Inspection on 22/02/06 for 40 School Road

This inspection was carried out on 22nd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

40 School Road 21/03/07

40 School Road 27/09/05

40 School Road 03/02/05

40 School Road 22/07/04

40 School Road 24/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 40 School Road Brislington Bristol BS4 4NN Lead Inspector Sandra Gibson Unannounced Inspection 22nd February 2006 04:45p 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 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 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 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. 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 40 School Road Address Brislington Bristol BS4 4NN 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 3772543 Bristol City Council Mrs Sheena Huggins Care Home 7 Category(ies) of Learning disability (7) registration, with number of places 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Respite care is for no longer than 6 weeks. Occupancy for over 6 weeks requires a formal application for variation. All rooms will have ensuites by 31st August 2005. Date of last inspection 27th September 2005 Brief Description of the Service: 40 School Road is operated by Bristol City Council and is registered by The Commission for Social Care Inspection to provide short-term accommodation to seven adults (male and female) with a learning disability between the age of 18 years and 64 years. A condition of the registration is that accommodation is not offered for a period longer than six weeks. The property is detached and is set in its own grounds. There are disabled facilities on the ground floor. There is also one double room, which would be suitable for a couple. The home is arranged over two floors, but all communal areas are on the ground floor. There is no lift facility. 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place mid week between the hours of 4.45pm and 7.15 pm. The inspection focussed on general care and welfare of service users and three were spoken to during the visit. Three staff members were seen during the inspection and a range of records were examined including care files, and health and safety records. What the service does well: What has improved since the last inspection? The system for dealing with complaints and the arrangements for protecting service users from harm have both improved since the last inspection which will ensure that service users are better protected. 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 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 the following standard(s): 2,5 Arrangements for fully assessing prospective service users’ needs are not wholly satisfactory with a result that service users and their carers do not know that the School Road can fully meet their individual needs. The information provided to service users and their representatives on admission to School Road has deteriorated slightly since the last inspection. It needs to improve to ensure that service users rights are protected. EVIDENCE: It was observed that contracts of care are now in place and a new one is drawn up before each admission. These contracts inform the service user of their weekly fees and room number. It was noted from a sample of four that two were completed and signed for but the other two were not completed or signed for. It was observed that these contracts are written in plain English but are not available in any other formats including symbolic. Prior to the inspection the inspector was informed that a checklist has been introduced by managers to ensure that all data including needs assessments within service user files will be reviewed/dated and signed by service users /or carers and staff. 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 Page 9 It was noted that there was no check lists available and that the needs assessments in place were out of date From a sample of three needs assessments seen one was dated November 2004, another November 2003, and the third was dated October 2005 but was noted to be in draft. There was no evidence to confirm that they had been recently reviewed. 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 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 the following standard(s): 6,7,8,9,10 The care planning system in place has deteriorated slightly since the last inspection. Urgent attention must be to the completition of care plans with service users and their representatives to ensure that all residents’ needs are identified and met. Service users continue to be well supported by the staff team of School Road who enable them to take risks so that they reach their own highest level of independence and achievement. Confidentiality safeguards are in place, which protects service users’ personal information. However, further attention is outstanding which would ensure that service users best interests are fully protected. EVIDENCE: The staff continue to devise pen portraits and personal profiles for residents on short-term stays of less that seven days. Care plans are developed for residents who stay at School Road for longer periods or who have complex needs. 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 Page 11 As discussed in the section above prior to the inspection the inspector had been informed that a checklist has been introduced by the manager to ensure that all data including personal profiles and care plans within service user files will be reviewed/dated and signed by service users /or carers and staff. It was noted that there was no check lists available and it was observed that from a sample of four seen only one was signed for and dated by the member of staff who had completed it. There was information to confirm that detailed risk assessments are carried out with individuals and where appropriate clear contracts are drawn up so that service users and their representatives are aware or their rights and responsibilities during their stay at School Road. Service users files are held securely in the office and service users confirmed that they are aware they can access this information. Observational evidence confirmed that staff respect service users personal information, which is handled in accordance with the Data protection Act 1998. There is a Bristol City Council Statement of confidentiality in place and prior to the inspection the inspector was informed that a more accessible confidentiality statement was in the process of devised with service users 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 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 the following standard(s): 11,12,13,14,15,16,17 School Road continues to provide service users with the opportunity to experience a stimulating and varied lifestyle during their short stay away from home. Various informal activities are made available and meals are well managed and provide daily variation, good nutrition and social contact for service users. EVIDENCE: On the day of the inspection all six service users accommodated in the home were present during the inspection. Three service users consulted spoke about the different activities they were involved including day care. All confirmed that they enjoyed their stays at School Road and talked about outings to Harry Ramsdens’ fish restaurant or going to the pub. All service users were observed spending time relaxing, talking to staff and watching Television and videos. Two residents said “ I like it here; I do not want to leave”. “I like the staff and I like the food “. 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 Page 13 Records continue to confirm that decisions are made on a daily basis about what activities service users want to do for example going shopping, or a trip to the cinema or ten-pin bowling. There is a key worker system in place. It was observed that all service users appeared very relaxed in the company of the staff members on duty that day and with the home environment. Service users are encouraged to bring personal items like radio, videos, DVDs and pictures of family, friends and pets during their stay at School Road. Visitors are made welcome. However there are rules about visitor’s behaviour whilst on the premise and service users are advised about these rules on admission. Service users are encouraged to clean their own room if they are able. Otherwise they are informed that a cleaner will come into their room between 9am and 12pm depending on the time they choose to get up. A communal evening meal is provided for all service users unless a risk assessment states otherwise or the service user is unwell. This meal is held in the dining area of the communal area. It was observed that one resident chose to eat by himself in the conservatory, which is close to the communal area. The inspector was invited to join in the meal but declined on this occasion. However, it was noted that the meal of Spaghetti Bolognaise, which had been made with fresh ingredients and chocolate cake with custard, looked well presented and nutritious. One member of staff was observed supporting a resident by chopping his food. This task was carried out in a sensitive, relaxed manner. Service users and their guests are informed that they are not allowed in the kitchen unless individually assessed due to Health and Safety legislation 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 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 the following standard(s): 20 Further attention must be given to developing the medication administration system. These safe guards once established will ensure that service users and staff are better protected. EVIDENCE: School Road is a respite facility consequently there is no community pharmacist who has responsibility for visiting to conduct regular medication audits. There is a Bristol Social Services and Health medication policy and procedure in place as well as the homes own medication policy and procedure in place that was drawn up by the manager. Both the manager and deputy manager are trained as nurses and they currently provide medication training to all staff. Following the last inspection the inspector required that the CSCI pharmacist review the medication administration system. This review took the form of an inspection, which was completed on the 19th December 2005. 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 Page 15 The CSCI pharmacist made two recommendations. One recommendation was for the registered manager to ensure that current medication profiles be kept in service users’ files to enable staff to ensure that medication brought in is current and complete. The second recommendation was to ensure that the manager continue to investigate and access medication training from a suitably qualified person outside the unit. Prior to the inspection the Team manager informed the inspector that the manager is currently addressing these recommendations but it was noted that there was there was no written evidence to confirm this information during the inspection. A medication administration check was not completed on this occasion. It was noted that following the last inspection that service users’ homely remedies are now held separately from those held for staff working in the home. 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 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 the following standard(s): 22,23 The system for dealing with complaints and the arrangements for protecting service users from harm have both improved since the last inspection which will ensure that service users are better protected. EVIDENCE: Bristol City Council has a complaints procedure that has also been translated into a pictorial format for the benefit of service users. This pictorial format was seen in the office. It was noted that an up to date copy of Bristol City Council complaints leaflet is now provided to service users and their representatives, which includes details of the Commission for Social Care Inspection. The team manager informed the inspector prior to the inspection that there are plans to develop the pictorial format to include details of the Commission for Social Care inspection. The manager has received complaints investigation training. No complaints have been reported to The Commission for Social Care Inspection during the last year. Three service users seen during the inspection said “I like it here, the staff are nice. They look after us and we go out shopping or to the pub to play pool” “I like coming here”. 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 Page 17 There is a copy of ‘No Secrets in Bristol’ held in the home. This is the Local Authority guidance on adult protection. Following the last inspection the majority of staff working in the home have recently completed Adult protection training provided by the Local Authority. It was noted that four members of staff have still to complete this training. It was understood that this was in the process of being organised by the Deputy Manager as the manager was currently on leave of absence. 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 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 the following standard(s): This standard was not assessed on this occasion. The environment was inspected during the last unannounced inspection conducted on the 25th September 2005 and all standard were met EVIDENCE: 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,36 The staffing levels have only been partially addressed since the last inspection. They need to be kept under review to ensure that service users benefit from an effective staff team. Attention to formal staff support has continued since the last inspection. However further improvement is required to take place so that service users continue to benefit from well supported staff. EVIDENCE: Prior to the inspection the team manager informed CSCI that staffing ratios currently meet national minimum standard despite vacant posts and that the vacant posts are due to be reviewed in 2006. This review had not taken place in January or February 2006 and there was no evidence to confirm that a date had been set. On the day of the inspection it was noted that there were the appropriate number of staff on duty. It was noted that one member of staff on duty was working in the home on a temporary basis. This member of staff explained that a couple of other staff were in the same situation and would be returning to the home they usually work at during the next few weeks. It was also noted that this member of staff had been asked to do a sleep in duty as well as her evening shift as a result of a staff member on leave of absence. 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 Page 20 The staff rota was examined and it was noted that staff shortages had improved since the last inspection but there were still gaps due to sickness, holidays and staff vacancies. It was noted that staff who work in the home try to fill the gaps in the rota where possible to ensure the residents have continuity of care. There was written evidence to confirm that staff team meetings take place on a regular basis. This was confirmed by one member of staff seen at the time of the inspection. Prior to the inspection the team manager explained that the management team will use a supervision checklist to ensure that supervision happens on regular basis (4-6wkly) via a cascade system and this would be put in place by the end of January 2006. The supervision check list was examined and it was noted that supervision was now taking place on a more frequent basis but there was evidence to confirm that it was not happening as often as it should and this was usually as a result of staff sickness or staff not working together on the same shift. Staff confirmed this at the time of the inspection 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,42 On the whole School Road continues to be well managed so that service users benefit from a well run home. There has been an improvement in health and safety records since the last inspection, which ensures that service users and staff are protected from risk of harm. EVIDENCE: The manager returned to School Road in August 2005 following a period of professional training within Social Services and Health. During the last inspection it was noted that the time to fulfil her role was reduced considerably as she was covering for staff sickness. 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 Page 22 Following the inspection the team manager was asked to review this situation with the manager. The inspector was informed prior to the inspection that this review had taken place and it had been agreed that there will be sufficient staff on duty at all times the manager is working to enable her to carry out her role. It was noted that there was a condition to this arrangement in that occasionally following sickness or annual leave the manager may still be required to cover at times. Unfortunately the inspector was unable to verify this arrangement during the inspection as the manager had been on leave of absence since the beginning of January 2006 and was not due back until 5th March 2006. However, it was noted that there was no evidence in place to suggest that the manager was not given time to carry out her role to a satisfactory standard. The inspector examined a sample of records, which are maintained for the protection, and safety of service users and staff. The records examined included the fire log. It was noted that the all of these records were up to date and accurate including the night staff who now receive three monthly fire safety training as required to at the last inspection. It was also observed that a new fire risk assessment had been completed in December 2005. 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 Page 23 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 X 2 2 3 X 4 X 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 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 2 33 X 34 X 35 X 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X 3 X X X X 3 X 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 Page 24 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 Regulation 14(2) Requirement All needs assessments must be kept under review and revised at any time following consultation with the service users and or their representative. Review. There must be an up to date assessment in place. This is an on going requirement from the previous inspection conducted on the 25th September 2005 2. YA5 5 An up to date contract / statement of terms and conditions must be in place for all service users. This contract must be in a format / language appropriate to each service user and /or reasonable efforts made to explain the contents. The service user or their representative must be provided with a copy which has been signed by the service user and the manager 31/05/06 Timescale for action 31/05/06 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 Page 25 3 YA6 15(1) Care plans must be compiled with services users and or the their representatives This is an on going requirement from the previous inspection Conducted on the 25th September 2005 Current medication profiles must be kept in service users’ files. The manager must continue to investigate and access medication training from a suitably qualified person outside the unit 31/05/06 4. YA20 13(4)(c) 31/05/06 5. YA33 18(1) An urgent review of the staff shortages at School Road must take place. A plan of action detailing how this situation is going to be improved must then be sent to the Commission for Social Care Inspection This is an outstanding requirement from the previous inspection conducted on the 25th September 2006 31/05/06 6. YA36 18(2) All care staff must receive supervision at least six times a year 31/05/06 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 YA10 Good Practice Recommendations The manager should develop a more accessible confidentiality statement for service users 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos 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 40 School Road DS0000053613.V283603.R01.S.doc Version 5.1 Page 27 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!