Inspection on 15/12/05 for 63 Lambrook Road

This inspection was carried out on 15th December 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

63 Lambrook Road 24/04/07

63 Lambrook Road 05/10/06

63 Lambrook Road 14/07/05

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 Inspection 15th December 2005 9.00 63 Lambrook Road DS0000026540.V270149.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 63 Lambrook Road DS0000026540.V270149.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. 63 Lambrook Road DS0000026540.V270149.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 63 Lambrook Road Address Fishponds Bristol BS16 2HA 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 9655912 0117 9709301 Aspects and Milestones Trust Mr Lawrence Bartlett Care Home 4 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (4) of places 63 Lambrook Road DS0000026540.V270149.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. 14th July 2005 Date of last inspection 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 1960s 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 DS0000026540.V270149.R01.S.doc Version 5.0 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 6 hours. The inspection methods used included record checks, case tracking, discussion with the manager and staff and discussion with 1 resident. Five requirements have been met leaving one partially met and three unmet Ten requirements have been made through this inspection including three immediate requirements. The manager continues 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 all staff receive fire training at regular intervals, and that a record is kept of this. (This was unmet from the last inspection and an immediate requirement was issued) 63 Lambrook Road DS0000026540.V270149.R01.S.doc Version 5.0 Page 6 The home needs to keep a record of all medication received from the pharmacy and any medication disposed of in order to ensure the health, safety and welfare of residents. (This was an immediate requirement) The home 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. (This is carried through from the last inspection) The home needs to risk assess financial procedures relating to the management of residents monies, including the current practice of withdrawing monies on their behalf. The home also needs to review the arrangements in place for the monitoring and control of financial procedures. Records held in the interests of the service users are in need of improving still such as being updated, signed and dated regarding their care plans/personal statements, risk assessments and other case file records. (This is carried through from the last inspection) The home needs to carry out reviews and update three residents care plans in order that their assessed needs are met. An action plan is in need of being set out as to how the home will meet the physical needs of an individual as assessed by specialist services and timescales for changes to the environment. The home needs to update staffing records to include the details of staff hours worked and start dates. The home needs to ensure fire equipment is maintained on a regular basis in order to ensure the safety of individuals. Three staff need to update food hygiene training in order to ensure the welfare of individuals. 63 Lambrook Road DS0000026540.V270149.R01.S.doc Version 5.0 Page 7 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 DS0000026540.V270149.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 63 Lambrook Road DS0000026540.V270149.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): EVIDENCE: There have been no changes in that here have been no new residents admitted to the home. Standard 2 was assessed at the last inspection as a key standard and scored 3. It was not assessed at this inspection. 63 Lambrook Road DS0000026540.V270149.R01.S.doc Version 5.0 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&9 The home is failing to provide a consistent care planning system for all residents and to adequately provide both staff with the information they need to satisfactorily meet individual needs. The arrangements in place to minimise risks so that the safety and welfare of individuals are promoted are poor and need to be improved. EVIDENCE: It was evident through records examined, that an individual’s care plan had been reviewed six monthly with the involvement of relatives. There was comprehensive information recorded to evidence that their needs were being met. Through observation of the other two residents care plans there was not sufficient up to date information in place and there was no evidence that regular reviews had taken place. A fourth person’s care plan could not be found. Through discussion with the manager and staff it was evident that an individuals physical needs have changed and this also needs to be reflected in their care plan (this has been recorded in detail in Standard 18.) Other aspects 63 Lambrook Road DS0000026540.V270149.R01.S.doc Version 5.0 Page 11 are also in need of review and updating such as their religious views, life skills and health notes. Risk assessments in place for an individual related to their previous home. Again, these are in need of review and being updated. Two requirements have not been met for risk assessments to be completed in relation to the moving and handling of residents, and individual and generic risk assessments are still in need of being updated. 63 Lambrook Road DS0000026540.V270149.R01.S.doc Version 5.0 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): 13 & 15 Residents have opportunities to participate in the local community and are offered meaningful activities, and holidays. Staff support residents with the maintenance of family relationships and contact with friends. EVIDENCE: Staff continue to support individuals within the community with shopping trips and midday meals at local pubs, café and restaurants. Three residents have been involved in making choices regarding holidays; one person chooses not to go on holiday. 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. However these need to be updated reflecting the true cost to residents. A taxi is booked if the lease car is in use; residents are not charged for the taxi. 63 Lambrook Road DS0000026540.V270149.R01.S.doc Version 5.0 Page 13 Through discussion with staff it is evident that staff have continued to support individuals in maintaining family contacts and friendships. A resident said she was supported in visiting her family on a regular basis, which she said was important to her. 63 Lambrook Road DS0000026540.V270149.R01.S.doc Version 5.0 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): 18, 19, & 20 The home is failing to offer personal care support to an individual as assessed through a specialist service in order to respect their dignity and maintain the health and safety and welfare of both the individual and staff. The home still needs to improve the arrangements for the review of safe moving and handling practices. The physical and emotional health needs of residents are well met with evidence of multi disciplinary working taking place. However the home needs to improve in the review and updating of individuals personal care and health plans in order that staff are fully informed and meet with their preferences. The home still needs to improve recording procedures regarding for the receipt and disposal of medication need to improve in order to ensure residents are not placed at risk. EVIDENCE: There has been no change in that all residents require the aid of a wheelchair both internally and externally. All individuals continue to be supported with their personal hygiene and bathing and have varying levels of assistance. 63 Lambrook Road DS0000026540.V270149.R01.S.doc Version 5.0 Page 15 It was evident through discussion with the manager and staff that a resident’s needs have changed and are now not being met. The existing bathroom environment needs to be altered if it is to meet this individual’s changing needs. A specialist service has assessed current practice in line with supporting this person with their personal care support. The manager said the assessment identified the need for an overhead hoist to be used; current practice involves the use of a bath seat but there are difficulties due to the space in the bathroom for this person to make transfers from their wheelchair. It has also been identified through regulation 26 visits that this is a major issue for both the individual and for staff in supporting them. The individual was not able to discuss this issue as they were unwell. A requirement has been made for the home to set out an action plan as to how the home will meet the physical needs of this person as assessed by specialist services. Discussion with staff indicated that individuals’ healthcare is monitored on a regular basis through visits to GP and specialist services. It was evident through observation of their health records that medical information is in need of being updated. Medication continues to be provided by Lloyd’s pharmacy in the form of medidose boxes on a weekly basis. Two requirements made through the last inspection have been met for the home to keep a record of medication transferred to bottle for the day activities; to be labelled with the residents name, and the name, strength, and doseage instructions. Also the keeping of a record of paracetamol administered to individuals. However it is evident that the home still needs to improve in the recording of medication; there was no record to evidence that recent medidose boxes had been received or checked by the home. Documentation also examined identified the lack of records regarding the disposal of medication. An immediate requirement was made to keep a record of both the receipt and disposal of medication. 63 Lambrook Road DS0000026540.V270149.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): 23 The home needs to improve the arrangements in place regarding financial monitoring and controls measures in place in order to protect individuals. EVIDENCE: Standard 22 was assessed at the last inspection and scored 3. It was not assessed at this inspection. All staff have attended training in the protection of vulnerable adults . A member of staff explained the arrangements in the home for accessing petty cash and supporting residents with their financial affairs. One member of staff is responsible for checking financial transactions on a monthly basis. There are procedures in place for all staff to check balances at staff handover periods. Appropriate arrangements are in place to access petty cash for items such as food shopping, taxis and petrol. Records examined evidenced two signatures in place for transactions; receipt/voucher were in place and double signed. All four residents have bank accounts with monies paid direct. Three of the residents need support to access their finances; records examined evidenced that there are arrangements in place for the three residents to access their personal allowance. There is one resident who handles their own financial affairs. One person is under the court of protection. 63 Lambrook Road DS0000026540.V270149.R01.S.doc Version 5.0 Page 17 It was evident through discussion with a member of staff that they are responsible for checking the majority of financial arrangements in place and that there are no other controls in place to monitor this. The member of staff was advised to consult with the manager and for him to review the arrangements in place for the monitoring of all financial transactions in order that the member of staff are not the sole person responsible. Therefore a requirement is made to risk assess financial procedures relating to the management of service users monies, including the current practice of withdrawing monies on their behalf. 63 Lambrook Road DS0000026540.V270149.R01.S.doc Version 5.0 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): 24 & 27 The location of the home offers easy access to the local community meeting lifestyle needs of individuals. The organisation needs to improve in providing a safe and suitable bathing environment to meet the changing needs of individuals. EVIDENCE: The home is small and domestic in style. The residents have access to local amenities, with the main Fishponds Rd shops being in easy reach by wheelchair or walking. It is evident that there are concerns as to whether the bathing area of the home is now suitable to meet the current needs of all the residents. A healthy and safety audit identified that the bathroom now is too small and the position of the bath is not satisfactory for the needs of individuals. The manager said those residents using wheelchairs are also not able to make use of the kitchen due to space required. The home is looking into replacing the bathroom and the kitchen in order that the environment is fit for purpose to meet the changing needs of individuals. A requirement is made for the organisation to set out an action plan as to the timescale for this to be implemented. 63 Lambrook Road DS0000026540.V270149.R01.S.doc Version 5.0 Page 19 In relation to a recommendation made, the manager said consideration is being given to remove the sofa in the lounge as it is not used by the residents and will make more space. 63 Lambrook Road DS0000026540.V270149.R01.S.doc Version 5.0 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 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 The staff are a consistent and competent team, and have a good understanding of individuals needs. Staff are in need of updating mandatory training in order to support residents safely. EVIDENCE: Discussion was had with a member of staff who related that the staff are a consistent team. Most of the staff have worked at the home for several years. There has been one new staff member since the last inspection. There are currently no staff vacancies. Examination of the rota evidenced that two staff are on duty at any one time. A staff member left their shift early as they had been attending to a resident who had been ill during the night. There was however only one staff left on their own as they were unable to get cover. With the manager working at the home for half of the week, due to managing another home in the organisation, all the team are involved in daily decision making. Staff have individual designated tasks such as duty rota, finances, and health and safety. It was evident that the team are confident and have always taken on specific responsibilities in the daily running of the home. It was not clear as to how often staff are supervised as it was not possible to examine supervision records. Arrangements are in place for bank staff to cover sleep in duty. 63 Lambrook Road DS0000026540.V270149.R01.S.doc Version 5.0 Page 21 Staffing records seen are in need of being updated in relation to the details of hours to be worked and start dates. Two of the staff have completed National Vocational Qualification Level 3 while two staff are in the process of completing this same qualification. It was evident through training records examined that three staff are in need of food hygiene training; manual handling training has been booked due to a previous cancellation. 63 Lambrook Road DS0000026540.V270149.R01.S.doc Version 5.0 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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): 38 & 42 The home still needs to improve with arrangements for all staff to receive fire safety training and in carrying out fire maintenance on a regular and consistent basis in order to ensure the safety of residents. The management of the home needs to improve in order to support staff within their role and ensure that residents benefit from a well run home. EVIDENCE: The manager manages two homes within the organisation- Lambrook Road being one of them. The manager was available for a short period of time during this unannounced inspection. A requirement is unmet for staff to receive fire training at regular intervals. Training records failed to record all staff members having attended fire safety. An immediate requirement was made for all staff to receive fire training at regular intervals in order to ensure the safety of residents. The fire log indicated that testing of fire equipment has taken place regularly. However the fire panel checks were not up to date. 63 Lambrook Road DS0000026540.V270149.R01.S.doc Version 5.0 Page 23 It was unclear from observation of the rota that the manager has met a requirement to ensure he is on duty at the home on a regular basis. This will be looked at in more detail at the next inspection. As indicated previously the staff team continues to support individuals on a daily basis but it is evident from observation of a range of records that the manager needs to take a greater role in the management of the home in relation to the monitoring and supervision of the home in order to support staff and ensure the safety of residents. 63 Lambrook Road DS0000026540.V270149.R01.S.doc Version 5.0 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. 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 x x x x Standard No 22 23 Score x 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 x x 1 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 1 x x x x LIFESTYLES Standard No Score 11 x 12 x 13 3 14 x 15 3 16 x 17 Standard No 31 32 33 34 35 36 Score 3 3 3 x 2 x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 63 Lambrook Road Score 1 2 2 x Standard No 37 38 39 40 41 42 43 Score x 2 x x 2 2 x DS0000026540.V270149.R01.S.doc Version 5.0 Page 25 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 YA9 Regulation 13(4) Requirement Carry out and update individual and generic risk assessments. (This is carried through from last inspection) Complete risk assessments in relation to the moving and handling of residents.(this is carried through from the last inspection) Keep a record of the receipt and disposal of medication. (this was an immediate requirement) Ensure all staff receive fire training at regular intervals and that a record is kept. (this was an immediate requirement) Carry out reviews and update residents’ care plans. Set out an action plan as to how the home will meet an individual’s changing needs. Risk assess financial procedures in place relating to the management of residents monies. Review arrangements in place for the monitoring and control of financial procedures. DS0000026540.V270149.R01.S.doc Timescale for action 31/12/05 2. YA18 13(5) 30/11/05 3. YA20 13(2) 15/11/05 4. YA42 23(4) 22/12/05 5. 6. 7. YA6 YA18 YA23 15(2)(b) 15(1) 12(1) 30/06/06 31/05/06 30/04/06 8. YA23 12(1) 30/04/06 63 Lambrook Road Version 5.0 Page 26 9 10 YA41 YA42 Sch 4(6) 23 Update staffing records Ensure fire equipment is maintained on a regular and consist basis. 30/06/06 15/11/05 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 Sign and date individuals care plans, personal statements, risk assessments and other case file records Train staff in food hygiene 63 Lambrook Road DS0000026540.V270149.R01.S.doc Version 5.0 Page 27 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 63 Lambrook Road DS0000026540.V270149.R01.S.doc Version 5.0 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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