Inspection on 05/11/08 for Bath Road (4)

This inspection was carried out on 5th November 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bath Road (4) 09/11/06

Bath Road (4) 12/07/05

Bath Road (4) 18/01/05

Bath Road (4) 12/08/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Bath Road (4) 4 Bath Road Bradford-on-Avon Wiltshire BA15 1SP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alison Duffy     Date: 0 5 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 24 Information about the care home Name of care home: Address: Bath Road (4) 4 Bath Road Bradford-on-Avon Wiltshire BA15 1SP 01225864280 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Sheila Mary Galley care home 1 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Mrs Galley has been providing care to the person using the service since 1979. Mrs Galley has supported the person for the majority of their life. They are considered an integral part of the family. They join in with all the familys social activities. They have their own single bedroom. Mrs Galley supports the person to attend day services and respite care in another care home. Mrs Galley does not intend to offer care to any other person. 1 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Within previous inspections, Mrs Galley was often out when we arrived. Due to this, we arranged the date of our visit with Mrs Galley. The inspection took place between 9.15am and 12.45pm on the 5 November 2008. We met with the person using the service before they went to their day service. Due to the persons health care condition we were not able to receive verbal feedback about the service they received. We observed interactions between the person and Mrs Galley. We looked at care records and medication records. We saw the communal space and the persons bedroom. We sent Mrs Galley an Annual Quality Assurance Assessment (AQAA) to complete. This was returned on time. Care Homes for Adults (18-65 years) Page 5 of 24 In order to gain feedback about the service, we sent surveys to Mrs Galley to be distributed to the persons care manager and health care professionals. These were not returned to us. The person using the service completed a survey with Mrs Galleys support. The last key inspection took place on the 9 November 2006. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. These standards are not applicable, as Mrs Galley does not intend to provide a service to anyone else. Evidence: Mrs Galley only provides care and support to one person. She told us that providing a service to others is not an option she has ever wished to follow. Care Homes for Adults (18-65 years) Page 9 of 24 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The written care plan does not fully detail the persons needs yet Mrs Galley uses her extensive knowledge of the person, when supporting them. Decision-making and risk taking are positively managed in relation to the persons needs. Evidence: Mrs Galley told us about the persons needs in detail. We saw that she knew the person well and was passionate about ensuring they were comfortable and well cared for. We looked at the persons care plan. The documentation gave us basic information about the persons needs and their likes and dislikes. Mrs Galley could however, tell us more about the person than what was recorded. We advised that she continued to add her depth of knowledge to the written care plan. Mrs Galley told us about how she encourages the person to make decisions on a dayto-day basis. This may include what the person would like to eat or drink. Due to the persons health care condition, the decision making process is limited. Mrs Galley told Care Homes for Adults (18-65 years) Page 10 of 24 Evidence: us that she ensures other interested parties such as the persons care manager are involved in more significant decisions, which need to be made. We saw that Mrs Galley had been a strong advocate for the person over various situations. Mrs Galley told us that she had worked with various professionals to develop the risk assessment process. She told us that she had a risk assessment for supporting the person with the stair lift and when using their car. At the last inspection we advised that the bathing risk assessment should detail whether the person had time alone in the bath. Mrs Galley told us that she had updated the assessment, as she does not now leave the person alone. We saw that Mrs Galley was aware of potential risks. These included choking, cold weather and poor posture. Mrs Galley spoke about ways in which she minimises these. Care Homes for Adults (18-65 years) Page 11 of 24 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The person benefits from being considered very much part of the family. They are involved in varied social activity provision and their rights are fully respected. Meal provision is well managed according to the persons needs and their individual preferences. Evidence: On arrival we saw that the person was ready to go to their day service. Mrs Galley told us that they attend on a Monday to Friday basis. They undertake sessions such as communication, music, drama and rambling. Mrs Galley told us that she generally provides transport to and from the day service. The person has his/her own car, which Mrs Galley drives. In order to meet the persons needs more effectively, Mrs Galley is currently gaining information about vehicles, which can accommodate a wheelchair. This would enable the person to use their wheelchair rather than having to transfer Care Homes for Adults (18-65 years) Page 12 of 24 Evidence: into an ordinary seat. Mrs Galley told us that she likes to support the person to their day service. This enables her to meet the staff and discuss the persons needs on a regular basis. Mrs Galley told us that the person also has regular respite at another care home. She said this enables the person to spend time with other people, which she felt was important. Mrs Galley told us that when not at the day service or on respite care, the person is fully involved in family life. This may involve spending time watching television, listening to music or going out. Mrs Galley told us that the person enjoyed visits to other members of her family. They also enjoyed local events and visits to places such as the local garden centre. Mrs Galley told us that the person was well known within the community. Neighbours in particular, always stopped for a chat and to enquire about the persons wellbeing. We saw that the person was well groomed, relaxed and content. They were animated with Mrs Galley and watched her when she went into another room. Mrs Galley was attentive and interacted with the person in a positive manner. The person was informed about the days events. Their wellbeing was assured before they left for their day service. Mrs Galley told us of her insistence that the person was treated, as an individual and in relation to their age. This was evident when she spoke of ensuring age related clothing and possessions in the persons room. Mrs Galley told us how she promoted the persons dignity when providing support with personal care routines. We saw that a record of all meals was maintained. This showed variety and the promotion of healthy eating. Mrs Galley was clearly aware of the persons dietary needs and their likes and dislikes. We saw that discussion had been held with health care professionals about maintaining a healthy weight. A record of the persons weight was maintained. Mrs Galley told us that positive outcomes in this area had been noted. Care Homes for Adults (18-65 years) Page 13 of 24 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The person benefits from the long established relationship they have with Mrs Galley. A review of the manual handling techniques currently used would enhance the safety of the person and Mrs Galley. The person has good access to health care services. The administration of the persons medication is satisfactorily managed. Evidence: Mrs Galley has supported the person for many years. She told us about the assistance the person needed. She said that over the years the best ways to support the person had been established. We saw that Mrs Galley was very aware of the persons needs and was attentive to ensuring they were met. Mrs Galley described how she supported the person to have a bath. We said that she must gain further guidance about moving the person more safely. Mrs Galley told us that a review of the persons needs had been arranged for the following week. She said manual handling would be discussed within this forum. We saw that the daily report, in the form of a diary, gave a good picture of how the persons care and support were being provided. The daily record showed what Care Homes for Adults (18-65 years) Page 14 of 24 Evidence: activities the person had undertaken, what they had eaten and their general wellbeing. Mrs Galley told us that the persons health care needs are regularly reviewed with the GP and care manager. Any appointments with specialised services are attended. Preventative measures such as a flu injection are promoted and discussed with the persons care manager. We saw that the person had recently had a new, specially designed wheelchair. There was a record of any ill health and any health care intervention. Mrs Galley told us about the ways in which she recognises what the person may need. This included assessing body language, gestures, verbalisations and facial expressions. Mrs Galley told us its difficult to explain but you just know what s/he wants or when s/he is uncomfortable or in pain. We saw that the person and Mrs Galley had established a way of communicating with each other. Mrs Galley told us about the administration of medication. The medication was stored securely. A record is made when the medication is ordered from the surgery and when it arrives into the home. Records showed that Mrs Galley recorded each administration and the time it was given to the person. We saw on the medication administration record that the dosage and the strength of the medication were not always recorded. Mrs Galley addressed this within the inspection. Mrs Galley told us that the persons medication is regularly reviewed with the GP. Care Homes for Adults (18-65 years) Page 15 of 24 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The person benefits from having Mrs Galley as a strong advocate. Mrs Galley is familiar with the local safeguarding vulnerable adults reporting procedure and would readily raise issues, if required. Evidence: Mrs Galley showed us the complaints procedure of the placing authority, which she works towards. She told us that she has not received any complaints about the service she provides. She said she has regular contact with the persons care manager and the staff at the day and respite services. Due to this, Mrs Galley told us that information is regularly shared and any complaints would be readily raised and addressed. Mrs Galley told us about occasions whereby she has needed to advocate for the person. She said she would be aware if the person was upset or distressed, which might be signs of potential abuse. Mrs Galley told us that she would have no hesitation in immediately reporting any suspicion of abuse to the persons care manager. Mrs Galley had a copy of the local safeguarding adults procedures. She told us she was regularly sent information from the placing authority about safeguarding. Care Homes for Adults (18-65 years) Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The person benefits from a clean, comfortable, homely and well-maintained environment. Evidence: The person has a single room on the first floor. A stair lift is in situ to give easier access. We saw that the bedroom was warm, clean and brightly decorated. Mrs Galley told us that the room had been decorated to reflect the age and gender of the person. There were photographs, pictures and certificates around the walls. The person had their own television and music equipment in the room. We saw that the persons bed was next to a radiator. We advised that this should be covered, to ensure the persons safety. Mrs Galley told us that she was planning to do this. We saw that the bathroom had been refurbished with a spa bath. The room was pleasant and inviting. As stated earlier in this report, we advised that Mrs Galley must consider manual handling equipment in the bathroom, to ensure the safety of the person and herself. We advised that guidance should also be gained as to the safest way to manage the steps on the landing. Mrs Galley told us these factors would be discussed within the persons review. Care Homes for Adults (18-65 years) Page 17 of 24 Evidence: We saw that Mrs Galleys bedroom is in close proximity to the persons room. Mrs Galley said that she is able to hear if the person needs assistance during the night. The person has a specially made armchair in the lounge, which is positioned next to the television. The positioning of the chair also enables the person to see into the kitchen. We saw that the lounge had recently been refurbished. The ceiling beams had been replaced and there was new furniture. The lounge, stairs and landing had been redecorated with new carpet. We saw that the home was cleaned to a good standard. We did not look at the laundry facilities although saw that the persons clothing was well maintained. Care Homes for Adults (18-65 years) Page 18 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. These standards are not applicable, as Mrs Galley does not employ any staff. Evidence: Mrs Galley provides the persons care and support herself and does not employ any staff. Care Homes for Adults (18-65 years) Page 19 of 24 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The person benefits from living within a family environment of which they are considered an integral part. Mrs Galley is committed to providing a good standard of care and aims to enable the person to feel content and valued. The persons wellbeing is promoted yet a review of manual handling procedures, would further enhance the persons safety. Evidence: Mrs Galley has had many years of experience of supporting people with a learning disability. This has been within hospitals, care homes and within education. Mrs Galley told us of the voluntary work she continues to undertake, while the person is at their day service. She told us that she had undertaken some training in subjects such as first aid and food hygiene. We advised that she keeps herself up to date with these areas. We said that training in relation to current manual handling techniques, must be investigated. We spoke about the goals and aspirations of the person and if there were any planned Care Homes for Adults (18-65 years) Page 20 of 24 Evidence: developments for the service. Mrs Galley told us that she wanted to continue to maintain and develop the persons health and general wellbeing. She said she wanted to continue to enable the person to be content and fully involved within the familys activities. As stated earlier in this report, Mrs Galley is in the process of investigating the options of a new vehicle. This would enable the person easier accessibility, when traveling. We saw that there were smoke alarms within the home. Mrs Galley told us that they are regularly tested. Records demonstrated this. We saw that potential risks to the person such as using the stair lift safely, had been assessed. Mrs Galley told us that any potential risk and its management are discussed with the persons care manager. Care Homes for Adults (18-65 years) Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 13 The registered person must ensure that up to date guidance is gained and followed in relation to moving the person when supporting them with a bath. To ensure the person is safe when being transferred to and from the bath. 30/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 The persons care plan should be further developed in order to capture the extensive knowledge of the registered provider in terms of the persons needs. The radiator next to the persons bed should be covered to ensure the persons safety. The registered person should ensure that they keep themselves up to date with key aspects such as first aid, food hygiene and manual handling. 2 3 24 37 Care Homes for Adults (18-65 years) Page 23 of 24 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 24 of 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!