Inspection on 03/04/09 for Bradbury Home

This inspection was carried out on 3rd April 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bradbury Home 03/04/08

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bradbury Home 2 Roots Hall Drive Southend on Sea Essex SS2 6DA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Vicky Dutton     Date: 0 3 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Bradbury Home 2 Roots Hall Drive Southend on Sea Essex SS2 6DA 01702435838 01702435877 lawrence.taylor@salvationarmy.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Salvation Army UK Territory care home 36 Number of places (if applicable): Under 65 Over 65 10 36 dementia old age, not falling within any other category Additional conditions: 0 0 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 than 10 service users with dementia over the age of 65 years of age (total not to exceed ten) Personal care to be provided to no more that 36 older people over the 65 years of age (total not to exceed thirty six) Date of last inspection Brief description of the care home Bradbury Home is a purpose built premises which opened in May 1992. It is owned and managed by the Salvation Army. Accommodation is provided over three floors that are accessed by a shaft lift. There are thirty two single rooms and two 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. Care Homes for Older People Page 4 of 29 Brief description of the care home 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 £505.10 per week. There are additional charges for chiropody, hairdressing, and other personal requirements. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key site visit. The previous site visit to the home took place on 3rd April 2008. At this visit we (CQC, formerly CSCI) looked at 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 helped to have a lifestyle that is acceptable to them. 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 was selected and various elements of these looked at to see how well these aspects of care and running the home are managed. Time was spent talking to, observing and interacting with people living at the home, and talking to staff. We also spoke to a Care Homes for Older People Page 6 of 29 visitor during the site visit. The homes Annual Quality Assurance Assessment (AQAA) was sent in to us. The AQAA is a self assessment tool that providers are required to complete by Law. The AQAA was received by the due date, was fully completed, and outlined how management 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. We received responses from four people living at Bradbury Home, two relatives, one visiting professional and five staff. The views expressed at the site visit and in survey responses have been incorporated into this report. We were assisted at the site visit by the manager, two principal care workers (PCWs) and other members of the staff team. Feedback on findings was provided throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the staff team, residents, relatives and visiting professionals for their help throughout the inspection process. What the care home does well: What has improved since the last inspection? Two new senior staff have been appointed. This has brought some stability and consistency to the management of the home enabling improvements in many areas to be made. Most requirements made at the previous inspection have now been addressed. People can now feel confident that the admissions process will include a thorough assessment of their needs, and having access to good information to help their decision making. Ongoing care records have improved so that it is possible to see the care people have been offered, and identify that any health or other issues have been followed through. An activities co-ordinator has been appointed. This is benefiting residents with more opportunities for occupation and stimulation in their daily lives. Staff and management now have a good awareness of how to make sure people are protected by working openly with outside agencies such as the local safeguarding team. The home is in the process of being redecorated and having new furnishings and equipment provided. This will give people a bright and fresh home to live in. People are cared for by staff who have been safely recruited and who undergo an induction training that will give them good skills to care properly for people from the start of their employment. Since the previous inspection staff have received training in caring for people with dementia. This will help to provide staff with knowledge, enabling a more consistent approach with people. Care Homes for Older People Page 8 of 29 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wishing to move into Bradbury Home can be assured that assessments carried out will ensure that the home is suitable to meet their needs.. Evidence: Recently updated in March 2009, the home had both a Statement of Purpose and Service Users Guide available to people. Both the manager and a Principal Care Worker (PCW) confirmed that a pre-admission information pack is given to people to help them decide if the home will be suitable for them. On surveys people said that they had been given sufficient information about Bradbury Home. From the files viewed we saw that staff from the home carry out a detailed preadmission assessment of peoples needs to see that these can be met within the home. A PCW said, We spend about two hours with people finding out what their needs are. Where possible, even if people are in hospital, we try and arrange for them to come Care Homes for Older People Page 11 of 29 Evidence: and send some time with us, so they can see if Bradbury will be right for them. This also helps our assessment process. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be sure that they will receive consistent care that is based on their needs and wishes. Evidence: On surveys, and in discussion at the site visit people felt that they received suitable care. People appeared well cared for. Discussion and observation showed that staff were attentive to peoples needs and had a good awareness of individuals requirements. A key worker system is in place to try and enhance residents individual care. At the previous inspection a comprehensive Needs Assessment and Care Plan Document had just been introduced. When three of these were viewed in detail at this site visit we saw that they provided a wealth of information about people, but did not actually provide a consistent plan of care that could be easily found and followed by staff. To compensate for this a further document, the Care Plan Diary had been introduced. This provided some duplication of information, but again did not provide a Care Homes for Older People Page 13 of 29 Evidence: robust care planning system, that identified and incorporated all peoples needs and gave staff clear instructions for meeting these. Important information about peoples needs and preferences was often recorded under review comments in the needs assessment and care plan, but did not appear anywhere else. Staff could therefore remain unaware of important information, such as behavioural issues or personal preferences, when delivering care. A PCW said that staff are given a lot of verbal information, but this again leaves potential for error and inconsistency. Five staff returned surveys to us. Only one felt that ways of passing on information about people always worked well. Daily records are kept separately from other documentation which may not encourage staff to find and make full use of other information that is potentially available. Although care planning remains inadequate and lacks a consistent, detailed and person centred approach, daily records of care have improved. People can now feel more confident that they will be offered appropriate care such as regular bathing and that these aspects of care will be consistently recorded. Discussion with PCWs and minutes of a staff meeting showed that management are still educating staff to think in a person centred way. The minutes said that over a year ago, Tools were introduced to Champions to be filtered through to staff on person centred care. This is for people with dementia but it should be for every person here at Bradbury. The tools will be passed on to staff through supervisions. The meeting also showed a DVD and encouraged staff to be seeing people as individuals, through the compilation of life histories. We saw that an issue raised at the previous inspection has still to be addressed to ensure that people receive safe care, that is appropriate to their needs. Three people use bed rails. No risk assessments are in place, and care documentation does not identify safe use practice for staff to follow. People felt that they always or usually received the medical support they needed. Again good health care has the potential to be compromised by a lack of consistent care planning. For example, one person was noted to have dressings on their legs. Their care records said that their skin was intact. Again however the recording of professional visits and other interventions had improved and was consistent on those records viewed. Care records showed that people access different health care professionals such as opticians, district nurses and others to meet their needs. A visiting professional said They take care to carry out an necessary requests regarding my ongoing treatment of residents. Peoples weight is now monitored so that any concerns can be identified. Nutrition records have been introduced but these only cover the main meal of the day with breakfast and supper being unrecorded unless noted in daily records. A PCW said that this would be easy to rectify, and that they would do so. People can feel confident that if they need help to manage their medicines, that this will be done safely. Where people are able to manage their own medicines we saw that Care Homes for Older People Page 14 of 29 Evidence: good assessments and safeguards were in place. We looked and systems and records and found that safe practice is maintained. We saw records to show that the supplying pharmacist conducts a regular audit of the system to ensure that standards are being maintained. Most care staff have received recent training in the management of medicines. The two PCWs received training prior to this, with one having a date of July 2003 recorded on the training matrix. They did however ably demonstrate their knowledge and good practice skills during the site visit. During the day staff were observed to treat residents with kindness and respect. A member of staff said, We have been taught to respect the wishes and wants of our service users. We noticed that one bedroom had a number of packets of incontinence pads on full view, this did not protect the persons dignity. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will have have some opportunities to enjoy a fulfilling lifestyle, and will enjoy good food. Evidence: A strength of Bradbury Home is the opportunities people have for spiritual fulfilment. A daily prayer meeting is held as well as a Sunday service. People can also be involved in home league meetings each week. A Chaplin is employed for 20 hours a week to provide pastoral care and support as needed. Since the previous inspection an activities co-ordinator has been employed to work 20 hours a week. A monthly activities schedule is on display to highlight activities and events. A record of activities undertaken is maintained in individual files and in a communal list. Activities are varied and entertainers also visit the home on an occasional basis. Events such as barbeques and garden parties are held during the year. A personal profile at the beginning of the care documentation file provides some information about peoples social interests and any hobbies, but then this information is not generally carried forward into care planning. As seen in the previous section management are hoping to work on peoples life historys which may improve this aspect. As at previous inspections there is still no means to assess and provide occupation according to the individual needs of people Care Homes for Older People Page 16 of 29 Evidence: who have dementia. The manager showed us some assessment material and information which is to be put in place to address this issue. The AQAA said that plans for the next twelve months included, All service users with or without dementia type illnesses to have personal centred care activities following [Name of specific trainer] training cascaded down to staff from the Champion. This work has now been planned for some considerable time. In spite of this lack of expected progress we observed that people are supported in their individual needs. One person was given an object known to comfort them, and another is supported in maintaining a long term favourite occupation. Four residents returned surveys to us. None felt that there were always activities available to them. One felt that there usually were and three that there only sometimes were. During the site visit staff were involved in helping people to make Easter bonnets. The home is fortunate that it has its own minibus. Staff spoken with hope that this will make outings possible in the warmer weather. People are encouraged and supported to maintain independence and autonomy. People were noted to move around freely spending time in their rooms or going where they wished. One person spoken with had requested to move to a ground floor room and this had been arranged for them. Peoples 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. The AQAA said that an improvement this year was that they had, Encouraged service users without family to establish advocacy through South East Essex Advocacy. The management team have recently completed training in Deprivation of Liberties and have made some referrals to ensure that peoples needs and rights are understood and upheld. Visiting is open and people said that they could welcome visitors at any time. A visitor said that they were always made welcome. Catering services are contracted out out to an external provider who, in consultation with staff and residents, provide a four weekly menu plan. Menus viewed showed that a good range of foods are offered and that people have a good level of choice. People have opportunities through a comments book, residents meetings and one to one feedback to comment on the food and make suggestions. The manager for domestic and catering services said that they have access to nutritionists so that any special needs can be discussed and catered for. People living at Bradbury Home remain happy with the food provided, and made comments such as I always enjoy the food, I look forward to my meals, and The food is generally good but sometimes the meat is tough. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for safely and protected by practice in the home. Evidence: There is a clear complaints process in place with a copy on display for people. On surveys people said that they knew how to raise any concerns. There was a relaxed atmosphere between staff and residents. People said that they felt at ease. One person said that they would speak to the Chaplin if they had any problems. Another said I would speak to a senior carer or the manager. The homes complaints records showed that one complaint had been made to the service since the previous inspection. This was well recorded and had been managed appropriately. No complaints have been raised with us (CQC, formerly CSCI.) The previous inspection highlighted concerns that safeguarding incidents were not being reported or managed effectively. This left people at potential risk. The manager has now completed safeguarding training, as have all staff. Staff spoken with confirmed that they had undertaken training and had an understanding of safeguarding issues. Appropriate policies and procedures were in place. Any incidents are now managed in an open way. Four safeguarding incidents have been reported since the previous inspection. Staff and management at the home have now shown that they act promptly to protect residents, and work well with the local safeguarding team. Care Homes for Older People Page 18 of 29 Evidence: Some people living at Bradbury Home can present staff with some challenges in the way that they react and behave. The current care planning system has a behaviour assessment incorporated into it. However, does not then lead on to an effective care plan to ensure that peoples needs are understood, and help staff in adopting a consistent approach. Staff confirmed that they had not received training in managing challenging behaviour but thought that dementia training had offered some support in understanding this aspect of care. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a pleasant home that is suitable to meet their needs. Evidence: Bradbury Home is purpose built with accommodation provided over three floors all of which can be accessed by a shaft lift. There are communal lounge areas on each floor. At the time of the site visit the home was in the process of having major decorating works done on the ground floor. This meant that the ground floor lounge was being used for a dining area and the other two lounges were being used for communal space during the day for everyone. Some people were finding this hard to adjust to and complaining about having people with dementia in their lounges. Management at the home were aware of the issue and trying to deal with it sensitively. The current phase of the refurbishment programme involves redecorating the ground and first floors with new furnishings and flooring also being arranged. In discussion with the manager it was clear that the needs of people with dementia were being considered as part of the programme to ensure suitable colours and textures. Other improvements such as rearranging the door entry system to improve security are in hand. There are pleasant grounds for people to enjoy. A maintenance person is available so that minor repairs can be dealt with in a timely manner. Bradbury Home provides spacious accommodation and good facilities for people. All Care Homes for Older People Page 20 of 29 Evidence: 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. Some work has taken place to provide better signage at the home to assist their orientation. At the moment signage is is mostly large text signs. The manager said that when the redecorating is finished pictorial signs will be worked on. On the day of the site visit the home appeared to be clean and there were no areas of unpleasant odour. As with catering, housekeeping, domestic and laundry services are contracted out to a separate provider. People on surveys felt that the home was always kept fresh and clean. One said Bradbury Home is very nice and clean The homes laundry was suitable to meet the needs of the home. Most staff have recently undertaken training in infection control, and this process is ongoing. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are looked after by staff who are safely recruited and adequately trained. Evidence: During the day people made positive comments about staff. There are some good staff here, I get on very well with all the staff, I find they are all kind and approachable, and, The staff are all very friendly and very good carers were some of the comments made. At the last inspection we found that staffing levels had been reduced, due to the number of vacant beds, to three staff and a PCW during the day and two staff on at night. Occupancy levels remain about the same as previously. Rotas viewed showed that in the mornings mostly four care staff are available, with three in the afternoons and two at night. Staff said that when only three staff on duty it was difficult, particularly in the mornings when PCWs were tied up administering medication and other tasks. They said and that when four or five were on duty things were much better and they could offer residents more time and opportunities. We need more staff in order to provide better care for service users, Not enough staff, and, More staff are needed were some of the comments made. A relative said Extra staff at busy times would ease the pressure. Staff said that agency staff were not allowed to be used if three of the homes own staff were on duty. Some agency staff are used however and the AQAA records that 66 care shifts have been covered by agency staff in the previous three months. The manager explained that staffing levels Care Homes for Older People Page 22 of 29 Evidence: will soon improve and use of agency reduce, as new staff are starting which will give at least four staff on shift on a more consistent basis. On the day of the site visit four staff were on duty and an extra PCW came on shift. Lounges appeared well covered during the day, and there were staff available to assist people when they needed it. Call bells were answered fairly promptly. There are no planned changes to night staffing levels. At the moment two care assistants are on shift, with the manager or PCW on call from their home. The AQAA said that eight people require the assistance of two carers at night. Accommodation at the home is over three floors. On a survey someone said, Two night staff are not enough. We have people with dementia, we also have people who wander. A lot of our service users need two people to see to them. There is not enough staff to cover the floors when we are busy. Twenty care staff/seniors were identified on the homes rotas. The Annual Quality Assurance Assessment (AQAA) and a training matrix identified that of these eleven care staff/PCWs currently hold a National Vocational Qualification (NVQ) at level two or above. Two other staff are currently working on NVQ at level two, and another member of staff is working on level three. The home has achieved a good position where 50 of their staff are trained to NVQ level two or above as advised in The National Minimum Standards. We looked at the files of two recently recruited staff to see if procedures that safeguard residents are maintained. We saw that recruitment is carried out to a good standard, with all checks such as Criminal Records Bureau, (CRB,) references, proof of identification, previous qualifications and fitness being carried out before the person starts work. We saw that a good induction process is carried out and that staff start to work on a Skills for Care programme to learn good skills from the start of their employment. Five staff surveys returned to us said that recruitment had been thorough and that their induction had covered everything they needed. A PCW confirmed that staff work as supernumerary for at least the first week of their employment in order to learn about the home. In October last year staff received training in dementia care. This had been an outstanding requirement for some time. The manager said that they hoped to build on this with further training and work. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe home where their views on the service are considered important. Evidence: The manager at Bradbury Home is experienced and qualified. Since the previous inspection two new PCWs have been appointed. Although there is still a further vacancy to fill at this level, the management team is now much stronger and more competent. There is a feeling that the home is now making good progress towards providing a stable and well managed service. For example, allocation sheets are now used giving staff responsibility for set areas and tasks. The call system is closely monitored to see how long people are waiting for attention. Management roles are clearer and the office accommodation has been rearranged so that the manager is having to spend less time on administrative tasks such as answering the phone and door entry. The home has a friendly and open atmosphere. The manager has an open door policy Care Homes for Older People Page 24 of 29 Evidence: and is always ready to make time for people. Regular residents meetings are held, as are regular staff meetings for all designations of staff. People are encouraged to be involved in the Friends of Bradbury group and home league groups. Strategies are in place to monitor the quality of the service. An annual announced inspection is undertaken by the organisation. This last took place in November 2008. It was very detailed and the report was freely available to people. Monthly visits are made by a senior person in the organisation as required by Regulation. The Annual Quality Assurance Assessment (AQAA) was completed and sent in when requested in March this year. It had been satisfactorily competed by the manager but did not identify areas of particular weakness as highlighted at this inspection, such as the lack of robust person centred care plans. People can be assured that if they wish to home to hold monies for safekeeping that this will be done in a way that protects their interests. Monies held by the home were sampled and were correct. Records were well maintained. The administrator explained that peoples monies were generally only available during office hours Monday to Friday, but that people were aware of this. 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. It was discussed that the laundry and kitchen areas are not secured in any way, so could be accessed and present a potential hazard for people who have dementia. The administrator said that this had been raised by a recent health and safety audit, and that plans were in hand to address this. It was also pointed out that disposable gloves and aprons were also accessible to people at points around the home. The manager undertook to address this. The home had a new fire alarm system installed in October 2008. 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. The fire service last visited the home in December last year and found things to be satisfactory. An environmental health officers visit had awarded the home four stars indicating that very good standards of food hygiene are maintained. The homes training matrix and staff training records showed that staff training in core areas such as health and safety, fire and infection control is ongoing. For moving and handling however most staff last undertook this training in 2007 and are over due for update training to ensure that they continue to care for people safely using up to date equipment and techniques. It was said that one of the PCWs was to undertake a four day training course to enable them to then train the rest of the staff team. As no fixed date is yet set for this, moving and handling training for staff may need to be accessed Care Homes for Older People Page 25 of 29 Evidence: through another source. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 So that peoples holistic 14/05/2008 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 peoples changing needs. This is a repeat requirement. The previous compliance dates of 30/07/07, 30/11/07 and 14/05/08 have not yet fully met. Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 12 So that people have opportunities for occupation and stimulation appropriate to their individual needs and preferences, staff should ensure that suitable assessment processes are carried out to identify peoples needs. So that people are cared for consistently by staff with good knowledge and skills training in managing challenging behaviour should be considered. So that people are cared for safely staff should be regularly updated in core skills such as moving and handling. 2 18 3 38 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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