Inspection on 14/02/06 for Bernash

This inspection was carried out on 14th February 2006.

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 but made no statutory requirements on the home.

Other inspections for this house

Bernash 17/10/06

Bernash 18/10/05

Bernash 12/10/04

Bernash 06/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Bernash 544-546 Wells Road Whitchurch Bristol BS14 9BB Lead Inspector Sandra Jones Unannounced Inspection 09:30 14 March 2006 th X10015.doc Version 1.40 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 Bernash DS0000026497.V283495.R01.S.doc Version 5.1 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 Older People. 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. Bernash DS0000026497.V283495.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Bernash Address 544-546 Wells Road Whitchurch Bristol BS14 9BB 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) 01275 833670 01275 545342 bernash@bernash.fsnet.co.uk Ms Beryl Nash Mrs Deborah Williams Care Home 23 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (17) of places Bernash DS0000026497.V283495.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th October 2005 Brief Description of the Service: Bernash is a detached property that can provide personal care and accommodation for 23 older people. It is arranged over two floors with a passenger and stair lifts to the first floor for less mobile residents. There are two double bedrooms and thirteen bedrooms are en-suite. Shared space is on the ground floor and consists of a lounge, dining area and conservatory. The property is on a main road, with shops, local amenities and bus routes located nearby. Bernash DS0000026497.V283495.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit was conducted over one day in March 2006. The inspection was based on key standards not inspected in 12 months. Residents feedback on the standards of care was sought and staff were consulted on the conduct of the home. Other sources used to confirm the outcomes for residents living at the home included a tour of the premises and assessment of the records kept at the home. The opportunity arose during the inspection to join residents for the lunchtime meal. The meal provided by the home was appetizing and well presented. What the service does well: What has improved since the last inspection? Since the last inspection, the manager has responded in a positive manner to the requirements made. There is now an emphasis on developing a person centred approach to meeting residents needs. A change in the staffing rota has taken place and waking staff are employed to cover night duty. It is evident from the changes that staffing levels are monitored to ensure residents needs are met. Bernash DS0000026497.V283495.R01.S.doc Version 5.1 Page 6 What they could do better: 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. Bernash DS0000026497.V283495.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bernash DS0000026497.V283495.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not examined at this inspection. EVIDENCE: Bernash DS0000026497.V283495.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&9 Care plans provide the basis for their needs to be met. Preferred routines must be incorporated onto the action plans to establish that individuals wishes are ascertained and taken into account. Risks are evaluated and action plans to minimise the risk to the individual are completed. Residents are protected by the safe practices of medication administration, recording. EVIDENCE: Care plans were reviewed since the last inspection. Action plans are clear and guide the staff to meet the person’s assessed needs. Key elements of rights, choice, independence are used within the format with likes and dislikes incorporated to further the person centred approach to meeting needs. The individuals preferred routines must be added to the plans of action to fulfil a person centred approach. It is the responsibility of the keyworker to review care plans monthly, which follow the progress and achievement of the action plan. It was understood that in future background histories will be appended Bernash DS0000026497.V283495.R01.S.doc Version 5.1 Page 10 onto the care plans. Background histories reinforce to staff that the individual has contributed and is a part of society. This is seen as good practice Risk assessments are completed for activities that may involve an element of risk including manual handling. Medications are administered through a monitored dosage system. Records of administration confirmed that staff sign the records immediately after administration. Homely remedies are administered from a stock supply by the staff when required by the resident. The records of administration are up to date and accurate. Medication profiles are in place and list the name of the medication, their purpose and side effects. Compatibility with homely remedies and the date the medication was prescribed is included within the profiles. Information leaflets provided by the pharmacist are available for further information. Bernash DS0000026497.V283495.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above 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&14 Residents are enabled by the staff to maintain their chosen lifestyles and the range of leisure activities provided ensure residents are alert and can engage in conversation. It was confirmed by residents that their visitors are welcome at all times. Members of staff support residents’ friends and family to assist residents in developing control over their lives. EVIDENCE: Care plans list the person’s likes, dislikes and preferred routines in terms of activities and leisure interests. Action plans that include daily routines must be developed to ensure that residents chosen lifestyle are maintained at the home. Organised entertainment occurs monthly from outside facilitators. Entertainers and reminiscence groups are arranged by the home. Other activities organised by the staff take place each afternoon. During the inspection residents were given the opportunity to select the activity. On the afternoon of the inspection, the group decided to play Bingo with prizes. Residents consulted during the inspection described the arrangements for recreational activities. Each morning one member of staff will lead residents with gentle exercises in the conservatory. More structured activities are organised in the afternoons. Bernash DS0000026497.V283495.R01.S.doc Version 5.1 Page 12 From the feedback sought from residents, there are a number of residents that prefer to remain in their bedroom and not socialise with other residents. It was reported that watching television in their bedrooms and pursuing hobbies were the means used to remain occupied during the day. For example, horse racing, reading and maintaining contact with friends. Members of staff welcome visitors to the home at any time. Residents confirmed that their visitors are welcome and visits can take place in their bedrooms for additional privacy. There are no restrictions currently imposed on visitors. Spiritual leaders visit the home for residents that have spiritual needs, other volunteers and community groups do not visit. The staff and residents friends and their relatives provide support with managing finances. Generally residents receive the part of their full personal allowance entitlement. Residents have access to the records kept on their behalf. The residents currently accommodated have input into their care from friends and family. Information about advocates is accessible at the home. Bernash DS0000026497.V283495.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17&18 Residents feel able to raise concerns and complaints and their comments expressed confidence with service provider in resolving their concerns. It is clear that the service provider takes protective issues seriously. Staff working directly with residents must attend external POVA training to be able to recognise forms of abuse and take appropriate action. Residents legal rights are promoted by the staff at the home. EVIDENCE: There were no complaints received at the since the last inspection. Residents were clear about the procedure for making complaints. They named the persons to be approached and expressed their confidence with their abilities to resolve issues raised. The residents are registered onto the electoral role and information on advocacy is available for residents. There were no allegations of abuse received at the home since the last inspection. It was understood from the manager that not all staff have attended POVA training. While the information is available for staff to read, external training for the staff must be considered to clarify procedures in line with “No Secrets” in Bristol. Members of staff must attend external POVA training to ensure staff working directly with residents are able to recognise forms of abuse and take appropriate action. Bernash DS0000026497.V283495.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22 The property is well maintained and fits its purpose. Residents are able to maintain their chosen lifestyle. There are sufficient public areas for shared activities and for private use. Toilets and bathrooms are within close proximity to bedrooms and shared space, as the ratio is above NMS the home can meet the needs of the residents. Equipment and Aids are provided to ensure that residents with mobility impairments can move around the home independently. The home is clean and free from unpleasant smells. EVIDENCE: Bernash is a detached property offering accommodation over two floors with passenger lifts and stair lift to ensure residents independence. Accommodation is mainly in single occupancy, however, there are two sharing rooms. The home is well furnished and domestic in style, with a comfortable and homely atmosphere. Shared facilities consist of a lounge, dining room and conservatory. There is a large lounge at the front of the premises, with seating for 11 people and in the conservatory there is seating for a further 11 people. The dining are leads into Bernash DS0000026497.V283495.R01.S.doc Version 5.1 Page 15 the conservatory and there is more seating with sufficient tables and chairs for the residents to sit together and eat their meals. As thirteen rooms are en-suite the ratio of people sharing communal toilets is 2:8. Toilets and bathrooms are in close proximity to bedrooms and shared space. On the first floor there are two assisted bathrooms and an unassisted bathroom on the ground floor. There is a passenger and stair lift to assist residents with mobility impairments to move around the home independently. Grab rails and assisted bathing facilities are installed to maximise residents independence in the home. With the exceptions of two, bedrooms are single. The double bedrooms are en-suite offering privacy with personal care. Bedrooms contain a combination of the home’s furniture and personal belongings and are furnished and equipped to meet the needs of the individual. Privacy is promoted through lockable doors with additional lockable space in bedrooms. The laundry room is sited away from the kitchen. The floor covering and walls are impermeable making surface readily cleanable. The washing machine has a specific programme for sluicing and there is a tumble dryer. Bernash DS0000026497.V283495.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 Staffing levels are monitored to ensure that the number of staff on duty can meet the changing needs of the residents. EVIDENCE: A senior member of staff and two care assistants are rostered with ancillary staff for cleaning and cooking. Three members are on duty from 7:30 – 10:00 pm, at night two staff are rostered for waking nights. The manager is generally on duty between 9:30-3:00. The staffing changes introduced for waking nights indicate that staffing levels are monitored to meet the needs of the residents. It was understood that members of staff working in the home are over 18 and staff left in charge of the home are over 21 years. Ancillary staff for cooking and cleaning are employed at the home. Bernash DS0000026497.V283495.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31&38 The manager must consider further training for personal development to maintain the established standards of care within good practice guidelines. The manager ensures compliance with associated legislation to promote a safe environment for residents and staff. For this reason data sheets and risk assessments must be completed for chemicals and substances used at the home. EVIDENCE: The manager has completed NVQ level 4 and since the last inspection has attended the external course on Infection Control. While the manager has completed POVA training, consideration must be given to the external course for providers and managers. The course will provide the manager with insight Bernash DS0000026497.V283495.R01.S.doc Version 5.1 Page 18 into multidisciplinary team working and clarify the procedures for allegations of abuse. In terms of personal development, the manager has not undertaken the RMA since completion of the level 4. Further training in the care of the elderly must be considered to ensure that the standards of care in place follow current good practice. Members of staff complete statutory training in moving and handling, fire safety and first aid. Since the last inspection, members of staff attended external infection control training. There are three boilers at the home, which are serviced annually by a competent contractor. Arrangements are in place for annual PAP testing of electrical equipment and appliances at the home. The local pharmacist visits the home to check storage and ordering of medications and to offer advice on safe handling of medicines. A company registered to manage the collection of waste removes clinical waste from the home. The records that relate to fire safety checks and practices were examined. Records suggest that checks and practices take place at the stipulated frequencies. Call bells, passenger lifts, stair lifts, hoists are serviced annually to ensure the safety of residents and staff. Chemicals are kept in a locked cupboard in the laundry, notices are displayed to maintain staff safety when using these chemicals. However, data sheets and risk assessments for each chemical used at the home. Records of accidents and incidents for residents and staff are maintained. Descriptions of the accident and the actions to be taken to minimise the risk are recorded in the accident book. Bernash DS0000026497.V283495.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x x x 2 Bernash DS0000026497.V283495.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? yes 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 2 Standard OP7 OP31 Regulation 12(3) 10 Requirement Care plans must incorporate residents preferred routines. The manager must consider attending external POVA training for providers and managers. b) RMA and care of the elderly for personal development. Data sheets and risk assessments must be completed for all chemicals and substances used at the home. Timescale for action 30/06/06 30/06/06 3 OP38 23 30/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bernash DS0000026497.V283495.R01.S.doc Version 5.1 Page 21 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 Bernash DS0000026497.V283495.R01.S.doc Version 5.1 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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