Inspection on 14/07/05 for 63 Lambrook Road

This inspection was carried out on 14th July 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

63 Lambrook Road 24/04/07

63 Lambrook Road 05/10/06

63 Lambrook Road 15/12/05

63 Lambrook Road 15/03/05

63 Lambrook Road 08/11/04

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 63 Lambrook Road Fishponds Bristol BS16 2HA Lead Inspector Sarah Webb Unannounced 14 July 2005 10:00 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 63 Lambrook Road Address Fishponds Bristol BS16 2HA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0117 9655912 0117 9709301 Aspects & Milestones Trust In process of registering new manager PC Care home 4 Category(ies) of LD(E) Learning disability - over 65 registration, with number LD Learning disability of places (4) 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate up to 4 persons aged 40 years and over. May accommodate up to 4 persons with a learning disability who also have a physical disability. Date of last inspection 15-Mar-2005 Brief Description of the Service: 63 Lambrook Road is a domestic style house in a suburban setting providing accommodation for four people with mild learning difficulties and varying levels of physical disability, operated by Milestones and Aspects Trust.The house was built in the 1960’s and has had some adaptations for disabled people.The main Fishponds Road shops are within easy reach by wheelchair or walking.The home has four single rooms and a lounge/dining room.There is both a front and back garden with a patio. 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out as an unannounced inspection and took place over a period of 1 day and a total of 4.5 hours. The inspection methods used included record checks, case tracking, discussion with staff and discussion with 2 service users. There is a new manager in place who is in the process being registered through the Commission for Social Care Inspection. He will continue to manage another home within the organisation as well as Lambrook Rd. What the service does well: What has improved since the last inspection? What they could do better: The service needs to ensure that individual and generic risk assessments are carried out and updated. (This is carried through from the last inspection) Risk assessments in relation to the moving and handling of residents need to be completed. 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 6 The home needs to improve its arrangements in place to review individuals’ care. The home needs to keep a record of medication transferred to bottle for the day activities. This needs to be labelled with the residents name, and the name, strength, and doseage instructions. The home also needs to keep a record of paracetamol administered to individuals. The home needs to provide suitable seating for a resident. The home needs to update manual handling training for staff. The manager needs to ensure he is rostered to be on duty on a regular basis in order to carry out his duties and responsibilities. The service needs to update staff training records. The service needs to ensure all staff receive fire training at regular intervals, and that a record is kept of this. Recommendations The service needs to ensure care plans/personal statements, risk assessments and other case file records are dated and signed. (This is carried through from the last inspection) The sofa should be raised or replaced to make its use more suitable for residents. (This is carried through from the last inspection) The home would benefit from storing old medication sheets in an alternative file. 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. 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, & 5 The assessed needs of residents are met and there are processes in place for the admission of new residents. Individual contracts are in place stating the terms and conditions of a placement at the home. EVIDENCE: There has been a new resident admitted to the home since the last inspection. A social services assessment was available as were case file notes transferred from their previous care home. The resident has made three visits to the home including an overnight stay. There were comprehensive records of their move to Lambrook Rd providing evidence that the resident has been offered information and supported with their move. Those staff spoken to indicated that the staff team has remained consistent and that staff had continued to support individuals and the management of the home since the last manager left in April 2005. A resident spoken to indicated they are supported well by staff; this was demonstrated through examples of their life style. Individuals’ license agreement includes additional services not covered by fees such as chiropody and the cost of using the lease car. 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 9 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 9 The home needs to improve its arrangements in place to review individuals’ care. The arrangements in place to minimise the risk so that the safety and welfare of individuals are promoted need to be improved. EVIDENCE: Although the home carries out annual service reviews and care goals are reviewed monthly, many of the documents in the case files are still not signed or dated. There were statements regarding individuals’ preferences and support needs. These are agreed in conjunction with residents and an assessment made by staff. There has also been no change to the current system of risk assessment documentation that is in need of being reviewed. Those generic assessments existing in relation to health and safety working practices for staff are also in need of being updated. 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 14 Residents have opportunities to participate in the local community and are offered meaningful activities. EVIDENCE: All three existing residents continue to attend a day service run by the Disabled Christian Fellowship for between 3 and 4 days per week. It was evident from discussion with one individual that they still continue to enjoy this placement. The recently admitted resident attends a day service run by Age Concern. Individuals continue to be encouraged and supported with household tasks such as cleaning their rooms, laundry, and domestic chores. All the residents attend local churches. It was evident that staff continue to support individuals with shopping trips and midday meals at local pubs, café and restaurants. An individual went out for a midday meal in the local community which they said they enjoyed. 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 12 There has been no change to transport arrangements. A lease car belonging to the Trust is used regularly. There is a local policy and individual agreements in place for payment of the car that are calculated on a monthly basis. A taxi is booked if the lease car is in use; residents are not charged for the taxi. There were records in place indicating that trips to the sea and Slimbridge had taken place. A resident said they had enjoyed a holiday at Exmouth. Another individual is booked to go on holiday later in the year. 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 The physical and emotional health needs of residents are well met with evidence of multi disciplinary working taking place. There is comprehensive information available for staff in order that individuals personal support needs are met in the way they wish, however this needs to be updated. The home needs to improve the arrangements for the review of safe moving and handling practices. The systems for the administration of medication need to improve in order to ensure residents are not placed at risk. EVIDENCE: Residents require the aid of a wheelchair both internally and externally. All individuals are supported with their personal hygiene and bathing and have varying levels of assistance. All residents use the bath hoist although all can weight bear to varying degrees. Records indicated individuals’ preferences as to how they wish to be supported. 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 14 Statements regarding people’s wishes not to have services such as dentistry hearing tests have been updated but still need to be signed and dated. Arrangements to assess the moving and handling safe systems of work have begun on two individuals regarding their mobility and how they are to be supported safely. These also need to be signed and dated. Health care notes recorded visits to GP, dentist and optician. It was also evident through health records that residents are supported with advice from specialist services. Medication continues to be provided by Lloyd’s pharmacy in the form of medidose boxes on a weekly basis. The receipt, administration and disposal records were up to date and in order barring the recording of paracetamol being administered to individuals. The home needs to ensure the administration of paracetamol to residents is recorded. The medication folder includes old records going back over a long period of time. It would be beneficial to the staff if all old medication sheets were filed in a separate filing system. There is only one resident who self medicates and this is when they attend their day placement and take their midday medication independently. Medication is transferred from the medidose box to a bottle by staff; this practice is not acceptable by the Royal Pharmaceutical Society. The individual themselves could continue to be independent in transferring their medication from the medidose box to bottle. The inspector has sought advice with regard to this practice from the pharmacist employed by the Commission, and it has been agreed that it is acceptable. Advice has been sought from the pharmacist, who has suggested the manager contact the supplying pharmacy and discuss all possible alternative methods of supply. If there is no practical alternative then the following is advised to minimise the risk of medication errors: 1) Risk assessment 2) Written procedure for the transfer of medication including checking by a second staff member. 3) A written record of the transfer of medication to the bottle, this could be made on the back of the MAR sheet. The record should detail date, quantity of medication supplied and signatures of the 2 staff members involved. The bottle must be labelled with the service user’s name, the name and strength of the medication and the dosage instructions of the medicines contained in the box. 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Arrangements are in place for protecting residents from possible risk of harm or abuse. The home has a satisfactory complaints system with evidence that residents feel that their views are listened to and acted upon. EVIDENCE: The Trust has a comprehensive complaints policy and the home’s policy is on display. A complaints log is in place. There have been no complaints since the last inspection. Both house meetings and monthly reviews offer opportunities for residents to express concerns they may have. A resident spoken to said they felt staff listened to them and that they had no complaints. There are policies and procedures regarding the protection of vulnerable adults and whistle blowing. All staff have completed training in the protection of vulnerable adults. It was not possible to see the record of the date CRB clearances are received on staff members, and the relevant ID number due to there being no manager present. 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 The location of the home offers easy access to the local community meeting lifestyle needs of individuals. The home needs to consider providing residents with appropriate seating. EVIDENCE: The home is small and domestic in style. It is suitable for its purpose and meets the current needs of the residents. The residents have access to local amenities, with the main Fishponds Rd shops being in easy reach by wheelchair or walking. The furnishings and fittings are of domestic style and in good condition. As at the last inspection the suitability of the sofa was discussed in relation to residents wanting to sit on it; two of the residents use wheelchairs internally but the other two would find it very difficult to get up, as it is so low. Staff indicated that only they sat on it. The new resident sat on a dining chair during this inspection. It was evident their preference was for an upright chair. The home needs to investigate obtaining a suitable chair for this person. 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 17 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, & 35 Staff need to be trained specifically in manual handling practices in order to support residents within a safe environment. Staff have a good understanding of the residents support needs. EVIDENCE: As at the last inspection, two of the staff have completed National Vocational Qualification Level 3 while two staff are in the process of completing this same qualification. There are currently 6 care staff employed at the home. Two staff are on duty at all times. Five of the staff have long experience with this or similar resident groups and have been working at the home for over 4 years. Those staff spoken with evidenced knowledge of residents’ needs and how they were supported. Staff training records indicated that first aid and food hygiene are up to date. Staff need to attend manual handling training due to a previous date being cancelled. 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 19 Since the last inspection, a staff member has attended a training course on epilepsy awareness. 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 41 & 42 The manager needs to ensure he is available to staff on a regular basis in order to carry out his duties and responsibilities. The home needs to ensure records are well maintained, up to date and accurate. The home needs to ensure that staff attend fire training at regular intervals. EVIDENCE: The manager manages two homes within the organisation- Lambrook Road being one of them. The manager was not available at this unannounced inspection. He is in the process of being registered as manager of the home with the Commission for Social Care Inspection. 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 21 Although the current staff team has continued to support individuals during the change of management, it was evident through observation of the rota and discussion with the service manager that the new manager needs to share allocated time between both of the homes he is managing. Staff spoken to said there have been no concerns whilst there has been no manager on site, however it was evident through this unannounced inspection that there are specific areas of recording and practice that need to be reinforced by the manager. There were records kept of resident activities, health notes, and relevant handover information in order to support both residents and staff in the provision of care. There was a current photo of all residents. There was a visitor’s book in place. Regulation 26 and 37 reports have been submitted as required. It was evident through discussuion with staff and training records observed that these are in need of being updated. The fire log indicated that testing of fire equipment has taken place regularly. It was evident through observation of records that fire training has not been carried out at regular intervals. There was a Gas Safety certificate safety record in place. The portable electrical testing is overdue. 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 22 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 x 3 3 x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x x Standard No 11 12 13 14 15 16 17 x 3 3 3 x x x Standard No 31 32 33 34 35 36 Score x 3 3 x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 63 Lambrook Road Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x x x 2 2 x D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 23 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 9 Regulation 13(4) Requirement Carry out and update individual risk assessments. (This is carried through from last inspection) Complete risk assessments in relation to the moving and handling of residents. Keep a record of paracetamol administered to residents Keep records of medication transferred to bottle for day activities. This needs to be labelled with residents name, and the name, strength, and dosage instructions. Provide suitable seating for a resident. Update manual handling training for all staff Update training records Ensure all staff receive fire training at regular intevals and that a record is kept. Ensure the manager is rotered to be on duty on a regular basis to carry out his duties and responsibilities Timescale for action 31/12/05 2. 3. 4. 18 20 20 13(5) 13(2) 13(2) 30/11/05 As from 14/7/05 As from 14/7/05 5. 6. 7. 8. 9. 24 35 35 42 37 13(3) 18(1) 17 23(4) 18(1)(a) 31/12/05 31/12/05 30/11/05 As from 14/7/05 As from 14/7/05 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 24 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. Refer to Standard 6 24 20 Good Practice Recommendations Sign and date individuals care plans, personal statements,risk assessments and other case file records Consider raising or replacing the sofa to make use more suitable for the residents Store old medication sheets in an alternative file. 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 25 Commission for Social Care Inspection 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 63 Lambrook Road D56_D05_S26540_Lambrook_V236751_140705_Stage4.doc Version 1.30 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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