Inspection on 27/11/07 for Bedrock Court

This inspection was carried out on 27th November 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 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bedrock Court 11/11/08

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 08/07/2008.

CARE HOME ADULTS 18-65 Bedrock Court 3 New Road Stoke Gifford South Glos BS34 8QW Lead Inspector Paula Cordell Unannounced Inspection 27th November 2007 09:30 The Gables DS0000003366.V352663.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 The Gables DS0000003366.V352663.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. The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bedrock Court Address 3 New Road Stoke Gifford South Glos BS34 8QW 0117 9798746 01454 772171 angelinegay@gmail.com 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) Mr John Michael Gay T/A Nightingale Care Homes Mrs Angeline Linda Gay ****Post Vacant**** Care Home 6 Category(ies) of Learning disability (6), Mental disorder, registration, with number excluding learning disability or dementia (1), of places Mental Disorder, excluding learning disability or dementia - over 65 years of age (1) The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 6 persons aged 19-65 years requiring personal care only May accommodate up to 1 person with Mental Disorder who may be 65 years or over. 5th June 2007 Date of last inspection Brief Description of the Service: 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 aged between 18 and 65 years of age. 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. The providers have recently appointed a new manager Mrs Anne Thomson who has day-to-day responsibility for the running the home. Mrs Thomson is in the process of submitting her application to become the registered manager. The fees at the time of the publishing this report range from £641.86 to £1374.27 per week. The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the 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 June 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 June 2007. The Commission for Social Care Inspection received a complaint in July 2007, which was forwarded to the provider to investigate using the organisation’s internal complaints procedure. The provider kept the Commission for Social Care Inspection informed throughout including the outcome. There has been a change of manager since the last visit. The provider has kept the Commission for Social Care Inspection informed throughout the process. The newly appointed manager was on duty on the day of the visit. 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. 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. The manager completed an annual quality assurance assessment in June 2007. In addition views were sought through surveys to relatives (3), visiting professionals (4) and people who use the service (5). The inspection was conducted over 5.5 hours. What the service does well: The home provides organised structured day care for individuals living in the home. The home provides services for people with complex needs that in the past it may have been difficult to place. The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Individuals must be assured that there is a contract of care that clearly states the fees that are payable, by whom and any additional fees that are expected of them. This will ensure an open and transparent service. There are still areas of concern relating to the environment with the flooring in the lounge and hallway requiring replacement and the replacement of some of the communal furnishings to bring this home to an acceptable standard. The home should consider meaningful ways to enable people who use the service to influence the running of the home including the planning of the menu and annual holidays. This remains an outstanding recommendation. People who use the service would benefit if staff had a training plan that developed core competence, which would address continual development both as individuals and as a team. Training must be linked to the needs of the individuals living in the home. Individuals must be assured that staff are competent, including staff completing an induction, which meets the Skills for Care workforce targets. This will ensure that staff fulfil the aims of the home and meet the changing needs of the people living in the home. People who use the service must be safeguarded and protected by staff attending training in food hygiene. This remains an outstanding requirement, however training is planned for January 2008. The provider should complete an audit on why there is a particularly high staff turnover in the home and take appropriate steps to improve retention. This would ensure a consistent approach for the individuals living in the home. The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 7 People who use the service should have more control over their finances and this should be readily accessible to them with information available to their representative. Supervision for staff should be clear and accountable and the supervisor must have knowledge of the staff member they are supervising. Consideration should be taken to review the present system of supervising staff, as this remains an outstanding requirement. People who use the service must have confidence that the provider, on a monthly basis, is monitoring the quality of the service. This is an outstanding requirement. 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. The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 8 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 The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 9 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): 1,2,5, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals have sufficient information available to them prior to moving to Bedrock Court. There are processes in place to ensure that the assessed care needs of the individuals can be met. Individuals are not assured an open transparent service in relation to the payment of fees and additional costs, as this was not included in the contract of care for the individual. EVIDENCE: The home has a statement of purpose and a service user guide. These have been expanded and reviewed over the last two years. The service user guide included photographs and was written in plain English. Both of these could benefit from a review to include the changes in staffing and the appointment of the new manager. The new manager has been in post since October 2007. There have been no admissions since the last visit. Presently the home has two vacant beds. There is an established group of people who live in Bedrock Court. The statement of purpose clearly describes who the home could support and the admission process. In addition the home has an admission policy. The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 10 Bedrock Court has recently changed its name from the Gables. The home is waiting for an amended certificate to reflect this change. Hence why the service information on this report has not been updated to reflect the change. Care files included copies of the placing authorities assessment and care plan, which informed the individuals care plan drawn up by the home. It was noted that the local placing authority has identified that the home is not meeting the care needs of one of the individuals. A letter dated December 2006 confirming this was seen stating that the placing authority was looking for an alternative placement. Twelve months later and the individual is continuing to reside in the home, a further review took place in April 2007 however the outcome again was that the placement was not suitable. The newly appointed manager stated that she felt the home was suitable and that the individual’s care needs could be met at Bedrock Court. It is strongly recommended that the home liaise with the local placing authority to determine the future of the placement. This was discussed with the previous manager who stated that some significant changes had been instigated in the planning of the care for the individual and it was hoped that the decision could be reversed. Again the newly appointed manager echoed this. At the last inspection it was noted that the contracts of care included details of the terms of conditions of the service, the fees payable and any additional costs. However for one person this was incomplete and failed to breakdown the fees or any additional costs. People receiving a service contribute towards their transport cost and pay a weekly fee for toiletries. This and the fees payable must be included in the individual’s contract. These standards will continue to be a focus for future visits in light of the two vacancies. The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 11 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): 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been significant improvement in the planning of the care. Whilst there is some evidence that individuals are involved in some day-to-day decision-making, now there is a newly appointed manager more of the decision should be cascaded from the provider to the home, which would empower both the individuals, the staff, and the manager. EVIDENCE: Care plans were viewed for three of the individuals living in the home. There has been a significant improvement with care documentation being expanded to include more guidance for staff ensuring a consistent approach. The newly appointed manager was in the process of reviewing the care documentation and it was evident that they could see areas for further improvement and the need to organise formal reviews for the individuals living in Bedrock Court. Some of these were slightly overdue but it was evident that The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 12 the manager was committed to ensure that the care was reviewed and that staff were consistent in their approach. There is an outstanding requirement, which relates to specific guidelines being devised to support an individual in relation to their specific challenges. Whilst the home has sought guidance from a web site, this was not pertinent to the individual on how the staff should support the person ensuring a consistent approach. The newly appointed manager stated that a referral is being made to psychology for assistance in this area. However, interim guidance should be drawn up involving the staff team and the individual. Risk assessments are in place detailing how the home supports individuals in keeping safe. These have been updated and reviewed in accordance with the National Minimum Standards. However, it was noted that the previous manager, the key worker or the individual (where they are able) did not sign these. Staff spoken with during this visit described how the individuals were involved in the day-to-day running of the home. This included planning activities, deciding when to get up and go to bed and what to eat. Three of the four individuals use non-verbal communication to express their needs. What was clear from talking with staff is that individuals will not participate in an activity if they do not want to. It was noted that individual’s have a communication dictionary detailing how they communicate using non-verbal communication. Staff did state that activities, menu planning and staffing is arranged from Bedrock Lodge with little input from the team or the individuals living in the home. A member of staff stated that one individual regularly does not like what is on the menu and another does not always want to go swimming or to dance and movement. This has been noted on previous visits to the home. The home had a complaint in July 2007, which related to the appropriateness of the activities that are offered to the individuals. Consideration should be taken for the provider to cascade this down to the newly appointed manager so that the individuals can be more empowered. Menus will be discussed further in the standards relating to Lifestyles. The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been some improvements across this group of standards and individuals have available to them meaningful activities. However the senior management team is making some fundamental decisions that people receiving a care service could be supported to make. EVIDENCE: From talking with staff it was evident that there is a commitment to ensuring that individuals have a structured activity plan. Individuals are supported to go swimming twice a week, train spotting and a weekly pub trip. Some of the individuals attend Bedrock Lodge for some of their weekly activities including arts and crafts and dance and movement. One of the individuals stated that they regularly go to Bedrock Lodge and help with the gardening and help look after the animals. On the day of the visit one The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 14 of the individuals from Bedrock Mews was visiting the home as part of their day care. The person stated that they liked coming to Bedrock Court. On the day of the visit three of the four individuals were taken swimming in the morning and a shopping trip in the afternoon. One person attends a day centre external to the organisation four days a week. Much of the activities are completed as a group rather than tailored to the individual. A member of staff stated that one of the individuals does not particularly like dance and movement but this continues to be part of their structured day care, and another does not always like to go swimming. The individuals may benefit from a review of their activities to ensure that it is appropriate with alternative options available. It was evident from talking with staff and the newly appointed manager that there were some good ideas being generated in relation to activities. Consideration could be given, for the planning of the activities to be cascaded back to the team working at Bedrock Court, which would ensure that activities are planned in a person centred way. Staff stated that there has been an increase in activities both during the week and at weekends. This was further evidenced in care documentation. A visiting professional commended the home on the commitment to ensuring that individuals have access to a wide range of activities both in the home and the community. There is a relaxation room with sensory equipment in place for the benefit of the individuals living in the home. From talking with staff it was evident that this was used on a regular basis. Family contact was noted in the plans of care. Feedback from relatives was positive including making them welcome, keeping them informed and ensuring that the individual’s care needs are met. From talking with the newly appointed manager it is evident that she is arranging to meet with relatives. Individuals have had an annual holiday in Devon in a cottage. All the individuals from all three homes visited the same cottage over a period of time. All four individuals went from Bedrock Court at the same time. Whilst it was evident that this was an enjoyable experience for the individuals especially one person who had an opportunity to visit family. There was no evidence that individuals were consulted, on where or who they wanted to go with. Just because individuals live in the same house it does not mean that they would want to go on holiday together. The provider for the three homes plans menus. Staff stated that the individuals do not always like what is on the menu. Alternatives are cooked but one member of staff stated that it would be better for the menu to have a list of alternatives or a choice. Another member of staff stated it would be good to plan the menu with the individuals living in the house. One individual on the The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 15 day of the visit very clearly stated they did not want what was on the menu, and staff were observed offering alternatives. This is good practice. The home maintains a record of alternatives. The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,1920 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individual’s personal and health care needs are being met. Poor documentation and storage of medication could potentially put individuals at risk. EVIDENCE: Improvements in this area have been noted with clearer plans being drawn up detailing how the home is supporting individuals to stay healthy. Each person has a Health Action Plan that details the support that is required for each individual. This included details on the support from other professionals, visits to appointments and general information about medication and any medical conditions. This is good practice. Good evidence was provided that individuals were attending health-screening appointments with the GP, dentist and opticians. It was evident that the home was liaising with the continence advisor. Feedback from visiting professionals was mixed however comments in one highlighted that this was due to the particularly high staff turnover and the lack of management direction in the past. One professional commended the The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 17 new manager stating that in the past the home has been reluctant to reduce medication, but it is evident that there is a commitment from the new manager. It was evident that the visiting professional was concerned about the amount of medication used to sedate individuals. This was now being reviewed with a clear plan being drawn up by the home and the professional. Visiting professionals stated that individuals’ privacy and dignity is maintained during their visits. One professional stated that “the home is doing a good job considering the complex needs of one of the individuals, they do their best”. 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 one individual has recently been prescribed temazepam, which is a controlled drug. This was not being stored in accordance with the Royal Pharmaceutical Guidelines and this was not recorded on the medication administration record. It was also noted that the stock records had not been updated since May 2007, and the book was falling apart. A member of staff stated that the temazepam was being used to enable an individual to attend appointments with the dentist. The staff had liaised both with the prescribing dentist and the psychiatrist to ensure that the medication was appropriate. This was clearly documented. It is unusual for this medication to be prescribed for this reason. Clear risk assessments must be developed in relation to the support of the person, as they could be at an increased risk of falls due to the sedating effect of the medication for a longer period of time. Competence of staff in the safe administration of medication was being checked with records supporting this. In addition staff have or are completing a distance learning pack in medication administration. The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lack of evidence of the home’s recording of complaints causes concern on how the home responds and listens to complaints. Individuals are being over protected in relation to their finances offering them no control and limiting their access. EVIDENCE: Completed surveys from relatives stated that they were aware how to make a complaint. The home has a complaint procedure. The home has had one complaint from an ex-employee who was concerned about the limited choice the individuals had in their day care, poor care practices, limited menus, staff more concerned with cleaning than welfare of individuals living in the home. The provider investigated this and provided a full report detailing how the home was responding to the concerns. Two areas of the concerns were substantiated with the provider agreeing that a better induction should have been provided for new staff. This related to staff having an opportunity to read care notes and poor cleaning practices that had been adopted in the home. However, there was no record in the home’s complaint record. This must be rectified with a record being maintained of the complaint and the outcome. The home has a policy on protection of vulnerable adults which meets with the National Minimum Standards as seen at the last inspection. Staff had a good The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 19 awareness of the policy. The newly appointed manager stated she has observed staff providing a good standard of care since being in post and they are committed to meeting the individual needs of the people living in Bedrock Court. Staff records confirmed that they have completed as part of their induction a section on abuse, and then as soon as a place becomes available staff attend a course with the local council on abuse. At the last inspection it was noted that no finances for the individuals are held in the home. The staff have available to them petty cash which individuals living in the home use and then the individual reimburses the home. Whilst this may be deemed as safe practice by the provider. This means that individuals have little control over their overall finances and staff are not fully able to assist them with budgeting, as information relating to their accounts is held at Bedrock Lodge. The legislation clearly states that the records of finances must be held in the home and that individual’s finances must not be pooled. It is not good practice for individuals to be loaned money, as is the system that has been adopted by Nightingale Care Homes. Individuals now benefit from an individual record of their finances as previously all individuals were recorded on one record. The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Continual improvements are being made to make Bedrock Court more homely. The home was clean and free from odour. Furniture is looking old and worn in parts and could benefit from a refurbishment programme. Flooring in communal areas could become a potential trip hazard. 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 front door is fitted with a key code so in theory the individuals cannot leave the building unsupervised. Documentation was in place supporting the reasons for the use of the key code. The home has consulted with the fire The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 21 brigade to ensure that it is suitable and does not restrict individuals in the event of a fire. There have been concerns in the past about the cleanliness of the home and a number of visits were completed. The complaint in July 2007 again raised concerns about the cleanliness of the home. However, on the day of the visit it was noted that all areas of the home were clean and free from odour. Each person has a bedroom. It was noted that two of the mattresses were soiled and require replacing. A member of staff stated that both persons had replacement mattresses in September. The manager has agreed to liaise with the provider as a matter of priority to get these replaced. Some of the bedrooms have been painted since the last visit. Furniture was looking old and worn. One person’s drawer was minus one of the handles. Two of the bedrooms still have borders that were child like as noted in November 2006. Staff stated that the individuals had chosen these. There was no evidence that the individuals were perceived other than as adults. Communal areas were a mix match of furniture, however staff were making an effort to making the areas more homely with ornaments and pictures. The communal areas had been painted. It was noted that the flooring was looking worn with areas of the laminate splitting. This could in the future become a trip hazard and must be replaced. It was noted that the home has replaced the lounge furniture. However, this was due to another home replacing their three-piece suite due to it being uncomfortable as noted at the visit at Bedrock Mews in April 2007. Again it was noted that the seating was uncomfortable. Consideration should be taken for this to be replaced. The home has adequate bathroom facilities and these contained toilet rolls, soap and hand towels. Two of the bedrooms have ensuite facilities. The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. High staff turnover has implications on the level of training and competence of the staff team, both individually and collectively. This could be at a detriment to the delivery of care in ensuring a consistent approach to the people living at Bedrock Court. EVIDENCE: An opportunity was taken to review the staff rota for the home. It was noted that the home was staffed in accordance with the Statement of Purpose. Three staff work in the home in the morning with two staff in the afternoon and one member of staff providing a waking night cover. A concern was raised prior to the inspection relating to the hours that staff work across the three homes. Three of the seven staff work in excess of 24 hours, by completing an early, late and a night shift. The manager stated that staff have chosen to work these hours. This could not be verified, as the staff working the long hours were not on duty during the visit. There was no evidence that staff have signed a working time directive or that the provider The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 23 has completed a work based assessment to ensure that this is safe working practice. A concern would be the commitment of staff and their ability to deal with the challenges that individuals may exhibit, ensuring the safety of all concerned when working these long hours. 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 to Bedrock Lodge that records demonstrating a thorough recruitment process was in place for three staff that were working at Bedrock Court. However, there was a lack of documentation to demonstrate that staff receive formal one to one supervision with a manager. Two staff spoken with during this visit stated that they had not received supervision with a manager although they had worked in the home in excess of five months. This remains an outstanding requirement. The home has experienced a particularly high staff turnover. Two of the seven staff, have worked in the home for two years, however, five staff have been employed since June 2007. A visiting professional highlighted a concern in relation to the high staff turnover and staff being consistent in the management of behaviours. It was noted that none of the staff have attended a valid course in supporting individuals that challenge. Two members of staff attended this course over a year ago, and one person nearly eighteen months ago. The organisation organises training using a national accredited provider. However for staff to continue to practice using this particular training there is an expectation that refresher training is given annually. None of the new staff have attended this training. The manager stated that this training is organised for March 2008. This is not acceptable and the organisation must review how this training is delivered and organised so that staff are given the skills and knowledge promptly. This remains an outstanding requirement. It was noted that a basic awareness of supporting individuals that challenge is offered during the induction. Inductions were taking place for new staff. However it was noted that one member of staff has not attended the three-day course, which is conducted by the provider. The manager stated that they were on holiday when this was arranged. No further date had been arranged. One member of staff stated that the induction was very thorough and enabled them to fulfil their role. Another member of staff stated that the providers are committed to providing training and they are now doing their National Vocational Award level 2. Due to the high staff turnover there is a lack of evidence of ongoing training for staff. None of the staff have a current food hygiene certificate as noted at The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 24 the last visit and only two of the seven have a valid first aid certificate. Whilst these are covered during the induction this is only a brief overview. A member of staff stated that an hour on first aid does not make a person competent and only covers the minimum. The provider has organised dates for Food Hygiene (January 2008) and First Aid (February 2008), it was not clear who would be attending this training. This will remain a requirement and will be followed up at the next visit to the home. Good progress is being made on the home working towards the government targets to ensure that 50 of the workforce has a National Vocational Award. Of the seven staff one member of staff has recently completed the award with a further three staff in the process of completing. This was confirmed in conversations with staff, the manager and in staff’s training files. The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 25 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): 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A new manager has been appointed. She has been in post less than four weeks. In light of this it is difficult to make a judgement on the management of the home. There are concerns that the service does not empower the individuals living in the home as discussed earlier in this report. EVIDENCE: The home has recently been through a management change. The providers dismissed the previous manager. A new manager was appointed on the 15th October 2007. Mrs Ann Thomson has many years experience in supporting individuals with a learning disability. She has lectured student nurses in The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 26 general Health and Social Care. Mrs Thomson has recently completed a threeday induction with the organisation. Mrs Thomson confirmed that she is in the process of applying to become the registered manager and will be completing the Registered Manager’s Award to enable her to fulfil her role and responsibilities. In the short time that Mrs Thomson has been in post it was evident that staff felt that there was an open door approach and that staff felt involved. Staff stated that Mrs Thomson is working as part of the team supporting the individuals. As the manager is newly appointed areas of quality assurance and service user involvement was not fully discussed. This will be followed up at subsequent visits to the service. However, it is hoped that issues identified on previous visits will be a focus for the provider and the newly appointed manager to discuss, developing an action plan to address some of the shortfalls. The focus of the health and safety was the fire records. All records were up to date and current. The risk assessment had been reviewed in June 2007. The home has demonstrated compliance to a previous requirement. However, one concern is that a risk assessment for one individual who has since left the service stated “no change” as part of the review comment. Again concerns are raised in relation to the monthly provider visits being conducted in respect of regulation 26. This has recently been discussed with the provider. It was noted that neither the home nor the Commission for Social Care Inspection are receiving copies of the visit reports. The last recorded visit in the home was July 2007. A further requirement is made. The newly appointed manager stated that the provider has visited the home on one occasion in the last four weeks when she was not on duty. It was not clear, as there was no record whether this was a visit in respect of regulation 26. The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 27 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 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 2 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 2 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X X X X X X 3 X The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 28 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 Develop a clear plan of care relating to one individual’s challenging behaviour ensuring a consistent approach. (Outstanding since 05/07/07) For the individuals to have a contract of care that details the fees, who is responsible for paying these and any additional extras for example contribution towards transport and toiletries. For the home to have suitable storage for controlled medication in time for the change to the legislation, which affects all care homes in April 2008. For all prescribed medication to be recorded on the medication administration record. For the home to maintain a stock control record of medication to enable an audit to be completed on medication held in the home. For the home to maintain a record of all complaints relating to the home and the outcome in the home’s record of complaints. Provide comfortable seating in the lounge, which is suitable to DS0000003366.V352663.R01.S.doc Timescale for action 27/12/07 2. YA5 5A 27/02/08 3. YA20 13 (2) 01/04/08 4. 5. YA20 YA20 13 (2) 13 (2) 05/12/07 10/12/07 6. YA22 22 Schedule 4.11 16 (2) (c) 23 (2) (i) 27/12/07 7. YA28 27/01/08 The Gables Version 5.2 Page 29 8. 9. YA24 YA35 23 (2) (b) 18 (1) (c) the needs of the individuals. (Outstanding since 05/07/07) Replace flooring in lounge and hallway. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform including structured induction training. (Develop training plans for all staff to include mental health, epilepsy, autism and communication, supporting individuals that challenge and ongoing health and safety training for the individual staff member and the home collectively. Ensure staff receive this training within a reasonable timescale ensuring that this training is delivered by a competent person by 08/03/07 and 05/08/07.) 27/02/08 28/03/08 10. YA36 18 (2) The registered person shall ensure that persons working at the care home are appropriately supervised. (Outstanding since 08/01/07 and 05/06/07) 27/12/07 11. YA35 18 (1) (c) 12. YA39 26 Staff to attend an accredited training course in Food hygiene (Outstanding since 05/09/07 training planned for Jan 2008) For the provider to complete DS0000003366.V352663.R01.S.doc 27/01/08 27/12/07 Page 30 The Gables Version 5.2 monthly visits in respect of quality monitoring. Copies of reports of the visits to be sent to the home and the Commission for Social Care Inspection. (Outstanding since 05/07/07) 13 14. YA33 YA23 13 (4) 12 (4) For the provider to risk assess staff that are working in excess of the working time directive. For service users finances and financial records to be held in the home. (Outstanding since 05/07/07) 27/01/08 27/01/08 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. Refer to Standard YA7 Good Practice Recommendations The manager should consider meaningful ways to enable the residents to extend their influence in the running of the home including regular meetings, menu planning and the planning of activities and holidays. (Outstanding since inspection in January 2007) 2. YA23 The provider/manager should consider ways to enable people receiving a care service to have more control over their personal finances within the management of risk and that information and individual’s finances are held in the home. (Outstanding since January 2007) 3. YA35 For staff to complete the Learning Disability Award Framework as part of their induction in line with Skills for Care. The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 31 4. YA26 Ensure staff receive structured and recorded supervision at least six times per annum from a competent and relevant person. Devolve the responsibility for carrying out structured supervision to the registered manager. (Not followed up as records held at Bedrock) 5. YA33 For the provider to conduct an audit on the high staff turnover and develop an action plan to ensure retention of staff. The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 The Gables DS0000003366.V352663.R01.S.doc Version 5.2 Page 33 - 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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