CARE HOME ADULTS 18-65
Bradbury House The County Durham Cheshire Home Worthington Close Crook Durham DL15 8NL Lead Inspector
John Trainor Unannounced Inspection 5th December 2006 11:30 Bradbury House DS0000000700.V320895.R01.S.doc Version 5.2 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 House DS0000000700.V320895.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bradbury House DS0000000700.V320895.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Bradbury House Address The County Durham Cheshire Home Worthington Close Crook Durham DL15 8NL 01388 768380 01388 768519 clare.booth@lc-uk.org www.leonard-cheshire.org.uk Leonard Cheshire 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) Mrs Linda Blair Care Home 24 Category(ies) of Physical disability (24) registration, with number of places Bradbury House DS0000000700.V320895.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Physically disabled 18 years and over Date of last inspection 12th December 2005 Brief Description of the Service: Bradbury House is owned by The Leonard Cheshire Foundation and is registered as a Care Home with Nursing. The building was designed to meet the needs of disabled people and was purpose built in 1992. The home is situated close to the town centre of Crook in County Durham and provides easy access to shops, the library and other local leisure facilities. Bradbury House provides spacious communal and private living space with wide corridors and doorways which helps to ensure ease of access for wheelchair users. Communal space is made up of central, open plan areas used as sitting and dining rooms. Resident’s accommodation consists of spacious bed-sits some with kitchenette facilities. All have lounge and bedroom facilities. All bed-sits have en-suite bathrooms with toilet, wash basin and with bath or shower facilities. Patio doors from all bed-sits allow easy access to patio areas and the homes gardens. The home also provides a Day Care facility for up to 9 people each weekday. This is located in designated areas within the homes communal space. Residents of Bradbury House can join in with day care activities if they wish. The home has their own specialist vehicles that have been especially adapted for the needs of service users. Fees at the time of inspection ranged from £642.87 to £972.25. Bradbury House DS0000000700.V320895.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection involved the home providing information to the Commission for Social Care Inspection before a site visit which was unannounced and lasted 4 hours 45 minutes. During this visit records were inspected including care plans and health and safety records. People were spoken to including people resident, staff and management. There was a tour of the building What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bradbury House DS0000000700.V320895.R01.S.doc Version 5.2 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bradbury House DS0000000700.V320895.R01.S.doc Version 5.2 Page 7 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People could be assured the home was able to meet their needs and had enough information to make a decision before moving into the home. EVIDENCE: Files inspected showed evidence of the homes own and care management assessments so a decision could be made based on people’s assessed needs. The statement of purpose and service user guide was prominently displayed in the foyer and all residents had copies when they moved in so they knew what the service was about. All service users had a contract or statement of terms and conditions. The contract and statement of terms and conditions did not include a full breakdown of fees and who is responsible for paying them which included a statement of the free nursing care determination. People said they had an opportunity to come and visit before moving in and some of them attended as a day care client before moving in. Bradbury House DS0000000700.V320895.R01.S.doc Version 5.2 Page 8 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were encouraged to make choices and their plan reflected their individual needs and preference. EVIDENCE: Care plans were good and told the story of the care people needed and how they wanted the care to be delivered. They included social occupational plans, risk assessment and risk management. The home used independent advocacy when needed and could evidence the use of CAB independent advocates. The organisation also ran an advocacy service with experts by experience, where disabled people from other projects acted as advocates. People’s needs were individually planned for and choice was encouraged. Staff were observed to treat people with dignity and respect. Bradbury House DS0000000700.V320895.R01.S.doc Version 5.2 Page 9 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples lifestyle reflected individual expectation and preference. EVIDENCE: People said their lifestyles met their expectations they could come and go as they pleased within a risk management framework. People reported going to the local pub and club, popping out to the shops. The home had worked closely with the local authority on disability adaptations to curbs etc enabling town centre access. People reported the food was, “alright,” and “very nice, I’m easily pleased…usually 2 or 3 choices.” People said that they were fully involved in care planning processes, “I have full access to my ISP.” Activities were individually planned and included in the individual service plan (ISP) people also had access to the day care facility if they wanted to.
Bradbury House DS0000000700.V320895.R01.S.doc Version 5.2 Page 10 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples health and social care needs were met in a planned way. EVIDENCE: Files inspected showed evidence of both primary health care team involvement and secondary health specialists where necessary. Care plans accounted for health and social care needs. Medication was stored safely in individual rooms, allowing those who wished and were able, to manage their own medication. Administration of medication was recorded accurately though improvements when handwriting instructions on the MARS sheets could improve safety. Bradbury House DS0000000700.V320895.R01.S.doc Version 5.2 Page 11 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People could be assured their concerns would be heard and responded to and there was a procedure to protect people from potential abuse. EVIDENCE: There were policies for the protection of vulnerable adults. Staff had been trained in POVA issues. Complaints procedures were robust and people could be assured their concerns would be heard and responded to. Records were kept of complaints, including outcomes. Bradbury House DS0000000700.V320895.R01.S.doc Version 5.2 Page 12 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People lived in a clean and homely environment specially adapted to meet their needs. EVIDENCE: The home was clean. Infection control measures were evident. Each room was en suite with hoist and tracking from bed to bath. Corridors were gleaming. Sluice areas and communal bathrooms were clean, there was an assisted bathroom on each wing. People said they liked their rooms which were personalised and had lockable space. Bradbury House DS0000000700.V320895.R01.S.doc Version 5.2 Page 13 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. Quality in this outcome area is (excellent, good, adequate or poor) This judgement has been made using available evidence including a visit to this service. People had their needs met by a well trained staff team deployed in sufficient number, with ancillary support, to meet their needs. EVIDENCE: The home continued to work to the old staffing notice as issued by the previous regulatory authority. Both the manager and head of care thought staffing levels were sufficient to meet needs. The home was creative in thinking about ways to meet peoples needs within budgetary constraints. The organisation was committed to training and 98 were NVQ 2 or above with most staff trained to NVQ 3. There was a nurse on duty 24 hours a day with 5 carers in the morning 4 in the afternoon and two carers at night. Some people had individual 1-1 time in addition to this. There were dedicated ancillary staff to supplement carers plus volunteers and separately staffed day care facilities which some residents attended. Staff were supervised within a cascading system which was well documented. Bradbury House DS0000000700.V320895.R01.S.doc Version 5.2 Page 14 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, and 42. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home was well managed, in the interests of the people resident, by a person competent to do the job. EVIDENCE: The manager was well qualified and committed. Quality assurance measures to check whether the home was doing a good job were excellent. Staff were supervised within a cascading system which was well documented. Service user monies were recorded accurately. Management systems were good and all information was easily to hand and had it’s place. Health and safety matters were managed well.
Bradbury House DS0000000700.V320895.R01.S.doc Version 5.2 Page 15 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 4 X X 3 X Bradbury House DS0000000700.V320895.R01.S.doc Version 5.2 Page 16 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 YA5 Good Practice Recommendations It is recommended terms and conditions and contracts are amended to include a breakdown of fees including detail of the free nursing care element where relevant and who is responsible for paying which element. Where handwritten instructions are recorded onto medication administration record sheets by nursing or care staff these should be initialled and checked and counter initialled to show this is an accurate reflection of the prescribers instruction. 2. YA20 Bradbury House DS0000000700.V320895.R01.S.doc Version 5.2 Page 17 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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 House DS0000000700.V320895.R01.S.doc Version 5.2 Page 18 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
