Inspection on 24/04/06 for Bradbury House, Salisbury

This inspection was carried out on 24th April 2006.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 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 15/11/05

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 Key Inspection 24th April 2006 11:30 Bradbury House DS0000064825.V291252.R01.S.doc Version 5.1 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.V291252.R01.S.doc Version 5.1 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.V291252.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Bradbury House Address The Portway Salisbury Wiltshire SP4 6BT 01722 349144 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 Jemma Louise Dowdney Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Bradbury House DS0000064825.V291252.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th November 2005 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. However, some emergency placements last longer than this if no appropriate accommodation can be found. Bradbury House DS0000064825.V291252.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day in April. Several service users and staff members were spoken to, and one family sent their comments about the home in writing. Various documents and files were examined, including care plans, the service user guide, risk assessments, staff files and medication records. The home is currently registered to take people under 65, although some service users who use the service are over this age. An application for a variation to the conditions of registration must be sent to the Commission for Social Care Inspection (CSCI) The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? The home has recently benefited from having the noisy water pipes silenced, which means that both service users and staff do not have their sleep disturbed. The building previously opened on to a busy road, although partial fencing had been erected. The manager and staff, and their employers, Wiltshire County Council, are to be congratulated for the efforts they have made to improve this. The garden has been fenced in so that residents can now be safe from the main road, and benefit from having a secure, attractive garden to use. Bradbury House DS0000064825.V291252.R01.S.doc Version 5.1 Page 6 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 DS0000064825.V291252.R01.S.doc Version 5.1 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.V291252.R01.S.doc Version 5.1 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. Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. 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. Much of the information about new service users 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. The assessment includes such information as mobility, specific health needs and family circumstances. Details of any medication support needed is written down and agreed with the service user or a relative. Bradbury House DS0000064825.V291252.R01.S.doc Version 5.1 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, although not everyone had a care plan. People are encouraged to make choices and decisions about their own lives. The lack of recorded risk assessments means that service users are potentially at risk. Quality in this outcome area is judged to be poor. This judgement has been made using available evidence including a visit to this service. . EVIDENCE: Three service user files were examined. Only two people had a care plan on file. One person had been there since Dec 2005 and had a care plan, although this was not signed and dated, and had not been reviewed. One service user who had recently been admitted also had a care plan, but again not signed or dated. One service user who had arrived on the day of the inspection had no care plan at all. The senior staff member on duty said that she would get one the next day, as the person who “does the care plans” would be on shift then. This means that there was no recorded plan for staff to use when caring for this person, who was unknown to the service. The home must from now on make sure that each person has a care plan on file, and that these are signed Bradbury House DS0000064825.V291252.R01.S.doc Version 5.1 Page 10 and dated. They must also ensure that care plans are reviewed on a regular basis. It is recommended that care plans are amended to include a date when the review will take place. 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 service user spoke of how happy he was to be taken shopping when he wanted, and that he could choose what he wanted to buy. Staff reported that 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. However, there were no risk assessments on any of the three files examined. One service user file said that the person would have difficulty with regulating the temperature of a shower, although the daily records said that she had showered alone. This service user had only been in the home for a few days, and was previously unknown to staff. One service user who was also new to the service had “inappropriate behaviour” highlighted in the community care assessment which accompanied her, although staff were unaware of what this meant. The lack of risk assessments means that there is no record of how these risks are to be managed, or what the potential consequences could be for the service users. Staff reported that the current lack of senior staff meant that they were not able to complete all the paperwork which should be done, and were aware of the need to do so. At the last inspection it was also noted that some service users did not have risk assessments on file, and the manager was asked to ensure that up to date risk assessments were completed for each service user. This has not been done, and has once again been made a requirement. Discussion was held with senior staff about the potential seriousness of failing to do this. Bradbury House DS0000064825.V291252.R01.S.doc Version 5.1 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, 16 and 17 Social and leisure activities are varied and tailored to individual need, with residents choosing what they wish to do. Service users can have as much or as little contact with family and friends as they wish, and are supported to do so by staff. Service users’ rights are respected and responsibilities recognised in their daily lives. They are offered a healthy diet, with their preferences taken into account. Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. 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 Bradbury House DS0000064825.V291252.R01.S.doc Version 5.1 Page 12 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 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. Service users can choose when to be alone or in company, and when not to join in an activity. Staff enter service users’ bedrooms only with the individual’s permission, and were seen to knock on the bedroom door before entering. Daily routines are flexible, with people choosing what they want to do when they return from day services. Support is given to those people who wish do their own laundry or cooking, and the home has its own training kitchen to help service users who want to develop more independent living skills. 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 spaghetti bolognese. 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. The dining room is light and airy and comfortably furnished, so people can enjoy mealtimes together. Bradbury House DS0000064825.V291252.R01.S.doc Version 5.1 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 not fully met as not all staff have had training in providing personal support in the way people need and prefer. The systems in place for administering and recording medication are potentially unsafe. Quality in this outcome area is judged to be poor. This judgement has been made using available evidence including a visit to this service. 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. Service users’ support plans show how any personal care should be delivered. This information is gathered from the initial community care assessment and from occupational therapists who visit each service user who needs the use of specialised equipment. Wherever possible, personal care is delivered by a member of staff the same sex as the service user. However, it was noted that one new service user needed support to change a colostomy bag, and although the male senior staff member on duty had training in this, the female member of staff had not, and had been shown how to do this by another female member of staff. In order to ensure that this procedure is done Bradbury House DS0000064825.V291252.R01.S.doc Version 5.1 Page 14 in the best way for the service user, the home must ensure that all staff have training in stoma care. 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, and can call on them for support if any crisis periods arise. All service users attend reviews on a regular basis, and the care plan may be amended at this time. 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. Two service users are supported to look after and administer their own medication. However, one person had two boxes of Superdrug paracetamol in the cupboard, with no obvious prescription for PRN use. All medication in stock must be prescribed by a medical practitioner, or if used as a homely remedy, medical agreement must be kept on file. One of the packets had been opened, although there was no start date recorded, and the manager has been asked to ensure that the start date is evidenced on any boxes of medication. One service user had PRN Diclofenac and PRN paracetamol prescribed, with a note alongside which said that one should be given after five of the other had been taken. There was no medical evidence which showed why this was so, and no guidelines about how often and under what circumstances the medication should be given. Medical guidance must be sought regarding the use of this PRN medication. One service user had a packet of Piriton in the cupboard, although there was no record of why this had been prescribed, and no guidelines for when it should be used. Another service user was prescribed PRN Risperidone, and again there was no protocol in place for when this should be used. At the last inspection it was noted that some service users did not have PRN medication protocols in place, and the manager was asked to ensure that this was done. These protocols were still not in place, and this has once again been made a requirement. Discussion was held with senior staff about the potential seriousness of failing to do this. Bradbury House DS0000064825.V291252.R01.S.doc Version 5.1 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 recorded. The home’s policies try to ensure that residents are safeguarded from abuse and harm, although procedures are not always followed, meaning some service users are at risk. Quality in this outcome area is judged to be poor. This judgement has been made using available evidence including a visit to this service. 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. One complaint had been received about the doorbell not being heard, and this had been rectified by replacing it. However, there was no record of this complaint on file, and the manager has been asked to ensure that all complaints are recorded and filed alongside the action taken to satisfy the complainant. 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. Two referrals made to the Wiltshire County Council vulnerable adults unit were seen to be dealt with appropriately. However, the daily notes of one service user had recorded Bradbury House DS0000064825.V291252.R01.S.doc Version 5.1 Page 16 that a bruise on his leg had been noted. No further action had been taken, and no further records had been made. The manager has been asked to ensure that any unexplained bruising is immediately referred to Wiltshire County Council’s vulnerable adults unit. In discussion with staff it was said that there have been several instances where staff have been attacked by service users. When incidents such as these occur the home must notify the CSCI, and the manager has been asked to ensure that this is done in future. Bradbury House DS0000064825.V291252.R01.S.doc Version 5.1 Page 17 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 and comfortable environment. It is clean and hygienic. Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. 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. The home has recently benefited from having the noisy water pipes silenced, which means that both service users and staff do not have their sleep disturbed. The building previously opened on to a busy open road, although partial fencing had been erected. The manager and staff, and their employers, Wiltshire County Council, are to be congratulated for the efforts they have made to improve this. The garden has been fenced in so that residents can now be safe from the main road, and benefit from having a secure, attractive garden to use. Bradbury House DS0000064825.V291252.R01.S.doc Version 5.1 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): 32, 34, 35 and 36 Service users are supported by staff with varying qualifications. Their individual and joint needs are not met by appropriately trained staff. They are protected by the home’s recruitment policies, although they do not benefit from well supervised staff. Quality in this outcome area is judged to be poor. This judgement has been made using available evidence including a visit to this service EVIDENCE: All staff have standard induction training which includes first aid, fire safety and administration of medication. Training records showed that staff also had training in communication in challenging behaviour, food hygiene and understanding abuse. One staff member has completed several open university courses and is currently studying Social Care, Social Work and the Law, and Care, Information and Knowledge. Another staff member has completed Advanced Management of Care and is currently studying Supervisory Management Level 3. One staff member has NVQ Level 2, three have NVQ Level 3, and one has NVQ Level 4. However, the home’s quality audit highlighted that several staff members were unhappy that they had been unable to access training in Manual Handling, anger management, LDAF and Recruitment and Selection. It also identified unmet training needs including PACE, Challenging Behaviour, and Autism. The service users who use this Bradbury House DS0000064825.V291252.R01.S.doc Version 5.1 Page 19 service frequently need support with their mobility and/or have challenging behaviours. Lack of training in these areas means that both service users and staff are being placed at risk. The service has passed their concerns to Wiltshire County Council. As stated elsewhere in this report, staff must be provided with training in stoma care. New staff are currently being recruited, with interviews for senior staff taking place later in the week. 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. However, one staff member’s file contained no CRB or references. Senior staff reported that this might have been because the staff member in question had recently transferred from another Wiltshire County Council home nearby. The manager has been asked to ensure that all staff files contain appropriate documentation. The manager should also have access to recruitment and selection training, if needed. Some staff supervision sessions had been started, although one was dated September 2005 and another November 2005. Staff on duty again said that because staffing levels were low, supervision had been frequently postponed, and that the new recruitment drive would help them to keep paperwork up to date. The lack of formal supervision means that staff have no protected time with their manager to discuss their working practice or to reflect on how this could be improved. The manager has been asked to ensure that all staff have formal supervision sessions, and that these are held at least six times per year. Bradbury House DS0000064825.V291252.R01.S.doc Version 5.1 Page 20 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 poor working practices mean that the health, safety and welfare of service users is at risk. Quality in this outcome area is judged to be poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager, Ms Jemma Dowdney, has recently been registered with CSCI. Ms Dowdney has previous experience of working with people with learning disabilities, has completed her NVQ level 4 in management, and is studying for her Registered Manager’s Award. She also has a Diploma in Psychology. Wiltshire County Council conducts regular audits, and the service manager sends a report to the CSCI on a monthly basis. A questionnaire has been devised for service users and their families, and the results compiled by staff. The manager has replied to those who gave their comments, several of which Bradbury House DS0000064825.V291252.R01.S.doc Version 5.1 Page 21 related to having more activities. The manager has added these comments to the individual activity sheets, and it is hoped that the addition of new staff will enable more activities to take place. Some families have written to Bradbury House with such comments as “I cannot thank you enough for looking after my relative” and “she’s so happy with you”. Whilst walking round the building, it was noted that the door leading to the Challenging Behaviour Unit was wedged open. Staff reported that this was because the service user who currently occupies the room is free to access all parts of the house, but cannot open the door. However, this means that the service user is potentially at risk because the fire door is wedged open. The manager has been asked to ensure that a magnetic catch is fitted to this door, and linked to the fire alarm system, so that it will close automatically in the event of a fire. Advice must be sought from the fire officer regarding this. 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 copy of the new Infection Control Guidelines, and all hoists and mobility equipment is serviced regularly. Checks are also done on the water supply for Legionella. The fire extinguishers are serviced annually, with the last one being done in June 2005. Much of the health and safety information has been moved to a new location in an office, and was clearly organised, making it easy to trace information. Training videos are available for staff, and these include Fire Prevention, Health & Safety in the Care Home, Risk Assessment and Fire Drills and Evacuation. The home has a designated fire officer, and one member of staff takes responsibility for health and safety matters. Because of the respite nature of Bradbury House, many service users use their facilities, and fire drills are an important means of ensuring that service users know what to do in the event of a fire. At the last inspection it was noted that there were no details of fire drills, although staff stated that this had been done once, and the manager was asked to ensure that fire drills were conducted on a regular basis. Fire records examined showed that fire drills had not been conducted for five months, and this has once again been made a requirement. Discussion was held with senior staff about the potential seriousness of failing to do this. Bradbury House DS0000064825.V291252.R01.S.doc Version 5.1 Page 22 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 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 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 2 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 X X 1 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 2 2 1 X 3 X 3 X X 1 x Bradbury House DS0000064825.V291252.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? YES 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 3 Standard YA6 YA6 YA9 Regulation 15 (1) 15 (2) (b) 13 (4) (b) Requirement Timescale for action 24/05/06 Each service user must have a care plan in place which outlines the way they like to be cared for. Care plans must be reviewed on 24/05/06 a regular basis Each service user must have an 24/05/06 up to date risk assessment on file. Comment: This is the second time this requirement has been made. All staff must receive training in stoma care. A medication protocol must be in place for all those service users receiving PRN medication. 4 5 YA18 YA20 18 (1) (c) (i) 13 (2) 24/05/06 24/04/06 6 YA20 13 (2) 7 YA20 13 (2) Comment: This is the second time this requirement has been made. Medical guidance must be sought 24/05/06 regarding the use of the PRN medication for one specific service user. All medication in stock must be 24/04/06 prescribed by a medical practitioner, or if used as a homely remedy, medical agreement must be kept on file. DS0000064825.V291252.R01.S.doc Version 5.1 Page 24 Bradbury House 8 9 10 YA20 YA22 YA23 13 (2) 22 (1) 13 (6) 11 12 13 14 15 YA23 YA34 YA35 YA36 YA42 37 17 Sch 2 (5) (7) 18 (1) (c) (i) 18 (2) 23 (4) (e) All medication in boxes must have the start date recorded. All complaints must be logged and the outcome recorded. Any unexplained bruising must be immediately referred to Wiltshire County Council’s vulnerable adults unit. Any incident of violence towards staff or service users must be reported to the CSCI. All staff files must contain two references and evidence of a CRB check. All staff must receive training in manual handling. All staff must have formal supervision sessions at least six times a year. Fire drills must be conducted on a regular basis. Comment: This is the second time this requirement has been made. A magnetic catch, approved by the fire officer, must be fitted to the main door of the Challenging Behaviour Unit instead of wedging the door open. 24/04/06 24/05/06 24/04/06 24/05/06 24/05/06 24/05/06 24/06/06 24/05/06 15 YA42 13 (4) (a) 24/06/06 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 2 Refer to Standard YA6 YA35 Good Practice Recommendations Care plans should be signed and dated and include the date of the next review. The manager should have access to recruitment and selection training, if needed Bradbury House DS0000064825.V291252.R01.S.doc Version 5.1 Page 25 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.V291252.R01.S.doc Version 5.1 Page 26 - 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!