Inspection on 30/07/07 for 8 Graeme Close

This inspection was carried out on 30th July 2007.

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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

8 Graeme Close 15/08/06

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 Jacqueline Sullivan Key Unannounced Inspection 30th July 2007 11:00 8 Graeme Close DS0000020242.V341117.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.V341117.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.V341117.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 F/P 0117 9652696 admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Mrs Elva Verretta Bennett 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.V341117.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 15th August 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.V341117.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 one day 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 new manager has been appointed. Staff members attend fire drills and training to ensure that they are aware of how to protect the residents in the event of a fire. 8 Graeme Close DS0000020242.V341117.R01.S.doc Version 5.2 Page 6 Action has been taken to ensure that medication errors are identified through random checks. New residents are given a copy of the homes Service user guide so they can see what services they will receive from the home. The policy for protecting adults from abuse has been reviewed so the staff team have up to date information about how to best protect the adults in their care. 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. The summary of this inspection report can be made available in other formats on request. 8 Graeme Close DS0000020242.V341117.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.V341117.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 3 4 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The residents have access to information about the home to allow them to make an informed choice. Admissions to the home are based on a full assessment. EVIDENCE: As noted at the last inspection the Admission procedure details 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. These assessments then are used to inform the care plans. Discussions with residents and evidence in their files showed that residents are given the opportunity to visit the home prior to admission. Resident’s surveys and discussions with residents confirmed that they receive a copy of the home’s Service User Guide. A selection of residents files seen showed that contracts were in place. 8 Graeme Close DS0000020242.V341117.R01.S.doc Version 5.2 Page 9 8 Graeme Close DS0000020242.V341117.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6 7 8 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made about the upkeep of care plans and risk assessments but the staff team need to work consistently. EVIDENCE: At the last inspection concerns were raised about the minutes of review meetings not incorporating the people present. Reviews seen since that inspection confirmed that this matter has been addressed. There was also a requirement that that the link between the care plans for the residents and mental health risk assessments was reviewed. Evidence in the files showed that work has taken place in this area. At this inspection it was noted that the residents files had been reorganised in a systematic manner so care plans and risk assessments were linked together. The last part of the requirement of the last report was that the monitoring of reports be better analysed. At this inspection it was found that whilst the staff team had worked hard this area but still had room for development. Staff members are not working 8 Graeme Close DS0000020242.V341117.R01.S.doc Version 5.2 Page 11 consistently. The manager is aware that staff consistency is an area for improvement and has tried to address this in staff meetings. The residents are not consistently signing their care plans to evidence that they have read, understood and agreed to the plan in place. Residents are encouraged to make decisions about their lives and independence training is in place. Regular residents meetings take place. At the last inspection it was noted that a number of residents smoke outside the designated areas. This had been resolved by placing smoking alarms in resident’s bedrooms to alert the staff. A downstairs smoking area is provided for staff. Some residents smoked in the quiet room upstairs but this is now an overflow office space. The issue about the residents smoking has been ongoing but the manager and the staff team have worked consistently to try to resolve this. 8 Graeme Close DS0000020242.V341117.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 16 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Opportunities exist for residents to undertake group activities. The activity coordinator and key worker 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. EVIDENCE: There is a wide range of activities available for the residents. In September 2007 some residents went on a holiday to Weston Super mare. There is an activity co coordinator who has an activity folder that lists what the residents do during the day. These activities include a weekly art group, support sessions, music and movement and a media group so the residents can keep up to date with events in the outside world and give their views. The activity co coordinator is extremely busy in the tine she has. However some staff felt 8 Graeme Close DS0000020242.V341117.R01.S.doc Version 5.2 Page 13 that staffing levels, which have been a concern and will be discussed more later on in the report, has sometimes meant that the staff feel they are just meeting the residents needs. As activities are available there is no requirement or recommendation made in this report however the further development of these activities will be a focus of the next inspection. None of the residents attend college courses. Residents move freely around the house and one resident spoken to said he regularly goes out. Visitors sign the visitor’s book and relatives were seen visiting the residents. One relative spoken with said he feels he can visit at any time The residents have a varied diet and a meal was sampled which was balanced and nutritious. All but one resident spoken to was happy with the meal. Menus seen showed that the standard of food is good. The activity coordinator plans the menu weekly with the residents and their choices were listed. Three residents spoken with said they ate their favourite foods. 8 Graeme Close DS0000020242.V341117.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19, 20 and 21 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The resident’s health needs are met. Further action needs to be taken to insure that all the residents have been consulted about their wishes if they die. EVIDENCE: Discussions with residents and Scrutiny of their files confirmed accommodated are registered with a local GP. It is clear from evidence provided prior to the inspection from the manager, discussions with staff members and residents that the residents health needs are met. As noted at the last inspection the staff also records other appointments with associated NHS facilities and hospital outpatients. Residents visit the chiropodist, optician and dentist. Some of the 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. 8 Graeme Close DS0000020242.V341117.R01.S.doc Version 5.2 Page 15 Medications are administered from the original packs by the staff. Only the qualified nurses administer medications and through PREP nurses maintain their skills with the administration of medications. The person responsible for the receipt, recording, ordering and storage of medications undertakes random checks and records of the checks are kept. At the last inspection it was noted that medication errors were identified. At this inspection it was noted that the actions taken are now listed. This requirement has now been removed. One resident via said that they needed more staff assistance in the bathroom. The files confirmed that all the residents do not have their recorded wishes about what they would like to happen if they die. The manager has identified this as an area for development. 8 Graeme Close DS0000020242.V341117.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are protected by policies and procedures within the home. The complaints procedure is known to the residents. A complaint raised at the inspection needs to be resolved. EVIDENCE: At the last inspection it was noted the Department of Health and Local Authority’s “No Secrets” guidance is available at the home. This remains the case In addition to the Trusts “Do the right thing”, there is an in-house Whistle blowing policy. It was required that the local protocol be reviewed to compliment the e Trust policy in respect of protecting staff from reprisals. Whilst there is staff training in relation to the protection of adults has not been completed for all staff. There is a plan in place for this training to take place. There were no concerns raised in the surveys received prior to inspection. The complaints procedure was seen to be in place. The timescales for the resolution of these complaints was not always kept to. However the manager is aware of this. One resident spoken with was concerned about the location of the phone. It is currently by the stairs on he ground floor. The resident had two concerns: that the phone that is by the stairs was not private and the residents could only use 8 Graeme Close DS0000020242.V341117.R01.S.doc Version 5.2 Page 17 it if they had twenty pence. Otherwise they had to ask to use the office phone, which was not always an option. The inspector saw a resident queuing to use the phone whilst another was the resident said she had but didn’t want to make a fuss and nothing was done about it. A recommendation has been made that the phone is either moved or made more private. 8 Graeme Close DS0000020242.V341117.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is homely and well maintained. Some improvement needs to be made in the bathrooms EVIDENCE: The dining room and lounge have been redecorated as required at the last inspection. All the rooms seen were personalised and four residents spoken with said they were happy with their room. One resident wanted their carpet changed as she said there were some marks on it. These were seen and although they were not big marks the manager agreed that as it was concerning the resident she would look to change the carpet. . One resident’s room has recently had a vinyl floor. One resident said the locks were too low on the doors and it was difficult for him to the open the door to his room. Consideration should be given to changing these if many of the residents find it a problem. 8 Graeme Close DS0000020242.V341117.R01.S.doc Version 5.2 Page 19 The carpet by the stairs and that in the quiet room upstairs had cigarette burns, as did the area by the phone. A requirement has been made that this is repaired. There are nine bathrooms for the residents with appropriate aids. The majority were clean but a recommendation has been made that the staff team checks them regularly as one toilet was not flushed and one had an unhygienic toilet brush. The residents have a training Kitchen where they can make their own snacks. 8 Graeme Close DS0000020242.V341117.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32 33 34 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff team is a fairly new team and there is some degree of reliance on agency staff, which means that the staff team is not as yet settled to fully support the residents. This is not assisted by the irregular supervision of the staff members. EVIDENCE: On the day of the inspection there were three agency staff one duty. The manager said this number of agency staff was rare. The rotas showed however whilst having three agency staff on duty is not the norm agency staff appear frequently on the weekly rotas. There has been four new support workers employed since April 2007 to replace the members of staff that left and the manager is trying to use regular bank or agency staff. One staff member said they sometimes feel very stressed when they are on duty with agency staff as they need more time that regular staff. On the day of inspection the agency staff appeared to spend most of their time in the dining area by the chaired space concentrating on the residents who used this space. One resident stated that she found the different staff disturbing. A staff member stated that as there is such a wide range of residents with a variety 8 Graeme Close DS0000020242.V341117.R01.S.doc Version 5.2 Page 21 complex needs the agency staff do not always have the specialist skills required which puts more strain on substantive staff. A requirement has been made that there is sufficient staff on duty at all times that have the skills and knowledge to care for the residents. 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. She has started this process but is not as yet complete. There has been quite a lot of managerial changes managerial up to the point this manger taking up the post and the staff meeting minutes and discussions with members of staff confirmed that this has caused some tensions in the staff team. The new manager stated that she made changes to the shift patterns that staff were used to working and this upset some staff members. The employment of a cook in February 2007 has ensured that the staff no longer have this duty. The frequency of staff supervision showed some staff members had four months between supervisions. The manager said she has tried but it is very difficult without a deputy to assist her. There has been no deputy at the home since September 2006 despite the organisation advertising the post. A requirement has been made that the frequency of staff supervision is increased. This is particularly important for a staff team that is fairly new and one that relies to a degree on the use of agency staff. 8 Graeme Close DS0000020242.V341117.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37 –43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has a clear idea of how to develop the home and has implemented many new practises and procedures to allow this to happen. EVIDENCE: The previous manager left the home in July 2006.The new manager is Elva Bennett who has completed her registration with the Commission. The manager is a qualified nurse with several years experience of managing similar homes. Discussions with staff and information in the residents and relative’s surveys confirmed that the manager is respected and seen as having strong leadership. Although initially this caused some tensions in the staff team. The manager is 8 Graeme Close DS0000020242.V341117.R01.S.doc Version 5.2 Page 23 resident focused and is trying to work along side each resident to allow them to develop to their full potential. Evidence in the staff minutes confirmed that the manager monitors the new systems she has put in place to improve the residents files, care plans and risk assessments. The evidence that she produced prior to the inspection showed that she has insight into the areas that need to be further developed. 8 Graeme Close DS0000020242.V341117.R01.S.doc Version 5.2 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 3 2 3 3 3 4 3 5 3 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 2 25 3 26 3 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 2 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 2 3 3 3 3 3 3 3 8 Graeme Close DS0000020242.V341117.R01.S.doc Version 5.2 Page 25 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15(1) Requirement Work continues to ensure the care plans are accurate reflection of any updated reviews. Work continues to ensure there is consistent monitoring of the care plans. The staff team must develop approach to supporting residents meet their needs identified in their care plans and ensure that all residents sign their plans. Repeat requirement although there has been substantive work in place to try to meet this requirement. Staff personnel files must contain the specified documentation. Repeat requirement. Although there has been substantive work in place to try and meet this requirement. Ensure that at all times suitably qualified, competent and experienced persons are working at the home in such numbers as appropriate for the health and welfare of service users. Carpet areas, which have DS0000020242.V341117.R01.S.doc Timescale for action 30/03/08 2. YA34 7,9,19 Sch. 2 30/03/08 3. YA32 18 30/03/08 4. YA24 23 30/03/08 Page 26 8 Graeme Close Version 5.2 5. YA36 18 cigarette burns, are replaced or repaired. The frequency of staff supervision is improved. 30/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA21 YA27 Good Practice Recommendations There is evidence that the resident’s views are recorded about their wishes if they should die. The bathrooms need to be regularly checked by the staff team to ensure they are hygienic. 8 Graeme Close DS0000020242.V341117.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V341117.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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