Inspection on 14/06/07 for 35 Cranbrook Road

This inspection was carried out on 14th June 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 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

35 Cranbrook Road 27/07/06

35 Cranbrook Road 02/11/05

35 Cranbrook Road 19/05/05

35 Cranbrook Road 20/09/04

35 Cranbrook Road 21/04/04

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 35 Cranbrook Road Redland Bristol BS6 7BP Lead Inspector Nicky Grayburn Key Unannounced Inspection 14th June 2007 09:30 35 Cranbrook Road DS0000026559.V336789.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 35 Cranbrook Road DS0000026559.V336789.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. 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 35 Cranbrook Road Address Redland Bristol BS6 7BP Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0117 9442021 0117 9709301 Peterdcarter8048@aol.com admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Mr Peter Carter Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 5 persons aged 40 years and over. Date of last inspection 27th July 2006 Brief Description of the Service: 35, Cranbrook Road is operated by Aspects and Milestones and is registered to provide personal care and accommodation for up to five people with mental health needs who are 40 years and over. At present there are five men in residence who have lived at the home for a number of years. It is a large residential house, which blends in with the local surroundings. It is built on three floors. It is close to local facilities and amenities, including shops and public houses. It is also close to a main bus route. 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the home’s Key inspection and was carried out over one day. It was unannounced. The inspector met with all of the residents and the manager and two members of staff. A second inspector carried out certain parts of the inspection as part of their induction. Since the home’s last Key inspection, there have been no other visits. There were 6 recommendations to follow up from the previous visit, which have been met. Prior to the inspection, previous records and reports held at the Commission for Social Care Inspection were read, such as the home’s monthly reports. The Manager also completed the Commission’s Annual Quality Assurance Assessment (AQAA) giving basic information regarding the service. 3 residents completed a survey; 3 relatives’ surveys, and 2 surveys from professionals were received and were read prior to the visit, and form part of this report. The inspectors looked at key documents; talked with and observed residents, staff and the Manager on a one-to-one basis; and undertook a tour of the property. 2 residents were case tracked and the inspector spot-checked the other resident’s records. Through discussion with the manager and with people living in the home, the term ‘Residents’ will be used in the report to refer to the people living in the home. The weekly fees are £240. What the service does well: 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 6 The residents have lived in their home for a number of years and are settled in their lifestyle and routines. They have a core group of staff who have also worked there for a number of years, providing consistency and stability. The staff have a good understanding of the residents’ needs and are fully aware of residents’ triggers in their behaviour which indicates their well being. The home is well maintained and enables residents to spend time alone or with others. The location allows residents to access the local community and its facilities. Relationships outside the home are well supported and residents come and go as they wish. Communication between the residents and staff is good. Residents feel that they can raise issues with any members of staff. What has improved since the last inspection? What they could do better: There are no requirements but a few recommendations, which have been made from this inspection. Many issues have been discussed with the manager and the inspector is confident that these will be resolved. Staff need to ensure that those residents who look after their own medication do it safely and potential risks are reduced. It is recommended that the manager contact the home’s pharmacy to get advice about giving medication to residents for time away from the home. The kitchen is looking old, with a door unit missing and it is recommended that it is refurbished. The bathrooms’ flooring also needs replacing as they are stained and blackened The residents’ weekly diaries need improving to show what the residents have done all week rather than just particular incidents. 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 7 It is also recommended that the manager undertakes training in safeguarding adults specifically for managers and the staff to have refresher courses in this subject. 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. 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. An updated Statement of Purpose will ensure that prospective residents are fully aware of what is on offer at the home to make an informed decision. Residents’ needs are fully assessed prior to moving in ensuring that the home can provide a good service for them. Prospective residents are offered numerous visits to home to make sure they like it before moving in. Residents would benefit from having a complete contract to make sure that they are clear about their rights and responsibilities and how much they have to pay. EVIDENCE: The copy of the home’s Statement of Purpose is held at The Commission for Social Care Inspection and is dated from 2003. There are some omissions from this and needs updating. This was discussed with the manager and he will be sending it to the inspector within 28 days of receipt of this report. This is important as there is a high probability that there will be a vacancy within the home in the near future and prospective residents will need all the 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 10 information about the home to make an informed decision. The manager also said that the residents have service user guides in their bedrooms. The Annual Quality Assurance Assessment (AQAA) outlined the home’s admission procedure, which was confirmed through discussion with the manager. The inspector has read the policy on previous visits. In the past, residents have often come straight from hospital and assessments have been thorough. The manager said that if a prospective resident was coming via a self-referral route, he would carry out an in-depth assessment following the Care Plan Assessment system. 1 resident’s survey said that their parents came first to visit, but the other 2 said that it was too long ago to remember. The AQAA stated that prospective residents would be invited to view the home; for meals; over night stays; then longer stays and then a decision would be made. The Statement of Purpose states that emergency placements would not usually be possible, and those “who actively show aggression, violence or sexually inappropriate behaviour cannot be accepted.” All 3 relatives’ surveys stated that they feel that the home ‘always’ meets the needs of their relative and the home ‘always’ gives the support to the resident as agreed/expected. The contracts for 3 residents were read. The residents had signed them in 2005 as part of a requirement from that inspection. The fees are kept in the residents’ finance records. The residents do not like signing documents and this is recorded. It is recommended that the manager update these contracts in line with National Minimum Standard 5. 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents have choice about what they do during their lives. Changing needs are assessed and are reflected in their care plans. Residents are enabled to take risks as part of their lifestyle. Good open channels of communication promote residents to participate in their home as much as they would like to. EVIDENCE: The home works with the Informed Care Planning Arrangement (ICPA) concept of having a key worker and care co-ordinator. The Statement of Purpose states that residents receive Care Plan Assessments every 6 months. The records in the residents’ folders confirmed this. Residents’ key workers, supporters and professionals are involved in this process such as the resident’s Psychiatrist and Community Psychiatric Nurse. The residents’ care plan and medication is reviewed during this meeting. Some residents attend but others choose not to. In this case, residents are asked to sign a document confirming “that I’ve had the opportunity to see my care plans, discuss their contents and make suggestions for inclusion”. Changes are written up in residents’ plans; 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 12 for example, changes in weekly personal allowance due to changes in behaviour evidenced this. A recommendation was made at the previous visit to keep the residents’ weekly diaries up-to-date. This has been partly met. The written information does not reflect the work that is carried out in the home. The diaries give information about certain incidents rather than an overview of what the residents had done that week. It was discussed with the manager how these can be improved and that this information will further evidence the good practice within the home. In light of the newly implemented Mental Capacity Act 2007, it is important that staff record this information along with when and how residents have made decisions in their life. This will be followed up at the next inspection but the manager is requested to send the Commission for Social Care Inspection the new pro forma to record such information. Residents meetings do not occur regularly as they do not want them. It was observed and residents told the inspector that they approach staff as and when they have something to discuss. The Statement of Purpose states that ‘Residents are encouraged to see the home as their home and to suggestions about everything from décor to having a say about prospective staff/residents.’ The Area Manager visited the home and it was observed how residents were consulted on aspects of the home and were able to communicate freely to him. All 3 of the residents’ surveys stated that they could do what they want during the day, evenings and weekends. 2 residents said that they could ‘always’ make decision about what they do each day, and 1 said ‘usually’. The relatives surveys confirmed that the service ‘always’ supports people to live they choose. In response to the question ‘what do you feel the care service does well?’ a professional further commented on their survey that the service ‘provides the individual needs of the clients in a holistic approach.’ Advocates have not been sought due to the level of support residents receive from their supporters. However, the AQAA stated that ‘if requested we’d be happy to involve other agencies in the care of residents or to act as advocates.’ Risk assessments are up to date and detail how the residents are supported to have as much of an independent life as possible and to remain safe, such as coming to harm outside of the home, and being home alone. 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 13 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): 11, 12, 13, 14, 15, 16, 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents have settled lifestyles and routines reflecting personal interests and leisure activities. Residents are supported with all their relationships. Residents are offered a varied and healthy diet in a relaxed atmosphere. EVIDENCE: Residents have lived in the home for a number of years and have settled lifestyles, which they have chosen. Some residents have part time jobs, some attend art groups and some are happy to access the local community a few times a day. Some residents also attend their chosen religious service on a weekly basis. An Occupational Health team also comes into the home and offer baking sessions, which the residents told the inspector about. 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 14 All of the residents have family members who are supportive and residents spoke positively about their relationships to the inspector. The inspector spoke with a relative and the 3 surveys from relatives stated that the home ‘always’ keeps them up-to-date with important issues. Most of the residents spend their weekends with their families. A staff member told the inspector how residents are supported with other relationships outside of the home. Some of the residents go on annual holidays with support from staff members, either abroad or in the UK. However, some prefer to stay at home. The AQAA stated that the staff keep trying to encourage residents to try new things generally as well as going away for a break but without seeming to pressurize the residents. It was evident that residents have their own daily routines and residents spoke with the inspector about what they choose to do. It was observed how residents could decide whether to spend time on their own or with the other residents. Despite the residents having lived together for a number of years, they do not spend much time together, and some residents told the inspector who they prefer to chat to and whom they don’t chat with. It was observed that residents have unrestricted access to all of the shared areas of the home. The inspector spoke with residents about their meal times and comments were positive. One resident told the inspector that the staff ask them what they would like on the menu for the following week. It was observed how residents could make drinks and snacks when they wish. There was a menu on display in the kitchen, which showed a variety of dishes such as liver and bacon; fish and chips; jacket potato, and mixed grill. The cupboards had a good selection of tinned and fresh foods. One resident cooks for himself, increasing his independence, and eats with the other residents once a week. Minutes from a recent staff meeting showed that staff raised the issue of buying economy foods such as fresh meats. This was discussed with the manager and the issue has been resolved. Staff are now not buying certain economy foods as it was deemed to be a false economy. 35 Cranbrook Road DS0000026559.V336789.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, 21 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ personal and health care needs are met in a way they want and require. Residents who choose to self medicate need to be risk assessed in order to minimise potential risks to further promote greater independence. EVIDENCE: Residents in the home have complex mental health needs and each has an individual folder documenting what support they need such as care plans; risk assessments, and weekly diaries. This ensures that communication between all those involved is open and enables residents to remain as safe as possible. Many residents refuse to attend health care appointments such as the dentist and optician. Residents told the inspector that if they feel unwell, they will inform staff or arrange an appointment themselves. The AQAA stated that staff always try to encourage residents to see their health care professionals. This needs to be recorded as discussed with the manager. Residents do not require any personal support with hygiene, but some need prompting, which is recorded in their care plans. 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 16 It was observed that residents get up when they want and dress and present themselves according to their personality and choice. Staff told the inspector how some residents go out at night and all have their own keys to the front door. All residents also have keys to their individual rooms to retain their privacy. One resident has a keypad system on their door, as this is easier for them. When residents become unwell, immediate action is taken by contacting the relevant professionals, to ensure that they are kept safe. It has been observed in the past and residents told the inspector that appointments take place in private. Returned professional’s surveys stated that they are ‘satisfied with the overall care provided to the service users within the home’ and the home ‘always’ respects the individual’s privacy and dignity. The second inspector looked at the medication records and spoke with a member of staff and the manager about the processes. The service has not reported any medication errors to the Commission. Residents’ records were up-to-date which include the dates when medication is received into the home, administered and a procedure for the disposal of unused medicines. The manager confirmed that residents’ medication is reviewed on a 6 monthly basis by the individual’s consultant. This was also seen in the care files. A staff member told the inspector that they undertake training with their local pharmacy every 2 years and will be having an update this year. 2 residents are able to look after their own medication, promoting their independence. However, there were no risk assessments or care plans ensuring that this is managed safely. To ensure that residents do take their medication, a member of staff told the inspector that they would be able to notice in residents’ behaviour and they randomly check the medication kept in the residents’ rooms. It was discussed with the manager and a further phone call confirmed that the risk assessments will be written in consultation with staff and the residents. The manager will be sending these to the inspector within 28 days of receipt of this report. It was noted that the home’s British National Formulary was dated from 2003. This was discussed with the manager and he confirmed that he will be purchasing an up-to-date book to ensure that staff and residents can keep abreast of information regarding the medication held in the home. It was also discussed with the manager that it is good practice to write the date of opening liquid medication to ensure that the medicine is rotated correctly. Another concern was the issue with secondary dispensing (re-packaging medicine into another container) of medication when residents go away from the home. The inspector spoke with the manager after the inspection, after 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 17 speaking with the Commission’s Pharmacist regarding this matter. It is recommended for the manager contact the home’s local pharmacy to gain further advice such as gaining a supply of labels for the new packaging and to ask the resident themselves to re-dispense the medication. Residents’ wishes at the time of death are not recorded. This has been discussed previously and some residents have signed to state that they are not happy discussing it. 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 18 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are assured that their views are listened to and acted upon. Residents are protected from abuse. EVIDENCE: The complaints procedure is not included in the Statement of Purpose but all the residents spoken with told the inspector what they would do if they had any concerns or complaints. All 3 residents’ surveys stated that they knew who to speak to if they were unhappy and 2 said that they knew how to make a complaint (1 was left blank). The relatives’ surveys also stated that they knew how to make a complaint. 2 residents stated in their surveys that the care staff ‘always’ listen and act on what they say, 1 said ‘usually’. All 3 relatives’ surveys stated that when a concern had been raised, it has ‘always’ been responded to appropriately. A survey from a professional added a comment stating that they had a “good established liaison with the service and the home.” The inspector read the complaints log and there have been 2 official complaints made in the past 12 months, which were dealt with appropriately and effectively. There have been no referrals to the Adult Community Care team regarding Protecting of Vulnerable Adults and the manager showed the inspector the literature they have regarding this matter. It is recommended that the manager undertakes the managers training in safeguarding adults. 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 19 The second inspector saw certificates for staff having undertaken training in safeguarding adults in 2004. It is good practice if staff refreshe this training and any new developments are talked through in staff meetings. 2 residents’ surveys stated that the staff ‘always’ treat the residents well, 1 said ‘usually’. Only 2 of the residents have their finances looked after by the home. These were checked and were correct. Others either do it themselves; have their family members helping them, or have solicitors involved. 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 20 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, 27, 28, 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. 35 Cranbrook Rd is a homely home and meets the needs of the residents. Residents’ bedrooms are individualised and suit their needs. Bathrooms are in sufficient numbers and would benefit from having new flooring. The home is clean and hygienic. EVIDENCE: The inspector undertook a tour of the property. The home is kept in good condition. It is over 3 floors with one room on the ground floor. A recommendation from the previous visit regarding re-painting the banister has been done and in fact the whole hallway was re-decorated and looks cleaner and fresher. There is 1 main lounge, which has also recently been redecorated with a specific smoke extraction system, which makes the room smell a lot better and is healthier for the residents. Residents told the inspector that they liked the new colours; flooring, and décor. 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 21 There is an open plan kitchen and dining area with sofas and home entertainment. As there is only 1 non-smoker in the home, the manager said that they are going to be making this space more comfortable and ‘loungelike’. It is advised that the manager contacts the local Environmental Health Officer to gain advice regarding the new smoking ban. The kitchen is looking tired and old. There is a cupboard door missing under the sink and the fixing for 1 side of the drawer panel was broken. A further phone call to the manager confirmed that this has been taken off to avoid potential injury. The AQAA stated that it is 10 years old and the manager confirmed that they are on the waiting list at the Trust for a new one to be fitted. Due to the disruption it will cause, the refurbishment needs careful planning to ensure that it is kept as minimal as possible for the residents’ well being. There are 2 bathrooms; 1 on the ground floor and 1 on the 2nd floor. There is also a separate toilet on the 2nd floor. Both bathrooms need the flooring replacing, as it is old and stained. Resident’s bedrooms were not viewed on this occassion, but they had been seen on previous visits. The rooms were very personalised with pictures and personal affects. Due to complaints from other residents, 2 residents have swapped bedrooms, which has proven to be positive. All residents have their own rooms. The garden at the rear of the home is a good size with a variety of plants and a greenhouse with vegetables growing. A gazebo is on the patio with a selection of chairs and tables, which was observed to be in frequent use by the residents. A recommendation from the previous visit was for the grass to be cut and the response to the last report stated that it had been done and the manager assured that it is done regularly. The AQAA stated that they would like to rearrange the garden, as residents want to use a space under some trees. No action has been taken on this and will be followed up at the next inspection. All 3 residents’ surveys stated that their home is ‘always’ fresh and clean. On the day of the visit, the home was clean. Residents told the inspector about their ‘chores rota’. This has been successful over the years but also causes some conflict between the residents due to their varying standards of cleanliness. This conflict is on going and the manager deals with it appropriately and effectively by talking with the residents. The inspector read this in the complaints log. The care staff also carry out some cleaning tasks. The manager said that he is pleased that residents see the home as their base. 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 22 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): 31, 32, 33, 34 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from having a committed, consistent and stable team. Staff are competent and are fully aware of the residents needs enabling them to be supported well. EVIDENCE: 35 Cranbrook rd has a small staff team of 4 care staff. All the staff have worked at the home for a number of years providing the residents with an extremely stable and consistent approach. A resident added on their survey that they “have had *** years of good care here. Much thanks due.” It was observed how staff are good listeners and that the residents approach staff for a variety of issues. There is a staff vacancy at present but the monthly visit reports state that there are no plans to advertise this post at the moment. This was further confirmed by the manager and whilst speaking with a member of staff. They both also confirmed that the current staff team ‘pick up’ the shifts, avoiding using bank staff. The AQAA and monthly visit reports stated that there is no sickness, and a member of staff commented on this as well. 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 23 2 members of staff have their National Vocational Qualification in care and another member of staff is about to start the course. One staff member told the inspector that they are in the process of doing a degree to become a qualified Psychologist. They confirmed that Aspects and Milestones are supporting them with this. The second inspector viewed the training records for the staff and found them to be up-to-date but some members of staff are due updates. The manager confirmed that these are planned for the near future. It is known from previous visits that Aspects and Milestones have a rolling programme of training, which includes additional training options, which the staff can choose from. The AQAA also stated that the home continues with mandatory training as arranged through the trust. This standard will be fully inspected at the next inspection. The second inspector viewed the recruitment files for 2 members of staff. These contained a completed application and references. However, 1 member of staff only had 1 reference on file. The manager said that head quarters carries out the administrative tasks of recruitment and then he is involved with the interviewing process. Head quarters also keep hold of the staff’s Criminal Records Bureau disclosure checks and send the home confirmation that the checks are satisfactory. If the vacant post is filled, the manager must ensure that all recruitment documents are obtained. This will be followed up at the next inspection. Despite there being no job descriptions in the staff’s files, staff are fully aware of their roles in the home which was evidenced through discussion, observations, care plans and discussion with residents. Involvement of outside professionals show that staff contact them when they need further advice. Staff meetings take place regularly and the inspector read the minutes from the past few meetings. It is commendable that all the staff attend these meetings despite not being on duty on the day. This indicates that the staff are committed to the home. A member of staff told the inspector that they had a recent team-building day with an external facilitator, who told the team that they were “the most stable staff team” he has worked with. The AQAA also informed the inspector about this day. Staff told the inspector that one of the best things about the home is the continuity of staff working in the home. 2 staff’s supervision notes were seen. In the case of 1 member of staff, notes showed that supervision took place infrequently due to logistics. The manager agreed and said that he intended to improve this. The other supervision file seen showed that supervision was taking place more regularly. A member of staff told the inspector that communication is good within the team, especially 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 24 as the manager is often around so they are able to discuss issues as and when they arise. This will be followed up at the next inspection. Added comments from the relative’s surveys responding to the question “what do you feel the home does well?” “[staff are] always on site, always approachable”; “we feel the staff at the home are very caring and understanding. Our son is very happy there”; “good nursing, good counselling, good food, keeps in touch regularly.” A resident told the inspector, “all the staff are very good, some are more experienced than others”. 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 25 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, 40, 41, 42 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a well managed home. The residents are involved in improving the home. Residents are safe in their home. EVIDENCE: The manager was present for the majority of the visit and was welcoming and informative. Mr Carter has worked for the Trust since 1998, is a Registered Mental Health Nurse (since 1977), has his National Vocational Qualification level 4 and is also an NVQ Assessor. Mr Carter has also been a Community Psychiatric Nurse. One resident told the inspector “Peter is the most excellent manager I’ve met.” There was an incident in December 2006, which should have been reported to The Commission for Social Care Inspection, along with two incidents recorded 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 26 in the incident book. All the incidents were dealt with appropriately and effectively. This was discussed with Mr Carter and incidents will now be reported to the Commission. This will be followed up at the next inspection. The quality assurance system is underway. Aspects and Milestones have coupled homes together to give advice and support in the same format as the National Minimum Standards. Mr Carter confirmed that this was nearly complete. In 2005, service user satisfaction surveys were completed and these will be done again at the end of this summer. The inspector looks forward to receiving the completed quality assurance report inclusive of the above elements. The home’s Area Manager also visits monthly to check on the home. These reports are duly sent to the Commission and provide good information. Aspects and Milestones have comprehensive policies and procedures. The inspector read some of these. The AQAA also gave details of what policies are in place with the dates of implementation. Most of these policies have been reviewed in 2005 and 2006, with some newer policies coming in in this year. The Manager has written a draft ‘lone working’ policy as the staff are mostly in the home on their own. This was discussed in the last staff meeting bringing up new aspects for it. It was observed that parts of the policy are already in place, such as staff carrying a phone with them at all times. This will be followed up at the next inspection. Records are kept mainly in the staff office. More confidential records (such as staff documents) are kept in a secondary office which is only accessible by the manager. Residents’ records are kept in a lockable filing cabinet. The AQAA confirmed, and it was observed, that the office is locked when there are no staff using it to ensure that records are not read by others. From reading the records, it is evident that they are kept up-to-date and improvements have been made. The Health and Safety folder was checked and it was evident that the appropriate tests are carried out. There is one member of staff who is responsible for carrying out such tests. The AQAA also gave dates of when contractors last came in to check on the home’s safety, which correlated to the certificates held in the home. The manager confirmed in writing that all the staff attended fire safety training in February 2007 but is still awaiting the certificate. The inspector saw that regular fire drills take place and are recorded with residents’ responses. Some residents leave the home without telling staff which could be problematic if there was a fire. However, from talking with staff, the residents do leave indicators that they have gone and this behaviour is a form of rebellion against previously lived in institutional establishments. Manual Handling training is being updated in the very near future ensuring that staff carry out duties in a safe way. 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 27 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 2 2 3 3 X 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 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 4 32 3 33 4 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 X 3 3 3 3 X 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 28 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. 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. 2. 3. 4. 5. 6. 7. Refer to Standard YA5 YA6 YA20 YA23 YA23 YA24 YA27 Good Practice Recommendations Residents’ contracts be updated in line with National Minimum Standard 5. Residents `weekly diaries’ should be kept up to date. Manager to contact the home’s local pharmacy to gain advice on secondary dispensing. The manager to undertake training for managers in safeguarding adults. It is good practice that staff have refresher courses in safeguarding adults. The kitchen to be refurbished. Both bathroom’s flooring to be replaced. 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 29 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 35 Cranbrook Road DS0000026559.V336789.R01.S.doc Version 5.2 Page 30 - 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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