Inspection on 03/04/08 for Bradbury Home

This inspection was carried out on 3rd April 2008.

CSCI found this care home to be providing an Adequate service.

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 26/10/07

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 3rd April 2008 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.V361802.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.V361802.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 435877 lawrence.taylor@salvationarmy.org.uk The Salvation Army UK Territory Mr Lawrence Taylor 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.V361802.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) 26th October 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 people 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 people 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 people 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. A statement of Purpose is available that sets out what the home aims to provide. Information booklets are available to people who are interested in using the service. It was confirmed that the current fees at the home are from £388.01 to £505.10. There are additional charges for chiropody, hairdressing, and other personal requirements. Bradbury Home DS0000034348.V361802.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced ‘key’ site visit. At this visit we considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are facilitated to have a lifestyle that is acceptable to them. The level of compliance with requirements made at the previous inspection was assessed. The site visit took place over a period of eight hours. A partial tour of the premises was undertaken, 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 people living 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. Feedback on findings was provided to the manager throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the manager, staff team, residents, relatives and visiting professionals for their help throughout the inspection process. Bradbury Home DS0000034348.V361802.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: A new care planning system has been introduced and this still needs to be fully understood and utilised by care staff. Although it is an improving picture people’s care needs are not always fully identified and properly planned for. Care staff need to become familiar and comfortable with the format and use the care plans on a day to day basis. Bradbury Home DS0000034348.V361802.R01.S.doc Version 5.2 Page 7 Bradbury Home is registered to provide care for people who have dementia. Staff have still not received training in this area. This means that they may not have the skills to understand and meet people’s needs in a consistent way that is in line with current ideas about best practice. When staff start work at the home they need to go through a proper induction process that will allow them to become familiar with procedures and practices in the home. This will help them to carry out their duties well and safely. Although staff are now taking a more active role in providing stimulation and activity for people, this area still needs to be developed. Peoples’ occupational and activity needs should be properly assessed and met on an individual basis. The management structure needs to be improved so that the home always has competent senior cover, and runs properly at all times. Procedures need to be reviewed so that management and senior staff are aware of, and always take appropriate actions in relation to any incidents or events. 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.V361802.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.V361802.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. People can expect to have some information about the home to help them make choices. They can be sure that their needs will be assessed to make sure that the home is able to provide them with suitable care. EVIDENCE: The home has a Statement of Purpose in place and ‘Welcome to Bradbury Home’ documents for both pre-admission use, and to give to people when they arrive. These were dated 2007 and were in place at the previous inspection. These documents do not meet the requirements of Regulations in terms of what information should be included in a ‘Service Users Guide’ and need to be reviewed so that they do comply, and give people all the information they need to make an informed choice about moving into the home. Information should include details about fees, and the home’s complaints process. Out of Bradbury Home DS0000034348.V361802.R01.S.doc Version 5.2 Page 10 nine survey responses seven people felt that they had been given enough information about the home before they moved in. Since the previous inspection there have been few admissions. The file of one person who has recently moved into Bradbury Home showed that their care needs had been assessed by staff before they moved in. This is to ensure that their needs could be met, and that the placement would be suitable for them. The assessment was comprehensive and had been well completed. Assessment information was also available from the Local Authority funding the placement. Although they had been unable to visit Bradbury Home themselves, family had visited on their behalf. Discussion with the manager showed that the needs of people, and whether the home can meet their needs is always considered. However although the home is registered to provide care for people with dementia, and people are admitted with this condition, staff have not received training in this area. Intermediate care is not provided at Bradbury Home. Bradbury Home DS0000034348.V361802.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 adequate. This judgement has been made using available evidence including a visit to this service. People generally receive the personal and health care support they need, but they cannot be sure that this will be based on consistent or good care planning. People can now be more confident that their medication will be properly and safely managed. EVIDENCE: People spoken with during the site visit seemed satisfied with the level of care offered by the home. On surveys the majority of people felt that they ‘always’ received the care and support that they needed. Staff spoken with had a good awareness of peoples individual care needs. Since the previous inspection a new care planning and care documenting system has been introduced. This provides a comprehensive tool for the assessment of care needs, planning and ongoing review and monitoring. Three care plans were viewed in detail and aspects of others sampled. Those viewed had mostly only just been completed and were of variable quality. Staff are still getting used to the format and using it in different ways. Most Bradbury Home DS0000034348.V361802.R01.S.doc Version 5.2 Page 12 ‘care planning’ elements seem to be recorded in the ‘review comments’ section, with the ‘care/action plan’ being left blank or with limited information. The format is not being used consistently which may lead to information being missed, or confusion about where to locate relevant information. In general there is information about peoples’ needs that would enable staff to provide satisfactory care. However consistency and quality does need to be reviewed. Sometimes there is a good level of detail and instruction to staff on meeting peoples’ and sometimes not. For example one care plan was good at describing a person’s behaviour, but not how staff were to deal with this. Whereas another provided specific instruction about managing behaviour. In some instances care may be compromised by being ‘format led.’ For example one person was noted to use bed rails. No risk assessment or care plan was in place relating to this, only one brief mention that ‘…..has bed rails in place.’ A small bed rails consent section is provided at the front of the care plan, but there seems no scope for a full and proper risk assessment. Some staff seem to be using different sections to record daily records and other incidents. For example one person’s ‘care/action plan’ was blank apart from recording about the person’s cancelled hospital appointment. Although care records such as weight, bathing, activities and professional visits are now encompassed within the new care plan document, daily ongoing records remain separate from care plans. This practice may not encourage staff to make full use of care planning information. Some staff have undertaken recent training in care planning and the need to move towards a more person centred approach. Care plans had been signed by people living at the home or their relatives to say that the care plan procedure had been discussed with them. People living at Bradbury Home can generally expect their health care needs to be met, and most people on surveys felt that they ‘always’ received the medical support they needed. On the day of the site visit the home was experiencing an outbreak of sickness, and people were being cared for appropriately. People spoken with and documentation viewed showed that people at Bradbury Home access appropriate health services such as dental, optical and chiropody care to meet their needs. Discussion and documentation showed that specialist referrals are made when needed. District nursing services provide good support for people in the home. A visiting professional said that they ‘always found the home helpful when they visited.’ Again care planning to support good health care was varied. One person’s care plan identified through assessment that they were at risk of pressure sores and said ‘Care staff need to keep an eye on …..because they are quite susceptible to pressure sores,’ but no remedial or preventative actions were identified. One person who regularly sees the district nurse had the issue clearly identified in their care plan with dates of re-dressings etc. clearly recorded. Another person who also regularly sees the district nurse had nothing recorded in their care plan about this aspect of their care needs. Bradbury Home DS0000034348.V361802.R01.S.doc Version 5.2 Page 13 Since the previous inspection the new care plan format has enabled people’s nutritional needs to be properly assessed. Scales have been purchased to assist in monitoring people’s weight, and this was noted to be happening. Adequate nutritional records are however still not being maintained. Choice sheets record what food was requested, and intermittent recordings in daily records might comment on if someone had eaten well or not. The manager was able to demonstrate that new nutritional records have been produced and are ready to be implemented. The management of medication has improved since the previous inspection. Records viewed were properly maintained and staff have received recent training, with a number having undertaken the providing pharmacists advanced training. Some people look after their own medicines. Risk assessments and procedures were in place for this to be managed safely. Some practice issues were highlighted, including the need to evidence what actions are being taken if someone is consistently refusing their medication, or not receiving it regularly for other reasons, and the need to properly sign any hand written entries on the medication administration records. Another issue that may need to be considered and managed is the length of the morning medication round. Staff said that this could take up to two or two and a half hours. This may have implications for the timing or spacing of doses of people’s medication. During the day staff were observed to treat residents with kindness and respect. Bradbury Home DS0000034348.V361802.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. People 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 people who have dementia. People with religious beliefs can be assured that they will be very well catered for. EVIDENCE: At the previous inspection it was said that Bradbury Home was seeking to recruit an activities co-ordinator. This has not yet happened. People spoken with during the site visit seemed generally happy with the level of activity available. On surveys out of nine responses, only one person felt that there were ‘always’ activities arranged that they could take part in. Three felt that there ‘usually’ were and others said ‘sometimes’ or ‘never’. A relative felt that the level of activity was good and said ‘there are interesting and appropriate activities with no hint of ‘it’s Tuesday so it must be bingo.’ People’s preferences are always taken into account and accommodated wherever possible.’ Staff confirmed that they do have the time, and often undertake activities with people and were sometimes able to take them out. Some activities are based around meeting people’s spiritual needs. Daily prayer Bradbury Home DS0000034348.V361802.R01.S.doc Version 5.2 Page 15 meetings are held, as are a weekly home group and a Sunday service. A Chaplin works at the home for twenty hours a week to provide whatever help and support is needed. During the site visit, in spite of it being a very busy day, staff undertook a game of skittles with people in the morning. A record of activities undertaken is now maintained within the care planning system this showed that other activities such as quizzes and word games take place. Although the new care plan format allows for the recording of people’s social activities, interests hobbies and religious activities, there is not yet a systematic approach to assessing and meeting the social and occupational needs of people living with dementia. This has been raised at previous inspection and has still not been addressed. People are encouraged and supported to maintain independence and autonomy. One person was taking themselves off to the doctor independently during the site visit. A relative said ‘……. is supported in decision making and mobility at just the right level.’ People were noted to move around freely spending time in their rooms or going where they wished. People’s rooms were homely and showed that they could bring their individual personal possessions into the home when they moved in. Information on advocacy services was available. Visiting is open and people said that they could welcome visitors at any time. Catering services have recently been contracted out to an external provider, although the same staff are employed. People living at Bradbury Home remain happy with the food provided, and say they are offered a good level of choice. Comments such as ‘The food is always good,’ and ‘the kitchen do a good job’ were made. A relative felt that there was now more choice available. A four week menu plan is followed. People have opportunities through a comments book, residents meetings and one to one feedback to comment on the food and make suggestions. Bradbury Home DS0000034348.V361802.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. People can be assured that any concerns they raise will be listened to and dealt with appropriately, but they have not been fully protected by staffs’ knowledge and understanding of safeguarding procedures. EVIDENCE: A clear complaints process is in place and on display for people in the lobby area. This does however need to be amended to show that we (CSCI) do not have statutory authority to investigate complaints, but that people can contact the local authority about any concerns or complaints they might have. Information booklets given out to people do not include the home’s complaints procedure as it should. In discussions and on surveys people said that they knew how to raise any concerns they had about the service. A satisfactory process for recording and managing any concerns or complaints is in place. No complaints had been recorded since the previous inspection. In an improvement from the previous inspection, care staff have had recent training in safeguarding people. Those spoken with were clear about this area of care, and able to describe their responsibilities under whistle blowing procedures. The manager was planning to undertake a Safeguarding for Managers course shortly after this site visit. Two recent potential safeguarding incidents have occurred at the home, and neither of these was reported under safeguarding procedures to the local safeguarding team as they should have Bradbury Home DS0000034348.V361802.R01.S.doc Version 5.2 Page 17 been. The manager stated that they were not informed about one incident until two weeks after it occurred, appropriate investigations and actions were taken but this did not include initially reporting the incident to the safeguarding co-ordinator, and being guided by them as to the most appropriate response and follow up actions. Other managers in the organisation had been involved in managing the disciplinary action that the incident provoked, and had also not prompted a referral being made. The second incident the manager had felt was not clear cut enough, and was trying to establish facts when the incident was reported to the safeguarding team through another source. The manager has now been asked by the safeguarding team to investigate. These incidents show that people living at the home have not been protected through management having a robust understanding of safeguarding policies and procedures and reporting protocols. The manager is now clear about their responsibilities to report any incident without delay, and the planned training should establish up to date knowledge and practice in the home so that people are kept safe. Care records looked at during this site visit show that some people living at the home can show challenging behaviours. Care plans reflect the behaviours but do not always give staff clear guidance as to the management of them. No staff have undertaken training to assist them in understanding and managing challenging behaviours. This means that people’s needs may not be consistently met. Bradbury Home DS0000034348.V361802.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, 20, 22, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a home that is suitable to meet their needs, but people with dementia care needs cannot be sure that the environment is assessed and monitored with their needs in mind. 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, but the lounge on the ground floor is now used as the main lounge area. The first floor lounge is used as a quiet lounge. Daily prayer meetings and other services take place in this area. The second floor lounge and kitchenette area are now used as an activities area. Some areas would benefit from redecoration. Since the previous inspection a new emergency call system has been installed. This is providing a better and more flexible system for people living in the home and staff. A maintenance person is available so Bradbury Home DS0000034348.V361802.R01.S.doc Version 5.2 Page 19 that minor repairs can be dealt with in a timely manner. There are pleasant grounds for people to enjoy. There is spacious accommodation and good facilities for people. All rooms are en suite, a hairdressing room, treatment room and bathrooms that provide a range of assisted baths and showers are available. People spoken with said that they were happy with the accommodation provided. Rooms viewed were comfortable and homely. Bradbury Home is registered to provide care for up to ten residents who have dementia. Staff have not yet assessed the impact of the environment for people with dementia care needs, and developed strategies that may assist them such as appropriate pictorial signage. This was raised at the previous inspection and an ‘environmental impact assessment’ was due to be undertaken. This has not happened. The manager said that now the new financial year had arrived arrangements were being made for picture fames to be fitted to doors for individual names/pictures etc to aid orientation. As with the catering service, housekeeping domestic and laundry services have now been contracted out since the beginning of February. On the day of the site visit the home was experiencing an outbreak of sickness and diarrhoea. Staff were managing the situation appropriately, but the outbreak had not been reported to the Health Protection Unit or us (CSCI) as required. This was done, and their guidance acted upon. The home manager worked with the on site catering/cleaning manager who brought in extra staff to ensure that all extra cleaning tasks as a result of the outbreak were managed effectively. People on surveys felt that the home was ‘always’ kept fresh and clean. The home’s laundry was suitable to meet the needs of the home. Staff have recently undertaken training in infection control. In a follow up phone call to the home it was confirmed that following the outbreak suitable deep cleaning routines were being carried out. Bradbury Home DS0000034348.V361802.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. People can expect to be supported by staff who have a good level of basic training but who may lack specialist skills such as for dementia care. Sufficient staff will generally be available to meet people’s needs. EVIDENCE: Feedback on staff and staffing was more positive than at the previous inspection. One relative said, ‘the staff have unlimited patience and appear to genuinely care. My visits are frequent and I have never seen a member of staff treat a residents with disrespect.’ Another said ‘the staff are always patient and cheerful and very caring.’ Relatives felt that staff at the home ‘always’ or ‘usually’ had the right skills and experience. People living at the home felt that the staff usually listened and acted on what they said. Of nine survey responses six people felt that there were always staff available to them when needed. One felt that there ‘usually’ were and two felt that staff were only ‘sometimes’ available when they needed them. A relative felt that staffing was an improving picture and said ‘occasionally the home is short staffed and my relative may have to wait to be bathed/dressed etc. This occurs less frequently of late.’ Another said ‘as always there are some who give more time and care than others.’ Bradbury were previously maintaining staffing levels at four care staff plus a principal care worker (PCW - senior in charge) during the day. At night there Bradbury Home DS0000034348.V361802.R01.S.doc Version 5.2 Page 21 were three staff on with one of these being in charge. The manager’s hours are on a Monday to Friday supernumerary basis. Two weeks rotas were viewed and showed that these previous staffing levels have not been maintained. Day staffing levels had been reduced to three care staff plus a PCW, and night staffing levels to two. The manager explained that this was because of the home’s reduced level of occupancy (28 people in residence out of the registered for 36.) The manager was reminded that any changes in staffing levels should be notified to us. On some occasions the rotas had not been properly maintained and it appeared that staffing levels had dropped to two care staff and one in charge. The manager was able to evidence that agency staff had covered on all but one of these occasions. There are currently vacancies for three care assistants. Agency staff are used to cover some shortfalls and some staff work additional shifts. At the site visit, despite it being a very busy day, people in lounges were generally well supported by staff. Twenty 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 a National Vocational Qualification (NVQ) at level two or above. A further six staff are undertaking an NVQ qualification. The home has 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 established that one new member of staff had started work at the home since the previous inspection. Information viewed showed that in general recruitment procedures that protect people are maintained and that appropriate checks are undertaken. Although a POVA first check had been undertaken the member of staff had commenced work before a Criminal Records Bureau check had been received. This is not best practice. The manager advised that they had worked under supervision during this period. The member of staff had commenced work at the beginning of December, had an NVQ at level two and had attended other relevant training both prior and since working at Bradbury Home. However, there was no evidence of any basic induction into the home being completed. It is important that new staff are orientated into the home when they start so that their work with people is safe and effective. The manager confirmed that member of staff had not yet commenced the Skills for Care induction programme. The lack of adequate induction for staff was raised at the previous inspection. Since the previous inspection a great deal of staff training has taken place, and a good level of staff being NVQ trained has achieved. Most training recently achieved has been in core areas such as health and safety and safeguarding. It is disappointing that despite it being raised at previous inspections staff have not yet received training in dementia care. Bradbury Home is registered to provide care for up to ten people who have dementia. At the previous inspection the manager provided evidence that training in dementia care was due to start within a few weeks of the inspection. The work was to consist of Bradbury Home DS0000034348.V361802.R01.S.doc Version 5.2 Page 22 training a ‘dementia champion’ who would then train and motivate the rest of the staff team. Staff have still not received training in dementia care. People with dementia cannot therefore be confident that they will receive expert care from staff that are skilled and up to date in this area. Bradbury Home DS0000034348.V361802.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, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People cannot be assured that the home is being managed effectively at all times. However people 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 since February 2007. They have completed the registration process with us. The manager has completed NVQ at level four, and expects to soon complete their Registered Managers Award, a recognised qualification for home managers. Although the manager is experienced and competent, and it is recognised that the situation at the home is an improving one, there are concerns about the Bradbury Home DS0000034348.V361802.R01.S.doc Version 5.2 Page 24 overall management of the home. The manager is in overall charge but day to day operations are stated to be managed by Principal Care Workers (PCW’s.) Management has been unsuccessful in recruiting sufficient numbers of, and suitable people into this management role. The home should have three PCW’s in post, but currently only two members of staff are covering the posts on an ‘acting up’ basis. This has left the overall management of the home weak. Due to the management structure and busy nature of the home, much of the manager’s time seems to be taken up with answering the telephone and attending the front door. The administrator employed does not undertake this role, and the PCW’s are usually busy with caring, medication and other tasks. On the day of the site visit this left the manager little time to ‘manage’ or complete other planned tasks. There also seems to be some confusion about the chain of command, and who is responsible for actioning what tasks. For example lack of notifications to us, the safeguarding team and Health Protection Unit, lack of monitoring that care plans are properly completed and robust, lack of staff induction. When discussed the implication is often that someone else should have completed these tasks. This means that things may be missed or not be done, and people are potentially left at risk. The manager continues 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. Minutes of residents’ meeting seen show that people feel free and confident in expressing their views. Meetings are chaired by the Chaplain and the manager responds to any points raised. People are encouraged to be involved in the home’s league of friends and home league groups. Strategies are in place to monitor the quality of the service. The manager said that surveys had been completed by people in February, but the results had not been evaluated yet. An annual announced inspection is undertaken by the organisation. Monthly visits are made by a senior person in the organisation as required by regulation. The Annual Quality Assurance Assessment (AQAA) was completed in January this year. This was sent into us and describes how the home feel they are performing against the National Minimum Standards. People’s monies held by the home were sampled and were satisfactory. Records were well maintained. The AQAA completed identified that systems and services are monitored and maintained so that people live in a safe environment. During the site visit no major health and safety issues were noted. Fire records viewed were satisfactory, showing that people are kept safe by the systems being regularly tested and kept in good order. Regular fire drills are held. At the last site visit it was seen that following a recent visit from the fire officer the home needed to complete a new fire risk assessment. It was stated that the home now had the information in hand to carry out this task. At this Bradbury Home DS0000034348.V361802.R01.S.doc Version 5.2 Page 25 visit a fire risk assessment was still not in place. The manager was able to evidence that that this work is scheduled to be done by an external contractor on 28th April. The home’s training matrix and staff training records showed that staff training in core areas such as moving and handling, health and safety, fire and infection control is very much improved. Most staff have received recent updates in all areas. Staff spoken with confirmed that they had recently attended many training courses. Bradbury Home DS0000034348.V361802.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 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 2 17 X 18 2 3 3 X 2 X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 X X 2 Bradbury Home DS0000034348.V361802.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 5 Requirement So that people have full information about the home a Service Users Guide that provides all the information required by regulation must be produced. A copy of this to be sent to CSCI. This is a repeat requirement. The previous compliance date of 14/01/08 has not been fully met. 2. OP7 15 So that people’s holistic needs are met, in a person centred way, a plan of care must be 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 dates of 30/07/07 and 30/11/07 have not yet fully met. 14/05/08 Timescale for action 01/06/08 Bradbury Home DS0000034348.V361802.R01.S.doc Version 5.2 Page 28 3. OP12 16(2) (m) (n) 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 dates of 30/08/07 and 14/01/08 have not yet been fully met. 01/06/08 4. 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 protected from abuse, harm and neglect. This refers to the need to ensure that proper safeguarding reporting procedures are understood and followed by all staff. 14/05/08 5. OP30 18(1) (c) 14/05/08 Staff working at the home must receive training for the roles they are to perform and to assist them in meeting peoples assessed needs. This refers to the need to ensure that induction is carried out effectively. This is a repeat requirement. The previous compliance date of 30/09/07 and 14/01/08 has not been met. 6. OP30 18(1) (c) So that people receive good and consistent care staff should receive appropriate training. This includes the need for training in dementia care and in managing challenging behaviour. The management structure of the home must be improved so that the home is operated with sufficient care, competence and skill at all times. 01/08/08 7. OP31 10 01/06/08 Bradbury Home DS0000034348.V361802.R01.S.doc Version 5.2 Page 29 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 OP16 Good Practice Recommendations So that people are aware of all their options the complaints procedure should be reviewed to show which authorities can properly assist them with any concerns or complaints about the home. To assist residents with dementia, an audit of the premises 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. OP22 Bradbury Home DS0000034348.V361802.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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.V361802.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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