Inspection on 25/04/07 for Bedrock Mews

This inspection was carried out on 25th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 no outstanding requirements from the previous inspection report, but made 4 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 17/01/07

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 25th April 2007 09:45 1 New Road DS0000058581.V334734.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.V334734.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.V334734.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 T/A Nightingale Care Homes Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 1 New Road DS0000058581.V334734.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 17th January 2007 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 a mental health issue 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. People who use the service have full access to a lounge, kitchen and conservatory/dining area. Currently no people who use the service have physical or sensory needs that require adaptations or equipment. There is a well-maintained 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.V334734.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 key inspection. The purpose of the inspection was to follow up the improvement plan and the requirements and recommendations from the visit in January 2007 and to monitor the quality of the care for the five people living at 1 New Road. There have been no additional visits to the service since January 2007 and there have been no complaints. In response to a requirement the home has submitted an application to change the current category of service provision to reflect the people that are accommodated in the home from learning disabilities to mental health. This has been agreed and a new certificate is being processed. 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. This provided a good opportunity to observe people who use the service 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 people who use the service and these were used as a focus for the site visit along with the pre-inspection questionnaire completed by the home. In addition views were sought through surveys to relatives (3), visiting professionals (3) and people who use the service (4). The inspection was conducted over five hours. What the service does well: 1 New Road provides a homely setting for individuals that could challenge the service. It is located in a good setting that affords people who use the service easy access to the shops and other amenities. People who use the service described a good level of satisfaction from living in the home. In addition relative and professional feedback was very complimentary about the service. 1 New Road DS0000058581.V334734.R01.S.doc Version 5.2 Page 6 People who use the service stated that they felt safe and secure. What has improved since the last inspection? What they could do better: People who use the service should be involved in the planning and the review of their care. People who use the service would benefit if the coping strategies were more pertinent to the individual. The home must review the generic risk assessment to ensure that it reflects the abilities of the individuals living at 1 New Road. People who self medicate must be protected by a risk assessment ensuring their safety. To ensure the confidentiality of people who use the service their meeting minutes must be kept separate from the record of staff meetings. 1 New Road DS0000058581.V334734.R01.S.doc Version 5.2 Page 7 People who use the service should have regular meetings to enable them to express their views and this should be extended to the staff team. 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.V334734.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.V334734.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): 1,2,3,4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information is available to people who use the service and their representatives. Whilst it is clearly documented the locking of the front door compromises human rights of the individuals living in 1 New Road. People who use the service can be assured that their care needs are assessed and have an opportunity to “test drive” the home. EVIDENCE: The home has responded to a requirement from the inspection in January 2007 to amend the statement of purpose to include the change of personnel working in the home. This includes a proposed change of name of service to Bedrock Mews whilst in principle this has been agreed with the Commission for Social Care Inspection a new certificate has not been issued. 1 New Road DS0000058581.V334734.R01.S.doc Version 5.2 Page 10 The statement of purpose includes the restrictions imposed on people who use the service including the locking of the front door and the kitchen area. A visiting professional through the home’s annual quality assurance process had raised this as a concern in regards to the legality of the locking of the door and individual’s human rights. This has been discussed on previous visits to the service by the named inspector. Again it is strongly recommended that the home review this policy, which is adopted across the three homes in a generic risk assessment to ensure that it links with the risk assessments of individuals and is appropriate to their level of independence. As seen at the last site visit, there was information available to people who use the service and their representatives in the form of a contract and service user guide. 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. People receiving a care service contribute towards their transport cost and pay a weekly fee for toiletries. The individual or their representative had signed these. The home has one vacancy at present. Evidence at previous inspections demonstrated that individuals are assessed prior to moving to the home. In addition they are offered a trial period to enable them to make a choice on whether to remain in the home. The home has a policy on the process of assessment and this is clearly described in the statement of purpose. From talking with the assistant manager it was evident that they would be involved in the process of assessment including meeting with the individual prior to them moving to the home. It was evident from this visit that the assistant manager was aware of the people that the home could admit within the home’s category of registration. This will be a focus at future visits to the home in relation to the next person to move to the home. In response to a previous requirement the home has submitted an application to change the category of registration to mental health from learning disabilities. As it was evident that the primary care needs of the individuals using the service was their mental health. This has been processed and the home is waiting for a new certificate from the Commission’s Central Registration Team. 1 New Road DS0000058581.V334734.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. People who receive the service have benefited from the improvements in the care planning processes. Whilst there is some evidence that individuals are involved in some decision making such as day to day living and social activities this is limited in relation to the long term planning of their care. The generic risk assessments in place could be curtailing the level of independence of the individuals living at 1 New Road. EVIDENCE: There has been a significant improvement on the planning of the care for individuals living at 1 New Road. Care plans have been expanded to enable the home to complete a review of the service provision. 1 New Road DS0000058581.V334734.R01.S.doc Version 5.2 Page 12 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 individual’s care. However, it was noted at the last site visit plans 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 has now been addressed with plans giving more specific advice and the home has developed a health action plan, which compliments the standard care-planning format. It was noted that the health action plan now acknowledges the individual’s mental health and how the staff should support the individual. There is still scope for improvement in that the coping strategy to assist them with the mental health for each individual was the same. Good practice would be that this was more personalised to the individual. A person stated that they did not want their relatives involved in the review of their care. It was evident that the assistant manager was supporting this. Good practice would be that this was documented in the individual’s care file and support given to relay this to the relatives. Whilst care plans were being routinely reviewed by the staff less apparent was the person being involved in a full review of their care. The assistant manager stated that annual meetings (Individual Program Meetings) are held involving the individual, key workers and other significant others. These are organised by the activity co-ordinator at Bedrock Lodge (the main office). There was no documentation supporting that this had been undertaken in the last two years. Placement review forms were seen in files but this appeared to only review part of their care for example their mental health with the psychiatrist. The assistant manager stated that these were called if a professional meeting is called, it was noted that some individuals had two or three in the last year and another had only had 1. The views of the person receiving a service were obtained during these review meetings and through an annual survey. Relative views were sought if they attended the review and through an annual survey. It was 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 and the daily activities that the individuals were taking part in. There has been an improvement in this area in response to a requirement from the last site visit. Daily entries were positively written and the home has devised a new recording record of social activities undertaken. 1 New Road DS0000058581.V334734.R01.S.doc Version 5.2 Page 13 An individual 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. Another person stated that they liked living at 1 New Road and felt safe. Another person stated, “that it was alright and they liked the staff”. 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 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 people receiving a care service and staff. It was evident that people living at 1 New Road were seen to be more independent than in the other two homes run by the Nightingale Care partnership. This remains an outstanding requirement. The risk assessment must reflect what is happening in practice and not curtail the independence of the individuals accommodated in the home. The assistant manager confirmed that the front door is locked when people are at home. As discussed previously this must continue to link with individual risk assessments and where one person requires this level of restriction serious consideration should be taken to review how this is impacting on the other people living in the home. Four of the people living at 1 New Road have a key to their bedroom, the fifth has chosen not to have a key and one individual has a key to the front door. It was noted at the last inspection that hot water is turned off in one of the person’s bedroom. There was no documentation on the reasons why. The assistant manager stated in response to the requirement this is no longer part of the individual’s plan of care as the water is regulated to 43°c and risk of scalding is minimised. Good practice would be for the isolating device to be removed if no longer in use. A key worker system operates in the home, where designated staff have been required to assist with the management of care for particular people who receive a service. Individuals receiving a service confirmed this in the completed surveys and in discussions. Individuals consulted with on the day of the site visit spoke positively about the support given to them by the staff. A member of staff described his role as key worker, which included supporting the individual’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 and supporting them with reviews. It was evident the member of staff was knowledgeable and had fostered a positive relationship with the person. 1 New Road DS0000058581.V334734.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): 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. People who receive a care service have available to them a structured day care plan which is varied. Individuals are encouraged to maintain contact with relatives. Whilst there is a varied and nutritious menu available, there is little involvement from the individuals living in the home. EVIDENCE: Each resident has a structured five-day care plan; the assistant manager stated that this is planned at Bedrock Lodge in consultation with the individual. Activities included swimming, gardening, woodwork, animal care and house keeping skills. Individuals confirmed attendance. 1 New Road DS0000058581.V334734.R01.S.doc Version 5.2 Page 15 The assistant manager stated that there are regular trips to the shops and individuals are supported to go to a local pub. There has been an improvement in the recording of activities undertaken in response to a requirement from the inspection in January 2007. One individual 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 and another stated that they like to visit relatives. Pre-inspection questionnaires returned indicated that all individuals are happy with the level of social activities during the day, evening and weekends. The assistant manager stated that all individuals are offered opportunities to go out in the evening with staff support and trips will be organised throughout the summer. Observations between the staff member and the assistant manager on duty and the individuals indicated that staff know the individuals well and evidenced that there is a good rapport with positive respectful relationships being nurtured. Three individuals spoken with stated that staff treated them well and they enjoyed living in the home. Risk assessments seen covered a wide range of activities and had been expanded and kept under review. Evidence was provided via conversations with staff, individuals and in the daily diaries that family contact was maintained. Staff stated that at the weekends individuals 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”, another stated, “the staff from Nightingale Homes are wonderful and it is not just a place to stay but his home and he feels safe”. Feedback from relatives has been consistently positive from the last two inspections. Menus were viewed and demonstrated that individuals are offered a varied and nutritious diet. Two of the individuals 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, shopping was being undertaken on the day of the visit. Individuals stated that they assist with the shopping. A concern is that the provider at Bedrock does the menu planning with little input from the individuals living at 1 New Road. Good practice would be that the individuals have more involvement in the menu planning. Individuals confirmed that they could have alternatives to the planned menu and the home caters for their likes and dislikes or special dietary requirements. Records were maintained supporting this. 1 New Road DS0000058581.V334734.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): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been significant improvements in relation to the care planning processes to demonstrate that the home is meeting the personal and health care needs of individuals living at 1 New Road. Generally there are robust procedures and practices in the home ensuring individuals are safeguarded in relation to medication administration. However there are concerns that where an individual self medicates safe practices are not being maintained. EVIDENCE: Significant improvement has been noted in relation to the care planning relating to meeting the health and personal care needs of individuals. Each individual has a health action plan that details the support required to ensure that an individual remains healthy. 1 New Road DS0000058581.V334734.R01.S.doc Version 5.2 Page 17 Individuals had evidently been involved in the process and included what it means to the individual to be healthy and how they feel when they are experiencing a relapse in their mental health. From talking with one individual it was evident they had a good insight into their own condition. This individual articulated clearly how they felt safe and well supported by the staff working in the home. As already mentioned the home should further build on this improvement and personalise the coping strategies for each individual. Care plans clearly documented the personal and health care needs of the individuals. Systems for monitoring an individual’s wellbeing were in place and concerns about health were quickly addressed. Individuals had access to other health professionals including a GP, opticians, chiropody, dentist and the community mental health team. The home has been keeping the Commission for Social Care Inspection informed of incidents that affect the wellbeing of the people who receive a care service in respect of regulation 37. Accident records were being maintained and cross-referenced with the diary of events for individuals. Appropriate action was seen to be taken. The assistant manager was able to describe how they were seeking support for one individual in relation to their challenging behaviour, but there have been some barriers, as the individual cannot access the South Gloucestershire Council’s behaviour team, as the individual’s diagnosis is mental health and not a learning disability. It was evident that the manager was requesting the support, which is good practice. Feedback from visiting professionals was positive. A social worker stated that the home has enabled a very complex person to live safely in the community, and the individual has not ever been so stable. Another social worker stated, “my client is well cared for at the home and staff are meeting his needs appropriately”. A visiting community mental health nurse stated “the home is generally well run, friendly home, dealing with some difficult behaviour professionally despite the poor staffing levels. Both my clients within the home seem contented with the regime”. The home has good procedures and practices on the administration of medication, including a comprehensive induction and training package for staff. However, concerns were raised relating to one individual who self medicates, there was no risk assessment and the assistant manager could not recall when the medication was last ordered or whether the individual had the medication. In addition there was no record of the prescribed medication on the medication record. This medication could be vital if the individual has an angina attack. 1 New Road DS0000058581.V334734.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. People who receive a service 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 individuals. Further training on protection from abuse will benefit the individuals living in the home. Individuals have little control over their finances. EVIDENCE: Questionnaires confirmed that four of the people receiving a care service knew whom to complain too. This was further confirmed in conversations with individuals who would take concerns to the assistant manager or the owner. According to the home’s records, there have been no complaints since the last inspection and the Commission for Social Care Inspection has received none. The home has a policy on protection of vulnerable adults, which meets the National Minimum Standards as seen at the last inspection. It was noted that the home has copies of the local authority’s procedure on protection. This is good practice. 1 New Road DS0000058581.V334734.R01.S.doc Version 5.2 Page 19 The home has a plan for ensuring all staff attend a course in protecting people receiving a service from abuse. The assistant manager provided evidence that staff that have not attended this training and that further courses have been arranged. It was noted that the assistant manager has not undertaken this training since 2002 and could benefit from an update. The manager stated that none of the people receiving a service exhibit behaviour that requires restraint, however individuals 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. This was noted at the inspection in January 2007. The assistant manager stated then 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, again 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 people who receive a service. This is held at Bedrock Lodge. The assistant manager stated that individuals 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 individuals have little control over their overall finances and the staff are not fully able to assist them with budgeting, as information relating to their accounts is held at Bedrock Lodge. The assistant manager stated that individuals are free to see this information whilst they are at Bedrock. All information relating to expenditure had been taken over to Bedrock and was not viewed on this occasion. Two individuals confirmed that that they could have access to their money if they asked staff. It was less clear whether individuals would have preferred to have more control. It is further recommended that the mechanisms for managing individuals’ finances be reviewed. 1 New Road DS0000058581.V334734.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): 24,30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 1 New Road provides a good standard of accommodation, which is homely, comfortable and is meeting the needs of the individuals living there. 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. Areas seen on this inspection were restricted to the communal areas. A full tour of the home was conducted in January 2007 and it was evident that the home was meeting the standards. The home was clean and there was good evidence that the home responds promptly to repairs. Communal areas were comfortably furnished and were homely. 1 New Road DS0000058581.V334734.R01.S.doc Version 5.2 Page 21 An individual stated that they are supported to clean their bedroom and are actively involved in the gardening. None of the people receiving a care service 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. 1 New Road DS0000058581.V334734.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): 32,33,35, Quality in this outcome area adequate This judgement has been made using available evidence including a visit to this service. Competent and adequate staff support people who receive a service. Staff would benefit from more frequent meetings to air their views and ensure that there is a consistent approach. EVIDENCE: The home is staffed with two staff during the day and one member of staff sleeping at night. This was confirmed in the staff rota and the statement of purpose. The assistant manager stated that from Monday to Friday 9am – 3.30pm approx there are rarely staff in the home as individuals attend day care either at Bedrock or the Gables. All recruitment information is now held at Bedrock Lodge as agreed with the Commission for Social Care Inspection. 1 New Road DS0000058581.V334734.R01.S.doc Version 5.2 Page 23 Staff recruitment records were viewed during the site visit to Bedrock Lodge in December 2006. All information was in place to demonstrate that individuals are protected by a robust recruitment practice. At the last inspection the assistant manager stated that she was 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 has now been addressed with staff files now containing certificates. The assistant manager stated that there is a new audit tool for training and this is held at Bedrock Lodge. This will be reviewed at the next inspection to Bedrock Lodge. The assistant manager stated that training has been organised for staff to attend food hygiene (3 staff) in May 2007, four staff attending a course in challenging behaviour in June and three staff in protection from abuse in May 2007. This is in response to an outstanding requirement to ensure that staff attend training relevant to their role. The assistant manager stated that out of the seven staff, four staff have now attended a course in mental health and one person is presently completing a degree in psychology. Further training is being purchased for the remaining staff. The home has demonstrated compliance to a requirement from January 2007. In addition a training pack has now been obtained for staff to complete on “diabetes”. The assistant manager stated that she has an NVQ 3 in care and the registered managers award and another member of staff has an NVQ 2 in care. A further two staff are in the process of completing and two staff are in the process of enrolling to complete an NVQ 2 in care. The home is evidently aiming to meet the government target to ensure that 50 of the workforce have an NVQ in care. There is a lack of staff meetings. The last meeting held in the home was in November 2006. Whilst the topic of conversation was recorded the minutes lacked detail of the discussions or an action plan. 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 are held at Bedrock Lodge. This will be inspected at the next site visit to Bedrock Lodge along with the new appraisal system that has been introduced. 1 New Road DS0000058581.V334734.R01.S.doc Version 5.2 Page 24 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): 37,38,39,42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use the service do not benefit from a registered manager that is available in the home, providing support and direction to the individuals and staff. Systems are in place to monitor the quality of the service including seeking the views of people who use the service. EVIDENCE: 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. 1 New Road DS0000058581.V334734.R01.S.doc Version 5.2 Page 25 This was found to be true on this occasion. The assistant manager confirmed that they were in the process of applying for the post of registered manager and was waiting for a criminal bureau record check before submitting the application. It was evident that the provider was in the process of addressing the requirement relating to the management of the home. This had been identified through the improvement plan that had been drawn up by the Commission for Social Care Inspection in consultation with the provider. 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 individuals with their day care and have regular contact with the providers as the main office is situated in Bedrock Lodge. Two individuals spoke positively about the providers and stated that they really liked living in 1 New Road. A review of the meetings held for people receiving a care service demonstrated that these were not held regularly. The last meeting was held in November 2006. It was noted that the minutes of these and staff meetings were recorded in the same book. This is cause for concern if an individual wanted to refer to a meeting, as they could be privy to confidential information concerning another. The home completes annual surveys and these are sent to relatives, professionals and people who receive a service. Surveys were seen for March 2007 generally feedback was positive and complimentary. One individual raised a concern about the garden and this has since been addressed. Other quality tools are being developed to measure the quality of the service including audits on the environment, medication and training. This is in response to a requirement and identified through the improvement plan agreed with the provider and the Commission for Social Care Inspection. Whilst the home is sending copies of the provider visits in accordance with Regulation 26. The assistant manager stated that she is completing these and the provider signs these and it was rare to see the provider in the home. This was discussed at the last inspection. 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. 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 and staff were attending training and taking part in routine fire drills. Minor accidents and incidents were recorded and more serious accidents and incidents affecting the well-being of individuals had been reported to the Commission for Social Care Inspection. 1 New Road DS0000058581.V334734.R01.S.doc Version 5.2 Page 26 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 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 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 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 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 2 2 3 X X 3 X 1 New Road DS0000058581.V334734.R01.S.doc Version 5.2 Page 27 No 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 YA20 Regulation 13(2) Requirement Where individual self medicate ensure there is a risk assessment in place, that adequate medication is in stock that is in date and recorded on the medication record. To personalise the coping strategies for each individual. To ensure that people who use the service are actively involved in the planning of their care. For the provider to appoint a registered manager who is competent and has the skills and knowledge to manage the service. Timescale for action 30/04/07 2. 3. YA6 YA6 15 (1) 15 (1) 25/05/07 25/08/07 4. YA37 8 25/05/07 1 New Road DS0000058581.V334734.R01.S.doc Version 5.2 Page 28 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 YA23 Good Practice Recommendations 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. (Outstanding since January 2007) 2. YA9 Review the generic risk assessment, which is across the three homes to ensure relevance to the individuals living at 1 New Road. To record the minutes of the staff and service user meetings separately to ensure confidentiality. For staff and people who use the service to have regular meetings. To offer the individuals in 1 New Road more responsibility over menu planning. 3. 4. 5. YA38 YA38 YA17 1 New Road DS0000058581.V334734.R01.S.doc Version 5.2 Page 29 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.V334734.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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