Inspection on 15/11/05 for Bradbury House, Salisbury

This inspection was carried out on 15th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bradbury House, Salisbury 15/01/09

Bradbury House, Salisbury 21/12/06

Bradbury House, Salisbury 24/04/06

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Bradbury House The Portway Salisbury Wiltshire SP4 6BT Lead Inspector Alyson Fairweather Unannounced Inspection 15th November 2005 10:00 Bradbury House DS0000064825.V266518.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 DS0000064825.V266518.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 DS0000064825.V266518.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bradbury House Address The Portway Salisbury Wiltshire SP4 6BT 01225 713000 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) Wiltshire County Council Mr Malcolm Wilson Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Bradbury House DS0000064825.V266518.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection This is the first inspection of Bradbury House Brief Description of the Service: The building is a purpose built residential unit offering respite care for up to 10 adults with learning disabilities. The building has 10 single bedrooms, some having hoisting facilities, several assisted baths and toilets, as well as equipment for people with a sensory impairment. There are two high dependency rooms and one room for emergency placements, as well as several lounges for communal use, a large dining room and a well-equipped kitchen. There is also a training kitchen which is used by service users hoping to increase their independence. It is envisaged that a respite period would not last more than 8 weeks, and an emergency placement would be reviewed after 48 hours. Bradbury House DS0000064825.V266518.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one full day in November. Several service users and staff members were spoken to, as well as three parents, an occupational therapist and a care manager. Various documents and files were examined, including care plans, the service user guide, staff files and medication records. What the service does well: What has improved since the last inspection? What they could do better: Medication administration practice must be improved. Medical authorisation is needed for medication which is administered in food, and procedures and guidelines must be in place for administering PRN medication and for giving medication by syringe. These procedures will help to make sure that service users are not put at risk. The garden needs to be made safe so that service users can access it without being placed at risk. The water pipes also need attention so that service users and staff do not have their sleep constantly disturbed. Bradbury House DS0000064825.V266518.R01.S.doc Version 5.0 Page 6 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 DS0000064825.V266518.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 DS0000064825.V266518.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): 1 and 2 Prospective clients and families are given information leaflets so that they can choose whether or not they wish to use the service. All service users have their individual needs assessed before they arrive, so that staff know how best to support them. EVIDENCE: The home has a comprehensive Statement of Purpose and Service User guide which give an overview of the service which will be provided. This is given to every potential service user, and also gives details of the organisation’s complaints procedure. The booklets are available in pictorial format. One family spoken to during the inspection said how happy they were to have been given such detailed information. Assessments are completed for all new clients, and records showed that a detailed range of information is obtained. This includes information on mobility, and specific health needs and family circumstances. Much of this information is gathered from the community care assessment which accompanies a referral, but staff also visit prospective service users’ homes or day services in order to get as much information as possible so that they know best how to support people. Details of any medication support needed is written down and agreed with the service user or a relative. One family was planning to stay with their relative for the first few visits so that they could show staff how best to manage her needs. Bradbury House DS0000064825.V266518.R01.S.doc Version 5.0 Page 9 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, 7 and 9 Care plans reflect the needs and personal goals of service users, who are supported to make decisions about their own lives. They are supported to take risks where appropriate, and encouraged to be as independent as possible. EVIDENCE: Each service user has a care plan which will be reviewed on a regular basis. Care plans focus on individual’s strengths as well as any need or problem, and contain sections on communication abilities, domestic abilities, mental health, physical health and sleep patterns, among others. They also contain information on the person’s daily routine, and notes are made about how the service user has been that day. Care plans showed that service users are supported to make choices in a number of areas, such as daily activities, where they would like to eat, and how they want to spend their money. Staff give guidance but are clearly aware that service users have the right to make their own choices. One care manager spoken to was very pleased that a service user who had recently gone to Bradbury House was able to take his drum kit with him. Bradbury House DS0000064825.V266518.R01.S.doc Version 5.0 Page 10 Service users are supported to take risks where appropriate, and staff work hard at trying to make sure that they are aware of any potential risk. Risk assessments were on file for some service users, although not all of them could be found, and some of those on file had not been updated. In discussion with staff, it was felt that with some people formal risk assessments had not been recorded, although staff knew how to protect service users from any potential risk. The manager has been asked to ensure that up to date risk assessments are on file for each service user. Bradbury House DS0000064825.V266518.R01.S.doc Version 5.0 Page 11 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, 15 and 17 Social and leisure activities are varied and tailored to individual need, with residents choosing what they wish to do. Residents can have as much or as little contact with family and friends as they wish, and are supported to do so by staff. They are offered a healthy diet, with their preferences taken into account. EVIDENCE: Residents are encouraged to develop and maintain their independence as much as possible and they can come and go as they wish. As Bradbury House caters for respite service users, many people already have outside activities which they enjoy, and they are supported to continue with these. One service user works for the Shaw Trust, and others attend college or day services or go hill walking. People also visit the local pubs, cafes, shops, library and cinema. Some people use public transport, with the local park and ride scheme a few minutes walk away. Another enjoys music, and has a drum kit and an organ in his room. Bradbury House has its own games room, with a pool table, skittles and a dartboard, and has supplied a Karaoke machine which has proved very Bradbury House DS0000064825.V266518.R01.S.doc Version 5.0 Page 12 popular. Service users can also have the use of a Sky DigiBox which enables them to access a number of extra-terrestrial TV channels. Friendships both inside and outside the home are encouraged, and staff support links between service users and their family and friends, although the frequency of contact varies depending on the individual circumstances. Because Bradbury House offers respite care to families, some do not choose to visit at that time. Service users are free to visit friends outside the house at any time, and can entertain and choose to see who they like either in the privacy of their own bedrooms or in the communal areas available. The menu supplied in the home is varied and nutritious, and is drawn up on a weekly basis. Breakfast usually consists of cereal & toast, with a cooked breakfast on Sundays. Lunch can be a cooked meal for those who wish, or a packed lunch for those who go out during the day. The main meal of the day is at supper time, and on the day of the inspection was potato and bacon gratin and lemon meringue pie. An alternative option was available for those who wished it. There was a good supply of fresh fruit and vegetables, and juices and yoghurts were also available. Staff have records of the food likes and dislikes of all service users, and of any feeding support necessary. One service user has a milk intolerance, and the kitchen assistant and other staff were clearly aware of alternatives which could be offered. The dining room is light and airy and comfortably furnished, so people can enjoy mealtimes together. Bradbury House DS0000064825.V266518.R01.S.doc Version 5.0 Page 13 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, 19 and 20 Healthcare needs of service users are written in care plans so that they can receive support in the way they need and prefer, and their physical and emotional health needs are met. The systems in place for administering and recording medication are potentially unsafe. EVIDENCE: Bradbury House has various adaptations and pieces of equipment in place to help with service users’ physical needs, including hoists, grab-rails and assisted baths. All service users have support plans for any personal care required. The information contained in them is gathered from the initial community care assessment and from occupational therapists who visit each service user who needs the use of specialised equipment. If the families live locally, the person’s own GP is used, and local GPs are used for those who live further afield. Medical professionals are seen as and when required. This varies according to the needs of individuals and the situations arising while having respite care. The home has good links with the local learning disability teams, which enables an effective response to any crisis periods that may arise. All service users attend reviews on a regular basis, and the care plan may be amended at this time. Bradbury House DS0000064825.V266518.R01.S.doc Version 5.0 Page 14 Medication is kept in a designated room and is kept in a locked cupboard in this room. Medication support is recorded on a Medication Administration Record (MAR) and is signed for by two members of staff. Each service user had a medication profile on their care plan. However, one person had two types of medication prescribed for the same thing, both differing doses, with no way of telling which one was to be used or when it should be used. This medication had not been used since the service user had been staying at Bradbury House, and the manager has been asked to ensure that there are clear guidelines in place for using PRN medication. Another service user was receiving medication disguised in yoghurt, although there was no record on file that this had been agreed by the GP. Staff reported that other medication for the same service user was to be given by syringe, although there was no statement to this effect on file. The manager has been asked to ensure that there are clear guidelines in place for staff as to how this is done, and that any medication which is disguised in food is done so with the explicit agreement of a medical practitioner. Bradbury House DS0000064825.V266518.R01.S.doc Version 5.0 Page 15 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 and 23 Service users’ views are listened to, but complaints have not always been dealt with. The policies and procedures the home has in place try to ensure that residents are safeguarded from abuse and harm. EVIDENCE: The home has a complaints procedure in place, and this is given to service users and their families. There is a compliments and complaints file, and several compliments have been received from the families of people who have had respite care provided in Bradbury House. Staff spoken to were clear that they wished the service to be run in the interests of the service users. However, several complaints have been received about the water pipes banging in the night and waking service users, and although the manager has been in touch with the building firm, this has not been rectified yet. The inspector spoke to another service user’s family member during the inspection. This person has made a complaint about the fact that there is no fence at the side entrance of the building, making it unsafe for service users who may run out on to the main road. The manager was aware of the complaints, but has been unable to do anything about them because of external factors. Requirements have therefore been made about the need for improving the safety and the quality of life for service users who use Bradbury House. The home has copies of the “No Secrets” document, as well as the organisational policy and procedure on responding to allegations of abuse. All staff members are encouraged to report any incidences of poor practice, and a “Whistle Blowing” procedure is also available. There are guidelines in place for the management of challenging behaviour, and those staff using the LDAF training methods have a session on Understanding Abuse. Bradbury House DS0000064825.V266518.R01.S.doc Version 5.0 Page 16 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 and 30 Service users live in a homely environment, although the lack of fencing makes it unsafe. The home is clean and hygienic. EVIDENCE: Bradbury House is an attractive home, with large airy rooms and comfortable furnishings. There are large mature gardens at the rear and side of the house, which service users have enjoyed using. Bedrooms were homely and each contained individual personal items. Each person has an en-suite bathroom. However, as previously stated in this report, there is an on-going problem with water pipes making a noise, particularly at night, and this has wakened both staff and service users. This noise is made worse by flushing the toilet, and the quality of life of service users is now being affected. Staff too are wakened during sleep-in duties, and are therefore un-refreshed when going back on duty in the morning. The manager has been asked to make sure that the noisy pipes are silenced so that people might sleep better. Although the building has only recently been built, only part of the garden is fenced off. Intruders have already entered the garden and stolen some garden furniture, and some young people have been caught riding their bicycles across the grounds. It was more concerning to note that the main driveway from the Bradbury House DS0000064825.V266518.R01.S.doc Version 5.0 Page 17 house leads to a very busy road, as many of the service users who use Bradbury House are unable to comprehend road safety. The inspector witnessed one service user trying to leave the building unaccompanied, although the alarm system alerted staff to this. Another service user has wandered away from his day services in the past, and has been reported to the police as a missing person. This means that some service users are at risk, and the manager has been asked to ensure that additional fencing is added to the property to make the garden safe. Bradbury House DS0000064825.V266518.R01.S.doc Version 5.0 Page 18 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): 34 and 35 Service users are supported and protected by the home’s recruitment policies and their needs met by appropriately trained staff. EVIDENCE: Staff recruitment is assisted by Wiltshire County Council’s human resources department. All staff have Criminal Records Bureau (CRB) checks and are checked against the Protection of Vulnerable Adults (POVA) register. Two written references and a medical declaration are also required. All the staff files looked at contained the appropriate documentation. All staff have standard induction training which includes first aid, manual handling, fire safety and administration of medication. Training records showed that staff also had training in communication in challenging behaviour, food hygiene and understanding abuse. All new staff are using LDAF training and some are working towards NVQ. Bradbury House DS0000064825.V266518.R01.S.doc Version 5.0 Page 19 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): 37, 39 and 42 Service users benefit from a well run home, where they can be confident their views are important to the development of the service. Some working practices do not promote and safeguard the health, safety and welfare of the people using the service EVIDENCE: An application has been received by CSCI to register Ms Jemma Dowdney as manager of Bradbury House. Ms Dowdney has previous experience of working with people with learning disabilities, is undertaking her NVQ level 4 in management, and plans to take her Registered Manager’s Award. The current manager would be the service manager, overseeing several other homes, and would have line management responsibility for Bradbury House. A questionnaire has been devised for service users and their families, and it is planned to ask for their feedback after every respite stay. Wiltshire County Council conducts regular audits, and the service manager sends a report to the CSCI on a monthly basis. The results of the questionnaires will be compiled in Bradbury House DS0000064825.V266518.R01.S.doc Version 5.0 Page 20 the near future. The families spoken to said that they were very happy with the service offered at Bradbury House. All staff have had food hygiene training and food temperatures are recorded on a daily basis. The fire bell is tested weekly and the emergency lights and fire fighting equipment are tested monthly. The home has a designated fire officer, and one member of staff takes responsibility for health and safety matters. However, the fire records examined did not have any details of fire drills, although staff stated that this had been done once. The manager has been asked to ensure that fire drills are conducted on a regular basis and that records are kept of all service users and staff who take part. Bradbury House DS0000064825.V266518.R01.S.doc Version 5.0 Page 21 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 3 3 X X X Standard No 22 23 Score 2 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 x 17 Standard No 31 32 33 34 35 36 Score X X X 3 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bradbury House Score 3 3 1 x Standard No 37 38 39 40 41 42 43 Score X X 3 X X 2 X DS0000064825.V266518.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? NA 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 YA9 Regulation 13 (4) (b) Requirement The registered person must ensure that each service user has an up to date risk assessment on file. The registered person must ensure that a medication protocol is in place for all those service users receiving PRN medication. The registered person must ensure that any medication which is given in food is done so with the explicit agreement of a medical practitioner. The registered person must ensure that there are clear guidelines in place for administering medication by syringe. The registered person must ensure that the garden is made secure in order that residents might use it safely. Comment: The home is near a busy main road and has only one area fenced off. The registered person must ensure that the noisy pipes are silenced so that service users’ sleep is not disturbed at night. DS0000064825.V266518.R01.S.doc Timescale for action 15/12/05 2 YA20 13 (2) 25/11/05 3 YA20 13 (2) 25/11/05 4 YA20 13 (2) 25/11/05 5 YA24 13(4 abc) 23(2 o) 15/01/06 6 YA24 12 (1) (a) 15/12/05 Bradbury House Version 5.0 Page 23 7 YA42 23 (4) (e) The registered person must ensure that fire drills are conducted on a regular basis and records kept of all service users and staff who take part. 15/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bradbury House DS0000064825.V266518.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 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 DS0000064825.V266518.R01.S.doc Version 5.0 Page 25 - 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. 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