave is relatively low and consequentially there is low usage of bank and agency staff other than regular night cover. The manager demonstrated a clear commitment and focus on training to enhance the quality of life and standards of care for residents. There is evidence from records and staff comment of learning and updating for all grades of staff in relevant areas to residents care needs. Two CA’s have level 3 and two level 2 NVQ awards. All remaining care staff bar one are on NVQ programmes three of who have almost completed. Away days have been held to deepen the team commitment to person centred care and empowerment of residents. All staff will receive six to eight weekly supervision by a cascade system of which written notes are made. The annual appraisal process has commenced using documentation supplied by the Trust. 33a Hampstead Road Version 1.10 Page 22 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, The staff are motivated to bring about improvements in residents quality of life that are possible because of the management structure and efforts of the staff. The staff seek to empower the residents and safeguard them from abuse. The home is a safe and well-maintained home. EVIDENCE: 33a Hampstead Road Version 1.10 Page 23 The manager is experienced in the care for people with mental health needs and has management experience. Ms Edwards states that she has commenced an Open University “Managing Health and Social care “ course. The Trust has a comrehensive range of policies and procedures and arrangements to review them. There are a range of local policies in place. A QA audit is carried out twice a year to review the operation and systems of the home this was last donne in November and is due to be repeated this month. The standards are assessed as part of the team meetings. Regular house meetings are held to access the views of the residents on the quality of life and services in the home. Seven of the eight comment cards returned indicated that residents did not want to be more involved with decision making in the home and this was bourne out in the limited conversations held with residents. Eight of the residents indicated in the comment card that they felt well cared for and treated well by the staff. Four relative comment cards were submitted; all gave positive comments or praise to the staff and home. There is a comprehensive Health and Safety policy and a Trust manager with delegated responsibility for such matters and arrangements to review them. Mr Benjamin has responsibility for H&S matters within the Trust. The fire log book, records and alarm/detector maintenance arrangements were up to date and in order. However the majority of the staff have not attended recent fire safety training. A monthly H&S audit is carried out to ensure the safety of the residents and staff. Annual updates for staff are arranged for load handling, food safety and First Aid and in general these were up to date. The gas safety and electrical safety inspection certificates were in order and continuing service arrangements remain in place. The hoist has been inspected. A log of hot water temperatures is maintained Any restrictions of personal freedoms are supported by risk assessment and care plan documentation. All the records required by Schedule 3 were in order and up to date. A copy of the Trusts accounts have been submitted to the Commission. The fire log book, training and service arrangements were up to date and in order. A visitors record is maintained. 33a Hampstead Road Version 1.10 Page 24 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 3 3 3 3 3 Standard No 11 12 13 14 15 33a Hampstead Road 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 Version 1.10 Page 25 16 17 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 2 3 33a Hampstead Road Version 1.10 Page 26 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 42 Regulation 23.4.(d) Requirement ensure all staff receive fire training as soon as practical and thereafter six monthly. Timescale for action 31/05/05 and six monthly thereafter. 2. 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 6 Good Practice Recommendations seek to better intergrate the enhanced careplan reviews and the person centered care plans 33a Hampstead Road Version 1.10 Page 27 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 33a Hampstead Road Version 1.10 Page 28 - 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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