CARE HOME ADULTS 18-65
6 Northumberland Road Redland Bristol BS6 7AU Lead Inspector
Kathy Marshalsea Unannounced Inspection 1st December 2005 10:00 6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 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 6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 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. 6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service 6 Northumberland Road Address Redland Bristol BS6 7AU 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 9423628 0117 9709301 Aspects and Milestones Trust Mr Antony Swanborough Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (4), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1) 6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. May accommodate up to 5 persons aged 18 years and over requiring personal care. 11th July 2005 Date of last inspection Brief Description of the Service: 6 Northumberland Road is an older property in a residential area. There are 5 single bedrooms and a communal lounge and dining room. There is a back garden with a small drive at the front of the house. There is no disabled access or lift facilities. 6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and conducted as part of the annual inspection programme. There was two inspectors due to a new inspector joining the lead inspector, with the home’s permission, as part of their induction. The inspector’s were at the home for 6.5 hours. They spent time with residents, talked to a new member of staff and read records and documents relating to the care of the residents. Alot of the information in this report was taken from comments made by the residents themselves. Feedback was given to the manager to conclude the inspection. What the service does well:
Residents spoken with made the following comments about their home: “ “ “ “ “ The food is lovely” It feels secure and you don’t worry about the outside world. I feel safe.” Someone will play Mozart on the key board and that’s lovely.” The staff are very good and easy going. I get money every day”. It’s a very good house and I don’t plan on leaving for a few years yet”. The two requirements made at the last inspection have been met. The recommendation about medication was also met. The ethos of the home continues to be open, positive and friendly. This has been facilitated by the manager who has had a positive influence on the home in the year he has been in charge. He has a person centred approach that has now permeated into every area of the management of the home. He communicates a clear sense of direction and enables the decisions to be made and/or influenced by the residents themselves. The person centred approach was crystal clear in every document read as the residents are at the heart of every decision made and they are recognised as the individuals they are. Residents are empowered to make their own decisions within a supportive and nurturing environment. Identified risks are clearly recorded and reviewed and show a clear rationale. The service continually looks at what they are doing and how they can improve and progress the services being offered. Care plans are a working document and show resident involvement. They are person centred and show a thoughtful and respectful approach to each need. They are reviewed according to the daily notes so that these feed back into the care plan. Reviews are held regularly and the staff support the residents in this process by offering them a pre-review meeting to share the information before the review and make it less intimidating. This is commended.
6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 Page 6 Continuing to provide the residents with choices of trips, external interests and activities in-house continues to have a high profile. Seasonal celebrations take place and a party is planned for New Years Eve. Medication continues to be reviewed regularly and reduced when appropriate. Health care is monitored and encouraged. Specialist advice is sought and acted upon when needed. Choices are encouraged for all areas of the residents’ lives from what they eat to how they spend their time. They are supported to increase their life skills through a risk assessment process. Staff listen to residents and enable them to express any anxieties. Sensitive issues are dealt with by the involvement of a multi-disciplinary team ensuring that decisions are not dealt with in isolation. Residents spoken with expressed the confidence to talk to staff about any concerns, including any issues relating to abusive behaviour towards them. The staff team are skilled and able to meet the home’s aims and objectives. Mandatory training is offered to staff by the Trust. The manager has organised external specialist training for the staff team relevant to the needs of the residents. This is commended. Staff are supported and appropriately supervised formally and informally. The home has met most of its aims from the business plan produced in April 2005.House and staff meetings are structured and held regularly. What has improved since the last inspection?
Extending the social sphere of the residents which has is now a focus. Involvement of the residents in the Clubhouse, which is a forum for service users and staff to meet informally. The purchase of new curtains and beds which were chosen by the residents. Medication recording has improved following the requirement and recommendation made at the last inspection. Windows above ground floor level have been restricted to comply with the requirement made about risk assessing them and taking actions to reduce any risk. There is now a gender balance in the staff team giving residents choices about having male or female support.
6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 Page 7 The provision of one to one therapeutic activities such as a staff member facilitating one residents to write their life story. 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. 6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 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 6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5 Residents are informed about life in the home in a clear and accessible format. Assessed needs are met and constantly reviewed. Each resident has an agreed contract so are aware of their terms and conditions. EVIDENCE: No new residents have been admitted to the home since the last inspection. 1.The home has a Statement of purpose and service user guide. These are separate documents, which the residents were familiar with and were able to discuss with the inspector. They also said that they had been given a copy of the document. The service user guide is written in plain English. Residents said that they felt happy with the format and felt it reflected what happened for them. The Statement of Purpose includes the business plan for 2005-2006. There is also a training plan, which includes providing specialist training which the manager has arranged for the New Year. These documents need to be updated to reflect the change in staff. 3. Residents spoken with confirmed that their needs are met. This was confirmed within assessments and other documents read. Specialist needs are also met and clearly understood by the staff. Advice is sought and therefore services are based upon best practice and regularly analysed for its effectiveness. 5.Signed contracts were seen in each residents file. One residents identified a blank copy of this agreement which is in the service user guide file.
6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 Page 10 6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 The care plans are person centred reassuring the residents that their holistic needs will be met. Consultation is evident in all documents as the residents sign them. Residents are supported to make their own decisions with assistance given when necessary. They participate in all aspects of life in the home. Risks are assessed and managed responsibly. EVIDENCE: 6,7.There was evidence of residents being involved in the review of their care plans so that they are aware of their assessed needs. The plans read showed a person centred approach and demonstrated a clear and respectful approach to each person’s different needs. Plans were clear in describing what level of support was needed to meet needs. Goals were realistic and achievable and the residents’ own goals. Information from daily notes is used in the care plan reviews making the plan a working document. The plans were reviewed and updated appropriately with the resident. Files also included signed contracts and house rules. 8. There is a weekly menu-planning meeting which the residents talked about. They also talked about their monthly house meetings, the minutes of which are
6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 Page 12 kept in the dining room. These showed that they influence key decisions in the home. This was particularly so for trips and activities in the home. Informal decisions were also witnessed during the inspection such as them choosing lunch and how their day was spent. Residents confirmed that they are always offered the opportunity to participate in all aspects of life in the home. 9. Residents are supported to take responsible risks. Risk assessments showed a clear rational and were updated and reviewed regualry.They are also linked to incidents which influence an increased risk and are reviewed more regularly till the risk is reduced. 6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,17 Opportunities are created for residents to develop personally, and take part in the community. Residents said that they take part in fulfilling activities in the home and outside. Family links are encouraged and maintained. Residents feel respected and take responsibility for their daily lives. EVIDENCE: 11.An example was given of a resident who expressed an interest in Buddhism. This was facilitated by the staff and now the residents attends the sessions on their own. 12. One resident spoke about trying employment by working initially as a volunteer which they hope will lead to a part time job. 13. Some residents go to local cafes and pubs. One attends a project at the Barrow Wood project which has enabled then to make friendships there. Another has been involved in setting up The Clubhouse and went to Gloucester to see the projects there. Another has a season ticket for Bristol City football team. Another goes to several drop-in centres. They all participate in some way in the local community.
6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 Page 14 14. A holiday is being planned for next year which has not been organised previously. The in-house provision of activities has improved. A new member of staff has experience in group activities and has encouraged one resident to write his life story which has been very successful therapeutically. Interests and hobbies are encouraged and facilitated when possible. Group trips are a normal part of life in the home and there have been trips to the Arbaretum,Zoo and museums. 15. Discussion took place about personal relationships. The manager stated that if a resident wished to have a relationship the staff would support the resident and ensure that they were aware of safe sex issues. All residents are encouraged to invite their friends and family to the house. Some residents are supported to maintain contact with their families and regular trips home are a part of their life 17. Food hazard analysis has been done for example safe transportation and cross contamination. The residents decide menus. Some residents are supported to cook and others are now expressing an interest in cooking too. One resident said that the food is lovely. Residents are encouraged to participate in chores. 6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 The homes own Policies & Procedures for Medication ensure that practices are safe. Residents can be sure that their medication is monitored for its effectiveness. EVIDENCE: All residents had an annual health check in July of this year. Medication systems comply with the home’s own Policies and Procedures. Records were clear and auditable. New staff are assessed for their competency before they administer medication. Medication is reviewed for its effectiveness and reductions made when appropriate. The manager was able to give the inspectors examples of medication being reduced, stopped or changed and the positive effect at had had for those residents. In one instance this had led to the resident becoming more alert and able to engage in more social activities. The manager was able to demonstrate his knowledge of medications being used and their possible side effects. 6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 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): Residents feel confident to talk to staff about any issues that have upset them, including whether they are treated well. EVIDENCE: 23.The Manager has talked to the residents about what constitutes abuse. Residents talked to the inspector about what they would do if a member of staff was unkind to them. They said that they would tell Tony (manager) and know that he would believe them and would do something about it. The Trust provides updates in prevention of abuse annually. Incidents of possible verbal and physical aggression are recorded and strategies in place for dealing with this appropriately. 6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,28. The home is suitable for its stated purpose as it is only accessible for those people who are independently mobile. Some effort is being made to update the house and furniture; some of it is way past its sell by date. Communal rooms also are going to benefit from being modernised. Carpets will need to be replaced in all communal areas. EVIDENCE: All residents have a single bedroom. There is a communal lounge which is a smoking area and a separate dining room. The home is functional but not homely. Communal areas are in need of re-decoration and refurbishment. This has been recognised and steps taken to address this. Shelves have been put in the lounge and plants have made it more homely. The inspector saw that lounge curtains have been purchased and are being fitted soon. New beds have been ordered which the residents chose. New bedding has also been purchased. A second hand three-piece suite is also on order. The residents bedrooms have been re-decorated and now need new furniture to make them homely and more comfortable. The carpets in the hall, lounge, dining room and stairs needs to be replaced. This must be done within the next six months.
6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 Page 18 The manager stated that a dishwasher is being purchased, with a new fridge and freezer. 6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 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): 31, 32, 33, 34, 35, 36 Staff understand their roles and responsibilities. They are competent and experienced enough to meet the residents needs. Staff are going to be provided with specialist training pertinent to their residents. Staff receive the support and supervision they need to carry out their jobs. EVIDENCE: Staff records were looked at. Two induction records were seen, these had not yet been fully completed but this was due to the fact that the staff were transferred from another home within the organisation. They only needed to become familiar with the home’s particular policies. Supervision records seen showed a regular and consistent approach to training and professional development. They also include discussing issues from the key worker role. Since the last inspection there has been changes in the staff team. Supervision records show that they have integrated well and are having a positive impact on the way the home is run. Recruitment is partially done through the organisation. The manager does short list candidates and ensures that the residents are consulted about a potential staff member. New staff are carefully selected to ensure that their skills compliment the existing staff team. The manager wants to include the residents in this process and advice is being sought about how best to involve the residents in the interview. 6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 Page 20 The manager is an NVQ assessor and is supporting a staff member with their NVQ 3. 35.All mandatory training is provided by the Trust. Due to the fact that no specialist training had been provided by the Trust the manager has arranged specialist training. The Bristol North Rehabilitation team is providing this. it will include Community Psychiatric Nurse and Occupational Therapist. it will specifically relate to issues presented by the residents so will be pertinent and tailored to the learning styles of the staff group. Staff asked for concise training and then be able to ask questions after. 36.Supervision records showed that regular meetings are held for each staff member. A staff member confirmed that they are supported by the manager and able to develop in their role. The manage plans to conduct annual appraisals and was advised to include a training plan for each individual in that process. 6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 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, 38, 42 The manager is competent and has a person centred philosophy. This benefits the residents as they are all treated as individuals. Residents benefit from a well run home which is influenced by them. The manager ensures as far as is practicable the health and welfare of residents and staff. EVIDENCE: 37. Mr Swanborough is now the registered manager of the home after successfully completing his registration with the CSCI. It was evident during the inspection that he fosters an open, inclusive and positive management approach. There are warm and respectful relationships between the residents and staff. The relationships between the residents themselves were also friendly and they told the inspector that they are now looking out for each other’s welfare. Staff meetings are held monthly. Agendas are posted for staff to add items. The minutes and staff confirmed that these are structured meetings. House meetings are also held monthly and the minutes kept in the dining room. The last one showed that the residents went out to choose their new
6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 Page 22 beds. It also showed their suggestions for trips and seasonal activites. It also informed the residents of the process of CSCI inspections and that they should feel able to discuss anything they wish with the inspector. A suggestion was made by one of the residents for a New Year party which has been arranged. The residents stated that there is also menu meeting weekly to decide what they are going to eat for the next week. 42.The home has the Trust’s Health & Safety Policies, Guidelines and Procedures book. Areas of responsibility are delegated to members of the staff team. Generic risk assessments have been completed including working in the kitchen, water spillage in the bathrooms and individual residents assessment for various activities. Substances that could be hazardous to health which are used in the home have been risk assessed. Data sheets for these products are also included. The Fire Book is kept up to date. The representative from the Trust conducts monthly Regulation visits to monitor the home and how it is run. These are sent to the CSCI and always include a review of each resident. 6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 X 3 X 3 Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 2 X X 2 X X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
6 Northumberland Road Score X X 3 X Standard No 37 38 39 40 41 42 43 Score 3 3 X X X 3 X DS0000026564.V268510.R01.S.doc Version 5.0 Page 24 NO 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. 2. Standard YA24 YA24 Regulation 16(2)© 16(2)© Requirement The carpets must be replaced in the communal areas stated in this report. Furniture throughout the home must be replaced. Timescale for action 01/05/06 01/05/06 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. 2. Refer to Standard YA6 YA35 Good Practice Recommendations End of life plans should be recorded. Individual training plans should be drawn up for each staff member. 6 Northumberland Road DS0000026564.V268510.R01.S.doc Version 5.0 Page 25 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
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