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Inspection on 18/10/05 for Bernash

Also see our care home review for Bernash for more information

This inspection was carried out on 18th October 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

One resident consulted reported that "the home could not be criticised in any way". During the inspection, residents were alert, stimulated and able to clearly express their views about the standards of care. Their comments indicated that staff promote and respect their rights, that their views are sought, and that they had confidence with the staff approach to any concerns they had. Members of staff follow policies and procedures that offer guidance on the approach to the provision of care at the home. Members of staff observed interacting with residents maintained eye contact and full attention. Feedback from relatives was sought through questionnaires in January/February 2005. A good response with positive comments was received about the standards of care at the home. Residents` health care needs are assessed and the manager ensures access to health care professionals to meet their assessed needs.

What has improved since the last inspection?

Since the last inspection, the exterior of the property has been updated and windows are being replaced.

What the care home could do better:

Requirements made at this inspection are based on reviewing the Statement of Purpose, developing the care planning process and medication practices.

CARE HOMES FOR OLDER PEOPLE Bernash 544-546 Wells Road Whitchurch Bristol BS14 9BB Lead Inspector Sandra Jones Unannounced Inspection 18th October 2005 09:30 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.V255152.R01.S.doc Version 5.0 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.V255152.R01.S.doc Version 5.0 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.V255152.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th October 2004 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.V255152.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced visit conducted in October 2005 with the manager, residents and staff. There were no additional visits to the home since the last inspection. The home has not been identified as needing any monitoring visits, to examine compliance with requirements. The manager has kept the CSCI office informed of events and occurrences through Regulation 37 notifications. Feedback from residents and staff were sought to confirm the standards of care. Records were examined to support the finding of the visit. What the service does well: What has improved since the last inspection? Since the last inspection, the exterior of the property has been updated and windows are being replaced. Bernash DS0000026497.V255152.R01.S.doc Version 5.0 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.V255152.R01.S.doc Version 5.0 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.V255152.R01.S.doc Version 5.0 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): 1, 2, 3, 4 & 5 For potential residents to make a decision about living at the home, the Statement of Purpose must incorporate more information. The Terms and Conditions of residency in place inform residents about the arrangements for the payment of fees, additional charges and expectations of both parties. Documentation in place confirmed that in advance of any admissions to the home, residents’ needs are assessed. Members of staff have the skills and capabilities to meet the registered category of needs. Trial periods are offered before permanent residency to assist with the decision making about living at the home. Bernash DS0000026497.V255152.R01.S.doc Version 5.0 Page 9 EVIDENCE: The Statement of Purpose provides an overview of the intended services and facilities. As the document requires updating, further details must be added to fully evidence the approach to the provisions of care. In terms of the staffing, the intended levels throughout the day and night must be described. While the range of needs is defined and the criteria listed, the information must be more detailed. The arrangement for privacy and dignity is missing and must be incorporated into the document. The Terms and Conditions of residency is detailed and describes the arrangements for the payment of fees and additional costs not included in the charge. Information regarding personal possessions, rules and expectations of both parties in included. The procedure for termination of residency and for making complaints is appended onto the agreement. For residents placed by the Local Authority, social workers needs assessments are in place. The manager conducts initial assessments for residents that self fund their placement. The home has a registration category for older people including six people with dementia. To meet the needs of the category, members of staff have training through the NHS. Contact with the NHS remains through one person that will assist with the provision of care. Evidence was provided that as residents’ needs change, training and guidance is provided. The staff at the home follow the procedure for new admissions before permanent residency is offered. Emergency admissions are avoided and following the week trial period, a review meeting is held to discuss long term arrangements. Bernash DS0000026497.V255152.R01.S.doc Version 5.0 Page 10 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, 8, 9 & 10 Care plans list the individuals needs along with the action to be taken by the staff to meet the needs. A more person centred approach must be incorporated for residents to have a more meaningful input into the action plan. Residents’ health care needs are assessed and the manager ensures access to health care professionals to meet their assessed needs. Although there generally safe practices for the administration and recording of medications, medication profiles need to be developed and the practice of decanting homely remedies into more convenient receptacles must cease, as it is open to errors. Although residents felt their privacy and dignity were respected, a Privacy and Dignity policy must be formulated to confirm the expected and established practices at the home. Bernash DS0000026497.V255152.R01.S.doc Version 5.0 Page 11 EVIDENCE: The case records of four residents were examined and care plans, risk assessments and monthly reports are kept and accessible to staff. It is evident that from the initial assessment and social workers care plans, home’s care plans are developed. Needs identified are listed along with the actions needed to meet the need. While care plans describe the actions in sufficient detail, a person centred approach should be considered. For example, likes, dislikes and preferred routines. For residents with dementia, care plans must incorporate additional information about their safety and communication needs. Risk assessments are in place for activities that may involve an element of risk. For example, Self-administration of medicines and leaving bedroom doors. From the records in place, one person has a pressure sore, which is managed by the district nurse. The district nurse visits twice weekly and to relieve the pressure sore aids and equipment is provided. Eight residents have continence difficulties and there is input from the Continence Advisor on the most suitable aids. Continence programmes are included in the person’s care plans. It was understood from the manager that resident visit their dentist as needs arise, the chiropodist and optician visit the home. An Audiologist visits the home twice yearly and for repairs of hearing aids the local clinic is used. There is a passenger lift and two chair lifts to assist less mobile residents with accessing the first floor. The corridors are wide for residents that use aids to move around the home. Handling belts, slide sheets are used by the staff for manual handling, with assisted baths for residents that cannot get in and out the bath without assistance. Medications are administered from a monitored dosage system by competently trained staff. Records of administration examined indicated that staff sign the record immediately after administering medicines. A record of medicines no longer required is maintained. The pharmacist countersigns the record to indicate receipt of the medication for disposal. Homely remedies are administered from a stock supply when required by the residents. The records indicated that safe systems of administration and recording exist at the home. However, the staff decant the remedies into more convenient containers for staff to use. This practice can be confusing and open to errors. The manager must seek more suitable way of handling homely remedies. Bernash DS0000026497.V255152.R01.S.doc Version 5.0 Page 12 Medication profiles are not currently in place. Drug profiles that describe the purpose of the medication, its side effects and compatibility with homely remedies must be devised. Information leaflets must then be appended onto the profiles. The written arrangements for promoting privacy and dignity are not currently in place. The residents giving feedback confirmed that their rights are promoted at the home. Staff knock and wait before they enter bedrooms, personal care tasks are conducted in private and GP’s visits take place in their bedrooms. In terms of residents records, the Record Keeping policy stipulates that residents have access to their records. The arrangements for sharing information are clearly described in the Confidentiality policy. Supplementary information about sharing information with third parties should be added to the policy. Bernash DS0000026497.V255152.R01.S.doc Version 5.0 Page 13 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): These standards were examined at the previous inspection where commendable practices were identified. EVIDENCE: Bernash DS0000026497.V255152.R01.S.doc Version 5.0 Page 14 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 Residents confirmed that the staff would take their concerns seriously and act upon them. EVIDENCE: The home’s Complaints procedure is on display in the home and appended onto the Statement of Purpose. The steps to be taken by the individuals wishing to make a complaint are detailed within the procedure, along with the telephone number and address of the CSCI. There were no complaints received at the home for investigation since the last inspection. Residents consulted confirmed that their views are sought. Confidence with the staff approach to their concerns was expressed. Bernash DS0000026497.V255152.R01.S.doc Version 5.0 Page 15 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): These standards were assessed at the last inspection and there were no shortfalls identified. EVIDENCE: Bernash DS0000026497.V255152.R01.S.doc Version 5.0 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): These standards were assessed at the last inspection and there were no shortfalls identified. EVIDENCE: Bernash DS0000026497.V255152.R01.S.doc Version 5.0 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): 32, 35 & 38 The systems in place ensure there is an inclusive atmosphere, which benefits the residents. Records of cash and valuable were up to date and in order safeguarding residents financial interests. Fire safety checks and practices maintain a safe environment for residents and staff. EVIDENCE: The residents were alert and able to air their views. Their feedback about the staff was positive and their comments indicated that staff respected them as individuals. Bernash DS0000026497.V255152.R01.S.doc Version 5.0 Page 18 Members of staff described the systems in place that ensured consistency of care. Staff meetings and shift meetings were described as essential for continuity. Additional comments were made by the staff about communications including the suggestion box, which improved the service. Teamwork and resolving issues between staff promptly were other means used to ensure an inclusive atmosphere is maintained. The rota in place indicates that three staff are on duty throughout the day with the manager acting as supernumerary. At weekends the service provider undertakes the role of a senior carer. Currently there is one waking and one sleeping in the premises at night. It was understood from the manager that the night cover arrangements are being considered. In future there may be two waking staff to meet the current needs of the residents accommodated. Facilities for the safekeeping of cash and valuable exist at the home. Cash records were examined during the inspection and the records were consistent with the balances. The records that relate to fire safety checks and practices were examined which are conducted at the stipulated frequencies. Bernash DS0000026497.V255152.R01.S.doc Version 5.0 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 2 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 x x 3 x x 3 Bernash DS0000026497.V255152.R01.S.doc Version 5.0 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 Standard Standard 1 Regulation Reg.4 Sch.1 Requirement Timescale for action 30/01/06 2 3 4 Standard 7 Standard 9 Standard 9 Reg.12.3. Reg. 13(2) Reg.13(2) The Statement of Purpose must be reviewed to fully describe the staffing levels, the admission process and the arrangements for privacy and dignity. The likes, dislikes and preferred 30/04/06 routines must be incorporated into the care plans. The practice of decanting homely 30/10/05 remedies into another container must cease. Drug profiles must be developed. 30/01/06 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.V255152.R01.S.doc Version 5.0 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.V255152.R01.S.doc Version 5.0 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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