Inspection on 26/02/06 for 8 Graeme Close

This inspection was carried out on 26th February 2006.

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 no outstanding requirements from the previous inspection report, but made 6 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 15/08/06

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 Melanie Edwards Unannounced Inspection 26th February 2006 09:30 8 Graeme Close DS0000020242.V283896.R01.S.doc Version 5.1 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.V283896.R01.S.doc Version 5.1 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.V283896.R01.S.doc Version 5.1 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.V283896.R01.S.doc Version 5.1 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 16th September 2005 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.V283896.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day. Eight residents were consulted to find out their views of the Home, and what their experience of daily life is like. Part of the inspection was carried out through discussion with residents, and by observing staff carrying out their duties. One registered nurse, and three care assistants were also consulted about their roles and responsibilities, training needs, and how they assist residents. A sample of records relating to the day-to-day running and management of the Home were inspected. Two resident’s care records and care plans were also reviewed. Lunch was also sampled in the company of residents at their invitation. The majority of the environment was viewed. What the service does well: What has improved since the last inspection? What they could do better: The resident occupying a bedroom identified at the inspection will benefit if the room was warmer. Currently the temperature of the room felt very cold, and the resident concerned told the inspector how cold they were in the room. Staff need to ensure all residents medication administration charts are signed for when medication is administered. This helps demonstrates residents have been administered prescribed medication as needed. The clinic fridge must be repaired or replaced is it is currently not working, and is needed to store medication that requires storage at cooler temperature. 8 Graeme Close DS0000020242.V283896.R01.S.doc Version 5.1 Page 6 To benefit residents’ health and safety a new food temperature probe needs to be obtained and temperature checks must be made of all high risks food prior to serving. This is to ensure temperatures are above minimum food safety guidance levels. The pipe running from the downstairs bath is leaking and needs to be repaired to ensure the bath is safe for use. Two staff identified at the inspection must attend fire safety update training as a priority to ensure they are up to date in understanding fire safety procedures. 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.V283896.R01.S.doc Version 5.1 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.V283896.R01.S.doc Version 5.1 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): 2,3, Residents assessed needs are met and assessment documentation demonstrates how needs are assessed. EVIDENCE: All the residents asked were positive in their views of the staff and the care they receive to meet different needs. Examples of comments residents made included, `it’s a very good Home they get things done,’ ` it’s alright,’ and, `the staff should be paid more money’. These comments were reflective of the views of all the residents who were consulted. Residents were observed being supported with their needs by understanding and sensitive staff. Residents and staff were communicating warmly and this was observed throughout the inspection. Residents looked relaxed and settled in their surroundings. To find out how residents care needs are being assessed two assessment records were inspected. 8 Graeme Close DS0000020242.V283896.R01.S.doc Version 5.1 Page 9 Assessments are carried out under a multi disciplinary team approach including residents and staff from the Home, as well as the psychiatrist and other relevant professionals. There is a detailed assessment carried out of resident’s physical, social psychological, and spiritual needs. The assessment information had been regularly reviewed and updated which helps show residents’ changing needs are being monitored by staff. Residents’ assessments and care plans are starting to be written from a `person centred perspective’. This should ensure residents’ views and wishes are central when care needs are assessed. Residents if they wish to be are actively involved in the assessment process, and sign care documentation in agreement with care to be provided. 8 Graeme Close DS0000020242.V283896.R01.S.doc Version 5.1 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): 6,8,9 Residents changing needs are met, monitored and reviewed, and residents are encouraged to take risks in their daily lives. EVIDENCE: To find out about the way that care is being delivered two resident’s care plans were inspected. The care plan contained a range of helpful information, and demonstrated how to support the residents to meet their care needs. Care plans had been written in a very clear and easy to follow style and showed what actions staff must take to support residents with their range of needs and specifically their mental health needs. The care plans also addressed the resident’s psychological, and social needs and stated how to respond and support the person if distressed. As has already been referred to in the report assessments and care plans are written in a `person centred style. This means residents help to identify what they feel their needs are, and how best they think staff can help them. This should help ensure care is individualised and based on involvement and participation of residents. 8 Graeme Close DS0000020242.V283896.R01.S.doc Version 5.1 Page 11 Residents are well supported to take risks in their daily lives by staff. There were detailed written risk assessments, which helped to demonstrate actions taken to support residents. Risk assessments also demonstrated residents are encouraged to live an independent and fulfilling life and take part in activities away from the Home. A small group of residents explained that staff will offer support if they wish to go to the shops or into the City of Bristol. Another resident explained that when they where first admitted to the Home staff walked with them around the local community to orientate them to the area. As already referred to previously, residents were assisted by staff through the morning, and during lunch, residents were being helped by staff who were understanding and helpful. 8 Graeme Close DS0000020242.V283896.R01.S.doc Version 5.1 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): 11,13,14,17 Residents are offered a varied well balanced diet, and they are supported and encouraged to live a fulfilling life in and out of the Home. EVIDENCE: The Home employs an activities co-ordinator who organise a number of activities throughout the week, including discussion groups and numerous trips out. Residents have in place a timetable of social and therapeutic activities during the week. Some of the activities residents said they attend include day centres, gardening groups and attending a local college. One resident said they enjoyed watching a local football club and attended matches through the season. During the inspection, the activities organiser ran the weekly menuplanning group with residents. This group is an opportunity for residents to chose what meals they would like for the forthcoming week. The lunchtime meal was sampled in the company of residents and staff. The meal consisted of roast chicken, roast potatoes, fresh cooked carrots, suede, cauliflower broccoli and gravy. The meal was tasty and well cooked, and was 8 Graeme Close DS0000020242.V283896.R01.S.doc Version 5.1 Page 13 nutritionally well balanced. There was also a dessert of fresh fruit salad or icecream .One resident said that the fresh fruit salad was `very tasty’. The resident’s menu book was reviewed to see what range of meal choices the Home offers. The choices seen were nutritionally well balanced and varied. All of the residents who were asked said they thought the meals served in the Home were very good. 8 Graeme Close DS0000020242.V283896.R01.S.doc Version 5.1 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, Residents are supported to meet their needs in their preferred way, however their medication is handled and administration in a way that is only partly safe. EVIDENCE: Residents care records include information that demonstrated residents have access to the GP dentist, optician and other health professionals. To support residents with their needs the Home liaises with other relevant professionals in the planning of care that is provided. This helps to ensure residents care needs are well met. Resident’s care plans included information about their personal care needs and the way they preferred their needs to be met. Staff assisted residents with their needs in a good humoured and sensitive manner. The procedures for the administration, storage, and disposal of medication were inspected with the assistance of the deputy manager, to monitor systems in place for handling medication. The medication administration charts of three residents were inspected in detail. There was a photograph of the resident maintained in the clinic to ensure medication is dispensed to the correct person as well as a medication 8 Graeme Close DS0000020242.V283896.R01.S.doc Version 5.1 Page 15 administration profile, which details the preferred way that residents have their medication administered. The medication administration charts were legible, up to date, and contained signatures of the dispensing registered nurses. However there were a number of gaps on the administration charts where staff had not signed for or, recorded why medication had not been administered. Staff need to ensure residents medication administration charts are signed for when medication is administered to demonstrate residents have been administered prescribed medication as needed. Up to date records were kept of all medication being received into the Home, and medication being returned to the issuing pharmacy. This shows there are safe systems in place to monitor how much medication is held in the Home. There is a fridge in the clinic to store medication that requires storage at a cooler temperature. However the fridge was not working, and needs to be repaired or replaced. 8 Graeme Close DS0000020242.V283896.R01.S.doc Version 5.1 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): 22,23 Residents are protected by the complaints procedure, which helps ensure complaints are thoroughly investigated. Residents are also protected from harm or abuse. EVIDENCE: Residents can access a copy of the complaints procedure, which is available in in the entrance hall. This is a well-frequented part of the Home. The complaints procedure has been written in a user-friendly format to assist the reader. The procedure includes the contact details for the Trust and the Commission for Social Care Inspection, if someone wants to contact the Commission directly. The complaints record book was viewed to find out how the Home responds to complaints. There had been one new complaints recorded since before the last inspection the complaint was between two residents and the Home had reposed promptly and thoroughly to the complaint. The record included the details of how the complaints were to be dealt with and the timescales for completion. All the residents who consulted said they felt able to speak to any of the staff if they had concerns or complaints. There are regular residents meetings held. This is an opportunity for residents to express any concerns or complaints they may have. This should help create a culture where residents feel `comfortable’ to complain. 8 Graeme Close DS0000020242.V283896.R01.S.doc Version 5.1 Page 17 To protect residents there are policies and procedures in place relating to the issue of protection of vulnerable adults from abuse. All staff attend training on the issue of `protection of vulnerable adults from abuse’. This should help ensure that residents are safeguarded from the risk of harm or abuse. In discussion with staff they demonstrated a good understanding of what their responsibilities are in the protection of vulnerable adults from abuse in the Home. 8 Graeme Close DS0000020242.V283896.R01.S.doc Version 5.1 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): 24,25,26,27,28,30 Residents live in a Home that is mostly adequately suitable for their needs. However attention needs to be given to the temperature of the home to make sure residents are comfortable. EVIDENCE: The Home is a purpose built property, built over two floors, which can be accessed by stairs or lift. The Home is situated close to shops, public houses, and there is a bus route nearby. Since the last inspection a refurbishment plan has been undertaken and rooms were decorated to a satisfactory standard giving a homely feel in rooms. 8 Graeme Close DS0000020242.V283896.R01.S.doc Version 5.1 Page 19 The majority of bedrooms and all the communal areas were viewed. Bedrooms are all for single occupancy, and were generally satisfactorily decorated and maintained. Bedrooms do not have en suite facilities, however there are bathrooms and toilets located within close proximity, and a washbasin in each bedroom. One bedroom identified at the inspection felt very cold. The resident occupying the room will benefit if the room were made comfortably warm. The resident concerned told the inspector how cold they were in the room. There is a dining room situated on the ground floor, as well as a television lounge and a designated ‘smoking’ lounge, this is a popular room as a number of residents are smokers. Residents were observed sitting in communal areas looking very relaxed and comfortable in the environment. Facilities were satisfactorily clean and tidy when viewed. A domestic assistant was observed carrying out their duties cleaning the Home. The bathrooms are accessible to residents with limited mobility. The facilities were generally in good order however there was a pipe running from the downstairs bath that is leaking and needs to be repaired. 8 Graeme Close DS0000020242.V283896.R01.S.doc Version 5.1 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): 32,33,36 Residents are supported to meet their care needs by competent wellsupervised staff. EVIDENCE: To find out if residents are well supported by the numbers of staff on duty, the duty record for February 2006 was inspected The number of staff on duty for each shift is a minimum of one registered nurses recorded as on duty at all times and three care assistants in the morning, with two care assistants and one registered nurses in the afternoon. At night there is one registered nurse and one care assistant on duty .The number of staff on duty is above the legally required minimum staffing numbers that are conditions of the Home’s registration. Residents were being assisted by good humoured and courteous staff and residents seemed to enjoy warm relationships with staff. Several staff told explained the system of supervision that is in place, they said they are provided with regular supervision sessions. A copy of the supervision format that is used was looked at, and this helped demonstrate how staff are supported and encouraged to develop their skills in their work and practice. 8 Graeme Close DS0000020242.V283896.R01.S.doc Version 5.1 Page 21 The staff training plan was inspected, and this demonstrated staff attend regular training relevant to the needs of residents. Staff also demonstrated that they communicate and support residents in a sensitive manner, and are working well as a team. 8 Graeme Close DS0000020242.V283896.R01.S.doc Version 5.1 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): 41,42 Residents’ rights are protected by the Homes record keeping polices and procedures, however the health and safety of residents, staff and visitors is only partly protected. EVIDENCE: Records are kept in the office and this room is kept locked when not in use ensuring residents confidential information is held securely. All the records inspected were satisfactorily maintained, and generally in reasonable order. Other records have been referred to elsewhere in this report, and demonstrate well-organised management in the Home. The environment looked satisfactorily maintained throughout. The kitchen was also inspected to check what systems are in place to ensure safe food handling, storage preparation and serving. The kitchen environment was clean and reasonably well maintained. There are health and safety procedures in place for staff and residents to follow to promote health and safety in the Home. 8 Graeme Close DS0000020242.V283896.R01.S.doc Version 5.1 Page 23 However to benefit residents health and safety a new food temperature probe needs to be obtained and temperature checks must made of high risk food prior to serving. This is to ensure temperatures are above minimum food safety guidance levels. The fire logbook record showed that the range of required fire safety checks were being carried out and were up to date helping to ensure the safety of people inside the building is maintained. However there were two staff identified at the inspection who have not attended fire safety update training for over twelve months. This must be addressed as a priority to ensure they are up to date in their understanding of fire safety procedures. 8 Graeme Close DS0000020242.V283896.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 3 3 3 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 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 X X LIFESTYLES Standard No Score 11 3 12 X 13 3 14 3 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X X X 3 1 X 8 Graeme Close DS0000020242.V283896.R01.S.doc Version 5.1 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23. (1) Requirement The bedroom identified at the inspection must be made comfortably warm. Residents’ medication administration charts must be signed for when medication is administered. A new food temperature probe needs to be obtained and temperature checks made of high risks food prior to serving, to ensure temperatures are above minimum food safety guidance levels. The two staff identified at the inspection must attend fire safety update training. The bath leak must be repaired. The medication fridge must be repaired or replaced. Timescale for action 27/02/06 2. YA20 13. (2) 26/02/06 3. YA42 13(4)(c) 06/03/06 4. 5. 6 YA42 YA24 YA20 23.4(d) 23(2)(b) 13.(2) 26/03/06 26/04/06 01/04/06 8 Graeme Close DS0000020242.V283896.R01.S.doc Version 5.1 Page 26 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.V283896.R01.S.doc Version 5.1 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 8 Graeme Close DS0000020242.V283896.R01.S.doc Version 5.1 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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