CARE HOME ADULTS 18-65
Bradbury House 14 Fairway Brislington Bristol BS4 5DF Lead Inspector
Sarah Webb Announced Inspection 30th November 2005 10:00 Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 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 DS0000026526.V258712.R01.S.doc Version 5.0 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 DS0000026526.V258712.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Bradbury House Address 14 Fairway Brislington Bristol BS4 5DF 0117 9716716 0117 9853092 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) Mr Neil Bradbury Miss Michelle Louise Hole Care Home 15 Category(ies) of Learning disability (15), Mental disorder, registration, with number excluding learning disability or dementia (3) of places Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. May accommodate up to 3 persons with Learning Disabilities and Mental Health needs. Can accommodate up to 15 persons aged 18 - 65 years with learning disabilities 18th July 2005 Date of last inspection Brief Description of the Service: Bradbury House and West Town Lane are registered with the Commission for Social Care Inspection to provide accommodation and personal care for up to fifteen persons with a learning disability, aged 18-64 years of age. Primarily it seeks to accommodate service users with autistic tendencies who may exhibit challenging behaviour. There is a condition of registration in that West Town Lane may accommodate up to 3 people with a learning disability and mental health need. Bradbury House is a listed building which is set back from the road in a quiet residential area. Within the grounds is a detached day care facility (the workshop), which is primarily accessed by the service users from Bradbury House. West Town Lane is a four-bedded property and is situated on the same site and is completely detached from Bradbury House. The home is managed by Ms Michell Hole who is registered with the Commission for Social Care Inspection. Mr N Bradbury owns Bradbury House and is the registered provider. Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 6.75 hours and was carried out as an announced inspection by Sarah Webb and David Smith. The inspection methods used included record checks, case tracking, incident reports, regulation 37 reports and discussion with the Area Manager, registered manager, day service manager, and staff. Individuals receiving a service were met during a tour of both properties and during the midday meal; their views were not fully pursued at this inspection but will be a focus at the next inspection. What the service does well: What has improved since the last inspection?
The home has complied in meeting three requirements made from the last inspection. The home has sent an action plan to the Commission indicating how staff are to be trained through the National Vocational Qualification process. Both Bradbury House and West Town Lane now keep records of named staff having attended fire drills. The home has continued to keep the manual handling needs of individuals under review via risk assessments; should individuals needs change regarding
Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 Page 6 their mobility or any other specific need where staff may need to offer physical support in their moving and handling, then appropriate manual handling training will need to be provided. 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. Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 Page 7 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 DS0000026526.V258712.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&4 The assessed needs and preferences of service users are met and there are processes in place for the review of their care. Prospective service users can ‘test drive’ a placement in order to make an informed choice. EVIDENCE: Since the last inspection, a service user who has been receiving a day service for many years has begun the process of filling a vacancy. Records evidenced, that, through the home’s admissions policy being followed, there are robust procedures in place in determining whether this person’s needs are to be met. The procedure involved an assessment carried out by funding authority, with a choice given to the individual as to whether they wanted to access another home in the organisation instead of Bradbury House. It was also evident that both several evening visits and overnight stays occurred. Meetings with family and social worker took place to review progress of the new placement. The home also works closely with all agencies in the management of risks, and it was evident that this is part of the admission process. Another service user has moved to another home in the organisation following appropriate procedures. It was evident through observation of records and discussion with the manager that the move has proved to be a positive move
Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 Page 9 for this individual. The home is to be commended for the admission arrangements in place and that these reflect good practice. Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 8 & 9 There is a clear and consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet individual needs. However a review of the home’s accessible formats would benefit service users so that they are involved in their care planning in a meaningful way. The home has risk management procedures in place to ensure individuals are supported safely in taking risks but the home needs to improve in the implementation of risk assessments for those individuals who are supported through restrictive interventions. EVIDENCE: Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 Page 11 Relevant documentation in care plans include a personal profile, assessment of need, personal care information and likes and dislikes. Other areas of recording included health reviews and six monthly care reviews. Observation of the care planning indicated that the home has made a start in using a symbolised format. However it was evident that the majority of service users do not understand this format, as it can be complex and needs to be learnt. Discussion took place with the area manager, home and day service manager concerning the accessibility of care plans, total communication approaches and the need for individuals to be involved more fully through all means. For example, one service user was observed selecting and carrying an object, but did not have a clear expressive communication strategy in place. She does not appear to be tactile defensive and it is therefore possible that objects of reference could be used as part of a person centred total communication approach. This could provide her with more opportunities and choices if successful and may also provide a route to develop some accessible information. A recommendation has therefore been made for a review to be carried out of the home’s accessible information in order that individuals are involved in the care planning process in a meaningful way. The home could access Speech and Language Therapy for support and advice, if necessary. If an adapted format cannot be meaningfully developed, the home should evidence how this has been assessed. Risk assessments had been completed and reviewed on a regular basis. There were risk assessments in place for those individuals who presented behaviour that challenges- these were also linked into the care planning system; these included triggers for challenging behaviour and diffusion techniques but did not include restrictive interventions. The home’s policy is this area was described to both inspectors as being consistent with the Department of Health Guidance on Restrictive Physical Interventions. However, the home’s reactive strategies do not include a Risk Assessment where the use of physical interventions are required. This is seen as central for safe and effective care planning and is in accordance with the Department of Health guidance. These therefore need to be implemented by the home and form part of relevant care plans. Copies of records of all incidents of challenging behaviour where restraint is used are sent to the Commission for Social Care Inspection on a monthly basis. Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 The home offers opportunities for individuals to take part in appropriate social, leisure and educational opportunities in order to enhance their lifestyle. Individuals are supported in maintaining contact with families. Individuals’ rights and responsibilities are supported through the daily routines of the home. The meals in the home are good offering both choice and variety. EVIDENCE: The home continues to offer a structured and varied programme for individuals. Records demonstrated that service users are offered opportunities to develop independent living skills with documentation indicating the outcome of these sessions. A workshop on site that is included in the service for individuals living within the Bradbury organisation, offers a choice of planned activities and courses to
Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 Page 13 suit peoples needs. All courses are affiliated through Filton College. The organisation also offers individuals placements at a farm on the Mendip Hills giving support to gain experience areas of Horticulture. Activities are offered to individuals in accessing both the local and external communities during the course of the week and during evenings. This was evidenced through the day diary and individuals records. Holidays are determined through individuals preferences and need; some people had been supported on a 1:1 basis such as visits to Paris and Centre Parcs, while others had been offered group holidays or day trips. The four people living at West Town Lane use public transport whilst Bradbury House has transport on site. Through discussion with the manager it was evident that the home has good relationships with families and that staff encourage individuals to maintain contact with their families. Staff support individuals with visits to families. A comment card returned by a relative indicated that they were satisfied with the overall care provided; that they were welcomed to the home at any time, and that they were kept informed and consulted in matters of importance concerning the care of their family member. It was evident that the home respects individuals’ privacy; whilst touring the home, the manager knocked on individuals’ doors prior to entering their bedroom. All service users have been offered a key to their bedroom; the manager said not all choose to use them. Risk assessments were in place regarding accessing keys and decisions made as to whether individuals held their own keys. It was evident through observation of the menu, cooking in progress, and discussion with the cook that meals are freshly prepared, nutritious, varied, and offer a balanced diet. The menu included options for service users to choose from. The cook has worked at the home for many years and identified individual’s preferences and special diets. This was evidenced through information available in the kitchen on dietary needs of the service users. Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 & 20 The home supports service users with their personal care support as identified in their care plan respecting their preferences and their cultural diversity. A monitored dosage system of medication for service users is in operation and this is well managed. EVIDENCE: Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 Page 15 Individuals’ personal care needs are recorded in care plans giving appropriate information in how support is given. Staff are required to compile monthly care updates for each service user as part of their Keywork responsibilities. The home continues to respect a service user with their cultural diversity and has an agreed protocol in place in how to support their individual personal needs through staff support preferences. This is recorded in their care plan and is a condition of their placement with the home. It was evident from observation of documentation and discussion with the manager that the home continues to access support and guidance from professionals such as physiotherapists, occupational therapists, psychiatrists, and psychologists. The home uses the Boots Monitored Dosage System of medicine administration. All medication is administered by staff. Staff records examined show that staff have received training by Boots on this system. Both the manager and her deputy have attended additional Boots Care of Medicines Training. Service users have their medication reviewed regularly. This process is supported by a Consultant Psychiatrist. Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The home has procedures in place to consult with both staff and service users about concerns and complaints but service users should be more informed through accessible means. The home ensures the safety and protection of individuals through appropriate measures. EVIDENCE: The home has a complaints policy setting out the procedure to take including action to be taken and timescales to respond to any complaint. There have been no recorded complaints since the last inspection. The recommendation made through Standard 6 to review accessible information should also include the complaints procedure in order that staff may work with individuals in a meaningful way to have a better understanding of how to complain. The home has a whistleblowing policy. The home has a policy for the protection of vulnerable adults. Staff are trained internally through the organisation’s NAPPI trainer in awareness of the protection of vulnerable adults. The trainer has attended appropriate training himself regarding the protection of vulnerable adults through both the local authority and NAPPI. Both the home manager and day service manager have attended investigatory training through Bristol Social Services. Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 Page 17 Staff receive annual training on restraint techniques and positive ways of dealing with challenging behaviour; these are nationally recognised and follow good practice guidelines. Documentation in place evidenced that staff have been police checked through the Criminal Records Bureau. Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 The home continues to provide a homely environment whilst considering the health and safety needs of individuals. EVIDENCE: Bradbury House is a two storey, semi detached, listed, 17th century property. It is set back from the main road and is in keeping with the local community. In the grounds of the property there is another home for four people with a learning disability, a day facility (workshop) and the office of the organisation and a training suite, which is detached from Bradbury House. Both Bradbury House and West Town Lane come under the registration of Bradbury House. This key standard was assessed at the last inspection and was met following redecoration and refurbishment of some areas. The manager said that the organisation continues to be committed in being creative in providing both a homely and safe environment for individuals to live in. The home has recently had problems in carrying out a consistent maintenance programme and are in the process of addressing this.
Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 Page 19 Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 35 & 36 Staff have a clear understanding of their role and responsibilities in order to meet service users needs. The home is working towards an action plan for staff to be qualified through National Vocational Qualification process in order to support service users competently. The homes recruitment policy is robust but is not always followed consistently in order to protect individuals. Staff are trained through appropriate means in order to meet individuals needs effectively. The home has arrangements in place for the supervision of staff. EVIDENCE: A new care worker related their previous experience, and their 2 week induction period in the organisation. They said they were supported well through this process with appropriate training given within statutory training including food hygiene and first aid. This was also evidenced through an
Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 Page 21 induction checklist that identified areas of staff’s duties and responsibilities. They were also able to explain processes and procedures used in situations if the need for restraint was required. They were clear about their role and how they supported individuals on a daily basis. A requirement has been met for the home to set out how staff are to be trained through the National Vocational Qualification process. Due to the length of time the organisation would have to wait for external assessors to work with staff, the organisation has decided that the senior management team undertake the appropriate National Vocational Qualification and assessors award. The area manager has started the assessor’s course whilst the home manager is in the processing of completing the Registered Managers award. There was evidence that staff have signed a disclaimer from the working directive to enable them to work in excess of 48 hours per week; any additional hours covered are recorded in a diary for the purpose of ensuring staff are paid for working appropriate hours. Discussion was had with the area and home manager regarding this practice and in ensuring that this is monitored in order that staff are able to carry out their duties and responsibilities effectively. The home has recently undergone a recruitment drive and has employed 5 new staff. Records seen included references, CRB, identity check, and other relevant documentation. All application forms were in place bar one. Training records evidenced that all staff are up to date with statutory training. Other training recorded included medication, epilepsy, incident report writing, and mental health. Part of the staff team have completed LDAF foundation level whilst the newer staff are still in the process of completing this at induction level. Discussion with both the manager and staff indicated that there are arrangements in place for staff to receive regular 6 to 8 weekly supervision. Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 41, & 42 The home has arrangements in place for the monitoring and review of the service. The home maintains records well ensuring the rights and best interests of service users are safeguarded. There are appropriate fire procedures and protocols in place in order to ensure the health, safety and welfare of both service users and staff. EVIDENCE: Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 Page 23 There are arrangements in place to measure the quality of the service being provided. The home has a comprehensive quality assurance tool in place with target indicators that cover all areas of the management of the home. This is compiled into a quarterly report with feedback given to the management team of the home. The home has previously compiled questionnaires for relatives, and service users. Staff questionnaires were in the process of being collated. It was evident that there are other arrangements in place for the reviewing the quality of care; this included care reviews, supervision and team meetings. Records seen during the inspection included care plans, risk assessments, regulation 37 reports/incident reports, and medication records. Those records seen in were up to date and in good order. The home sends incident forms to Commission for Social Care Inspection on a monthly basis informing the Commission of any restraint used. Two requirements have been met regarding the keeping of a record of fire drills and the names of staff who attend, and also in ensuring staff attend fire drills at West Town Lane. The fire log indicated that all appropriate testing of fire equipment was being maintained and staff had attended fire training. Not all areas of standard 42 were assessed at this inspection. Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 Page 24 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 4 x 3 x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 x 3 2 x Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x x LIFESTYLES Standard No Score 11 x 12 4 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 x 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Bradbury House Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score x x 3 x 3 x x DS0000026526.V258712.R01.S.doc Version 5.0 Page 25 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 2 Standard YA9 YA34 Regulation 13(4)(c ) Sched 2 Requirement Carry out risk assessments for those individuals who are in need of physical intervention. Keep copy of application form for new staff. Timescale for action 31/05/06 30/04/06 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 YA6 Good Practice Recommendations Review accessible formats in order that service users are involved in their care planning in a meaningful way Bradbury House DS0000026526.V258712.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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