Inspection on 15/08/06 for 8 Graeme Close

This inspection was carried out on 15th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

8 Graeme Close 30/07/07

8 Graeme Close 26/02/06

8 Graeme Close 16/09/05

8 Graeme Close 15/02/05

8 Graeme Close 19/05/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME ADULTS 18-65 8 Graeme Close Fishponds Bristol BS16 3SF Lead Inspector Sandra Jones Key Unannounced Inspection 15 & 23rd August 2006 9:30 th 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 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 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 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. 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 8 Graeme Close Address Fishponds Bristol BS16 3SF 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 9652696 0117 9709301 admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Mrs Rachel Mary Cornell Care Home 16 Category(ies) of Dementia (16), Mental disorder, excluding registration, with number learning disability or dementia (16) of places 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 16 Adults with Mental Disorder excluding those detained under the Mental Health Act 1983 Staffing Notice dated 02/07/1999 applies Manager must be a RN on parts 3 or 13 of the NMC register Date of last inspection 26th February 2006 Brief Description of the Service: Graeme Close is a registered care home providing 16 nursing care places for people between 18 and 65 years of age who have mental health difficulties. The home cannot accept people detained under the Mental Health Act. The building was purpose built in the late 1990’s and offers care over two floors, there is a lift, which gives wheelchair access to the upper floor. Accommodation is offered in single rooms and there is a variety of communal space and quiet rooms. The house is very near to the Fishponds shops, local social venues and is situated on a main bus route. The home encourages residents to be as independent as possible with support and empowerment from full time care staff lead by a team of Registered Nurses. The home is operated as part of the Aspects and Milestones charitable trust. 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key visit was conducted unannounced over two days in August 2006 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the residents, ensure the premises are well maintained and to examine health and safety procedure. During the site visit, the records were examined, a tour of the premises conducted and feedback sought from residents and staff. In addition to key records, surveys were sent to residents, visitors and GP’s in advance of the inspection. What the service does well: What has improved since the last inspection? Since the last inspection, a manager was appointed and will be proceeding with the registration process. The requirements from the last inspection were actioned allowing a better service for residents. The appointment of a clinical lead nurse will ensure that the care planning process is further developed. 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Admissions to the home are based on full assessment. From the assessments, care plans must be formulated. Residents must be provided with a copy of the home’s Service User Guide during the admission process. EVIDENCE: The Admission procedure purports that preliminary assessments will follow Individual Care Programme Approach (ICPA) meetings. The preliminary assessment conducted at the home is based on personal details, Mental Health history, health care, communication and preferred routines. It was understood from the deputy manager that sixteen residents are currently accommodated and one person is on respite care. The future of this placement is dependant on funding. It was further reported that external agencies and the Trust are the main sources for referrals to the home. One person was admitted as respite/permanent placement on 11/08/06 from another home within the Trust. The Care Coordinator provided the home with an assessment of needs and the care plan from the previous care home was also provided. The deputy manager explained that before the admission, the manager visited the person at home and information about the care needs of this individual was passed on, through the communication book. In terms of preliminary assessments, the deputy stated that they usually occur during 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 9 introductory visits. It transpired that because an introductory visit had not occurred the assessment had not taken place. A priority care plans was developed during the course of the inspection. The resident on respite care agreed to give feedback on the process followed. It was stated that a care coordinator was appointed and essential information about the home was verbally conveyed. While essential details were provided on arrival, additional information about the home would have been useful. Also a copy of the home’s Service User Guide was not provided. 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 &9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The minutes of the review meeting must incorporate the names of the people present at the meetings. A clear link between the care plans and mental health risk assessments must be develop to ensure members of staff are guided on the appropriate action to be taken. Monitoring reports must be better analysed, the success of the action plan must be defined and the amendments necessary to the care plan. Appropriate action must be taken to prevent an outbreak of fire from residents that smoke outside designated areas. EVIDENCE: Five residents were case tracked during the site visit to the home. Annual reviews and Care Programme Approach (CPA) meetings have taken place for four residents. For two residents, their reviews focus on their background, mental health history, physical care and independence skills with a review of the previous year. Care management reviews were convened for the two residents recently admitted and for one person a review had not taken place. The deputy manager confirmed that the outstanding reviews would be completed by the end of August 2006. The review minutes for the meetings 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 11 convened by the home staff do not incorporate the people present at the meeting. It was understood that the keyworkers prepare the review minutes are prepared in advance of the meeting. Care plans describe the need, goal and plan of action. Mental health risk assessments are completed following the formulation of the care plan for residents, with acute mental health care needs. The management of the mental health care plan must be more specific. A clear link between the care plan and risk assessment must be developed as it is unclear which plan is to be followed. It was further stated that one person can become verbally aggressive, care plans and risk assessments are in place. However, the information must be clear about the steps to be taken to prevent an escalation of the situation. Another resident may self-harm and the deputy manager reported that a priority assessment would be completed. The deputy manager explained that a person centred approach to meeting needs is used for residents that wish to participate in the approach. For other residents the keyworker will develop a care plan from observed behaviours. Where the care plans are developed by the keyworker, residents are asked to sign the document as an indication of their agreement with the plan of action. Keyworkers monitor care plans on a three monthly basis, and compile a brief summary on the progress made during the month. It is evident that if the keyworker is away from the home the care plan is not updated. The deputy manager explained that traditionally the manager developed care plans, but in future a clinical lead nurse will be responsible for the care planning process with keyworkers. The reports must be better analysed, to incorporate the success and changes of the care plans. The residents giving feedback during the inspection visit confirmed their awareness of their care plan and the keyworkers responsibility for developing the care plan. A support worker consulted during the inspection explained that qualified nurses act as keyworkers and support workers undertake the role of co-keyworker. Co-keyworkers have access to the records and will add information to the care plans. The residents accommodated can communicate verbally and partly through relationships with staff and forums, the deputy manager felt, residents are empowered to make decisions. Agendas for forums are always displayed in advance of meetings. Choices about key workers are possible during the admission process, which assists the relationships. Money management is another area that the deputy manager felt supported residents to be more independent. Members of staff record the residents daily activities, outcomes of visits and their observations of the person. Decisions about daily routines are also recorded in their individual daily reports. Risk assessments are in place for activities that may involve an element of risk. Risk assessments are in place for smoking, road safety, self-care, 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 12 hygiene and checking at night. It is evident that a number of residents smoke outside the designated areas. While it is acknowledged that some precautions are taken to prevent a fire at the home, decisions must be made about smoking in bedrooms. It is clear that residents are informed about the smoking policy and continue to disregard the rules on smoking. Appropriate measures must be taken to ensure the staff and residents are protected from outbreak of fire. It was understood from the deputy manager that there are no restrictions imposed on freedom and choice. The staff control one individuals tobacco and must complete tasks before the tobacco is given. Strategies which evidence the person was involved in the process must be developed. There must be clarity within the strategy about the consequences for imposing the restriction. 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 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): 12,13,15,16 &17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Opportunities exist for residents to undertake 1:1 and group activities. The activity coordinator and keyworker support residents to become part of the local community. Residents confirmed that their friends and relatives are welcome at the home and visits can take place in private. The house rules in place develop residents independence and staff’s attitude respect the individual. Residents are satisfied with the quality and quantity of the meals. The record of meals provided must list the choices made by the person. EVIDENCE: The Statement of Purpose states that the activities coordinator develops activities programme based within the home. The coordinator will work closely with keyworkers and residents to provide individual packages. Through the coordinators’ support, residents will be able to attend and become involved with learning and recreational opportunities. The deputy manager confirmed that an activities coordinator is employed over five days per week. The role holds responsibilities for the home’s Quality Assurance and arranging holidays and outings. The coordinator was previously a support worker and therefore 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 14 has specific insight into each person’s need and by attending handovers is kept informed about residents changing needs. The activities for the week are on display and residents can participate in the activities if they wish. The deputy manager reported that 1:1 with residents takes place and it is the responsibility of the key worker and activity coordinator to ensure it occurs. There are activity folders for all residents and for three residents an activity overview was completed. Favourite activities, interests and hobbies along with relationships are included in the overview, with client profiles for all other residents. The activity coordinator giving feedback stated that not all residents agreed to participate in developing an activity overview. During the admission process, a plan is developed with the person, which is followed-up with a weekly activity plan. Individual activities are mainly ad-hoc, with set times for meetings and forums. The activity coordinator stated that while activities with the residents are the main priority, it was recognised that the programmes in place would benefit from more structure. Six residents responded through surveys and five people indicated that they make decisions about what to do each day. Six felt that they can always do what they want throughout the day. Two residents agreed to give feedback on the opportunities for education and occupation at the home. One resident stated that socialising with the resident group and going out for coffee are the preferred activities. The other resident reported that during the week the care coordinator arranges three shopping trips and attends the various forums. The deputy manager reported that two residents are able to leave the home without support from staff. The residents are registered onto the electoral roll. There is a Home Guide, which is sited in the lobby and the arrangements for visiting are described within the guide. It states that visitors are welcome, refreshments will be offered and there is access for private visits. Residents confirmed that their visitors are made welcome by the staff and bedrooms can be used for additional privacy. The Service User Guide describes the responsibility of the people that live in the home. Participating in household chores and abiding by the licence agreement are described as the rules of the home. The rights of the individual and a commitment towards supporting the individual in achieving independence are also incorporated. There is a Smoking policy in place, which is that residents must not smoke in bedrooms to reduce the risk of fire. From the case records examined, it is evident that residents are expected to maintain their bedrooms tidy and undertake their own laundry. Care plans are developed for residents that require support with independence living skills. A brief summary of the person and the reasons for needing assistance are 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 15 detailed in the care plan. The goal and plan of actions are described and for some the actions plan is reviewed. However, the effectiveness of the plan is unclear. Two residents giving feedback during the inspection confirmed that there is an expectation that they undertake household chores. It was further stated that depending on their levels of independence, staff would assist residents with these task. Residents feedback regarding the house rules and routines evidence that staff respect their individuality. Residents reported that staff knock and wait for an invitation to enter their bedrooms, their mail is handed to them unopened and residents are involved in menu planning. A member of staff on duty stated that bedrooms are single and lockable, with 1:1 and group activities. The catering staff were consulted during the inspection and it was understood that menus are prepared a week in advance. On Sundays the residents get together to plan the menu for the following week. It was understood from the member of staff that where possible, residents are encourage to plan healthy meals. A cook is employed on a part time basis and staff prepare meals whenever the cook is off duty. In the kitchen there is a wide range of fresh, frozen and canned goods, which reflect the menus in place. A record of meals provided is maintained and the record must include the meals chosen by the residents. There is a record of the temperatures of the fridge, freezer and cooked meats maintained. 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Personal and nursing care is provided in a manner that respects residents rights. Members of staff monitor residents health care needs and where necessary referrals are sought for specialist support. Records of random medication checks must include the actions taken for medications errors. EVIDENCE: Case records contain personal statements about the assistance needed with personal care. The individuals’ preference on the member of staff to provide the assistance is also included. For example, permanent staff, female or male. Where personal hygiene needs are identified, care plans include a summary of the person’s view with the goal and action plan. Keyworkers review the plan and report on its success. It was understood from the staff in charge that because of residents mental health care needs, times to rise vary. Staff endeavour to prompt residents with getting up between 9:30 – 10:00 am during the week. At weekends there is a more relaxed routines. In terms of specialist support, referrals are sought through the GP and currently there is not input from physiotherapist, Occupational and Speech therapist. A Community Psychiatrist Nurse (CPN) 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 17 visits one resident. A psychiatrist visits the home fortnightly and if needed more often for patients with acute mental health care needs. However, there is no formal notification of the visits. Female residents under 65 years are invited for routine screening. It was understood that qualified nurses undertake the administration of medications including depot injections, minor dressings and blood pressure readings as part of their clinical tasks. The residents accommodated are registered with a local GP. There is a record of the visit, with the reasons for requesting an appointment and outcome of the visits. It is evident that when residents refuse to attend appointments, staff take steps to ensure residents health care needs are met. The staff also records other appointments with associated NHS facilities and hospital outpatients. In terms of NHS facilities, residents visit the chiropodist, optician and dentist. Four residents have diabetes, which is controlled by medications, and residents care plans include the management of their diabetes. The actions plans are developed to monitor diet and blood sugars, with risk assessments to minimise the level of risk. Regular blood sugar checks are undertaken and staff are aware of the procedure for results that fall outside the safe range of 4-7. Residents giving feedback reported that staff accompany residents on GP visits and other health care related appointments. The qualified nurses administer medications and through PREP nurses maintain their skills with the administration of medications. Medications are currently administered from the original packs by the staff. The records indicate that staff sign the records immediately after administration. A record of medications no longer required is maintained and witnessed by the staff. The person responsible for the receipt, recording, ordering and storage of medications undertakes random checks and records of the checks are kept. From examination of the checks conducted medication errors were identified. However, the actions taken are not listed. For the record to be meaningful, the action taken about medication errors must be listed. 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents know who to approach if they are not happy. By discussing the Complaints procedure at residents meetings, the views of the residents will be sought. There is a commitment towards safeguarding residents from abuse. Local protocols for protecting adults from abuse must be reviewed to reflect current guidance. EVIDENCE: There were no complaints received at the home from residents or their representatives since the last inspection. The Complaints procedure is in the home’s Service User Guide and also in prominent places. Residents confirmed their awareness of the policy. Through residents surveys, the six individuals that responded indicated that they know who to speak to if they are unhappy. While four people indicated that they know how to complain, two did not know. It is the intention of the manager to have the complaints procedure as a rolling item for discussion during residents meetings. The Department of Health and Local Authority’s “No Secrets” guidance is available at the home. In addition to the Trusts “Do the right thing”, there is an in-house Whistleblowing policy. The local protocol must be reviewed to compliment the Trust policy in respect of protecting staff from reprisals. Within the policy, staff’s duty to report poor practice must also be defined. The manager reported that there are no disciplinary currently in progress. Trust policies that relate to safeguarding adults are in place at the home. To ensure staff’s awareness, there is an expectation that they sign copies of the “Do the right Thing”, with copies kept in their personnel files. Safeguarding 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 19 Adults training is provided by the Trust and the training department contact members of staff directly with dates to attend the training. 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 20 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home is accessible and free from offensive smells, the dinning room and lounge would benefit from redecoration. EVIDENCE: The property is a purpose built nursing home for sixteen adults with mental health care needs. It is situated off the Fishponds Road close to shops, amenities and bus routes. Arranged over two floors with shared space on the ground floor and bedrooms on both floors. There is level access into the home and a passenger lift to assist less mobile patients with moving around the home independently. While a tour of the property took place, not all bedrooms were examined. The empty room was viewed and contained the appropriate furniture and fittings. It is acknowledged that steps have been taken to improve the standard of décor. There are areas that require redecoration, it was understood that the carpet in the dining area was to be replaced with vinyl flooring to match with 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 21 the rest of the room. The dining room and lounge would benefit from redecoration. There are many bathrooms and toilets for use of residents. The majority of them were clean and had appropriate grab rails. There are numerous areas for residents to spend time out of their rooms. The main lounge area is the designated smoking room for residents. There is also a seating area adjoined to the dining room, which overlooks the garden. On the ground floor there is also a communal dining room where residents eat their meals together. The laundry room is separate from the kitchen, with painted walls and vinyl flooring for easy cleaning. There is a large industrial washing machine with a sluicing programme and two domestic size washing machines. 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 22 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): 34 &35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Staff personnel files must comply with Schedule 2 & 4 of the Care Homes Regulations. Training available at the home ensures that members of staff are skilled to meet the changing needs of the residents. EVIDENCE: The Trust is working towards having copies of staff personnel records at the home. The manager must therefore ensure that staff records contain the documentation that complies with Schedules 2 & 4 of the Care Homes Regulations. The manager stated that the Trust prospectus is available to all staff at the home. Staff training needs are discussed during 1:1 and currently one person is undertaking a teaching course at UWE, support workers are undertaking NVQ level 2 training and two staff are undertaking Community Mental Health training. In terms of PREP for qualified nurses, the Trust has agreed to enable the nurses employed at the home to maintaining their skills. Training records indicate that staff attend courses that are specific to the residents category of needs. New staff must complete an induction booklet and Manual Handling, First Aid, Food Hygiene and POVA training form the statutory programme for the home. Refresher training is provided and overall all staff are up to date with their statutory training. 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 23 A support worker on duty during the inspection commented that they were given opportunities for training. They said that Aspects and Milestones have an annual training programme from which they could choose courses. In addition to this they confirmed that they received statutory training. 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 &42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The current manager has applied to register and recognises that the home needs stability. Members of staff must attend fire training and drills at the stipulated frequencies to promote a safe environment for residents and staff. EVIDENCE: The manager took up the appointment on 19/06/06 and the application to register, as manager has been submitted to the CSCI. A qualified nurse with 3.50 years experience managing registered services and previous employment within the NHS. The manager reported that the role entails the day-to-day management of the home for residents. Regarding the staff, the manager stated that enabling staff to maintain their qualification to provide adequate care was also part of the role. Additional comments were made about the managers responsibility towards the environment. The manager commented that a people management approach is used, listening and trying to accommodate without compromising. Bringing some stability for gradual integration for residents to take control of their personal 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 25 life was part of the role. A member of staff on duty commented that there has been a lack of continuity with managers at the home and it is “too soon to comment about the managers’ style.” The records that relate to fire safety were examined and it is evident that checks are conducted at the stipulated frequencies. However, not all staff have attended fire drills and fire training is out of date. Members of staff must attend fire training and fire drills at the stated regulated timescales. Service certificates and documentation of check conducted by the contractors are in place for the passenger lift, portable equipment, hazardous waste and boiler indicating that residents and staff’s safety are promoted. 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 2 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 x 33 x 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x x x x 2 x 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 27 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 Regulation 5 (2) Requirement Residents (specifically new residents) must be provided with a copy of the home’s Service User Guide. a) The minutes of the review meetings must incorporate the people present. b) There must be a link between the care plans and mental health risk assessments. c) Monitoring reports must be better analysed The action taken must be recorded, where medication errors are identified through random checks. The local policy for protecting adults from abuse must be reviewed to reflect current guidance. Staff personnel files must contain the specified documentation. Members of staff must attend fire drills and training at the stipulated frequencies a) Appropriate action must be taken to prevent an outbreak of fire from residents that smoke outside designated smoking areas. b) Risk assessments for DS0000020242.V296779.R01.S.doc Timescale for action 30/10/06 2. YA6 15(1) 30/12/06 3. YA20 13(2) 30/10/06 4. YA23 13 (6) 30/10/06 5. 6. 7 YA34 YA42 YA9 7,9,19 Sch. 2 23 (4) 13 (4) (b) 30/12/06 30/10/06 30/10/06 8 Graeme Close Version 5.2 Page 28 8 9 YA24 YA17 23 (2) (b) 17(2) Sch.4.13 people that may exhibit aggressive behaviour must be clear about the steps to minimise escalation of the situation. The dining room and lounge 30/12/07 requires redecoration. The record of food provided must 30/10/06 include the choices made by the person RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 29 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 8 Graeme Close DS0000020242.V296779.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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