CARE HOMES FOR OLDER PEOPLE
Bradbury Home 2, Roots Hall Drive, Southend on Sea, Essex. SS2 6DA Lead Inspector
Jacqueline Graves Unannounced 9th June 2005 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 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 I56-I06 S34348 Bradbury Home V233039 090605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Bradbury Home Address 2 Roots Hall Drive Southend on Sea Essex SS2 6DA 01702 435838 01702 434406 munro@salvadtionarmy.org.uk The Salvation Army UK Territory Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Anne Munro Care home 36 Category(ies) of Old Age OP (36) registration, with number Dementia DE(E) - over 65 (10) of places Bradbury Home I56-I06 S34348 Bradbury Home V233039 090605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Number of service users for whom personal care is to be provided must not exceed 36. 2. Personal care to be provided to no more than 36 older people over 65 years of age. 3. Personal care to be provided to no more than 10 service users with dementia over the age of 65 years of age. Date of last inspection 24th January 2005 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. Two floors have a kitchenette where residents can prepare their own snacks and drinks. The kitchenette / lounge on the second floor has been developed to accommodate those residents who have dementia. Meals are served in a 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. There is one large lounge and two smaller lounges as well as areas with seating outside the lounges. 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 I56-I06 S34348 Bradbury Home V233039 090605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over three hours and was a routine, unannounced inspection. The inspector toured the premises, spoke to the manager, staff and residents and looked at some care records. What the service does well: What has improved since the last inspection? What they could do better: Bradbury Home I56-I06 S34348 Bradbury Home V233039 090605 Stage 4.doc Version 1.30 Page 6 Further facilities, such as signs on doors, may assist those people with dementia. However, the home has already planned to develop such things but is waiting until the carpet is re-laid. The Friends of Bradbury have raised money for sensory materials for those people with dementia. The home identified team meetings as something which could be developed to improve their purpose and usefulness. 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. Bradbury Home I56-I06 S34348 Bradbury Home V233039 090605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Bradbury Home I56-I06 S34348 Bradbury Home V233039 090605 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,4,5 and 6 The home ensures people are assessed before moving into the home and when they move in on a trial basis to ensure their needs can be met. EVIDENCE: Prospective residents and / or their family are able to visit Bradbury. Trial periods are offered so that people may move in and get to know staff and other people before making a decision about permanently living in the home. The home sees this as part of a continuing assessment period where the staff can get to know individuals to ensure their needs can be met. Written assessments are made and form the care plans. The lounge and kitchenette on the second floor have been developed to provide a safe, secure environment for those residents who have dementia. The home feels this is the best way to preserve people’s dignity and to provide suitable activities and facilities for them. Bradbury does not admit people for intermediate care. Bradbury Home I56-I06 S34348 Bradbury Home V233039 090605 Stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,9 and 10 The home continuously tries to develop care plans so that care needs are clearly defined. Care is person-centred and residents are respected. EVIDENCE: The home is continuously trying to improve the care plan format. Care plans make clear the care people need. Evidence of the involvement of the resident / their representative in drawing them up would improve them further. Risk assessments had been carried out and reviewed often. Senior staff are trained to administer medicines and up date their training periodically. The storage, administration and recording of medication is well organised. Those residents spoken to said they were treated kindly and staff respected their privacy. Staff were observed to speak politely to residents and treat people as equals. Bradbury Home I56-I06 S34348 Bradbury Home V233039 090605 Stage 4.doc Version 1.30 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 Bradbury provides a stimulating, homely atmosphere where people are encouraged to remain as independent as they wish to be. The meals are of very good quality. EVIDENCE: Information about planned activities is given on the residents’ notice board. Meetings are held regularly where residents can give their views on all aspects of life in the home. Some residents were involved in a prayer meeting on the day of the inspection. Arrangements are in place for residents to visit local churches or be visited by church representatives. People who have dementia had activities available to suit their needs. A coffee morning with The Friends of Bradbury was taking place during the morning. This support group plans activities and fund raising events for residents. All residents spoken to praised the quality and variety of food and appreciated the efforts of the kitchen staff. Some residents thought that portions were too generous and this worried them, as they did not like to waste food. This matter had been raised at a residents’ meeting and conveyed to the cook. Meals are served in a very congenial setting. Menus are displayed to help residents make choices.
Bradbury Home I56-I06 S34348 Bradbury Home V233039 090605 Stage 4.doc Version 1.30 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home has satisfactory arrangements for protecting residents and responding to any concerns. EVIDENCE: The manager has an ‘open door policy’ and welcomes comments and suggestions from people. The home’s complaints procedure is available to residents/visitors. This makes it clear that people may complain directly to CSCI if they wish to. No complaints have been made to CSCI since the last inspection or to the home. Bradbury Home I56-I06 S34348 Bradbury Home V233039 090605 Stage 4.doc Version 1.30 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23,25 and 26 A high standard of comfortable, clean accommodation is provided which suits residents’ needs. EVIDENCE: The home is purpose build and won a design award in 1994. The building is very well maintained, bright and airy. The central garden is very attractive and well kept. It is easily accessible to people. Since the last inspection, new carpets have been laid and corridors and the dining room has been decorated. Alterations to the second floor kitchen / lounge have been completed to create a unit especially for those people who have dementia, although further improvements are planned. There is a high standard of cleanliness and hygiene in the home, with no unpleasant odours. Laundry is organised in a hygienic manner to prevent the spread of infection.
Bradbury Home I56-I06 S34348 Bradbury Home V233039 090605 Stage 4.doc Version 1.30 Page 13 Those residents spoken to said they liked their rooms and were pleased to have some of their own possessions in them. Those rooms seen were comfortably furnished. The home does find storage a problem as some people do bring their own pieces of furniture with them when they move in and what the home provides has to be stored. A bathroom, which is being used for storage, was open and should be kept locked. Bradbury Home I56-I06 S34348 Bradbury Home V233039 090605 Stage 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 The residents benefit from having sufficient staff, some of whom have got to know them over a period of time. EVIDENCE: The home reports having sufficient staff and agency staff were not being used. Bank staff are used to cover shortages. Some of the staff have been at the home for a considerable time and have got to know the residents and routines of the home well. Those staff spoken, to had a positive attitude towards the residents and the home. They had a good understanding of how to keep residents safe. Some said that the home employed good staff who gave no concerns about them working with elderly, vulnerable people. They felt the home was a good place to work. The home assigns a key worker to each resident. Key worker notes showed they check all aspects of people’s care to ensure they are getting all they need. Staff spoke about working towards NVQ Level 2 in care and attending training on caring for people with dementia. The manager advised that most staff are working towards NVQ Level 2 and some are doing Level 3. Staff said they are encouraged to learn new things on courses and update their skills, for example in manual handling.
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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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,36 The home is well managed and efficiently run. Staff are appropriately supervised and guided to ensure residents get consistent quality care. EVIDENCE: The manager is very motivated to provide the best possible care for people. She has long experience of working with older people and holds an NVQ Level 4 in Management. Staff confirmed that they have regular supervision where they can raise issues, and request training etc. Bradbury Home I56-I06 S34348 Bradbury Home V233039 090605 Stage 4.doc Version 1.30 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4
COMPLAINTS AND PROTECTION 4 3 3 2 4 x 3 4 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x x x x 3 x x Bradbury Home I56-I06 S34348 Bradbury Home V233039 090605 Stage 4.doc Version 1.30 Page 17 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP22 Regulation 23 (2)(L) 13 (4)(a) Requirement That the bathroom currently used for storage is kept locked. Timescale for action 1/7/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP28 OP31 Good Practice Recommendations That care plans are signed by residents or their representatives to evidence their involvement in writing them. That 50 of care staff achieve NVQ Level 2 by 2005. Carried forward to next inspection as not inspected. That the manager achieves NVQ Level 4 in care, or equivalent, by 2005. Bradbury Home I56-I06 S34348 Bradbury Home V233039 090605 Stage 4.doc Version 1.30 Page 18 Commission for Social Care Inspection Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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