Inspection on 04/07/06 for Bedrock Mews

This inspection was carried out on 4th July 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bedrock Mews 03/10/07

Bedrock Mews 25/04/07

Bedrock Mews 17/01/07

Bedrock Mews 01/11/05

Bedrock Mews 26/07/05

Bedrock Mews 07/12/04

Bedrock Mews 16/07/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME ADULTS 18-65 1 New Road 1 New Road Stoke Gifford South Glos BS34 8QW Lead Inspector Paula Cordell Key Unannounced Inspection 3rd July 2006 09:30 1 New Road DS0000058581.V302448.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.V302448.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.V302448.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1 New Road Address 1 New Road Stoke Gifford South Glos BS34 8QW 0117 9694198 01454 772171 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Nightingale Care Homes Mr John Michael Gay Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 1 New Road DS0000058581.V302448.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 1st November 2005 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 newly registered with the CSCI in February 2004 to provide accommodation and personal care to six adults with learning disabilities up to the age of 64. The home is situated in Stoke Gifford close to the Avon ring road and bus routes. There are retail outlets and shops close to the home. Bristol Parkway railway station is within easy reach of the home. During the last inspection the home had under gone major building works to provide a further two bedrooms. In addition the kitchen area had been reconfigured to provide superior facilities. An application to vary the conditions of registration was submitted to the Commission for Social Care Inspection for consideration when the work was completed. The application was successful and the home was extended in numbers. Each bedroom has its own bathroom. Residents have full access to a lounge, kitchen and conservatory/dining area. Currently no residents have physical or sensory needs that require adaptations or equipment. There is a wellmaintained garden and a summerhouse. Mr John Gay manages the home with an assistant manager overseeing the day-to-day running of the home. 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection. The purpose of the visit was to monitor the progress to the requirements and recommendations from the last unannounced site visit in November 2005 and review the standard of care provided to the residents at 1 New Road. The focus of the site visit was on the general care of a sample group of residents and the environment, including an extensive tour of the premises. This provided a good opportunity to observe residents as well as allowing for informal conversations with individuals and the staff supporting them. Two members of staff were spoken with during the inspection, which included the assistant manager. The home has been sending information in respect of regulation 37 notices of events affecting the well being of the residents and these were used as a focus for the site visit along with the pre-inspection questionnaire completed by the home, relatives (1) and residents (6). The site visit was conducted over a period of 7 hours. What the service does well: What has improved since the last inspection? Residents now benefit from clear information about the home in the form of a service user guide and a contract of care, which specifies the terms, and conditions of the service provision. Residents are now safeguarded from a record of staff signatures demonstrating that medication has been administered. There has been some improvement to the information sought in relation to demonstrating a safe recruitment process in that all staff records contained the 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 6 appropriate documentation. However, this was not sought prior to the individual being employed in the home, which is a breach of the regulations. Residents now benefit from regular meetings to enable their views to be sought on the running of the home. Residents now benefit from the second locking devise being removed from their bedroom doors. The home has explored ways of ensuring the privacy of an individual by being creative on the window coverage where curtains were being regularly removed by the individual. What they could do better: Residents must have clear information describing the service provided at 1 New Road. Residents must be assured that the home is operating legally within the category of registration. Residents must benefit from clear measurable care plans and records that fully describe their needs. Actions that are taken to ensure the safety of individuals must be clearly documented. Residents must be assured that staff are competent to meet the care needs of the people living in the home collectively and individually including a formal induction to the home and the organisation. Residents should be assured that where there are restrictions imposed this is clearly documented and reviewed to ensure that this remains appropriate taking advice from placing authorities. Residents must be protected by robust medication systems. Residents must be assured that there is guidance available for staff to ensure residents are protected in the event of an abuse allegation. Residents must be protected by a rigorous recruitment process to ensure their protection. This remains an outstanding requirement. Residents must be assured that the home has a registered manager that works in the home to support and guide staff. This remains an outstanding requirement. Residents must be assured their safety in the event of a fire by being supported by competent staff. 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 7 There are a number of recommendations to fine tune the service provided to the residents. Residents should be assured that staff are competent in the administration of medication and attend a formal induction that is based on the skills for Care National Standards. Staff would benefit from a clear training plan to enable them to fully support the residents and have regular supervision in accordance with the National Minimum Standards. A resident should be consulted about replacing his bed. Residents should be assured their safety in relation to the chemicals that are kept in the home. 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. 1 New Road DS0000058581.V302448.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.V302448.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents have some information available to them. Residents are admitted to the home based on a full assessment of needs, however the home is in breach of the conditions of registration, as the home is not registered to support individuals with mental health needs only. EVIDENCE: There was information available to residents and their representatives in the form of a contract and service user guide. The individual and or their representative had signed these. The contract for the recent person to be admitted to the home was with the placing social worker. The contracts included details of the terms of conditions of the service, the fees payable and any additional costs. Residents are expected to contribute towards their transport cost and pay a weekly fee for toiletries. The individual or their representative had signed these. The assistant manager was unable to locate the statement of purpose and agreed to deliver this to the Commission for Social Care Inspection within four working days. This is an outstanding requirement from the last inspection as this was held at Bedrock Lodge. The assistant manager delivered this within two days. The statement of purpose did not fully describe who the service was 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 10 for, the staffing arrangements on a daily basis, any restrictions (for example the locking of the front door), the management arrangements and the number and the sizes of the rooms. The manager stated that the provider is in the process of reviewing the documentation an amended copy must be sent to the Commission for Social Care Inspection. Since the last inspection the home has admitted three residents to the home, and one person has moved on, as the placement was not appropriate to their care needs as the individual wanted to move to Wales. Care files included copies of placement authorities assessments and care plans. All residents had a plan of care. The care plans drawn up by the home were in place within a reasonable timescale of the individual moving to the home in accordance with the National Minimum Standards. The home has an admission policy, however this makes reference to individuals with a mental health need and does not fully detail the criteria for potential residents moving to the home. Without a clear criteria the home could take individuals whose care needs they are not able to meet fully. The home is registered for individuals with a learning disability and not falling within any other category. From reviewing care records drawn up by the home and placing authorities it was evident that four of the six residents had either a mild learning disability and/or mental health and their primary care need was their mental health care needs. It was clear from documentation that these individuals were placed by mental health services. One individual had only recently moved from another home within the organisation and this individual was placed by Avon Wiltshire Partnership (a mental health service). This was questioned at the time with the provider as to whether the home required a variation to include mental health to the certificate of registration. The provider stated to the contrary that the individual care need was primary their learning disability. The home is in breach of their conditions of registration and an application must be submitted for consideration to include mental health to the home’s certificate. It was noted that only one member of staff has attended a course in supporting an individual with mental health care needs. As part of this application the home must demonstrate that staff are appropriately trained to meet the mental health needs if an application is to be considered. Residents confirmed in the completed surveys that they had received information on the home prior to moving in. Care files further evidenced that residents had been supported to visit and these visits had been tailored to suit the individual. The home offers a three-month trial period after which the placement is reviewed with all involved to ensure that the placement is appropriate. There was evidence that existing residents were involved in the process via the residents meetings. One resident had attended a resident 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 11 meeting prior to moving to the home to enable them to meet with existing residents. 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents are involved in the planning of their care, however plans of care seen lacked detail to fully assess whether the home was meeting the needs and aspirations of the individuals. There has been an improvement in the consultation process with residents and they are supported to air their views. Residents are not fully protected by the home’s risk assessment process. EVIDENCE: Care files were viewed for three residents in full in relation to the National Minimum Standards and a further two files were viewed for the content of the care plans and the individuals primary care need. All care files seen were being reviewed a minimum of six monthly. Social workers are in the process of reviewing all individual care plans as part of a protection strategy to ensure that the home is a suitable placement and can meet the care needs of the individuals. The manager confirmed that this had taken place for four of the six residents. As yet no new care plans have been received and no concerns had been raised with the home. 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 13 All care plans seen made reference to a mental health and their diagnosis with no or little mention of a learning disability. As already discussed the home is in breach of their conditions of registration. Care files were well organised and divided into sections including personal details, background, assessments, care plans and risk assessments, medication profile and correspondence. In addition the home maintains a central file containing all current care plans and risk assessments for the six individuals living in the home. Care plans included a lot of valid information relating to the individuals care, however the plan of care resembled an assessment of need and identified areas but did not give staff specific detail to guide them in supporting the individuals living in the home ensuring a consistent approach. There were good examples given during discussion with staff and residents and through reading care plans how residents are encouraged to participate in the planning of their care and the running of the home. Residents meetings are now taking place monthly in response to a recommendation from the inspection in November 2005. Discussions included activities, holidays, decoration, as already mentioned new residents and staff. The assistant manager clearly saw that this as a fundamental role in the home to ensure that residents’ views were sought and that they had the control and autonomy over their individual lifestyles and the running of their home. Through the inspection process, the assistant manager stated that 1 New Road was the residents’ home and that the staff were guests. A resident confirmed that this 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. However, this was not documented in the plan of care. The assistant manager stated that the front door is locked when residents are home. There was no documentation on the decision process and the impact this could have on more independent residents or linked to residents who required the front door to be locked. The home must clearly document the reasons, keep under review and link to individual’s risk assessments and plans of care. The home has responded to a requirement from the last inspection to remove the star key lock, which is controlled by staff on bedroom doors in five of the six bedrooms. The assistant manager stated that this particular individual wanted this to remain. However, there was no documentation in place to guide staff on when this was to be used or confirming that the resident had been consulted. 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 14 It was noted that one resident’s water in the individual’s bathroom is controlled by the staff. Again there was no clear guidance for staff on when and how often this should be checked or when the resident could have access. Daily records lacked any information on how the home was supporting individuals in relation to their plans of care. This will be commented on in the standards relating to activities and personal care. It was noted that one daily record made reference to an episode of behaviour and the description lacked any real depth to measure what was exhibited and just stated “unsettled all evening” given as and when medication. This was not cross referenced with the individual’s chart on behaviour. The lack of information would make it difficult for a full review to take place. A key worker system operates in the home, where designated staff have been required to assist with the management of care for particular residents. Residents confirmed this in the completed surveys and in discussions. Residents consulted with on the day of the site visit spoken positively about the support given to them by the staff. One of the resident’s key workers is based at another home, and from discussion with the assistant manager this was seen as a positive relationship with the staff member regularly taking them out, supporting them with doctor appointments and assistance with personal purchases. 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. 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 the service. Residents have available to them a wide range of activities both in the home and community. However there is limited documentation to support this and care plans did not fully capture what was being undertaken or were lacked specific detail to guide staff on how to support individuals. EVIDENCE: Care plans included information on how a resident would like to be supported in maintaining contact with relatives and social occupation. However this lacked clear guidelines for staff to follow with measurable outcomes. Daily records lacked detail to determine how residents were occupied during the day and concentrated on evening activities (resident led) and the weekends and focused on an individual’s well being, so therefore it was difficult to determine or measure how the care plans were being implemented or what activities individuals were participating in. For example one individual’s care 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 16 plan stated to increase life skills. This is a vast area. This was not broken down into measurable outcomes for the individual offering staff clear direction and ensuring consistency. The assistant manager stated that this had been highlighted recently in a review conducted by the individual’s named social worker. The assistant manager stated the home is in the process of addressing this. Each resident has a structured five-day care plan; the assistant manager stated that this is planned at Bedrock Lodge in consultation with the resident. Activities included swimming, gardening, woodwork, animal care and house keeping skills. Residents confirmed attendance. Residents go out in the local community on a regular basis. This is either for pre-arranged activities, or to local cafes, shops, the pub, leisure centres. This was confirmed in conversation with residents and staff. However, there was limited documentation in daily records to confirm this. Observations between the two staff on duty and the residents indicated that staff know the individuals well and evidenced that there is a good rapport with positive respectful relationships being nurtured. Two residents spoken with stated that staff treated them well and they enjoyed living in the home. Another stated it was all right and one individual did not want to speak with the inspector choosing to retire their bedroom. Risk assessments seen covered a wide range of activities. These were not dated or signed so it was difficult to determine how current they were. As with the care plan they did not fully document what was happening in practice. Whilst the outcome for residents was that they were safe as evidenced from conversations with staff for example the locking of the front door, the locking of all chemical hazardous to health, turning of an individuals water, and supervision in the kitchen there was no documentation supporting the decision process or that this was kept under review. As some of these are infringements of rights then there must be clear documentation in place as to the reasons why. These must be kept under review. All actions staff undertake to ensure the safety of the individual must be clearly documented, ensuring that where possible an individuals independence is not curtailed. Residents were seen moving freely around the home accessing the lounge, conservatory, the dining room, their bedrooms and the kitchen the latter with support from staff. Staff stated that residents could access the kitchen with support from staff and staff will respond to requests for drinks or snacks. All residents came into the communal areas of the home to have a drink from there return from Bedrock. Care Plans included information relating to friends and relatives, and how contact should be maintained. One individual’s care plan stated to write a letter but it was not clear on the frequency or who should complete this. There 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 17 was no evidence in daily records that the individual had been supported with this. Three relative questionnaires were returned; two stated that they were not kept informed of important matters with the third stating they were relating to the care of the individual. However, all three stated that they were satisfied with the overall care provided. Menus were viewed and residents had available to them a nutritious and varied diet. The provider planned this on a four weekly basis. Concerns were raised at the last inspection that this did not allow residents choice, however, evidence was provided that the home offered a variation to the planned menu and a record was maintained. One of the residents care plan made reference to diabetic diet. There was little information in the plan of care to guide staff on what could be eaten or what alternatives could be offered. The assistant manager stated that alternatives are offered for example sugar free puddings and fruit. No training had been undertaken by staff on diabetes, nor had the home consulted a dietician or a diabetic nurse in the planning of the menu or the support required for the individual. Residents consulted with during this site visit stated that they were happy with the food available to them. There were adequate supplies of food in the home, including fresh vegetables and fruit. 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. 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 the service. Residents personal and health care needs were being met, however this could have been better recorded in the plan of care detailing what each individual’s support care needs were. The home has a good system for the administration of medication; however, records re staff competence were not clear as to what was being assessed. EVIDENCE: Care plans detailed some of the support needs of the individuals. However, from conversations with staff it was evident that three of the personal care plans were not relevant and did not reflect the individual. Staff stated that only two residents require minimal support with personal care where as the personal care statement stated that a further three individuals needed both physical support and verbal prompting. All personal care plans seen were similar in content. Care plans stated an annual “MOT” would take place however; it was not clear from documentation that this was in place or what this entailed. Health care needs were being responded to by the GP as and when required, resident’s 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 19 files seen demonstrated that they were regular attending optician and dental appointments. The home was maintaining records of routine weights for some of the residents and this was linked to their plan of care. However, one resident required routine blood sugar levels being taken by the staff, the care plan lacked information on the frequency or what was normal for the individual or what should be done if there was a concern. The staff were not completing records of the sugar levels consistently and there was no evidence of staff training in this role. A community psychiatric nurse (CPN) visits the home on a weekly basis to support two of the individuals and to administer a weekly injection. The home must maintain a record of this on the medication record; a signature is not required as this is administered by the CPN. There was no documentation of the weekly injection on the medication administration record. Residents, where relevant, were being reviewed with the consultant psychiatrist. Letters were seen confirming this. The medication system in the home was the monitored dosage system. Staff administered this. The home has responded to a previous requirement to ensure that staff sign for the administration, because at the last inspection it was noted that there was a significant number of gaps. It was noted that one as and when required medication had been omitted from the medication record of administration. The assistant manager agreed to contact the pharmacist and rectify this within 48 hours. A copy of the medication record was sent to the Commission for Social Care Inspection and it was evident that the home had complied with the requirement. There was a medication competency assessment for staff. It was difficult to determine what had been reviewed as there was no indication of what had been reassessed. There were a number of competency charts that remained in the file, even though the members of staff had left the organisation’s employment. The assistant manager stated that all staff were either in the process or had completed a distance learning pack on the administration of medication. The competency assessment had not been updated to reflect this. 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. 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 the service. Residents have confidence that their concerns will be listened to and responded to appropriately. However, the policy relating to protection failed to demonstrate that residents are protected and this is in the process of being reviewed. Present, financial arrangements for residents do not allow control to the individual. EVIDENCE: The home has recently reviewed the complaint procedure. Resident’s questionnaires confirmed that four of the residents knew whom to complain too and one chose not to answer. According to the home’s records the home has had one complaint since the last site visit. This related to noise levels of one of the residents who has since left the home due to incompatibility. The home has recently implemented a new policy on protection of vulnerable adults. This makes reference to the home completing an investigation without consultation with social services. The assistant manager stated that this has been made a requirement in another home within the organisation and the provider is in the process of reviewing the policy. This will be followed up at the next inspection. The assistant manager was aware of the role of social services in the process of reporting abuse. It was noted that the home has copies of the local authorities procedure on protection. This is good practice. 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 21 The home has a plan for ensuring all staff attend a course in protecting residents from abuse. 3 staff have attended and a further two staff are attending this year, date as yet not confirmed. At the last inspection it was noted that the home should be more proactive in enabling residents and staff to make changes as a result of having their views heard. The home is now ensuring that both resident and staff meetings are more frequent. Residents confirmed in the completed survey and in discussion that their views were listened to and acted upon. An area at the last inspection was identified as being menu planning which is done at the main office, however from this site visit, it was noted residents could have alternatives to the planned menu this was evidenced via the variation record and in discussion with two of the residents. The manager stated that none of the residents exhibit behaviour that requires restraint, however residents can at times be verbally challenging. Staff files demonstrated that they have received training in supporting individuals that challenge and this is updated annually. There is no money in the home that belongs to the residents this is held at Bedrock Lodge. The assistant manager stated that residents can have money at all times and this is taken from a petty cash budget and the home is reimbursed by the individual’s funds. Whilst this may be deemed as safe practice by the organisation. Residents have little control over their overall finances and the staff are not fully able to assist residents with budgeting, as information relating to their accounts is held at Bedrock Lodge. The assistant manager stated that residents are free to see this information whilst they are at Bedrock. The expenditure is recorded on a form for all residents, which would mean that it is difficult for representatives or the individual to view without breaching confidentiality of the other residents. It is recommended that the finances be reviewed. However, South Gloucestershire Council is auditing the organisation on the financial procedures including 1 New Road as part of a Protection of Vulnerable Adults strategy that relates to one of the other homes. This will be followed up at the next site visit once the audit has been completed. 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. 1 New Road provides residents with a homely and clean environment that is meeting their present care needs. The residents would benefit from safe working practices being documented to ensure staff consistency, which is kept under review ensuring that it is relevant to the individuals’ care needs and abilities. EVIDENCE: 1 New Road is a two-storey semi-detached property of domestic style that is within easy reach of local facilities and public transport routes. The home in November 2005 was successfully granted an increase of numbers from four to six residents. All residents have access to a bedroom with ensuite facilities. The home has been refurbished in the last twelve months to include an additional two bedrooms, a replacement kitchen and a staff room with ensuite. Whilst there was a futon in this room, the assistant manager stated that staff are employed to remain a wake at night. 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 23 The home was clean and there was good evidence that the home responds promptly to repairs. On the day of the site visit a maintenance person was installing a second set of handrails to the stairs in response to a fall over the weekend. The assistance manager stated that this has been fully investigated and was not due to physical health but that the individual had consumed alcohol. Risk assessments must be drawn up for the individual in light of the incident at the weekend ensuring his safety and that of the other residents and staff. Bedrooms seen were personalised and decorated to suit the individual. The home has responded to two environmental requirements to ensure that one individual has access to curtains ensuring their privacy and the removal of the second locking system on bedroom doors. All residents have access or are offered a bedroom door key and where a resident is more independent a front door key. One resident has refused a key at this present time and the assistant manager stated that this is kept under review. Documentation was in place confirming access to a bedroom door key. It was noted that one individual’s bed was wobbly and the legs did not look particularly sturdy. The assistant manager stated that a replacement has been offered with the individual requesting a repair only. It is strongly recommended that in consultation with the individual that the bed be replaced ensuring the safety of the individual. None of the residents had specific needs in respect of their mobility that required adaptations to the home or specialist equipment. There are two ground floor bedrooms both have ensuites however the main bathroom is on the first floor accessed by stairs. The home would not be suitable for an individual who required a wheelchair due to its layout. The home has separate laundry facilities that are located in the garage adjacent to the rear of the property accessed via a garden. Staff stated that these facilities were adequate to meet the needs of the home. The assistant manager stated that these are locked however residents are supported by a member of staff to complete their laundry independently. The assistant manager stated that the reason that they are locked is that the chemicals for cleaning are kept here. There was no documentation supporting this ensuring that there were safe working procedures for staff to follow. 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. 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 the service. Sufficient staff support residents on a day to day basis. However the home has failed to demonstrate that residents are supported by trained staff or protected by a robust recruitment process. EVIDENCE: The home is staffed adequately to meet the care needs of the residents. However the staffing levels should be clearly described in the statement of purpose to enable residents and their representatives to monitor and measure the service provision. The assistant manager stated that there are always two staff in the home during the day when residents are home with one member of staff providing waking night cover. This was confirmed on the staff rota for the last three months. The assistant manager stated that the home is in the process of employing a further member of staff to work in the home on a Saturday to assist with activities so that they will be three members of staff. This will be their primary role as they will not be able to undertake personal care due to being under the age of 18 years. It was evident from talking with the assistant manager they were aware of the National Minimum Standards relating to staff being over the age of 18 for personal care and 21 years for being left in charge of the home. The assistant manager stated she would draw up a risk assessment in respect 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 25 of the staff member being under the age of eighteen once they commence employment. Concerns were raised at the time of the inspection as two staff were working a shift of 24 hours including a waking night. This could be deemed as unsafe practice taking into consideration the complex needs of the residents. Both staff consulted stated that they remain awake during the night. The home must ensure that this is safe practice and residents care needs are not being compromised. It was noted that whilst there was a letter confirming that staff were willing to opt out of the European Working Time Directive, these had not been signed by the staff member in at least two cases. The provider has responded by stating that these related to staff that do not work nights. This will be followed up at the next inspection. Staff records were viewed for four staff, whilst there was a completed application, two references and proof of identification it was noted that some staff had started work prior to a POVA first Check and a criminal record bureau check being received. One member of staff started in March 06 and the POVA first was received on the 19th May 2006, and another had been working in the home for a period of two years with a leave of absence of six months. No information re references or a criminal bureau check had been obtained after the period or absence and the criminal record bureau check seen was dated June 06. This was an outstanding requirement from the inspection in November 2005. Enforcement action is being taken on one of the other homes within the organisation relating to this matter. The manager stated that staff would only commence employment now, once all documentation is in place and any staff without the appropriate checks already in employment will not continue as from the 30th July 2006. A warning letter is to be sent, regarding staff employment checks to the provider. Further non-compliance could lead to enforcement action being considered. The manager stated that the individual without a CRB who commenced in employment in March 06 did not work unsupervised. This was confirmed on the rotas seen. Whilst this is good practice, this member of staff should not have commenced employment until a satisfactory POVA first check was received and then not worked unsupervised, within a documented risk assessment framework until a satisfactory criminal record bureau check was received. One member of staff has worked in the home since March 2005 and has not completed their in-house induction or their Skills for Care Induction, which is completed at Bedrock. The home is not meeting the minimum standards by ensuring this is met within the timescales. Training records were difficult to navigate although each staff member had a file containing certificates. It is the staff’s responsibility for ensuring these were up to date. There was no overview of what each member of staff had 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 26 attended other than the statutory training which the provider expects all staff to do. There were gaps on this form. Whilst it was evident that there was a wide spectrum of training this was not consistent for all staff and the poor recording system meant that all training was not captured. The home has introduced a record of training in the staff file, however in three staff members files this had not been completed. One member of staff has had no training according to the records since 2004. The National Minimum Standards states that staff should have access to a minimum of 5 days training per annum and pro-rata for individuals employed part time. Only one member of staff has attended training in mental health. As part of the application to vary the conditions of registration to include mental health all staff must attend training relevant to the care needs of the individuals living in the home. Training must reflect the needs of the individuals, as already mentioned none of the staff have attended training in diabetes or evidence that they have been formally assessed of their competence in relation to checking blood sugars in respect of one individual. Supervision records were seen for four staff, there were no records for three staff. The assistant manager stated that either the manager of the Gables, the provider or an assistant manager at Bedrock, completes these. One member of staff has had two formal supervisions in the last twelve months. The home is not meeting the National Minimum Standards by ensuring that staff receive formal supervision at least six times per annum. Records relating to supervision must be held in the home. Whilst the home has an annual appraisal system in place, these had not been completed for the four staff members seen. 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 27 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents do not benefit from a registered manager that is available in the home, providing support and direction to the residents and the staff. Residents’ health and safety could be compromised due to the lack of documentation and the competence of staff. EVIDENCE: At the last two inspections there was strong evidence that the registered manager, who is also the proprietor was not spending sufficient time at the home in order to provide adequate leadership and direction to the staff. This was found to be true on this occasion. Whilst it was evident that the assistant manager was working well within her lines of accountability and staff felt confident in her management skills there were gaps in the overall management of the home. 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 28 At the last inspection, the proprietor advised that he would work in the home at least thirty hours each week until a new manager has been appointed. There was no record in the home confirming the hours worked. The home must have a registered manager who has the qualifications and experience to fulfil the role. The proprietor had confirmed in previous discussions that he has no role in providing personal care or the care documentation in place. There was no evidence that the proprietor participated in the team meetings held at 1 New Road. The assistant manager stated that the registered manager completes the repairs in the home and orders all stock for example the weekly shopping. Staff spoke positively about the support offered by the proprietors although this support in the main was delivered by telephone or by regular contact at Bedrock Lodge. The registered manager of the Gables visits for brief periods during the week and completes audits on the medication, however as yet does not get involved in any other aspect of the management of the home. One resident spoke positively about the proprietors and stated that they really liked living in 1 New Road and the security that this offered them. The individual was advocating for all individuals with a mental health to live in a home like Bedrock and 1 New Road. Another resident stated, “You will not find a better home in Bristol”. Residents confirmed that they had individual planning meetings and regular resident meetings where their views could be heard. The home completes an annual survey, however these were not seen on this occasion. Staff attend courses relating to health and safety as part of their induction (as already stated one staff member has worked in the home since March and has not completed an induction). The assistant manager stated that two staff have a first aid certificate and a further two staff have this training planned. Certificates were seen. One member of staff has a current food hygiene certificate and this was obtained in their previous workplace. From discussions with staff once staff have completed their induction there is no refresher on health and safety training. The home must develop a training plan for individual staff members and as a team collectively. Health and safety in general was reviewed and whilst staff described the action they took to ensure the safety of residents there was a lack of documentation in the form of risk assessments or within plans of care. Policies and procedures were not seen on this site visit. Fire risk assessments were in place and these had been kept under review. The fire record demonstrated that equipment in the home was being routinely checked in accordance with the fire brigade’s recommendations. However, drills were not taking place six monthly for all staff, and whilst there was evidence of six monthly fire training this was not at the prescribed intervals of three monthly for night staff. The assistant manager has responded to this and 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 29 has sent in a copy of the fire record which demonstrates that all staff have now taken part in a fire drill. Minor accidents and incidents were recorded and more serious accidents and incidents affecting the well-being of residents had been reported to the Commission for Social Care Inspection. 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 1 3 X 4 3 5 3 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 3 26 2 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 2 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 1 2 3 X X 2 x 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 31 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4 (1) (c) Requirement To review the statement of purpose including the information as detailed in this report (standard 1) ensuring compliance with schedule 1 of the Care Homes Regulations. The home to apply for a variation to include mental health to the conditions of registration. The registered person must ensure that all resident’s care plans are expanded to give clear direction to staff on all aspects of care of the individual. Daily records must give more detail – for example the implementation of goals, behaviour, and social activities to enable the home to fully review care given. For staff to have training in diabetes and the plan of care to be expanded to give staff clear guidance. All risks must be clearly documented including social activities, care of substances hazardous to health, access to the kitchen and risk assessments DS0000058581.V302448.R01.S.doc Timescale for action 04/09/06 2. YA2 Care Standards Act 12 (2), 14 15 30/09/06 3. YA6 04/09/06 4. YA6 15 (2) (b) 04/08/06 5. YA19 (15) (2) 18 (1) (c) (i) 15, 13 (4) 04/08/06 6. YA9 04/08/06 1 New Road Version 5.2 Page 32 7. YA7 23 8. YA20 13 9. YA23 13 (6) 10. YA35 18 (1) (c) (i) 18 (1) (c) (i) 11. YA35 12. 13. YA32 YA34 18 (1) (c) (i) 19 14. YA37 8 in place need expanding to detail strategies for staff to follow to minimise the risks whilst encouraging independence of the individual. Documentation must be in place supporting the decision process for the second locking facility that has been fitted to one bedroom door, the switching off the water to one individuals bedroom and the locking of the front door as this could impinge upon residents’ rights. This must be kept under review. The home must ensure that all prescribed medication is recorded on the record of medication. The provider must review the policy on abuse to ensure that it complies with the Department of Health’s guidance on “No Secrets”. All staff must attend training in mental health based on the care needs of the individuals accommodated in the home. A training plan must be developed for individuals and the home collectively. Clearly stating frequency of training. A copy to be sent to the Commission for Social Care Inspection. Staff must complete an induction within the timescales as detailed by Skills for Care. That a CRB disclosure application is made prior to appointment and that a ‘POVA first’ check is carried out before each new staff member commences employment. (Outstanding since 31/05/06) That this service has a qualified, competent manager that is working in the home a sufficient number of hours to run the DS0000058581.V302448.R01.S.doc 04/08/06 06/07/06 16/07/06 04/09/06 04/09/06 04/08/09 04/07/06 04/09/06 1 New Road Version 5.2 Page 33 home for the benefit of residents and in order to comply with the Care Homes Regulations 2001. (Outstanding requirement date for compliance 01/07/06). A record of the management hours must be maintained. 15. 16. YA42 YA42 23 (4) (e) 23 (4) (d) For staff to attend a drill once in a six month period. All staff to attend fire training – six monthly for day staff and three monthly for night staff. 28/07/06 28/07/06 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. 2. 3. Refer to Standard YA20 YA6 YA23 Good Practice Recommendations That the Medication Competency Assessment is reviewed to show what aspects of competency have been reassessed. (Outstanding) Date and sign risk assessments and care documentation. The provider should consider ways to enable residents to have more control over their personal finances within the management of risk and that information and individual’s finances are held in the home. Replace the bed in room 4 in consultation with the resident concerned. Induction should be to the National Training Organisation’s (Skills for Care) standards. (Outstanding) Staff to attend at least 5 days training per annum or prorata for part time staff. That all staff receive formal supervision at least six times per annum. (Outstanding) For the home to obtain the data sheets in respect of Care of chemicals Hazardous to Health (COSHH)- in accordance with the COSHH Regulations 1999. 4. 5. 6. 7. 8. YA26 YA35 YA35 YA36 YA42 1 New Road DS0000058581.V302448.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 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.V302448.R01.S.doc Version 5.2 Page 35 - 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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