Inspection on 26/10/07 for Bradbury Home

This inspection was carried out on 26th October 2007.

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 but made no statutory requirements on the home.

Other inspections for this house

Bradbury Home 03/04/09

Bradbury Home 03/04/08

Bradbury Home 27/04/07

Bradbury Home 22/11/05

Bradbury Home 09/06/05

Bradbury Home 24/01/05

Bradbury Home 26/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Bradbury Home 2 Roots Hall Drive Southend on Sea Essex SS2 6DA Lead Inspector Ms Vicky Dutton Unannounced Inspection 26th October 2007 08:30 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 Bradbury Home DS0000034348.V348888.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 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. Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bradbury Home Address 2 Roots Hall Drive Southend on Sea Essex SS2 6DA 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) 01702 435838 01702 434406 The Salvation Army UK Territory Vacant Care Home 36 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (36) of places Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Number of service users for whom personal care is to be provided must not exceed 36 (total number not to exceed thirty six) Personal care to be provided to no more that 36 older people over the 65 years of age (total not to exceed thirty six) Personal care to be provided to no more than 10 service users with dementia over the age of 65 years of age (total not to exceed ten) 27th April/24th May 2007 Date of last inspection Brief Description of the Service: Bradbury is a purpose built home which opened in May 1992 and is run by the Salvation Army. Accommodation is provided over three floors that are accessed by a shaft lift. There are 32 single rooms and 2 double rooms. All rooms are en suite. The first and second floors have lounge areas and an attached kitchenette, where residents could prepare their own snacks and drinks. One of these areas is used as a quiet contemplation and prayer area, and the other is set up as a space where activities can take place. On the ground floor there is one large lounge area for residents to use. Meals are served in a pleasant dining room that overlooks the garden. There is a hairdressing room and a treatment room so that residents can meet with nurses, chiropodists and other health professionals in private. The garden has patio areas and seating. Ramps allow access for those residents who use wheelchairs. The garden is secure. A staff room with lockers and a kitchenette is also provided. Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced ‘key’ site visit. The visit took place over a nine hour period. At this inspection all the key standards were considered. The home’s compliance with requirements made at the previous inspection was assessed. Following the previous inspection the home had been required to complete an improvement plan to show how they were going to make improvements to the home to benefit residents in line with the requirements made. Their success in achieving their improvement plan was also considered. At the site visit a tour of the premises took place, care records, staff records, medication records and other documentation were selected and various elements of these assessed. Time was spent talking to, observing and interacting with residents at the home, and talking to staff. Prior to the site visit the home had completed and sent in to CSCI their Annual Quality Assurance Assessment (AQAA). This outlined how the home feel they are performing against the National Minimum Standards, and how they can evidence this. Before the site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives involved professionals and staff. At the site visit a notice was displayed advising people that an inspection was taking place, and with an open invitation to speak with the inspector at any time. The views expressed at the site visit and in survey responses have been incorporated into this report. The inspector was assisted at the site visit by the manager, and other members of the staff team. A senior member of staff from the Salvation Army was also in the home during the inspection, and assisted with the process. Feedback on findings provided throughout the inspection. The opportunity for discussion or clarification was given. The inspector would like to thank the manager, staff team, residents, relatives and visiting professionals for their help throughout the inspection process. What the service does well: Comments on the service were varied, but a number expressed positive views about the home such as ‘good food, pleasant staff and good atmosphere, ’ and ‘whenever I visit my relative, all is well.’ Visitors are always made welcome in the home. Relatives felt that the home communicated with them well and kept them up to date with any issues Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 6 concerning their relative. They also felt that the home was good at supporting residents and relatives if the resident had to attend or go into hospital. The home provides well for the spiritual needs of residents. Daily prayer meetings are held in addition to regular services. A Chaplin is available to provide individual care and support. Residents were almost universal in their praise for the food provided by the home, and felt that it met their needs. What has improved since the last inspection? What they could do better: Improvements are still needed in many areas so that residents receive good and safe care delivered by well trained and skilled staff. Some of the issues noted below were also raised at the previous inspection of the home. Although new care plans have been introduced, improvements are still needed so that they work properly, and provide a good basis to deliver individual Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 7 comprehensive and consistent care to residents. Care staff need to become familiar and comfortable with the format and use the care plans on a day to day basis. Other aspects of caring for residents need to be improved. This includes the monitoring and documentation of their nutritional needs, risk assessments in relation to any specific individual needs, choices offered in relation to bathing, and ensuring that residents are offered appropriate activity and stimulation in line with their assessed needs. Residents and their relatives did not feel that there were always sufficient staff available in the home to meet their needs. Therefore the levels of staff, mix of skills or the ways that staff are deployed needs to be reviewed. Residents’ medication is not being well or safely managed and requires urgent review. Staff responsible for administering medication have not received adequate training and monitoring. Staff training in other areas has also been lacking at the home, Staff have yet to complete training in dementia care, although this is now planned. For many staff training in safeguarding adults and core areas such as health and safety and food hygiene has not been undertaken or kept up to date. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 8 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 Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents cannot be sure that the home will fully assess their needs and confirm with them that Bradbury Home is able to meet their needs. For people whose assessed needs include dementia care needs, they cannot be sure that staff are trained and skilled in meeting their needs. EVIDENCE: The manager said that the home’s Statement of Purpose and Service Users Guide still needed to be updated as highlighted at the previous inspection. They had however developed two information packs, one for pre-admission and one to give people on their arrival at the home. These provide residents with a good level of basic information about the home. Responses on surveys were equally divided between those who felt that they had received enough information about the home and those who had not. Two people who were recently admitted were spoken with and said that they had received Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 10 information about the home, one had spent time at the home before making a final decision to move in. Before people move into Bradbury Home, their needs should be assessed so that it can confirmed to them that the home will be able to meet their needs. The files of two recently admitted residents were viewed to see if the home has improved in assessing residents’ needs before they move into the home. It was explained that a new format was in place to facilitate a comprehensive approach to residents’ assessments. On one file only an assessment of needs completed on admission could be found and some important sections of this such as nutritional needs was blank. On another file a pre-admission assessment had been completed, but again some sections such as nutritional needs, continence and medication sections had not been properly completed. Both files contained some information from social work teams. One person who was recently admitted is registered blind. According to training records only two members of staff have undertaken training in sensory loss and this took place in 2002/3. The home is currently registered to provide care for up to ten residents who have dementia. The level of staff training in this area is extremely low. Training records could only identify that three staff have undertaken training in this area, and that was undertaken a few years ago. Residents cannot therefore be confident that they will receive expert care from staff that is skilled and up to date in this area. The manager provided evidence that staff training in dementia was due to commence within the next few weeks. Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be sure that they receive care that is based on their needs and wishes, and comprehensibly planned for. Their medication may not be managed in a way that supports their care and wellbeing. EVIDENCE: Residents spoken with seemed generally satisfied with the level of care offered by the home, but there was a feeling that it depended on what staff were on and comments such as ‘it depends on the carers,’ were made. On surveys received the picture was varied. Only one person felt that they ‘always’ received the care that they need. Two said ‘usually,’ three said ‘sometimes,’ and one said ‘never.’ A number of relatives raised the issue that residents do not receive adequate personal care in relation to regular bathing. One complaint at the home also related to this, as a resident’s carer had been off on their ‘set day,’ and the resident then had to wait another week before having a bath. This is not acceptable practice. Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 12 As part of this inspection a number of care plans were viewed. Since the previous inspection a new format for care planning has been introduced into the home, and these were in place for all residents. The new format provided for a more person centred approach to care. Although it was clear that the home have worked hard to introduce the new format and improve care planning and documentation, those viewed still did not provide a consistent or satisfactory basis for care to be delivered to residents. For a resident admitted nearly a month prior to the site visit, no care plans had been completed. For another resident care planning did not fully reflect their assessed needs for example sensory loss and history of falls. For a resident with high dependency needs, care planning lacked the level of detail needed to provide staff with good information to help them to care for the resident in a holistic way. This particularly in relation to communication. Appropriate risk assessments were not in place for example relating to the use of bed rails. There was no evidence that care plans are properly reviewed on a monthly basis, or more often as required. A key worker system is in place, but this did not seem to be adding value or quality to resident care. Daily records and other records relating to residents’ care such as bathing are kept separately from residents’ care files. This practice may not encourage staff to make full use of care planning information. People spoken with and documentation viewed showed that residents at Bradbury Home access appropriate health services such as dental, optical and chiropody to meet their needs. District nursing services provide good support for residents in the home. On surveys people felt that they ‘always’ received the medical support that they needed. Feedback from visiting professionals showed that good relationships are maintained. One visiting professional felt that the home were always willing to seek advice, that staff are always polite and provide good background information on residents’ needs. Two relatives commented that the home had provided good support when their relative had been admitted to hospital. A list of support services and contact details were available to staff to assist them in making appropriate referrals. Other aspects of residents’ healthcare need improvement. Residents’ nutritional needs are not properly assessed or monitored. Residents are not routinely weighed or properly assessed on admission or an ongoing basis. The home only currently has stand on scales, which cannot be used by more frail residents. (Sit on scales were ordered during the inspection.) Menus are not nutritionally assessed and adequate nutritional records are not maintained. For one resident it was recorded in daily notes that they had a skin flap on their left leg. There was no explanation of how this happened or what follow up occurred. A number of issues were raised in relation to the management and administration of medicines at the home. A handwritten entry for one resident was for Temazepam 10mg one at night and half a tablet two or three times a day. Although this was as prescribed, no staff had queried this, or the potential risks to the resident. There was no protocol in place for the use of Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 13 the additional doses. The medication is a controlled drug. It had not been properly booked in or the entry signed, therefore no adequate audit trail was provided. On another resident’s medication administration record (MAR) sheet there were gaps in signatures. The medication was missing from the packs and there was no explanation given for this. Another resident had missed a number of doses of medications for the control of diabetes and depression. This was either recorded as refused or that the resident was asleep. There was no indication that staff administering medication had picked up on this or taken action to address any problems. The resident was observed at times during the day to be agitated, tearful and distressed and then sleeping. The name of one resident recorded on the repeat prescription form and the blister pack label was different from the name that they are known by in the home, and that is recorded on all other documentation. This had not been picked up on or dealt with by staff administering medication at the home. A number of other practice issues were identified and discussed with the manager. As identified at the previous inspection staff administering medication have not received adequate training or ongoing competence monitoring. Training records showed that the last training undertaken was in 2005 and 2004. The manager said that training from the supplying pharmacist had been planned but had been postponed. They undertook to contact the pharmacist for new dates as a matter of urgency. The home has commenced a system of periodically auditing medication systems at the home. This had so far taken place on two occasions. A number of issues relating to medication practices were raised at the previous inspection. It is therefore of concern that residents are still not protected by robust procedures and practices being in place. During the day staff were observed to treat residents with kindness and respect. One resident was however observed to be sitting on a commode with their bedroom door wide open. A visiting professional said ‘when I visit patients/residents I am always accompanied by a member of staff and the client is treated with respect in a private setting.’ Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents will have some opportunities for activity and stimulation, but cannot expect that this will be based on their individual assessed needs. This will be particularly so for residents who have dementia. Residents can expect to enjoy the food provided by the home. EVIDENCE: The home does not currently have an activities co-ordinator in post and will be seeking to recruit to this role. Whilst it was felt that care staff did provide some stimulation and activities, it was recognised that this is still somewhat limited. During the site visit no specific activities took place, but staff did spend time with some residents interacting on a one to one basis. Many residents are able to, and supported in occupying themselves with preferred activities such as painting and knitting. Residents said that a mobile library visited the home on a regular basis, which they appreciated. In discussion and on residents’ surveys the response to whether the home provides sufficient opportunities for activities was varied. A relative said that the home could improve by ‘organising more activities for the residents.’ They said that residents used to go out for rides and tea but that this does not happen now. Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 15 The home does have a minibus available but this is not currently used for outings, but more for facilitating residents’ medical appointments and so on. Daily prayer meetings take place for residents. A ‘friends group’ has been developed and a home league meets at the home on a regular basis. The home also benefits from having a chaplain employed for 20 hours a week who can provide support to residents, relatives and staff. The home has recently purchased a range of equipment to expand the range of activities and opportunities available. As previously mentioned staff training in dementia care has been limited, and the activity social and occupational needs of residents with dementia are not currently fully assessed and met. Strategies for ensuring that these residents are offered appropriate choices and stimulation are not in place. During the day of the site visit residents with dementia mainly sat in the lounge with the television on. Residents’ preferences in terms of daily routines are recorded to a degree in care planning, but lacked proper assessment and detail. Visiting at the home is open and residents said that they could welcome visitors at any time. Residents’ rooms viewed were homely, and many had clearly brought in items of their own furnishings. Information on advocacy services was available, and one resident currently uses this service. Residents at the home are encouraged to maintain their independence and autonomy. A number still manage their own financial affairs. The chef at Bradbury Home plans menus on a day to day basis. A main choice is offered with options such as salad being always available. On the day of the site visit the main choice for lunch was sausages, and the main choice for tea was fish fingers. Feedback from residents about the food provided by the home was varied, but mostly positive. One said that ‘the food is marvellous.’ A relative said ‘menu extremely good, lots of good food and choice which is important. A good cook who has been here a long time and that helps.’ Another said ‘the diet is varied and well presented.’ The home has a pleasant dining room that was nicely presented. The home currently has two sittings for main meals one for more able residents and one for those that require a higher level of assistance. During the day of the site visit there seemed to be an issue about respecting residents’ choices, with some staff feeling that residents were not allowed to take their meals in the home’s lounge if they wished. Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can be assured that any concerns they raise will be listened to and dealt with appropriately. Residents cannot be assured that they are cared for by staff who have a robust understanding of safeguarding procedures and practice. EVIDENCE: The home has a clear complaints process in place that is on display for residents and visitors in the home’s lobby area. In discussions and on surveys most people said that they knew how to raise any concerns they had about the service. The process of managing complaints has improved since the previous inspection and clear records are now maintained. Two complaints had been recorded by the home since the previous inspection. The manager at the home had managed both of these complaints appropriately. Since the previous inspection one incident had been reported and investigated by Social Services under safeguarding adults procedures. Although the concerns raised were unfounded, they did highlight that the home needed to improve their recording processes in relation to residents’ care. It was difficult to get an accurate picture of how effective the home is in safeguarding residents from any form of abuse. Training records showed a low level of staff training in safeguarding adults, and the training identified dated from 2005. Three staff surveys received all indicated that training had been Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 17 undertaken in this area, and a number of staff at the home have undertaken National Vocational Training (NVQ) which was stated to cover safeguarding issues. Some staff spoken with said that they had not undertaken any training. All said that they would report any concerns that they had. One of the complaints made to the home showed that staff may need to have a greater awareness of what sort of issues may constitute abuse. One resident speaking about residents’ meetings said they sometimes felt wary about expressing their views ‘in case staff take against you.’ The manager said that they had a training pack on safeguarding adults on order, which would be gone through with all staff. Although it does not appear to be an issue at this time, no staff at the home have undertaken training in managing challenging behaviour. Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is suitable to meet their needs. EVIDENCE: Bradbury Home is purpose built with accommodation provided over three floors that can be accessed by a shaft lift. There are communal lounge areas on each floor of the home but the lounge on the ground floor is now used as the main lounge area in the home. The use the ground floor lounge room for the homes main lounge area makes it quite crowded at times and means that chairs are placed in a large ring around the room giving it a somewhat institutional feel. The first floor lounge is used as a quiet lounge. Daily prayer meetings and other services take place in this area. The second floor of the home was previously set up as a dementia care unit. This is no longer the case, and people with dementia care needs are integrated throughout the home. The second floor lounge and kitchenette area are now used as an Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 19 activities area. During the site visit apart from a prayer meeting, and one resident using the top floor activities area the communal areas on the first and second floors remained unused. Some areas of the home would benefit from redecoration. The manager said that it was planned to replace some furnishings in the home including the dining furniture to improve the environment for residents. Due to difficulties with the current emergency call system a new system is about to be installed that will provide a better and more flexible system for residents and staff. The home employs a maintenance person so that minor repairs can be dealt with in a timely manner. The home has pleasant grounds, which were being enjoyed by one resident on the day of the site visit. The home provides spacious accommodation and good facilities for residents. All rooms are en suite, a hairdressing room, treatment room and bathrooms that provide a range of assisted baths and showers are available. Residents spoken with said that they were happy with the accommodation provided by the home. Rooms viewed were comfortable and homely. At the moment the home is registered to provide care for up to ten residents who have dementia. The home have not yet assessed the impact of the environment on these residents and developed strategies that may assist them such as appropriate pictorial signage. A large information whiteboard is available to detail such things as the weather, but this is not ideally situated for residents to view. On the day of the site visit the home appeared clean and was odour free. Residents on surveys felt that the home was ‘always’ or ‘usually’ kept fresh and clean. The home’s laundry was suitable to meet the needs of the home. Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents cannot be sure that staff will always be readily available to assist them with their needs. They also cannot be sure that staff will always have the right training and skills needed to care for them in an effective way. EVIDENCE: Residents’ and relatives’ comments about staff at the home were sometimes positive. A relative said that the staff were caring and often ‘went the extra mile.’ A resident said that ‘mostly the staff are marvellous but like anywhere there are some flies in the ointment.’ Through discussion and surveys there was a feeling that some staff were good and ‘very dedicated,’ but that others were not and did not ‘act as they should.’ Although some agency staff are used at the home, there is a stable group of core staff, many of whom have worked at the home for a number of years. This provides consistency for residents. Four weeks rotas were viewed and showed that the home are maintaining staffing levels at four care staff plus a principal care worker (senior in charge) during the day. At night there are three staff on with one of these being in charge. The manager’s hours are on a Monday to Friday supernumerary basis. Ancillary staff are employed but no laundry/domestic staff work after 14.00, and at weekends no laundry staff are on duty. This means that care staff may have to do additional tasks during these times. Some relatives felt that not Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 21 enough staff were employed by the home. One said ‘I feel there are never enough staff on duty, and the residents are left to sit in the chairs without much in the way of stimulation.’ Another said ‘we feel most strongly that the staff/resident ratio is insufficient………the people coming into the home now are very much frailer and yet no more staff are employed.’ On surveys no residents felt that staff were ‘always’ available to them when needed. Opinion was equally divided between ‘usually’ and ‘sometimes.’ During the site visit there were periods when frail residents were left unattended for some time in the main lounge. On one occasion a confused resident was at risk through walking around pushing a small table for balance. Also during the visit the response to call bells was slow. These issues show that the numbers or the deployment of staff may not be sufficient to meet the holistic needs of residents. Twenty three care staff/seniors were identified on the home’s rotas. The Annual Quality Assurance Assessment (AQAA) identified that of these eleven permanent staff currently hold NVQ at level two or above. A further six staff are undertaking an NVQ qualification. The home has nearly achieved a position where 50 of their staff are trained to NVQ level two or above as advised in The National Minimum Standards. It was stated that one member of staff had been recruited since the previous inspection. This file was viewed to see if the home’s recruitment procedures protect residents. It was seen that the recruitment process had been carried out to a good standard with well a documented interview processes, and POVA first and Criminal Records Bureau checks (CRB) being in place before the member of staff commenced their duties. Although the member of staffs’ identification had been checked as part of the CRB application process, copies of these documents were not available on file. A health declaration was also not available having been sent up to the organisation’s headquarters. An induction process was in place for the most recently recruited member of staff. Management explained that staff completed the initial induction over the first few weeks of employment and then move on to working through Skills for Care modules. Although the member of staff had been working at the home for two months, the initial induction process had not yet been completed. Where sections had been completed this had not been done within the stated timescales for example ‘to be completed on the first day,’ or ‘during the first week.’ It is important that new staff are orientated into the home as soon as possible so that their work with residents is safe and effective. At the moment there is no system of identifying individual staff training needs, or of ensuring that appropriate levels of training and skills are maintained within the staff group. It has already been mentioned that the level of dementia training at the home among both care staff and management is very poor. The manager said that they are in the process of going through records, finding out what training staff have undertaken and will be addressing the shortfalls. Again given the findings of the previous inspection it is Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 22 disappointing that further progress has not been made in ensuring that residents are always cared for by staff that are well trained and skilled. Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can be assured that management at the home is working towards improving the service and will seek their views about the home and the service offered. EVIDENCE: The manager has been in post at the home since February 2007. They have completed NVQ at level four, and expect to soon complete their Registered Managers Award, a recognised qualification for home managers. Both residents and relatives felt that the new manager was having a positive impact on the home. A number of relatives said that over recent times they had felt increasing levels of concern about the home and the level of care offered, but now made such comments as ‘I am confident that the new manager has Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 24 already addressed certain issues,’ ‘new manager, new staff and new ideas bodes well for a happy home,’ and ‘I know that the new manager is working very hard to raise the standard, which sadly had slipped in the last two or three years.’ Residents also felt confident in the new manager and said that they were very approachable. The manager is trying to develop an open culture within the home. An ‘open door’ policy is maintained. Regular residents meetings are held, as are regular staff meetings for all designations of staff. Residents who are able are being encouraged to be more active within the running of the home. The manager explained that one resident was about to be involved in the home’s health and safety committee, and involvement in the home’s league of friends and home league group is being encouraged. The findings of the previous inspection report and this report indicate that the organisations processes for evaluating, monitoring and improving the quality of the service provided by the home may not be robust enough. Although strategies are in place such as an annual announced inspection by the organisation, monthly visits by a senior person in the organisation, internal surveys used by the home and medication audits, these processes have failed to maintain a consistent and good service for residents. Residents’ monies held by the home were sampled and were satisfactory. Records were well maintained, though it was advised that two signatures should be used for each transaction. The AQAA completed by the home identified that systems and services are monitored and maintained so that residents live in a safe environment. During the site visit no major health and safety issues were noted but the home do need to be vigilant in relation to the needs of residents with dementia. For example boxes of disposable gloves being left around and the laundry area being accessible. Fire records viewed were satisfactory, showing that residents are kept safe by the systems being regularly tested and kept in good order. Following a recent visit from the fire officer the home needs complete a new fire risk assessment and now have the information in hand to do this. Regular fire drills are held. It was advised that a clearer record of staff attending drills might assist in identifying if any staff have not attended one for a while. A visit from the environmental health officer earlier in the year only found minor issues to address. The home’s training matrix and staff training file show that although care staff have now had up to date training in moving and handling the levels of staff training in other core areas such as fire awareness, health and safety, food hygiene and first aid is poor. Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 25 Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 26 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 X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X X 2 Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 27 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 OP1 Regulation 6 Requirement So that residents and other parties have access to full information about the home an up to date Statement of Purpose and Service Users Guide must be developed as required by regulation. Potential residents must be assured that the home will be able to meet their needs. Therefore people must only be offered a place at the home once a detailed assessment of their needs has been carried out by a suitably skilled person, and it is determined that following this assessment that the home will be able to meet the persons needs. The home should confirm this in writing to the potential resident. This is a repeat requirement. The previous compliance date of 30/06/07 has not been met. 3. OP7 15 So that residents’ holistic needs are met, a plan of care must be DS0000034348.V348888.R01.S.doc Timescale for action 14/01/08 2. OP3 14(1) (a) 30/11/07 30/11/07 Page 28 Bradbury Home Version 5.2 developed showing how individual assessed care needs are to be met, and any risks associated with their care managed. The care plan must be kept under regular review and kept up to date to reflect people’s changing needs. This is a repeat requirement. The previous compliance date of 30/07/07 has not been met. 4. OP8 17(2) Schedule 4 Residents should be assured that their wellbeing is assessed and monitored. The home must consistently and properly assess residents nutritional needs and keep an adequate record of residents’ nutrition to be able to show how this aspect of care is properly managed. Residents must know that when they allow the home to manage their medication for them that this is done in a safe and effective manner. The home must review all their medication procedures and ensure that staff are trained and competent to manage this aspect of care. A range of activities must be provided which meet the assessed needs and capabilities of people living at the home. This is a repeat requirement. The previous compliance date of 30/08/07 has not been met. 7. OP18 13(6) Arrangements must be made and implemented in the home so as to ensure that so far as it is possible that people are DS0000034348.V348888.R01.S.doc 30/11/07 5. OP9 13(2) 14/11/07 6. OP12 16(2) (m) (n) 14/01/08 14/12/07 Bradbury Home Version 5.2 Page 29 protected from abuse, harm and neglect. This refers to the need to ensure that all staff are trained and have a good understanding of safeguarding issues. This is a repeat requirement. The previous compliance date of 30/07/07 has not been met. 8. OP30 18(1) (c) Staff working at the home must 14/01/08 receive training for the roles they are to perform and to assist them in meeting the assessed needs of residents. This refers to the need to ensure that induction is carried out effectively and shortfalls in staff training identified throughout the report are addressed. This is a repeat requirement. The previous compliance date of 30/09/07 has not been met. 9. OP38 18 So that residents are cared for 14/01/08 safely staff must receive good and regular training in core areas such as health and safety and first aid. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP19 Good Practice Recommendations To assist residents with dementia, an audit of the premises DS0000034348.V348888.R01.S.doc Version 5.2 Page 30 Bradbury Home should be undertaken to identify any potential hazards and assess the benefit of any aids such as signage that may help in their daily living and orientation. 2. OP27 In view of residents and relative’s comments and the findings of this inspection, staffing levels or the deployment of staff needs to be reviewed. So that residents are cared for by skilled staff, 50 of the home’s care staff should be trained to NVQ level two or above. 3. OP28 Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Colchester Local Office Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bradbury Home DS0000034348.V348888.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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