Inspection on 11/11/08 for Bedrock Court

This inspection was carried out on 11th November 2008.

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

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

Bedrock Court 27/11/07

Bedrock Court 05/06/07

Bedrock Court 07/11/06

Bedrock Court 14/06/06

Bedrock Court 16/02/06

Bedrock Court 11/10/05

Bedrock Court 24/03/05

Bedrock Court 02/12/04

Bedrock Court 28/01/04

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 31/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Bedrock Court 3 New Road Stoke Gifford South Glos BS34 8QW     The quality rating for this care home is:   one star adequate 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: Paula Cordell     Date: 1 1 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 30 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 30 Information about the care home Name of care home: Address: Bedrock Court 3 New Road Stoke Gifford South Glos BS34 8QW 01179798746 01454772171 angelinegay@gmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr John Michael Gay T/A Nightingale Care Homes,Mrs Angeline Linda Gay care home 6 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 6 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home Bedrock Court is one of three homes operated by Nightingale Care Homes. All three homes are owned and operated by the proprietors, Mr and Mrs Gay. The other homes within the group are Bedrock Lodge and Bedrock Mews. Bedrock Court is a mature detached house and is registered with the Commission for Social Care Inspection to provide personal care and accommodation for six people with a learning disability. The home is situated within close proximity of the Avon Ring Road. There are bus routes approximately 300 yards from the home. There are local shops and the home is within easy reach of Bristol Parkway railway station. Accommodation is on two floors. Mrs Anne Thomson has day-to-day responsibility for the running the home as the Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 6 Brief description of the care home registered manager. The fees at the time of the publishing this report range from 641.86 to 1374.27 pounds per week. Care Homes for Adults (18-65 years) Page 5 of 30 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: one star adequate 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: This was an unannounced visit as part of the key inspection process. The purpose of the visit was to review the progress to the requirements and recommendations from the visit in November 2007 and monitor the quality of the care provided to the individuals living in Bedrock Court. There have been no additional visits to the service since November 2007. There have been no complaints received by the Commission for Social Care Inspection. The focus of this inspection visit was on the general care of a sample group of people who use the service and the environment, including an extensive tour of the premises. Care Homes for Adults (18-65 years) Page 6 of 30 The home has been sending information in respect of regulation 37 notices of events affecting the well being of the people who use the service and these were used as a focus for the site visit along with the annual quality assurance assessment completed by the manager. In addition views were sought through surveys visiting professionals (2), staff (5) and people who use the service (2). The inspection was conducted over 6.5 hours. 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 8 of 30 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 9 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals have sufficient information available to them to make a decision. However, this does not reflect the changes in the management and the staff team. Individuals can be confident that their care needs would be assessed prior to moving to Bedrock Court. Evidence: The home has a statement of purpose and a service user guide. The statement of purpose clearly states what the service can provide and the people they can support. The service user guide was available in an accessible format and included pictures of the home, the staff and the individual. The picture of the member of staff was a member of staff that has since left the employment of the organisation and would benefit from being reviewed and updated. The statement of purpose requires updating to reflect the change of manager. The manager has been in post since November 2007. Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: The statement of purpose describes the assessment process that will be completed prior to a person moving to the home. This includes the manager completing an assessment of need and gathering information to ensure the home is suitable. The individual is supported to visit the home prior to making a decision. Presently the home has three vacancies. Contracts were not viewed as the manager stated that these are held at the main office at Bedrock Lodge. There is an outstanding requirement relating to contracts and these will be reviewed when at the main office which is to ensure that contracts detail what is and not included in the fees and any additional amounts that are paid for by the individual in respect of transport, activities and toiletries. Care Homes for Adults (18-65 years) Page 11 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals can be confident that their care needs are being met and their safety assured. However, this is not fully captured in the records held in the home with care plans being updated as needs change. Whilst it is evident that individuals are encouraged to make decisions on a day to day basis the provider should consider cascading more control to the manager, the staff and the individuals. Evidence: Care plans were viewed for three people living in the home. There has been some improvements noted since the last visit and the home has responded to a requirement to ensure that there is a plan of care to support one individual with a specific challenge that they exhibit. It is evident that staff have a more consistent approach which has assisted in reducing Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: the persons anxieties this was evidenced from reading care records and talking with staff and the manager. From care records it was evident that the home was liaising with appropriate professionals in supporting both the individual and the staff team. From reading the care plans it was evident that the manager has formally reviewed some of the care plans. However, from talking with staff, the manager and observations one persons mobility has deteriorated and whilst it was evident that the home was working with other professionals to find the cause, there was no care plan detailing the changes or a risk assessment in respect of the reduction in skills or a risk assessment for falls. Risk assessments were in place detailing how the home supports individuals in keeping safe. These covered a wide range of activities including matters relating to keeping the individual healthy. Care plans included information on how the person wanted to be supported on a daily basis. This was person centred. Staff spoken with during this visit stated that the home has improved since the new manager has taken up post. This has included communication, support and direction. Staff stated that this has improved the care delivered. Staff described how individuals were involved in the day to day running of the home from choosing when to get up to going to bed, what they wanted to do and some choices relating to food. Some of the individuals use non-verbal communication to express their needs. What was clear from talking with the staff and the manager is that individuals will not participate in an activity if they do not want to. It was noted that individuals have a communication dictionary detailing how they communicate using non-verbal communication. Again it was noted that many of the decisions are made from Bedrock Lodge including menu planning, daily activities including the planning of holidays. In addition some of the records are held there including individuals contracts and all financial records relating to the individuals. Care Homes for Adults (18-65 years) Page 13 of 30 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. Individuals are encouraged to participate in daily activities as organised by the provider whilst there is evidence of some person centred care some activities and the holiday lacks real involvement of the individual ensuring it is tailored to their needs. Individuals have a healthy and varied diet. Evidence: From talking with staff, the manager and reading records individuals are encouraged to participate in daily activities organised by the home. Since the last visit two of the individuals are now encouraged to go to Bedrock for their day care five days per week. Activities include swimming, rambling, animal care, gardening, house skills and arts and crafts. One individual enjoys train spotting and this is incorporated into their structured weekly activities. All the individuals have an Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: opportunity to go the pub once a week. Evening activities include skittles and pub outings. On the day of the visit all the individuals were planning to go to the shops to buy Christmas gifts for relatives and then on for a Christmas meal. One person attends a day centre four days per week, and one day per week at Bedrock Lodge. From conversations with the manager, staff and one of the individuals it was evident that they enjoyed going to Bedrock Lodge for their activities. Records detailed the activities that the individual had been involved in. A visiting professional stated the home encourages individuals to participate in a array of life opportunities. During the summer there were trips organised to places of interest. The individuals from Bedrock Court joined the other two homes in the group. Discussions were had with the manager and the provider on whether this was person centered in that there was an expectation that all would attend and that the trips were not individualised. The provider stated that individuals were given a choice on whether to go or not, some visit relatives or are enabled to stay at home. Individuals are asked what they would like to do and this is accommodated in the itinerary of trips. The manager stated that key workers are encouraged to go out with individuals at least once per month. Individuals are supported to have an annual holiday. As they did last year the individuals went to a cottage in Devon. All three homes were offered the same holiday and were grouped into smaller groups of four to five individuals with three staff. Again this does not lend to person centred care with holidays being tailored to the individual. Individuals care records included information about keeping in contact with friends and family. One person visited their relative whilst on holiday. Relatives are encouraged to visit the home. Menu planning is completed by the provider for all three homes. The manager stated alternatives are given if the person does not like what is on offer. A daily record is maintained of what food is offered to the individuals. It is evident that individuals have a varied and healthy diet. However, consideration should be given for the individuals to have more choice and more involvement in the planning of the menu. Care Homes for Adults (18-65 years) Page 15 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals personal and health care needs are being met. Individuals could be put at risk due to the medication records held in the home. Whilst this was not completed by the pharmacist, the home has a responsibility to ensure good systems are in place. Evidence: Individuals personal and health care needs are documented in the plan of care. Each person has a health action plan detailing how the person is supported to stay healthy. This included details on the support from other professionals, visits to appointments and general information about any medical conditions. This is good practice. It was noted that one persons diagnosis in the plan of care was not consistent with the consultants psychiatrist letters. Staff did not know what the abbreviations that were used in the plan of care meant. This should be rectified. Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: Accident records were seen. The home is informing the Commission for Social Care Inspection of incidents that affect the wellbeing of the individuals living in the home in accordance with regulation 37 of the Care Homes Regulations. Medication systems were checked. It was noted that the medication administration record provided by the pharmacist had labels instead of a computer generated record. These were not stuck on very professionally and the home is strongly advised to raise these concerns with the pharmacist as this is not good practice. In addition it was noted that as and when required medication did not give clear instructions to staff the home is advised to discuss this with the prescribing doctor to request that more information is recorded on the medication administration record. When staff were questioned in respect of as and when medication for one person it was evident that there was some conflicting advice. This must be addressed and clear guidance must be included in the persons medication profile on the administration of as and when medication including when and how much to give. The home has a medication policy and procedure as seen at previous visits to the home. Staff attend training with the pharmacist and their competence regularly review in relation to the administration of medication. Records were maintained confirming this. The home has responded to a requirement to ensure that medication is stored in accordance with the Royal Pharmaceutical Guidelines. A new medication cabinet has been purchased. The manager stated that the none of the individuals are prescribed any control medication as it was noted during the last visit to the home that this was not being stored in accordance to the guidance. Care Homes for Adults (18-65 years) Page 17 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals can be confident that the staff would listen and act upon complaints raised. Individuals are being over protected in relation to their finances offering them no control and limiting their access. Individuals could be put at risk as staff do not have a current training in supporting them with their challenging behaviour. Evidence: The home has a complaint procedure. Two of the three individuals use non-verbal communication including physical gestures, body language and vocilisation. It is evident from talking with the manager and the staff team that they have built good relationships and have a good understanding of the needs of the people living in Bedrock Court. Care documentation includes information on how the individual communicates. The home maintains a record of complaints, there have been none since the last visit. The Commission for Social Care Inspection have not received any complaints. The home has policies and procedures relating to safeguarding including whistle blowing. Staff were aware that these are in place. Staff have attended training in Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: Protection of Vulnerable Adults with the provider during induction and with the local placing authority. One member of staff has this training planned in the not too distant future with the local council as confirmed by the manager and the member of staff. Staff attend training in supporting individuals that challenge however, as noted at previous visits this is not current for all staff. The provider accesses an external trainer and there is an expectation that this is updated annually. It was noted that at least two staff have needed an update since September 2007 and so no longer have a current certificate. Both staff work in the home on their own. The manager stated that training is organised in January 2009. The provider is advised to review the planning of the training in relation to challenging behaviour to ensure that it is appropriate as this has been an ongoing concern relating to the lack of annual updates which means that staff do not hold a current certificate. Individuals care plans include information on the capacity to make decisions. Individuals have plans of care relating to supporting them where relevant with challenging behaviour. These included the triggers and how staff should support them. From talking with staff and the manager restraint has not been used for some considerable time. The home has a restraint record but there has not been an entry in the last twelve months. Staff stated that there has been a significant reduction of one persons challenging behaviour and they feel that this has been as a result of the improved communication between staff and a more structured and consistent approach. As noted at previous visits to the home, all financial records and money belonging to the individuals is held at Bedrock Lodge. Whilst this may be deemed as safe practice by the provider. This means that the individuals have little control over their finances. Staff have access to petty cash which individuals use and then a administrator from Bedrock Lodge reconciles the amounts and pays the provider back what is owed on behalf of the individuals. Care Homes for Adults (18-65 years) Page 19 of 30 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. Individuals have benefited from the continual improvements in making the home more homely and comfortable. Evidence: Bedrock Court is a detached property in keeping with the local neighbourhood, There are good amenities within walking distance including shops, sport facilities, a pub and good transport links. The home is fitted with a key code so in theory the individuals cannot leave the building unsupervised. Documentation is in place to support the use of the key code ensuring individuals are safe. This must be kept under review. Individuals have benefited from the communal areas being made more homely,. New furniture has been sought for the lounge area including new curtains and new flooring. It was noted that one of the bathrooms on the ground floor was being replaced. A slight odour was noted in the toilet on the first floor. Staff stated that this is cleaned daily. This must be investigated by the provider. Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: Each person has a bedroom which has been decorated to reflect the taste of the individual. One persons room is minimal furnished and this was clearly documented in the plan of care on the reasons behind the decision process. The home has access to a maintenance person who visits regularly to complete repairs to the building. A record is maintained and it was evident there was a good response to repairs. The home has infection control policies and procedures to ensure the protection of individuals and staff. A good supply of gloves were seen in the home and hand washing facilities. The home has a separate laundry facility which is situated in one of the outbuildings in the back garden. This was well organised. Appropriate laundry equipment is in situ. Care Homes for Adults (18-65 years) Page 21 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has been an improvement in the moral, communication and guidance given to the team which has enhanced the care provided to the individuals with a more consistent approach being in place. Individuals should be assured that competent staff are supporting them with their challenging behaviour. Evidence: The home is staffed with a minimum of two staff during the day and one member of staff working at night as evidenced in the homes duty rota. The individuals and the staff spend the day at Bedrock Lodge as already mentioned. The home is adequately staffed to support the individuals living at Bedrock Court. There are presently three people living in the home. There were three vacancies at the time of writing this report. Staff continue to work long hours. The manager stated that where staff have chosen to work long hours, they have signed a working time directive which is held at Bedrock lodge on staff files. This will be followed up at the next visit to Bedrock Lodge. The provider stated that in addition to the above documentation a questionnaire is given to staff on the hours that they work and a health assessment. This is held at Bedrock Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: Lodge and will be a focus of future visits. Information relating to staff recruitment and supervision is held at Bedrock Lodge as agreed with the Commission for Social Care Inspection. It was noted at the last visit that records seen demonstrated a thorough recruitment process had been completed for a random sample of staff working at Bedrock Court. Training records were viewed for two staff it was evident that staff had attended training on first aid, health and safety and fire. In addition staff have attended training in safeguarding. The home maintains an overview of training attended and certificates are displayed on the wall of the office. Four out of the six staff have attended training on mental health. The home has responded to a requirement to ensure that staff have attended a food hygiene course. The manager stated that they have recently attended training on Equalities and Diversity. It was not clear how the provider intends to cascade this to the staff team. Staff described a positive atmosphere in the home with clear direction being given by the manager. Staff had a good insight into the needs of the individuals living in the home and were much clearer on their roles. Three staff have an National Vocational Award at level 3 in care and three staff are in the process of completing. This is good practice and demonstrates the homes commitment to exceeding the standard in relation to 50 of the workforce having an NVQ in care. Staff described a good working atmosphere and this has improved since the employment of the manager twelve months ago. Staff stated that there was better communication on a daily basis. The manager stated that team meetings happen in frequently as staff meet up on a daily basis. However, it is good practice for staff to have regular meetings as per the National Minimum Standards. Care Homes for Adults (18-65 years) Page 23 of 30 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. Individuals benefit from a well managed service. Improvements have been made in relation to the management of the home. However, the manager has limited control and much of the decision making is completed by the provider from Bedrock Lodge. Individuals are assured their safety. Evidence: The manager Mrs Thomson has been in post since October 2007. Mrs Thomson completed the fit person process with the Commission for Social Care Inspection in May 2008 and is now registered. Staff described an open door style of management. It was evident that Mrs Thomson works alongside her staff on a daily basis. From the duty record it was evident that there was no management time built into the rota for Mrs Thomson to do paperwork in the home. Mrs Thomson stated that this is done from Bedrock Lodge however, this may not always be appropriate if the care documentation or records are at Bedrock Court. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: As already mentioned in this report many of the decisions in respect of day care, holidays, financial arrangements and menu planning are made from Bedrock Lodge and by the provider. Consideration should be taken for some of these decisions to be cascaded to the home now there is a competent manager in post so that the individuals can have more control and choice. Feedback from a visiting professional stated that since the manager has been in post she has endeavored to adopt an open approach to both the social and health care needs of the individuals and that there is a better atmosphere since the manager has been in post. Another comment described both the home and the manager as being more professional whilst maintaining a relaxed atmosphere. Health and safety on this visit focused on the fire. It was evident that records were maintained of the fire checks on the equipment, staff fire drills and training. All was satisfactory. Other visits have provided evidence that risk assessments are in place in relation to health and safety with guidelines in place to ensure the safety of the individuals. The home sends surveys to relatives and individuals living in the home. Feedback seen was positive. In addition annual reviews are completed on care with the individuals placing authority. The manager stated that regular audits are completed on the environment to ensure the home is a safe place to live and work. Care Homes for Adults (18-65 years) Page 25 of 30 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 26 of 30 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 1 4 The registered manager must ensure that the statement of purpose and the service user guide is kept under review. Ensuring the individuals are aware of the service provided and reflect the change in management. 24/12/2008 2 6 15 To ensure that care plans are updated to reflect the changing needs of the individuals. Ensuring care is current and consistent. 11/01/2009 3 9 13 Where an individual has an increase risk of falls for a risk assessment to be completed. Ensuring a consistent approach and the safety of the individual. 20/12/2008 Care Homes for Adults (18-65 years) Page 27 of 30 4 20 13 Ensure that medication records are clear in respect of guidelines for staff on the use of as and when required medication. For the medication protocol to include guidelines for staff on medication administration ensuring a consistent and safe practice is adopted. 20/12/2008 5 30 24 Investigate and take 18/12/2008 appropriate action in relation to the odour in the first floor toilet. Ensure all areas are free from odour. 6 33 18 To review the training in 21/01/2009 relation to supporting individuals that challenge to ensure it meets the needs of the individuals. To ensure that staff all have current training. 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 8 To explore how individuals can have more control over making decisions including menu planning, planning of holidays and control over their finances. Ensure that medication administration records are clear. The home should liaise with the pharmacist and request that the Medication records are printed. Review training on supporting individuals that challenge to ensure appropriate as provider not ensuring staff have annual updates. Consider how the home can have more control over Page 28 of 30 2 20 3 23 4 23 Care Homes for Adults (18-65 years) supporting individuals with thier finances. 5 33 For staff to have regular meetings (at least six per annum) as detailed in the National Minimum Standards with records maintained. Care Homes for Adults (18-65 years) Page 29 of 30 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. 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