Inspection on 03/10/07 for Bedrock Mews

This inspection was carried out on 3rd October 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bedrock Mews 25/04/07

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 Bedrock Mews 1 New Road Stoke Gifford Sth Gloucestershire BS34 8QW Lead Inspector Paula Cordell Key Unannounced Inspection 3rd October 2007 09:30 Bedrock Mews DS0000058581.V348442.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 Bedrock Mews DS0000058581.V348442.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. Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bedrock Mews Address 1 New Road Stoke Gifford Sth Gloucestershire BS34 8QW 0117 9694198 01454 772089 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 Mrs Beverley Hancock Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is 6. Date of last inspection 25th April 2007 Brief Description of the Service: Bedrock Mews 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 mental health. The statement of purpose describes the individuals the home can support including the age range, which is 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. Ms Beverley Hancock is the registered manager. The fees for the home are in excess of £685 per week based on the individual’s care needs. Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home was given 24-hour notice of this visit due to the individuals and the staff not being in the home during the day. The purpose of the visit was to review the progress to the requirements and recommendations from the visit in April 2007 and to monitor the quality of the care for the five people living at Bedrock Mews. There have been no additional visits to the service since April 2007 and there have been no complaints. In response to a requirement the home has submitted an application to register a manager with the Commission for Social Care Inspection. This has been processed and Ms B Hancock is now the registered manager and a new certificate has been 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. All the individuals and staff were at Bedrock Lodge so the visit was conducted with the manager. However, all individuals completed a survey and staff were met during the visit in April and subsequent visits at Bedrock Lodge. The home has been sending information in respect of regulation 37 notices of events affecting the well being of the people who use the service and these were used as a focus for the site visit along with the annual quality assurance assessment completed by the manager. In addition views were sought through surveys to relatives (3), visiting professionals (4) and people who use the service (5). The inspection was conducted over 5.5 hours. What the service does well: What has improved since the last inspection? Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 6 Individuals now benefit from a manager who has more responsibility for the day-to-day management of the home. Individuals that self medicate can be assured that this is clearly documented in the plan of care in relation to their competence and understanding. Individuals can be more confident that their plan of care is more detailed to enable the carers to consistently support them. Generally there has been an increase in activities in the evenings and weekends for individuals. Individuals can be assured their confidence in relation to the documentation of the house, staff meetings and their financial expenditure. What they could do better: The home has significantly improved in the last twelve months. However, consideration should now be taken to explore how individuals can be fully independent both in their care and lifestyles. Some of the responsibility that the provider has should be cascaded to the manager, the staff but more importantly the individuals living in Bedrock Mews. Individuals should be consulted along with their placing authority on how the home can fully rehabilitate individuals back into the community and maximising the individual’s full potential. Consideration should be taken on how this can be done safely but allowing individuals to take more risks as part of their care package in accessing community facilities both for leisure and work. Individuals should be confident that the restrictions that are in place across the three homes link to individuals’ plans of cares. Where an individual potentially can put others at risk in the home’s vehicle this should be clearly assessed and documented in relation to safe working practice. Individuals must be confident that their plan is person centred and details strategies that are pertinent to the individual in supporting them with their mental health and challenging behaviour. Individuals must be confident in the competence of staff with an ongoing package of training in place, which links to the needs of the people living in the home and includes a rolling programme of statutory health and safety training. This has been an ongoing concern with Nightingale Homes. Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 7 Staff must receive supervision with clear links to the roles and their needs in relation to training and support. 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. Bedrock Mews DS0000058581.V348442.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 Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,5, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information is available to individuals and their representatives. Whilst it is clearly documented, the locking of the front door compromises human rights of the individuals living in Bedrock Mews. Individuals can be confident that their needs would be assessed prior to the agreement of a placement at the home. EVIDENCE: The statement of purpose and the service user guide was viewed during the inspection in April 2007. This clearly described the service available to individuals living in the home. 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. The manager stated that this has recently been discussed with the provider in relation to the locking of the kitchen and the provider stated that this must continue as part of the generic risk assessment for the three homes. Concerns are raised in that none of the individuals living in the home are detained under the mental health act and there was no link in the placing authorities care plans to the need to have restricted access to the kitchen or the locking of the front door. This must clearly link with the individual’s plan of care and the local placing authority must be made aware of this level of restriction. Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 10 As seen at the last inspection there was information available to people who use the service and their representative in the form of a contract and a service user guide. People receiving a service contribute towards their transport cost and weekly toiletries. The individual or their representative had signed these. There is one vacancy at present. The statement of purpose clearly describes the process of admission which would include visits being arranged to suit the person, including seeking the views of the people already living at Bedrock Mews. The manager stated that she would be involved in the admission process for a new person moving to the home. This would include obtaining relevant information about the person. One of the individuals stated in the returned survey that they had visited the home with their relative prior to making a decision to move to Bedrock Mews. It was evident relatives have an active part in the lives of the individuals living in the home. Bedrock Mews DS0000058581.V348442.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): 6,7,8,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is scope for the home to explore the impact of the restrictions that are imposed on the people living in Bedrock Mews and explore how individuals can have more control over their lifestyles. Strategies for supporting individuals with their mental health and challenging behaviour should be reviewed to ensure more person centred and reflective of the person. EVIDENCE: Three persons care was reviewed on this occasion. Care files were well organised and devised 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 five people living in the home. Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 12 Care plans included a lot of valuable information relating to the individual’s care these have been expanded to include comments from previous visits to the home. Health care plans detailed individuals support needs in relation to their mental health. There is still scope for improvement as noted at the last visit. Documentation that detailed “coping strategies” was the same for each person living in the home. Although the manager had highlighted potential coping strategies from the list, one made reference to offering “as and when” medication. However, there was no “as and when” (PRN) medication recorded on the medication record. The manager has agreed to liaise with the individuals and the staff to devise a more personalised approach for each person. Risk assessments covered a wide spectrum of activities. However, as mentioned earlier in this report concerns are raised in that the Generic Nightingale Care Home’s risk assessments curtail independence in relation to the locking of the front and the kitchen door. Social Service’s care plans made no reference to the need for a secure environment and all three plans seen made reference to encouraging the individual to be independent. Presently only one person has a front door key and accesses the community independently. The manager gave many reasons for the door to be locked including road safety skills, issues in relation to behaviour including “this is the way it has always been”. Consideration should be taken to discuss this with the individual’s placing authority to ensure that the home is encouraging as much independence as deemed appropriate to the individual. Consideration should be taken to review individuals abilities to access the community independently and all parts of their home within a risk assessment framework. From reading accident and incident records it was noted that one individual had attacked a driver in the home’s vehicle. Whilst this incident was over twelve months ago, there was no risk assessment in place safeguarding the individuals and the staff. From records it was evident that the person continues to use the vehicle. The home must ensure that there is a risk assessment in place detailing how the individuals can be assured of their safety. The manager stated that there is a lock on the lounge door and this has recently been locked to ensure the safety of the individuals living in the home when one person was particularly aggressive. This must be clearly documented ensuring that this is appropriate. Where individuals are at risk the home must implement adult safeguarding procedures. Records must be maintained of when this restriction is imposed, including the reasons why, the length of time with clear guidance being developed for staff. The manager stated that this is only used as a last result and has been used only twice as far as she is aware in the last twelve months. Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 13 During the last visit, individuals stated that they were involved in the planning of their care specifically around the activities. This was further evidenced in house meetings and annual individual program meetings completed by the day care co-ordinator who is based at Bedrock Lodge. From reviewing the care documentation it was evident that professionals were involved in the planning of the care, with reviews being completed by Social Workers, community psychiatric nurses and psychiatrists. The manager stated that the home is actively seeking advice from the local authority in relation to an individual that can be challenging. The manager stated that this has been difficult in that the intensive challenging behaviour team support individuals with a learning disability and not a person with mental health needs. The manager has agreed to discuss further with the individual’s social worker. Bedrock Mews DS0000058581.V348442.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 living in Bedrock Mews have available to them a structured day care plan which is varied. Individuals are encouraged to maintain contact with relatives. There are limitations to the involvement of the individuals in making decisions and access to opportunities to wider activities outside the organisation of the home. EVIDENCE: Each resident has a structured five-day care plan; the manager stated that this is planned at Bedrock Lodge in consultation with the individual. Activities included swimming, gardening, woodwork, animal care and house keeping Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 15 skills. Individuals confirmed attendance at the last visit. All individuals on the day of the visit were at Bedrock Lodge. The manager stated that all the activities are presently organised by Bedrock Lodge. Whilst there is access to the community this is done with Bedrock Mews and Bedrock Lodge staff. Consideration should be taken whether individuals could hold down different employment, college courses or activities that are external to Nightingale Homes, which could broaden the horizons of the individuals living in the home. The manager stated that there are regular trips to the shops and individuals are supported to go to a local pub. In addition throughout the summer individuals have been supported to go out on regular Sunday outings. This was clearly recorded in the individual’s plan of care and daily records. Pre-inspection surveys returned indicated that all individuals are happy with the level of social activities during the day, evening and weekends. Observations at the visit in April between the staff member and the 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. Four of the completed surveys stated that staff treat them with respect and listen to what they want. Individuals have recently had a holiday, four of the individuals from Bedrock Mews went away together and one person went with some of the other individuals living in the other two homes. An anonymous complaint was received in relation to the planning of the holiday for one of the homes within the organisation and ensuring that there was adequate staff to support the individuals. The manager stated that four of the individuals from Bedrock Mews and one person from Bedrock Lodge had a really enjoyable holiday and staffing was adequate. The Commission for Social Care Inspection received a notification in respect of regulation 37, detailing an incident whilst on holiday of aggression from one person living in the home. From conversations and records seen it was evident that the person was adamant that they did not want to go on holiday but was told by the provider that they are entitled to a holiday. Staff from Bedrock Lodge had to collect the individual from the holiday. Risk assessments were forwarded to the Commission for Social Care Inspection prior to the holiday but these were limited to the drive to the holiday with no reflection on the destination/accommodation, staffing or the rationale behind the plan of the holiday for example why the group were grouped together. The manager stated that the provider plans the holidays. This will be further explored with the provider in relation to the planning of the holidays, staffing and choice for the individual on the visit to Bedrock Lodge. Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 16 Evidence was provided via conversations with staff, individuals and in the daily diaries that family contact was maintained. The manager stated that at the weekends individuals are supported to see their relatives or friends. The home has organised house meetings for the individuals. The focus has been on activities and the planning of the trips. It was noted that in May and August two of the individuals requested to go to Alton Towers. The manager stated that this has not happened. The meetings would benefit from a broader agenda, which could include menu planning, staffing and décor. With the purpose that this could increase the involvement of the individuals in the running of the home. Three 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 Lodge and Bedrock Mews”. Another stated, “My relative is very happy here, and feels safe”. Feedback from relatives has been consistently positive from the last three inspections. Menus were not viewed on this occasion. Concerns have been raised on previous visits that the individuals have little input into the planning of the menu as this is done centrally for the three homes. The manager stated that the individuals on a recent holiday planned all the meals and this had been successful. Individuals had demonstrated a good understanding of good healthy eating. Individuals confirmed during a previous visit 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. Bedrock Mews DS0000058581.V348442.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): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been noted in the way the home supports individuals with their personal and health care. Individuals are generally protected by the home’s systems of administration of medication. This must be extended to the individual that self medicates ensuring that there is a clear record maintained. EVIDENCE: Each individual has a health action plan that details the support required to ensure that an individual remains healthy and a care plan that details support in relation to personal care. 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 Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 18 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. Feedback from visiting professionals was mixed. A social worker stated that the home has enabled a very complex person to live safely in the community”, 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, both my clients within the home seem contented with the regime”. Another professional stated, “The home will actively seek advice and act upon it”. One professional stated that the home could improve by doing more in the community”. Two visiting professionals stated that the home has little concept in understanding the principles of recovery, rehabilitation, that the staff use inappropriate language and there is no emphasis on individuals moving on. They went on further to say that the there are concerns on how the home is meeting the physical health care needs of the individual. 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 during this visit and the one in March. There was no record on the medication recording chart of the prescribed medication. However, the home has responded to a requirement to ensure that where individuals self medicate there is a risk assessment. The manager stated that there is presently only one person who self medicates. Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 19 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. Individuals have systems for raising concerns about the home. However the lack of staff training in protection could potentially put individuals at risk. Individuals still have little control over their finances. EVIDENCE: The home has a complaints procedure. The manager and the completed annual quality assurance assessment stated that the home has not received a complaint in relation to the service. However, an anonymous complaint was received prior to the inspection relating to the planning of the holidays for one of the other homes. This was discussed earlier in this report, as the individuals had recently been on holiday. Completed questionnaires and conversations with people who use the service on a previous visit provided evidence that individuals knew how to complain. The home has a policy on the protection of vulnerable adults. The manager has recently liaised with the safeguarding co-ordinator who has advised that the duty desk is to be contacted where individuals are involved in acts of aggression from another, so that this can be closely monitored to ensure the safety of individuals living in the home. It was noted at the last inspection that three staff have not attended training in the protection of vulnerable adults ensuring that individuals are safeguarded Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 20 from abuse. The manager stated that one person was rostered to do this in September 2007 but for personal reasons could not attend. The manager stated that they had completed a course on protection from abuse specifically for managers and had found this very useful. The manager stated that generally individuals living in the home rarely exhibit challenging behaviour, which results in violence towards staff or the people living in the home. However, individuals can be verbally challenging at times. Areas of concern have already been raised in this report relating to locking of the lounge door when one person was being particularly challenging and the lack of documentation to support this. From reviewing staff training it was again noted that 2 staff have not received training on supporting individuals that challenge, two staff which includes the manager are well overdue for an annual update and four staff member’s training expires in October. The manager was unaware of any forth-coming dates. The provider must ensure that staff are adequately trained to support the individuals. Again 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 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 manager stated that individuals are free to see this information whilst they are at Bedrock. It is further recommended that the mechanisms for managing individuals’ finances be reviewed. From reviewing the records relating to individual’s finances it has been noted that some positive changes have taken place. This has included an individual record of expenditure, where as before this was recorded on one record for all five people. This was reviewed to ensure the record of individual’s expenditure and financial transactions remains confidential. In addition individuals are being encouraged to sign for their expenditure. The manager stated that one person has now responsibility for some of his weekly personal allowance. Records were seen confirming this. However, this could be extended to the other people living in the home using a risk assessment approach. Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 21 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. Bedrock Mews is a comfortable and homely place to live. EVIDENCE: Bedrock Mews 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. One individual stated that the lounge furniture could benefit from replacement in the completed survey. The manager stated that new lounge furniture has been ordered. It was noted that the sofa was uncomfortable and low to the floor. Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 22 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. Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 23 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. There is a lack of training and support for staff, which could potentially put individuals at risk of harm. EVIDENCE: As already mentioned the individuals attend Bedrock Lodge during the day. The staff working in the home from Monday to Friday support the individuals over at Bedrock during the day. From reviewing the rota, it was evident that there are always two staff working in the home in the mornings and evenings and at weekends with one member of staff providing a waking night cover. The manager stated that the rotas are now planned centrally from Bedrock Lodge. From conversations it was evident that this has not always been successful in relation to ensuring a driver is on duty (the provider stated that this is not an issue as drivers could be sought from one of the other homes) or that staff have the appropriate training for example a person trained in first aid or staff working alongside someone who has been trained in supporting individuals that challenge. The manager stated that this would be discussed with the person who has been allocated responsibility for completing the rota. This will be followed up at the next visit. Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 24 All recruitment information is now held at Bedrock Lodge as agreed with the Commission for Social Care Inspection. Staff recruitment information was viewed during an inspection in June 2007 for two staff and all was satisfactory with the appropriate checks in place. Further concerns have been raised about the lack of training in supporting individual that challenge, mental health, health and safety first aid and food hygiene with the appropriate updates in place. For example a member of staff who has completed their induction, which includes health and safety, will not attend further updates even though they have worked for the organisation in excess of four years. None of the staff have a current food hygiene certificate or training in manual handling, three members of staff out of seven do not have a first aid certificate and 3 members of staff do not have training in protection of vulnerable adults. Various reasons were given including staff do not attend once the course has been arranged. Most of the staff work in the home alone after 10 pm and it is vital that this training is given to all staff with regular updates. The manager stated that she has a National Vocational Award at level 3 in care and the Registered Managers Award a further member of staff has an NVQ 2 in care. A further 3 staff are either completing an NVQ 2 or 3 in care. It is evident that the home is trying to meet the government target of 50 of the workforce having an NVQ 2 in care. Since the visit in April 2007 two staff meetings have been organised. The manager stated that she is aiming to have these monthly but due to holidays it has been difficult to arrange. This will be followed up at the next visit to the home. The staff minutes are now separated from the house meetings ensuring confidentiality and more detail is recorded. Supervision records are held at Bedrock Lodge with staff files. However, an overview was seen. It was noted that 2 of the staff working in Bedrock Mews had not received formal supervision in the last twelve months. From the overview a further 8 staff had not received any supervision in the last 12 months. The manager stated that this is the responsibility of another manager working for Nightingale Homes in respect of one person and the other works only one day per week and it has been difficult to arrange. From talking with the manager it was evident that she was committed to ensuring staff are supervised, however, she is not solely responsible for supervising the staff working in Bedrock Mews and could in fact be responsible for supervising staff working in the other two homes. There are issues in that the supervisor does not work alongside the supervisee and may not have a good understanding of how that person works. The overview showed that the manager has not received formal supervision since May 2007. The provider must review and ensure that all staff receive appropriate one to one supervision with consideration that this is cascaded to the appropriate person. Within the Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 25 legislation this responsibility would normally fall to the registered manager or an appropriate person working in the home, as they would have a good understanding of the role of the person and the people they are to support and be in a position to alleviate concerns. Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 26 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 adequate. This judgement has been made using available evidence including a visit to this service. There is now a registered manager that has day-to-day responsibility for management of Bedrock Mews. Shortfalls in the home’s training in relation to health and safety could be putting people at risk. EVIDENCE: Ms B Hancock has recently completed the process to become the registered manager. Previously the provider Mr Gay, who had no responsibility for the planning of the care or the direct management of staff, completed this role. Ms Hancock has in excess of four years management experience and has a National Vocational Award Level 3 in care and the Registered Managers Award. She is also an NVQ assessor. Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 27 Quality assurance was not reviewed on this occasion. There is still a lack of regulation 26 visits being completed by the provider. The last one to be received by the Commission for Social Care Inspection was July 2007. Again the manager stated that it is rare for the provider Mrs Gay to visit the home when she is on duty. It is the provider’s legal responsibility to ensure that these are being completed. The manager stated that the home has recently had two environmental health visits in relation to food and health and safety. The manager stated that the home has been awarded “four stars out of a possible five” for safe handling of food. Areas raised during the visits were risk assessments relating to manual handling, lone working and assessments for staff with allergies to latex gloves. The manager stated that these have been completed. Concern was raised with the manual handling risk assessments as they make reference to a sack trolley for assisting with shopping. However, there is not one in the home and the other concern relates to the competence of the staff completing the risk assessments in relation to manual handling. There are specific courses for manual handling risk assessors. Other areas of concern relating to the health and safety in the home were the lack of ongoing training covering the areas of first aid, food hygiene and manual handling. There were no formal updates once the member of staff has completed their initial induction. Fire records were viewed during the visit. Routine checks were being completed on the equipment and staff were receiving adequate training and participating in fire evacuations. Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 28 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 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 29 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 YA20 Regulation 13(2) Requirement Where individuals self medicate ensure that this is recorded on the medication record. (Outstanding since 30/04/07) To personalise the coping strategies for each individual. (Outstanding since 25/5/07) To risk assess an individual using the home’s vehicle in relation to aggression. Ensure that staff are adequately supervised. For all staff that have not previously attended training in the protection of vulnerable adults to do so. For all staff to attend training in food hygiene. For staff to attend training in challenging behaviour in accordance with the home’s policy with annual updates. Ensure that the person who is completing the manual handling risk assessments is competent within this role. Timescale for action 10/10/07 2. YA6 15 (1) 03/11/07 3. 4. 5. YA9 YA36 YA35 13 (4) 18 (1) 18 (1) (c) 10/10/07 03/10/07 03/01/08 6. 7. YA35 YA42 YA35 18 (1) (c) (i) 18 (1) (c) (i) 18 (1) (c) (i) 03/02/08 03/12/07 8. YA42 03/12/07 Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 30 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. (Outstanding since April 2007) For individuals to be encouraged to be more independent in consultation with placing authorities in relation to accessing the community based on a risk assessment approach. To expand on the agenda and topics for discussions at house meetings for people who use the service. To offer the individuals in 1 New Road more responsibility over menu planning. (Outstanding since April 2007) To review the culture that activities are completed within the boundaries of Bedrock Lodge or with staff – for example college, work placements etc so that social networks can be expanded. Staff to receive at least six one to one supervisions per annum. For the manager to complete a National Vocational Award at level 4 in care. 3. YA9 4. 5. YA38 YA17 6. YA13 7. 8. YA36 YA37 Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bedrock Mews DS0000058581.V348442.R01.S.doc Version 5.2 Page 32 - 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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