Inspection on 13/07/05 for 76-78 Hampstead Road

This inspection was carried out on 13th 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

76-78 Hampstead Road 26/11/08

76-78 Hampstead Road 04/06/08

76-78 Hampstead Road 05/06/07

76-78 Hampstead Road 06/07/06

76-78 Hampstead Road 15/11/05

76-78 Hampstead Road 13/01/05

76-78 Hampstead Road 18/06/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 76-78 Hampstead Road Brislington Bristol BS4 3HN Lead Inspector Sandra Jones Unannounced 13th July 2005 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. 76-78 Hampstead Road D56_D05_S26628_HampsteadRd_V238696_ 130705_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 76-78 Hampstead Road Address 76-78 Hampstead Road Brislington Bristol BS4 3HN 0117 9728513 0117 9699000 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) The Brandon Trust Mr Julian Cyril Thomas Morse Care Home Only 12 Category(ies) of PD Physical disability,12 registration, with number LD Learning disability,12 of places 76-78 Hampstead Road D56_D05_S26628_HampsteadRd_V238696_ 130705_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate up to 12 persons aged 18 - 65 receiving personal care. Date of last inspection 13-Jan-2005 Brief Description of the Service: Hampstead Rd is operated by the Brandon Trust and managed by Julian Morse. It is a registered care home for twelve younger adults with learning and/or physical disabilities. The property was purpose built to accommodate people with physical impairments. As the property is purpose built to accommodate people with physical impairments, there is level access and wide corridors. It blends well with its local residential environment and close to shops, park and bus routes. The Statement of Purpose specifies the intended services to be offered by the home, with the Service User Guide, which includes the aims and objectives. Tewo additional posts for senior support workers were created. Since the last inspection two staff wer appointted to these posts. This will assist with the NMS standard of 50 staff to have vocational qualifications by 2005. 76-78 Hampstead Road D56_D05_S26628_HampsteadRd_V238696_ 130705_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted on an unannounced basis over two days in July 2005. The residents are unable to make comments about the standards of care at the home. Interaction between residents and staff was directly and indirectly observed. Records were examined as a means of making judgements on the standards of care in place at the home. There were no additional visits to the home since the last inspection. What the service does well: What has improved since the last inspection? What they could do better: Requirements made are based on the care planning, risk assessments and the environment. For some residents ELP’s require updating to ensure residents changing needs are consistently assessed. Monthly reviews by keyworkers were not up to date for some residents and senior staff must monitor the content. 76-78 Hampstead Road D56_D05_S26628_HampsteadRd_V238696_ 130705_Stage4.doc Version 1.40 Page 6 Through conversation it transpired that bathrooms are kept locked because of the stock that is stored in these rooms. As restricting access to these rooms is for staff convenience, risk assessments must be completed to evidence that maintaining the bathrooms locked is the safest method and corresponds with the level of risk identified. It was noted that for some residents their chest of drawers were labelled with the item of clothing kept in the drawer. It was understood that the furniture was inherited from the residents previous accommodation, where the labelling had occurred. As this practice is seen as institutional, the labels were removed for the second inspection visit. 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. 76-78 Hampstead Road D56_D05_S26628_HampsteadRd_V238696_ 130705_Stage4.doc Version 1.40 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 76-78 Hampstead Road D56_D05_S26628_HampsteadRd_V238696_ 130705_Stage4.doc Version 1.40 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) 1 The Statement of Purpose requires further development regarding the admission criteria to the home. EVIDENCE: Since the last inspection, the manager has taken action to meet the requirement to update the home’s Statement of Purpose. While the staff qualifications and information on the person centred approach to care was included, the admission criteria must be added to the statement. 76-78 Hampstead Road D56_D05_S26628_HampsteadRd_V238696_ 130705_Stage4.doc Version 1.40 Page 9 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, 7 & 9 Planning for Life files have been updated to integrate ELP, a person centred approach to care. Daily sheets and review monitoring sheets must be updated to better evidence that residents changing needs are monitored and to focus on the success of ELP. Risk assessments for locking bathrooms and toilets must be completed. Where risks are identified, risk assessments are completed. Manual handling risk assessments describe the support, with photographs illustrating the technique. Other risk assessments based on activities that may involve an element of risk are in place. EVIDENCE: Planning for Life files were updated to incorporate a person centred approach to care within the Trust homes. Essential Living Plans (ELP) are detailed and guide the staff to meet all aspects of the person’s assessed needs. However, the dates of the last review indicate that the plans require reviewing. Members of staff reported that care plans and monthly reviews are undertaken although documented evidence was not available. The explanation given are 76-78 Hampstead Road D56_D05_S26628_HampsteadRd_V238696_ 130705_Stage4.doc Version 1.40 Page 10 accepted, records must be kept up to date particularly as the residents have high levels of dependency needs. The daily sheet format was changed since the last inspection to focus on activities and responses to care provided throughout the day and night. However, evidence of decision-making was not provided through the sheets. A physical focus remains evident, for example up, dressed and ate. Monthly monitoring evaluation forms are completed by keyworkers and sent to representatives. Since the last inspection the manager updated the format to seek feedback from representatives. From the reports examined instances were found that the process was not followed for all the residents. For others the information was brief and showed little input from the staff towards meeting identified goals. ELP’s clearly describe the manning in which the individual communicates. Daily reports indicate that residents make choices about their daily routines for example times to rise and retire and meals served. In terms of communication needs, the dates on the information indicates that the information must be reviewed in order to ensure that residents changing needs are monitored and where appropriate information is amended. Regarding daily reports the evidence that guidance within the ELP was used to inform the decision made by the resident was not included. Senior staff stated that access to the first floor is restricted to residents and the kitchen door is shut whenever staff are not in the kitchen. Risk assessments that evidence appropriate action are in place for these restrictions. Through conversation with senior staff, it transpired that bathrooms and toilets are kept locked. It was understood that this is because of the gloves and continence aids kept in the bathrooms and toilets and to safeguard one person. Risk assessments must be completed to evidence that the actions are the safest for the person and the group and not for the convenience of the staff. ELP’s detail essential information about the individuals mobility needs, which is supplemented by a risk assessment. Manual handling risk assessments describe the aids and techniques to be used, with photographs to illustrate correct procedures. Additional risk assessments based on activities that may involve an element of risk are in place. These include bathing, eating and leaving the home. 76-78 Hampstead Road D56_D05_S26628_HampsteadRd_V238696_ 130705_Stage4.doc Version 1.40 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) 11, 12, 13, 14 & 16 Residents have opportunities to experience 1:1 community-based activities. Annual holidays and outings are organised by the staff. Members of staff ensure that residents have access to the local community. EVIDENCE: 1:1 community-based activities take place for each person at least weekly and ranges from hydrotherapy, momentum and rebound. ELPs detail the essential leisure activities with desirable and liked activities. Supporting evidence of the success of the goal recorded in the daily reports. From the reports it is evident that the activities do not take place at the stipulated frequencies. The residents currently accommodated are not able to participate in employment and college courses. With staff support residents visit shops and participate in events accessed by the home’s transport, local public transport and taxis. 76-78 Hampstead Road D56_D05_S26628_HampsteadRd_V238696_ 130705_Stage4.doc Version 1.40 Page 12 Annual holidays are arranged at the home and with two exceptions residents have a seven-day break away from the home with the staff. Day trips to the seaside, restaurants or galleries are organised, based on the perception of the persons interest, on a monthly by the staff with individual residents. Lockable bedrooms and bathrooms are provided and because of their levels of understanding, they do use these facilities. It was understood from the staff that mail is opened and read to the person by staff. Integration between residents and staff was discussed with the staff on duty. It was reported that there are guidelines in the handover book about staff’s expectation to interact with residents and not with each other. Training for staff was specified as another measure used to breakdown barriers and observations of staff during their shift, ensures staff engage with residents. 76-78 Hampstead Road D56_D05_S26628_HampsteadRd_V238696_ 130705_Stage4.doc Version 1.40 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) 20 Safe practices are in place for the administration of prescribed medication. Running balances for when required paracetamol must be maintained. EVIDENCE: Medications are administered from a monitored dosage system by the staff. The records of administrations indicate that staff sign the records once the medication is administered. Paracetamol is administered from a stock supply when required. A separate record of recording when required medications including paracetamols are used. However, the running balances for paracematol were not consistent with the medications held. A “returns” book provided by the pharmacist is used to record medications no longer required at the home. The record is countersigned by the pharmacist to indicate receipt of the medication for disposal. The individual profiles in place lists the medications prescribed, with its purpose and side effects, incorporating their compatibility with homely remedies. 76-78 Hampstead Road D56_D05_S26628_HampsteadRd_V238696_ 130705_Stage4.doc Version 1.40 Page 14 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) These standards were not examined at this inspection. EVIDENCE: 76-78 Hampstead Road D56_D05_S26628_HampsteadRd_V238696_ 130705_Stage4.doc Version 1.40 Page 15 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, 25, 26, 27 & 30 The property was purpose built to accommodate people with physical impairments. It is comfortable but to maintain a homely environment some remedial action is necessary. Bedrooms have sufficient floor space for wheelchair users. A combination of the home’s furniture and residents personal belongings is contained in bedrooms. Keyworkers decorate residents bedrooms to their perception of the persons’ lifestyle. While the ratio of toilets and bathrooms meet NMS, they are kept locked and risk assessments must be completed to evidence that this is the most appropriate action. EVIDENCE: 76-78 Hampstead Road D56_D05_S26628_HampsteadRd_V238696_ 130705_Stage4.doc Version 1.40 Page 16 The property was purpose built to accommodate people with physical impairments and level access into the property and wide corridors is therefore provided. It consists of two bungalows, with six single bedrooms and separate facilities, linked together by a passageway with separate staffing for each house, operated by one manager. A tour of the premises took place during the inspection and from observations, remedial action is necessary. There was an unpleasant smell in one bedroom, their chair was soiled and the cabinet doors needed replacing and in two bedrooms the carpets needed cleaning. It was noted that large quantities of continence aids were stored in bathrooms and toilets and for this reason the toilets and bathrooms are kept locked. Packing boxes were found in the conservatories where wheelchairs are stored, appliances labelled faulty were found in this room. While the reasons for the packing boxes and faulty appliances were acknowledged, the packing boxes are a hazard and the staff took immediate action. Accommodation is arranged into single occupancy, with sufficient floor space for wheelchairs. Individual bedrooms have a combination of the home’s furniture and residents personal belongings. Which is decorated into the keyworkers perception of the persons lifestyle. There are bathing and showering facilities with separate toilets in each house, which are wheelchair accessible. With low level toilets and grab rails to enable transfer from wheelchair to toilet. Toilets and bathrooms are provided in sufficient numbers to meet NMS. Laundry facilities are sited in passage that links both houses and shared by both houses. The washing machines and tumble drier are domestic in scale, with facilities for sluicing foul linen. Through conversation, it was understood that the appliances are in constant use and breakdown frequently. It was explained that by having two small washing machines, there is always one operating if the other breaks down. 76-78 Hampstead Road D56_D05_S26628_HampsteadRd_V238696_ 130705_Stage4.doc Version 1.40 Page 17 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) These standards were examined at the previous inspection. The two requirements made at the previous inspection relate to staff training and records to be kept in the home. In terms of training the requirement timescale has not lapsed and the requirement regarding personnel records remains outstanding. EVIDENCE: 76-78 Hampstead Road D56_D05_S26628_HampsteadRd_V238696_ 130705_Stage4.doc Version 1.40 Page 18 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) 38, 41 & 42 It is evident that staff engage with residents and because of the staff’s knowledge of the person, residents are supported with their lifestyle. Bank and Agency staff are used to maintain staffing levels, as there are 220 vacant hours. Proper fire safety precautions are in place. EVIDENCE: Members of staff were observed interacting with residents. Tasks to be performed were explained to the person before taking place. Residents entering the kitchen/dining rooms were offered refreshments and not ignored. As the weather was very hot, members of staff ensured that residents were not left in the garden for long periods. They were coaxed into the home to undertake other recreational activities. 76-78 Hampstead Road D56_D05_S26628_HampsteadRd_V238696_ 130705_Stage4.doc Version 1.40 Page 19 Staff reported that the home was short staffed and therefore relied on bank and agency staff. The rota in place indicates that steps are taken to have three members of staff on duty in each house. It was understood from the manager that currently there are 220 vacant staff hours and there is a recruitment drive in progress. It was confirmed that statutory training is provided and other training is accessible for staff to increase their skills and abilities to meet residents needs. The records that relate to fire safety policies, procedures, checks and practices were examined. From the records it is evident that checks and practices are conducted at the stipulated frequencies. 76-78 Hampstead Road D56_D05_S26628_HampsteadRd_V238696_ 130705_Stage4.doc Version 1.40 Page 20 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 2 x x x x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 2 2 x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x 3 x Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 76-78 Hampstead Road Score x x 2 x Standard No 37 38 39 40 41 42 43 Score x 3 x x 3 3 x D56_D05_S26628_HampsteadRd_V238696_ 130705_Stage4.doc Version 1.40 Page 21 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 Regulation 17, 19 Schedule 2 Regulation 4 (1) (c) Regulation 15 Regulation Standard 34 Standard 1 Standard 6 Requirement Staffs personnel records are kept at the Trust office and not at the home. Previously required 18/1/05 The admission criteria must be included in the Statement of Purpose. a) ELPs must be reviewed, b) representatives must be kept informed through monthly reviews, c) daily sheets must evidence decision-making by residents, d) Risk assessments for locking bathrooms and toilets must be completed. Running balances of paracetamol administered when required must be maintained. a) the unpleasant smell in one bedroom must be addressed, their soiled chair and wardrobe door must be repaired, b) the two soiled carpets must be cleaned. Timescale for action 30/9/05 2. 3. 30/9/05 30/10/05 4. 5. 6. Regulation 13 (4) Regulation 13(2) Regulation 23 Standard 9 Standard 20 Standard 24 30/9/05 30/7/05 30/10/05 76-78 Hampstead Road D56_D05_S26628_HampsteadRd_V238696_ 130705_Stage4.doc Version 1.40 Page 22 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 Good Practice Recommendations 76-78 Hampstead Road D56_D05_S26628_HampsteadRd_V238696_ 130705_Stage4.doc Version 1.40 Page 23 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos. 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