CARE HOME ADULTS 18-65
Berwick Bridges 4a Roberts Lodge Tweedmouth Berwick Upon Tweed Northumberland TD15 2YN Lead Inspector
Deborah Haugh Unannounced Inspection 15th January 2006 10:00 Berwick Bridges DS0000000617.V258098.R01.S.doc Version 5.0 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 Berwick Bridges DS0000000617.V258098.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 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. Berwick Bridges DS0000000617.V258098.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Berwick Bridges Address 4a Roberts Lodge Tweedmouth Berwick Upon Tweed Northumberland TD15 2YN 01289 - 303173 01289 - 303173 bbt.berwick@btinternet.com 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) Berwick Bridges Limited Mrs J A Murray Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Berwick Bridges DS0000000617.V258098.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Of whom 2 may have an additional physical disability Date of last inspection 4th August 2005 Brief Description of the Service: Berwick Bridges, at 4a Roberts Lodge, provides care and support for up to six individuals with a learning disability. The Home is a purpose built bungalow and is situated in a small residential estate in Tweedmouth, on the outskirts of Berwick upon Tweed. Community facilities are within walking distance and Berwick is only a short drive or bus ride away. The Home has an adapted people carrier and the area is well served by public transport. The accommodation includes six single bedrooms, plus a staff ‘sleep-in’ room, an open plan lounge, dining and kitchen area and a separate utility room. Adequate toilets and bathing/showering facilities are provided. The Home is domestic in character and decorated and furnished to a good standard. There is an enclosed garden/patio area to the side of the building as well as a small car park. The Service is operated by Berwick Bridges Ltd. a voluntary organisation that was set up to provide a service for people with learning disabilities from the local area. Berwick Bridges DS0000000617.V258098.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on 15/01/06 at 10.00am at the weekend. At the time of this inspection Ursula Donnelly, senior support worker was the senior on duty. There were 6 service users at the time of the visit and staffing levels were checked. Time was spent looking at the kitchen, lounge, toilets, bath ands showers and laundry to check the cleanliness, maintenance and decoration. Two service users invited the inspector to see their bedrooms. Service users shared their views about the home. Time was also spent observing the contact between service users and staff. Care planning arrangements were examined. Arrangements for the protection of vulnerable adults (POVA), staff training, the homes Statement of Purpose, recruitment and quality assurance were checked. Fire safety training was also inspected. What the service does well:
The service users who live at Berwick Bridges are encouraged and supported to be as independent as possible and this was observed during the visit. Service users said they did their own laundry, hanging washing out on the line, drying clothes and ironing (if able). People take turns and help out with household chores such as drying dishes, taking the bins out and cleaning their own bedrooms. People were seen to pursue their own interests such as walking, watching videos and spoke about things they enjoy, - ‘I like Eastenders.’ - ‘I’m having a birthday party, I’m going to be 40.’ - ‘I like swimming, I have a cup.’ - ‘We had a long walk.’ - ‘ I chose my bedroom colours, I like blue.’ - ‘Ursula is my key worker.’ - ‘We went to Edinburgh yesterday to choose a suite.’ Staff work to the principles of valuing people and Berwick Bridges is the service users own home. Staff involve service users in decision making, discussions and taking ownership of their home and other aspects of their lives. The training needs of staff are identified. The home has exceeded the minimum standard for NVQ Level 2 training for staff (50 at NVQ Level 2 by 2005) at 57 .
Berwick Bridges DS0000000617.V258098.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. Berwick Bridges DS0000000617.V258098.R01.S.doc Version 5.0 Page 7 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 Berwick Bridges DS0000000617.V258098.R01.S.doc Version 5.0 Page 8 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 (NMS 2 was assessed and met at the last inspection) The Statement of Purpose reflects the service provided in the home. EVIDENCE: 1) The aims and objectives of Berwick Bridges have have been reviewed in light of the changing needs of service users. The Home’s Statement of Purpose has been amended to reflect the changes arising from the review. Berwick Bridges DS0000000617.V258098.R01.S.doc Version 5.0 Page 9 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, (NMS 7 & 9 were assessed and met at the last inspection) Person Centred Planning will be introduced and so plans of care will adequately address the longer term and anticipated needs of the residents. EVIDENCE: The Registered Manager is working towards Person Centred Planning with service users where goals and aspirations are identified as well as daily living needs and strengths. Documentation is in place. Staff will also receive training and the schedule was seen. Berwick Bridges DS0000000617.V258098.R01.S.doc Version 5.0 Page 10 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): 15 & 16 (NMS 12,13 & 17 were assessed and met at the last inspection) Service users maintain relationships with family and friends. Service users rights are respected. EVIDENCE: 15) Service users are actively supported to maintain relationships and make new ones. One persons family live abroad and an Internet connection is available to keep in contact. During the inspection service users took private telephone calls. 16) Routines in the home are centred on the preferences and needs of the service users. This was observed during the visit and from talking to service users. Service users explained the choices and turns, which they take to help out in the home and plan activities, outings, menus and decisions. Berwick Bridges DS0000000617.V258098.R01.S.doc Version 5.0 Page 11 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): 21 (NMS 18, 19 & 20 were assessed and met at the last inspection) Appropriate arrangements are being made for consulting with service users about their wishes in relation to growing older, terminal illness and death which will empower them. EVIDENCE: 21) A workshop is planned with service users, who want to discuss their wishes should they become ill and getting older. Documentation is in place. Staff will also receive training and the schedule was seen. Berwick Bridges DS0000000617.V258098.R01.S.doc Version 5.0 Page 12 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): 23 (NMS 22 was assessed and met at the last inspection) Systems are in place to protect service users from abuse EVIDENCE: Staff have received training in abuse and the Protection of Vulnerable Adults (POVA). More training is planned for all staff. Staff are aware of Whistle Blowing and reporting poor practice. Physical Intervention training is also planned to take place. Berwick Bridges DS0000000617.V258098.R01.S.doc Version 5.0 Page 13 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 & 30 Service users live in a home, which is suitable for their needs. Infection control measures protect service users. EVIDENCE: 24-26) Time was spent looking at the kitchen, toilets, bath ands showers, lounge and laundry to check the cleanliness, maintenance and decoration. Two service users invited the inspector to see their bedrooms. The home is proposing to improve the following facilities in the October 2005 Statement of Purpose; - Improve the exit from the side of the house (wheelchair width) - Fencing being replaced in Spring 2006 - Possible replacement of the suite. (Service users travelled to Edinburgh 14/01/06 to select new suites). - Possible redecoration of the living and kitchen areas. Service user bedrooms are personalised and people have chosen their own decoration and layout. Each one reflects the interests and wishes of the person.
Berwick Bridges DS0000000617.V258098.R01.S.doc Version 5.0 Page 14 30) The cleanliness and maintenance of the home is good and everyone helps to keep the home clean and tidy. There were no concerns identified at this inspection in relation to infection control. The laundry is used by everyone and was organised and equipment maintained. The kitchen was clean and well maintained. Berwick Bridges DS0000000617.V258098.R01.S.doc Version 5.0 Page 15 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, 33, 34 & 35 Staffing numbers are appropriate to the assessed needs of the residents, size, layout and purpose of the home, at all times. Service users are cared for by staff that are trained and competent. Recruitment arrangements must be robust and protect service users. EVIDENCE: 33) The staffing levels are adequate to meet the needs of service users. A minimum of two care staff are on duty throughout the day and at night (one person sleeping in and an on call facility). Shifts are planned to suit the needs of the service users and to support them in their daily lives both at Roberts Lodge and within the community. A designated senior member of staff is on duty in the absence of the Manager. The home has two additional bank staff. 32) & 35) Staff are provided with mandatory training such as First Aid, Food Handling, Moving and Handling, Infection Control and Fire Safety. Refresher training is identified. Training programmes are in place and linked to staff appraisal and supervision. The home has 57 of care staff with at least NVQ Level 2. The National Minimum Standard is 50 by 2005 so the home has exceeded this. Two staff are completing NVQ Level 3 and Level 2.
Berwick Bridges DS0000000617.V258098.R01.S.doc Version 5.0 Page 16 Training plans for 2006 are Person Centred Planning, Medication, Fire Safety, Physical Intervention, Dementia, Communication, Death, Dying and Bereavement. Staff have received training in abuse and protection of vulnerable adults (POVA). Further training is planned from April 2006. New staff complete the Learning Disability Award Framework (LDAF). It is recommended that copies of training certificates be consistently retained in staff training files. 34) The Registered Person was not on duty and so confidential recruitment and staff records were not accessible. A Criminal Records Bureau certificate relating to a requirement from the last inspection was available. Other recruitment checks could not be made and staff records required under Schedule 2 of the Care Homes Regulations 2001 will be checked at the next inspection. Berwick Bridges DS0000000617.V258098.R01.S.doc Version 5.0 Page 17 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, 39 & 42 Service users live in a home with robust management arrangements. Quality assurance systems are informally in place. Formal systems are due to be implemented to ensure the home continues to meet the service users needs and objectives of the home. Fire Safety arrangements ensure that service users are protected. EVIDENCE: 37) The Registered Manager has recently completed the Registered Managers Qualification NVQ Level 4. She is undertaking NVQ Level 5 Diploma in Management. Staff spoke positively about the leadership in the home and opportunity to engage in discussions and training. 39) The homes Quality Assurance/Review is planned to be undertaken alongside service users and staff using the British Institute of Learning Disability (BILD) publication ‘My Life.’ Berwick Bridges DS0000000617.V258098.R01.S.doc Version 5.0 Page 18 Informally service users participate in bi-monthly meetings and a range of subjects are discussed which reflect people taking decisions about the quality of their lives. Monthly monitoring visits to the Home were being carried out under Regulation 26. 42) The Fire Safety arrangements were examined and maintenance/service checks are in place. Suitable checks are made regarding emergency lighting, alarms, fire extinguishers and fire doors. Staff now receive fire instruction and take part in fire drills at the frequency recommended by the Fire Authority. One of the support staff is a competent fire warden. At the last inspection it was recomemnded that the Homes Fire Risk Assessment should include reference to the frequency staff should participate in fire drills. Berwick Bridges DS0000000617.V258098.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 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 X X X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 4 3 2 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Berwick Bridges Score X X X 2 Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X 3 X DS0000000617.V258098.R01.S.doc Version 5.0 Page 20 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 YA6 Regulation 15 Requirement Residents individual plans of care need to be developed to address each persons anticipated long term needs. (Previous timescale of 31.5.05 not met.) All Service Users, supported by a representative where required, must be given the opportunity to express their wishes in relation to dealing with growing older, terminal illness and death. This information must be recorded as part of each person’s individual assessment. (Timescale of 31.05.05 not met) The Registered Person must ensure that: 1. The information and documents specified in Schedule 2 of the Care Homes Regulations 2001 is in place for each person working at the Home and available for inspection. Timescale for action 31/03/06 2 YA21 12 & 17 31/03/06 3 YA34 19 31/01/06 Berwick Bridges DS0000000617.V258098.R01.S.doc Version 5.0 Page 21 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 YA39 YA35 YA42 Good Practice Recommendations Take action to implement the Homes Residents Quality Assurance Policy. Retain copies of training certificates consistently in staff training files. Revise the Homes Fire Risk Assessment to include reference to the frequency staff should participate in fire drills. Berwick Bridges DS0000000617.V258098.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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