Inspection on 17/01/07 for Bedrock Mews

This inspection was carried out on 17th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found 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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bedrock Mews 03/10/07

Bedrock Mews 25/04/07

Bedrock Mews 04/07/06

Bedrock Mews 01/11/05

Bedrock Mews 26/07/05

Bedrock Mews 07/12/04

Bedrock Mews 16/07/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 1 New Road 1 New Road Stoke Gifford South Glos BS34 8QW Lead Inspector Paula Cordell Key Unannounced Inspection 17th and 25th January 2007 09:30 1 New Road DS0000058581.V323407.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 1 New Road DS0000058581.V323407.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. 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1 New Road Address 1 New Road Stoke Gifford South Glos BS34 8QW 0117 9694198 01454 772171 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) Nightingale Care Homes Mr John Michael Gay Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 6 persons aged 18 - 64 years with learning disabilities 4th July 2006 Date of last inspection Brief Description of the Service: 1 New Road (Springfield) is one of three homes operated by Nightingale Care Homes. The home was registered with the CSCI in February 2004 to provide accommodation and personal care to six adults with learning disabilities up to the age of 64. The home is situated in Stoke Gifford close to the Avon ring road and bus routes. There are retail outlets and shops close to the home. Bristol Parkway railway station is within easy reach of the home. Each bedroom has its own bathroom. Residents have full access to a lounge, kitchen and conservatory/dining area. Currently no residents have physical or sensory needs that require adaptations or equipment. There is a wellmaintained garden and a summerhouse. Mr John Gay manages the home with an assistant manager overseeing the day-to-day running of the home. The fees for the home are in excess of £685 per week based on the individual’s care needs. 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection. The purpose of the visit was to monitor the progress in meeting the requirements and recommendations from the last unannounced site visit in July 2006 and to review the standard of care provided to the residents at 1 New Road. There have been no additional visits to the service. However, the providers have attended a meeting at the local office of the Commission for Social Care Inspection relating to the registration of the home. The providers had submitted applications in relation to the management of the service and to vary the conditions of registration to include mental health as a category of registration. The applications did not contain appropriate information and the proposals were not in line with the Care Homes Regulations and the National Minimum Standards and were returned to the provider. The variation of category application has recently been resubmitted and is now being processed by the Commission for Social Care Inspection. The purpose of this application is to ensure the certificate of registration accurately reflects the primary needs of residents accommodated at 1 New Road so that residents, relatives and commissioning and purchasing authorities can be assured that the home is correctly registered. An amended application about the management of the home is awaited. A further meeting to review these matters is being held. The focus of this inspection visit was on the general care of a sample group of residents and the environment, including an extensive tour of the premises. This provided a good opportunity to observe residents as well as allowing for informal conversations with individuals and with the staff supporting them. Two members of staff were spoken with during the inspection, which included the assistant manager. The home has been sending information in respect of regulation 37 notices of events affecting the well being of the residents and these were used as a focus for the site visit along with the pre-inspection questionnaire completed by the home, relatives (1) and residents (4). The visit was conducted over a period of two days and ended with structured feedback. 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Residents must be assured that the home has a registered manager who works in the home to support and guide staff. This remains an outstanding requirement. 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 7 There are a number of requirements that remain outstanding relating to the care planning processes. For example, residents must benefit from clear measurable care plans and records that fully describe their needs. Actions that are taken to ensure the safety of individuals must be clearly documented. Whilst there has been addressed in part for one individual this must be in place for all residents. Residents need to be assured that where there are restrictions imposed these are clearly documented and reviewed to ensure that they remain appropriate, taking advice from placing authorities. There are also requirements that remain outstanding relating to the training of staff. Residents must be assured that staff are competent to meet the care needs of the people living in the home collectively and individually including a formal induction to the home and the organisation. Also, residents must be assured of their safety in the event of a fire by being supported by competent staff. Residents would benefit from robust quality assurance audits being completed by the providers to ensure that the home is meeting National Minimum Standards and to ensure that there are good quality outcomes for the residents. Residents must be protected by robust medication recording systems. As part of this inspection the home will be required to develop an improvement plan to address these shortfalls. The Commission for Social Care Inspection will monitor the service to see that these improvements have been made and further non-compliance will lead to enforcement action being taken. There are also a number of recommendations to fine tune the service provided to the residents. 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. 1 New Road DS0000058581.V323407.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 1 New Road DS0000058581.V323407.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): 1,2,3,5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents have some information available to them. Residents are admitted to the home based on a full assessment of needs, however the home is continuing to breach their current conditions of registration by admitting residents with a primary need relating to their mental health. EVIDENCE: The home has a statement of purpose, which had been amended and updated after the last inspection in response to a requirement. This included restrictions imposed on residents including the locking of the front door and the kitchen area. However, it was noted that this requires further amendment to ensure that it reflects the service provided at 1 New Road as the staffing information relates to Bedrock another home owned by the provider. In addition the two assistant managers have since left and a new assistant manager is now in post. 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 10 There was information available to residents and their representatives in the form of a contract and service user guide as seen at the last inspection. The individual and or their representative had signed these. The contracts included details of the terms of conditions of the service, the fees payable and any additional costs. Residents are expected to contribute towards their transport cost and pay a weekly fee for toiletries. The individual or their representative had signed these. The home has one resident vacancy at present. The home has an admission policy, and this has been amended in response to a previous requirement. The home demonstrated at the last inspection that residents are assessed prior to moving to the home. In addition they are offered a trial period to enable residents to make a choice on whether to remain in the home. There are concerns that the home has taken residents outside their category of registration which means that there are issues with the home’s assessment process. A clear criteria for potential residents must be drawn up which is included in the statement of purpose detailing the care needs and the abilities of the residents the home intends to support. This would ensure it is clear for potential residents, relatives and placing authorities. The home is registered for individuals with a learning disability and not falling within any other category. It was noted at the last inspection and again during this visit that four of the five residents had either a mild learning disability and/or mental health needs and that their primary care need was their mental health care needs. It was clear from care planning documentation that these individuals were placed by mental health services. The home’s conditions of registration were therefore continuing to breached. An immediate requirement notice was left with the home for a further registration application to be submitted to the Commission for Social Care Inspection within seven days to remedy this. The providers have demonstrated compliance in completing and submitting the appropriate documentation and this application is now being processed by the Commission for Social Care Inspection. It was noted during this site visit that only one member of staff has attended a course in supporting an individual with mental health care needs with a further two staff attending an external course within the next month. As part of this application the home must demonstrate that staff are appropriately trained to meet the mental health needs of the individuals if an application is to be considered. The home has failed to demonstrate that all staff have adequate training to support individuals with mental health care needs and a further requirement has been made. The assistant manager stated that they had attended mental health training in the past but this could not be verified as their training file was at Bedrock Lodge their previous place of employment. 1 New Road DS0000058581.V323407.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 poor. This judgement has been made using available evidence including a visit to this service. The home is continuing to fail on the care planning processes, as these do not fully guide staff. Care documentation including risk assessments lack detail to fully assess whether the home is meeting the needs and aspirations of the individuals. EVIDENCE: Care files were viewed for two residents in full in relation to the National Minimum Standards and a further two files were viewed for the content of the care plans and the individuals primary care need. Social workers have recently reviewed all individual care plans as part of a protection strategy to ensure that the home is a suitable placement and can meet the care needs of the individuals. The manager confirmed that this had taken place: as yet no new care plans have been received from placing 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 12 authorities and no concerns had been raised with the home through these reviews. It was noted that care plans had not been formally reviewed for one of the residents for a period of eleven months. However the new assistant manager has started to make alterations to the plan of care. No requirement will be made at this particular time but will be followed up at the next site visit. Plans of care must be reviewed at least six monthly. The home has a form for recording changes to the plan of care however information recorded focused on attendance of medical appointments rather than specific areas of need as identified in the care plan. All individual’s care plans seen made reference to mental health and their diagnosis with no or little mention of a learning disability. As already discussed the home is in breach of their conditions of registration. In addition there was little guidance for staff on the additional support they may need in relation to their diagnosis of mental health. For two of the individuals it was about ensuring that their medication was administered. This should be expanded to include how each individuals mental health is exhibited and what staff should do to support them including directions when to call on other professionals for advice and support. Care files were well organised and divided into sections including personal details, background, assessments, care plans and risk assessments, medication profile and correspondence. In addition the home maintains a central file containing all current care plans and risk assessments for the six individuals living in the home. Care plans included a lot of valid information relating to the individuals care, however the plan of care resembled an assessment of need and identified areas but did not give staff specific detail to guide them in supporting the individuals living in the home ensuring a consistent approach. This was noted at the last inspection and a requirement was made for this to be addressed. The home has failed to demonstrate compliance. This was discussed in detail with the assistant manager and in a letter sent to the provider. Further noncompliance could lead to enforcement action being taken as this could put residents and staff at risk. As noted at the last site visit daily records lacked any information on how the home was supporting individuals in relation to their plans of care. This will be commented on in the standards relating to activities and personal care. A resident stated that 1 New Road was his home and he could come and go as he wished and have access to all parts with no restrictions and that they could have a key to their bedroom and the front door. Access to the kitchen is only restricted when a member of staff is not present in the ground floor of the building. The assistant manager confirmed this, however the risk assessment 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 13 states that this must be locked at all times. The risk assessment is a generic risk assessment across the three homes. This must be amended to reflect the practice at 1 New Road to safeguard residents and staff. It was evident that residents were seen to be more independent than in the other two homes run by the Nightingale Care partnership. The assistant manager confirmed that the front door is locked when residents are home. This has since been documented in the statement of purpose and on a generic risk assessment in response to a requirement from the last site visit. However, this must continue to link with individual risk assessments and where one resident requires this level of restriction serious consideration should be taken to review how this is impacting on the other residents. It was noted at the last inspection that hot water is turned off in one of the resident’s bedroom. However, there was no documentation on the reasons why and on the day of the inspection the hot water had not been isolated. The assistant manager was unaware of the turning of device, which was under the sink in the kitchen. This must be reviewed to ensure appropriate clearly documenting the reasons why. The assistant manager stated that water is regulated to 43°c. If this temperature is maintained the risk of scalding is minimised. A key worker system operates in the home, where designated staff have been required to assist with the management of care for particular residents. Residents confirmed this in the completed surveys and in discussions. Residents consulted with on the day of the site visit spoken positively about the support given to them by the staff. A member of staff described her role as key worker, which included supporting resident’s contact with relatives and supporting them in making decisions and enabling them access to the community depending on the needs and choices of the individual resident. It was evidently a role that the staff member enjoyed. 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 14 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): 11, 12, 13, 14, 15, 16 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have available to them a structured day care plan which is varied. However, there is limited documentation to support this and care plans continue to not fully capture what is being undertaken or lack specific detail to guide staff on how to support individuals. Residents are encouraged to maintain contact with relatives. EVIDENCE: From care plans and information contained in the daily diary it was difficult to determine how residents are supported during the day with their planned day care. In the main information was sought from residents, staff and the 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 15 assistant manager and the inspector’s knowledge of visiting Bedrock. Bedrock Lodge is where residents are supported with their day care. The assistant manager stated that all documentation relating to day care is held at Bedrock Lodge. A requirement was made at the last inspection for the home to expand on the daily recordings both to demonstrate that residents were participating in their day care and evening activities. It was noted that broad statements remained in the care plan in relation to the teaching of new skills. The plan failed to state what the new skills were and how residents were to be supported to gain these skills and the frequency. Broad statements as seen make the plan of care difficult to review as their lack specific measurable goals for individuals to follow. The assistant manager stated that all residents are offered opportunities to go out in the evening with staff support. However, there was little evidence in daily records of resident’s participation in social outings or that they had been offered and or even refused the opportunity preferring to spend time in their home. The assistant manager stated that regular trips to the shops are offered to residents. There was little evidence that residents had been offered any activity other than going to the shops in the evening and at weekends. One resident stated that he can go out independently and chooses to go to the shops, whilst another stated that they enjoyed going to Bedrock for their day care. Pre-inspection questionnaires returned indicated that all residents are happy with the level of social activities during the day, evening and weekends. However, the home must improve on the documentation to demonstrate that residents are given opportunities based on their interests and where a resident declines this is clearly documented in the individuals daily diary. Each resident has a structured five-day care plan; the assistant manager stated that this is planned at Bedrock Lodge in consultation with the resident. Activities included swimming, gardening, woodwork, animal care and house keeping skills. Residents confirmed attendance. Observations between the two staff and the assistant manager on duty and the residents indicated that staff know the individuals well and evidenced that there is a good rapport with positive respectful relationships being nurtured. Three residents spoken with stated that staff treated them well and they enjoyed living in the home. Another stated it was all right and one individual did not want to speak with the inspector choosing to remain in the dining area. Risk assessments seen covered a wide range of activities. These were not dated or signed so it was difficult to determine how current they were. As with the care plan they did not fully document what was happening in practice. Whilst the outcome for residents was that they were safe as evidenced from 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 16 conversations with staff for example the locking of the front door, the locking of all chemicals hazardous to health and supervision in the kitchen there was no documentation supporting the decision process or that this was kept under review. As some of these are infringements of rights then there must be clear documentation in place as to the reasons why. These must be kept under review. All actions staff undertake to ensure the safety of the individual must be clearly documented, ensuring that where possible individuals independence is not curtailed. This remains outstanding. Evidence was provided via conversations with staff, residents and in the daily diaries that family contact was maintained. Staff stated that at the weekends residents are supported to see their relatives or friends. Two returned relative questionnaires stated that they were made welcome and were informed of changes to an individual’s care. Feedback included “my relative has improved in himself and his quality of life, and most of this is due to the staff at Bedrock and 1 New Road and the special relationship with his key worker”. Another relative stated that “the resident concerned has lived in various homes but is most happy at 1 New Road and the individual feels safe and finds all staff accommodating”. The relative offered praise for “getting it right”. Menus were not inspected during this site visit. Two of the residents stated that they were happy with the food that was available to them. There were adequate supplies of food in the home, including fresh vegetables and fruit. Residents stated that they assist with the shopping on the weekend, again this was not documented in the daily dairies. 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are some serious shortfalls in the home’s care planning processes to demonstrate and guide staff in the health care needs of individuals including supporting individuals with their mental health. Staff are now competent in administration of medication but the records fail to fully capture residents prescribed medication. EVIDENCE: Care plans detailed some of the support needs of the individuals. At the last inspection it was noted that some of the personal care plans did not reflect the abilities of the individual as evidenced via conversations with staff and that they were similar in content. The newly appointed assistant manager has addressed this. 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 18 Care plans continue to state an annual “health MOT” would take place however; it was not clear from documentation that this was in place or what this entailed. Health care needs were being responded to by the GP as and when required, resident’s files seen demonstrated that they were regularly attending optician and dental appointments. The home was maintaining records of routine weights for some of the residents and this was linked to their plan of care. However as noted at the last visit one resident required routine blood sugar levels being taken by the staff, the care plan lacked information on the frequency or what was normal for the individual or what should be done if there was a concern. The staff were not completing records of the sugar levels consistently and there was no evidence of staff training in this role. This remains an outstanding requirement. A member of staff stated that they had received no training in this area, whilst another stated that they had attended training in a previous role. An immediate requirement was made for the home to address the shortfall in the care planning processes for this individual with a longer-term plan to address the training. An amended care plan was available for the second day of the inspection, whilst this had been expanded it still failed to guide staff on the frequency of the checking of the individual’s blood sugar levels. This was addressed by the following day with a full care plan being submitted to the local office of the Commission for Social Care Inspection. The home has demonstrated compliance. A community psychiatric nurse (CPN) visits the home on a weekly basis to support two of the individuals and to administer a weekly injection. The home must maintain a record of this on the medication record; a signature is not required as this is administered by the CPN. There was no documentation of the weekly injection on the medication administration record or the medication profile for the individuals. This remains an outstanding requirement. In addition care plans lacked any detail about an individual’s mental health state and only made reference to a diagnosis and not how staff should support them or what triggers would indicate that professional advice should be sought. This could be serious mitigation in the care planning processes. The provider has introduced a health action plan for one individual in respect of the above immediate requirement. This has addressed some of the above shortfalls in relation to the individual’s mental health and was available for the second day of the inspection. The registered manager from the Gables stated that this is in the early stages but this will be in place for all residents across the three homes. Residents, where relevant, were being reviewed with the consultant psychiatrist. Letters were seen confirming this. 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 19 The medication system in the home was the monitored dosage system. Staff administered this. The medication record contained a staff signature confirming administration of the individual’s medication. Residents had a medication profile detailing prescribed medication and the side effects. However, it was noted that as detailed above that the injections had been omitted. There was a medication competency assessment for staff. In response to a requirement the documentation has been reviewed and demonstrated that staff have been assessed as competent in the administration of medication. The assistant manager stated that all staff were either in the process or had completed a distance learning pack on the administration of medication. The competency assessment had been updated to reflect this. 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident that their concerns will be listened to and responded to appropriately. Policies on protection and raising concerns are in place to protect the residents. Residents have little control over their finances. EVIDENCE: Resident’s questionnaires confirmed that four of the residents knew whom to complain too. A resident was aware of their rights and stated that they would have no hesitation to raise concerns with staff. According to the home’s records, there have been three complaints in the last twelve months. This related to noise levels of one of the residents who has since left the home and two concerns raised by a relative in relation to the care of one of the residents. It was evident that discussions were taking place with relatives, the resident and the placing authority to resolve the issue but this remains ongoing. The home has reviewed the policy on protection of vulnerable adults in response to a previous requirement. The assistant manager was aware of the role of social services in the process of reporting abuse. It was noted that the 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 21 home has copies of the local authorities procedure on protection. This is good practice. The home has a plan for ensuring all staff attend a course in protecting residents from abuse. The assistant manager stated that it is the provider’s intention to ensure all staff attend this training however courses that have been booked with the local authority have been cancelled by the trainer. This will be followed up at the next inspection. The manager stated that none of the residents exhibit behaviour that requires restraint, however residents can at times be verbally challenging. Staff files demonstrated that they have received training in supporting individuals that challenge and this has been updated annually for five of the seven staff. The assistant manager stated that two of the staff are part-time and it has been difficult to organise the time of the course to suit the staff. However, it was noted that both work in the home with no other staff with this appropriate training. The assistant manager stated that this is being explored and further training dates are being scheduled. At the last inspection it was noted that there is no money in the home that belongs to the residents: this is held at Bedrock Lodge and again noted during this site visit. The assistant manager stated that residents can have money at all times and this is taken from a petty cash budget and the home is reimbursed by the individual’s funds. Whilst this may be deemed as safe practice by the organisation, this means that residents have little control over their overall finances and the staff are not fully able to assist residents with budgeting, as information relating to their accounts is held at Bedrock Lodge. The assistant manager stated that residents are free to see this information whilst they are at Bedrock. The expenditure is recorded on a form for all residents, which would mean that it is difficult for representatives or the individual to view without breaching confidentiality of the other residents. A resident confirmed that that he could have access to his money and all he needs to do is ask staff. It was less clear whether this particular person would of preferred to have more control. It is further recommended that the mechanisms for managing residents’ finances be reviewed. 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 22 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with homely, clean and comfortable surroundings, which meets their needs. The home is accessible to local amenities. EVIDENCE: 1 New Road is a two-storey semi-detached property of domestic style that is within easy reach of local facilities and public transport routes. The home in November 2005 was successfully granted an increase of numbers from four to six residents. All residents have access to a bedroom with ensuite facilities. The home has been refurbished in the last twelve months to include an additional two bedrooms, a replacement kitchen and a staff room with ensuite. 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 23 The home was clean and there was good evidence that the home responds promptly to repairs. On the day of the site visit a maintenance person was completing minor repairs and another was redecorating a bedroom. The resident who occupied this room confirmed that they had been consulted on the colour and confirmed that they were pleased with the redecoration as was at the time of the inspection. The assistant manager stated that a plan of works in relation to redecoration is in place for the home, which has included a recent programme of redecoration to the dining and conservatory area. Further redecoration was planned in the bedroom areas. All residents have access or are offered a bedroom door key and where a resident is more independent a front door key. One resident has refused a key at this present time and the assistant manager stated that this is kept under review. Documentation was in place confirming access to a bedroom door key or the reasons why residents did not want a key. A resident confirmed that they had access to a bedroom and a front door key and described the freedom and privacy that this affords them. It was noted at the last site visit that one individual’s bed was wobbly and the legs did not look particularly sturdy and a recommendation was made for this to be repaired or replaced in consultation with the individual. This was still outstanding but addressed during the visit by one of the maintenance personnel. None of the residents had specific needs in respect of their mobility that required adaptations to the home or specialist equipment. There are two ground floor bedrooms both have ensuites however the main bathroom is on the first floor accessed by stairs. The home would not be suitable for an individual who required a wheelchair due to its layout. Water temperatures were discussed, as one of the resident’s hot water is isolated. The reason for this was not clear from the risk assessment or the plan of care. However the assistant manager stated that the water is thermostatically controlled to ensure safe levels are maintained and to prevent scalds. Consideration should be taken to review the practice of isolating the hot water or to clearly document the reasons why it is switched off. It was the inspector that had to show the assistant manager where the isolating switch was which would bring into question is this actually being switched off consistently by all staff. The home has separate laundry facilities that are located in the garage adjacent to the rear of the property accessed via a garden. These were not seen during this visit. Staff stated at the last visit that these facilities were adequate to meet the needs of the home. The assistant manager stated that these are locked however residents are supported by a member of staff to complete their laundry. The assistant manager stated that the reason that they are locked is that the chemicals for cleaning are kept here. Documentation was 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 24 seen confirming these safe working practices and linked with individual risk assessments seen. Fire equipment was discussed with the assistant manager at the time of the inspection in relation to the present system, which consists of smoke detectors in each bedroom, hallway and the communal areas. The provider stated that these were suitable for the size and the number of occupants in the home. Further advice was sought from the fire safety officer via the telephone after the inspection who confirmed that a fire panel and break glass points were not required under safety legislation but could be seen as good practice due to the size of the home. 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 25 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 poor. This judgement has been made using available evidence including a visit to this service. Sufficient staff support residents when they are in the home. However, induction and ongoing training and supervision for staff lacks consistency and there is no formal plan for each member of staff. EVIDENCE: The statement of purpose states that there are three staff on duty at all times and management are present during the hours of 8am - 4pm. This information relates to Bedrock Lodge and not 1 New Road. The assistant manager stated that when residents are in the home two staff provide cover with one member of staff providing waking night cover. The assistant manager stated that from Monday to Friday 9am – 3.30pm approx there are rarely staff in the home as residents attend day care either at Bedrock or the Gables. 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 26 This must clearly be documented in the statement of purpose to reflect actual practice to ensure that it is clear for existing and prospective residents moving to 1 New Road. The rota provided evidence that there were two staff working in the home during the day with one member of staff providing waking in night cover. It was noted during the last inspection that some staff work in excess of 24 hours including a waking night shift. The assistant manager stated that this is the choice of the staff member and staff have signed a form agreeing to opt out of the European Working Time Directive. Concerns were raised about the safety of staff in light of the complex needs of the residents and the ability to continue to meet residents needs when sleep deprived. However the provider stated that this is down to individual staff choices in the response to the previous requirement. The provider must document the potential risks and the impacts this has on both staff and the residents if this is to continue. Staff records were viewed during the site visit to Bedrock Lodge. All information was in place to demonstrate that residents are protected by a robust recruitment practice. The organisation has received an enforcement notice relating to the recruitment of staff and evidence was provided that the home is compliant with the legislation. All recruitment information is now held at Bedrock Lodge as agreed with the Commission for Social Care Inspection. The assistant manager stated that they are in the process of reviewing staff training and it has been difficult due to the lack of certificates and records held in staff files. This was noted at the last inspection. A member of staff has been working in the home since October 2006 and has yet to complete the Skills for Care Induction. The assistant manager stated that this is not from want of trying on the provider’s behalf but the member of staff is part-time and courses that have been arranged have not been suitable. A further requirement is made to ensure staff receive an induction in accordance with the Skills for Care. In addition only one member of staff has a certificate of food hygiene and only one person has protection of vulnerable adults training according to the assistant manager. Information from the pre-inspection questionnaire evidenced only 3 staff hold a first aid certificate out of six staff. All staff work alone in the home and for that reason this training would be seen as compulsory for all staff. Whilst it is evident that training is available there is no consistency on who attends and records do not capture the training undertaken. Information is not available for a full audit of this area to be completed by the provider or via the inspection process and what is available evidences that there are some shortfalls. A member of staff stated that they had received supervision at regular intervals from a member of staff at Bedrock. Records were not seen as these 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 27 were kept with the supervisor. There was a requirement for the home to review the practice of supervision and for the records to be held at the home. This remains outstanding. 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents do not benefit from a registered manager that is available in the home, providing residents support and direction to the residents and staff. Residents would benefit from the quality of the service being monitored and assured by the providers in a comprehensive and effective way. Safety of residents could be compromised due to the lack of staff training. EVIDENCE: 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 29 At the last three inspections there was strong evidence that the registered manager, who is also one of the providers, was not spending sufficient time at the home in order to provide adequate leadership and direction to the staff. This was found to be true on this occasion. Since the last inspection the provider has transferred an assistant manager to manage the home. There was no evidence that the registered manager was working in the home at least thirty hours each week until a new manager has been appointed (as agreed at the last inspection). There was no record in the home confirming the hours worked. The home must have a registered manager who has the qualifications and experience to fulfil the role. The provider submitted an application for the manager of the Gables to manage that home and 1 New Road. The Commission for Social Care Inspection did not approve this. As seen at the last inspection the current registered manager has no role in providing personal care or the care documentation in place. There was no evidence that the current registered manager participated in the team meetings held at 1 New Road. The assistant manager stated that the registered manager completes the repairs in the home and orders all stock for example the weekly shopping. This was confirmed in discussions with the current registered manager. Staff spoke positively about the support offered by the providers although this support in the main was delivered by telephone or by regular contact at Bedrock Lodge. Staff working at 1 New Road work at Bedrock during the day supporting residents with their day care and have regular contact with the providers as the main office is situated in Bedrock Lodge. Two residents spoke positively about the providers and stated that they really liked living in 1 New Road. Another resident stated, “You will not find a better home in Bristol”. Residents confirmed that they had individual planning meetings and regular resident meetings where their views could be heard. The home completes a resident annual survey, however this was not seen on this occasion. The home must develop a quality assurance audit tool that assesses the quality of the service provided, and the documentation that is in place and which also addresses the shortfalls that have been identified during this inspection. This should include care planning, staff training and supervisions as these areas that are not meeting the National Minimum Standards and continue to be requirements. Whilst the home is sending copies of the provider visits in accordance with Regulation 26, it was noted that the assistant manager who is working in the home was completing these. It is the provider’s legal responsibility to ensure that these are being completed and that whilst this can be delegated to another this cannot be an employee who is working in the home. In light that 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 30 there are a number of requirements that are outstanding it would be good practice that the person visiting is the person with the legal responsibility. Staff attend courses relating to health and safety as part of their induction (as already stated one staff member has worked in the home since October 2006 and has not completed an induction). The assistant manager stated that three staff have a first aid certificate and further training was planned for the remainder of the staff team, no date was available. Certificates were seen. One member of staff has a current food hygiene certificate and this was obtained in their previous workplace. From discussions with staff, once they have completed their induction there is no refresher on health and safety training. As noted at the last inspection the home must develop a training plan for individual staff members and as a team collectively. Health and safety in general was reviewed and whilst staff described the action they took to ensure the safety of residents there was a lack of documentation in the form of risk assessments or within plans of care. Policies and procedures were not seen on this site visit. Fire risk assessments were in place and these had been kept under review. The fire record demonstrated that equipment in the home was being routinely checked in accordance with the fire brigade’s recommendations. An immediate requirement was left with the home to ensure that staff complete a fire drill once in a six-month period as per the fire brigade’s stipulations. One member of staff has worked in the home since October 2006 and has not participated in a fire drill. For some staff it was difficult to see when they had completed a fire drill, due to the lack of records, as their permanent workplace was Bedrock or the Gables, the other two homes that form part of Nightingale Homes. This was responded to by the second day of the inspection by the member of staff undertaking a fire drill. The providers must ensure that the requirements under the Regulatory Reform (Fire Safety) Order 2005 are complied with. Minor accidents and incidents were recorded and more serious accidents and incidents affecting the well-being of residents had been reported to the Commission for Social Care Inspection. 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 31 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 2 2 1 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 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 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 2 14 2 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 2 X 1 X 2 X X 2 X 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 32 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 YA1 Regulation 4(1)(c) Requirement Review the statement of purpose to make sure it includes the information as detailed in this report (standard 1), which will ensure compliance with Schedule 1 of the Care Homes Regulations. Ensure documentation is in place, which supports the decision process for the switching off the water to one individual’s bedroom. Timescale for action 25/03/07 2. YA7 13(4)(a), 23(2)(j) 25/02/07 3. YA20 13(2) 4. YA6 12(2), 14, 15 Keep this decision under review. (Outstanding since 25/08/06) Ensure that all prescribed 25/02/07 medication is recorded on the record of medication. (Outstanding since 06/07/06) The registered person shall: 25/04/07 Keep the service user’s plan under review; Where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the DS0000058581.V323407.R01.S.doc Version 5.2 Page 33 1 New Road service user’s plan; Notify the service user of any such revision. (The registered person must ensure that all resident’s care plans are reviewed and expanded to give clear direction to staff on all aspects of care of the individual). (Outstanding since 04/09/06) 15 (2) (b) Daily records must give more detail - for example the implementation of goals, behaviour, and social activities to enable the home to fully review care given. (Outstanding since 04/08/06) 18(1)(c)(i) The registered person shall, having regard to the size of the home, the statement of purpose and the number and the needs of the service users ensure that the persons employed in the home receive appropriate training to the work they are to perform. (Ensure staff have training in diabetes). (Outstanding since 04/08/06) 7. YA9 15, 13(4) Ensure all risks are clearly documented including social activities, access to the kitchen. 25/04/07 5. YA6 25/02/07 6. YA19 25/04/07 8. YA35 Ensure risk assessments, which are in place, are expanded to detail strategies for staff to follow to minimise the risks whilst encouraging independence of the individual. (Outstanding since 04/08/06) 18(1)(c)(i) All staff must attend training in 25/06/07 DS0000058581.V323407.R01.S.doc Version 5.2 Page 34 1 New Road 9. YA35 mental health based on the care needs of the individuals accommodated in the home. (Outstanding since 04/09/06) 18(1)(c)(i) A training plan must be 25/03/07 developed for individuals and the home collectively. This plan must clearly state the frequency of training in relation to mandatory training and training relevant to the needs of the care provided. A copy of this plan is to be sent to the Commission for Social Care Inspection. (Outstanding since 04/09/06) 18(1)(c)(i) The registered person shall, having regard to the size of the home, the statement of purpose and the number and the needs of the service users ensure that the persons employed in the home receive appropriate training to the work they are to perform including structured induction training. (Staff must complete an induction within the timescales as detailed by Skills for Care). (Outstanding since 28/07/06) The provider must ensure that the requirements of the Regulatory Reform (Fire Safety) Order 2005 and any regulations made under it are complied with in respect of the care home. 10. YA32 25/02/07 11. YA42 23 (4) (e) 17/01/07 12. YA39 24 (1) (For staff to attend a drill once in a six-month period). (Outstanding since 28/07/06) (1) The registered person shall 25/06/07 establish and maintain a system for reviewing at DS0000058581.V323407.R01.S.doc Version 5.2 Page 35 1 New Road appropriate intervals; and improving, the quality of care provided at the care home. The registered person shall supply to the Commission a report in respect of any review conducted by him for the purposes of paragraph (1), and make a copy of the report available to service users. (3) The system referred to in paragraph (1) shall provide for consultation with service users and their representatives. (The home must develop a quality assurance tool, which ensures the home is meeting the National Minimum Standards and has positive outcomes for residents.) 13. YA37 8 That this service has a qualified, competent manager that is working in the home a sufficient number of hours to run the home for the benefit of residents and in order to comply with the Care Homes Regulations 2001. (Outstanding requirement date for compliance 01/07/06). A record of the management hours must be maintained. 25/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 36 1. 2. YA6 YA23 Date and sign risk assessments and care documentation. The provider should consider ways to enable residents 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. To provide residents with a wider choice of leisure activities in the evenings and at weekends. Where residents are offered this choice record resident’s responses. Staff to attend at least 5 days training per annum or prorata for part time staff. 3. YA14 4. YA35 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 1 New Road DS0000058581.V323407.R01.S.doc Version 5.2 Page 38 - 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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