CARE HOME ADULTS 18-65
Bradbury Wing The Minories Rosebury Crescent Jesmond NE2 1EU Lead Inspector
Irene Bowater Unannounced 22 June 2005 11:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Bradbury Wing Address The Minories Rosebury Crescent Jesmond Newcastle upon Tyne NE2 1EU 0191 281 7996 0191 281 7102 info@london.leonard-cheshire.org.uk Leonard Cheshire Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Ann Stocker CRH 20 Category(ies) of PD Physical Disability (20) registration, with number of places Bradbury Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None. Date of last inspection 14th January 2005 Brief Description of the Service: The Bradbury Wing is situated in a residential area of Jesmond.It is a single storey building which provides both nursing and residential care for 20 younger people with a diverse range of disabilities. The home is run by Leonard Cheshire in Northumberland,however the building is leased from the City of Newcastle upon Tyne and they remain responsible for the maintenance of the building,grounds and gardens. Resident bedrooms are all single occupancy,have large en-suites including showers and ceiling track hoist systems. There is a range of adapted specialist bathrooms and toilets throughout the home. There is a large lounge and separate dining room.Dining facilities are shared with the adjioning day unit. Residents are able to access the courtyard gardens as they wish and are supported to use all local amenities. There is limited car parking to the front of the home. Bradbury Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over four hours. Part of the inspection was to investigate a complaint made by a resident. This was not progressed, as the resident was not available on the day. Arrangements have been made with the resident to visit the home to discuss the concerns made. The home manager was available and assisted throughout the inspection. Many of the residents have communication problems and have high dependency health care needs; it was therefore difficult to talk to a large number of them. Two residents, six staff and two visitors were spoken to throughout the visit. A part of the time was spent examining records and the majority of the time was spent touring the home and talking to staff, residents and visitors. What the service does well:
The home ensures that all residents who are admitted to the home have detailed assessments by qualified nurses and other professionals to ensure that the home can meet all of the residents needs. Each resident has a plan of care, which sets out how the residents needs will be met by the staff. There was an impressive range of information and documentation for staff to follow to improve the quality of life for the residents. The residents have many disabilities and the staff support them to continue with their lifestyles in regard to all aspects of daily living, enable them to make choices and retain control over their lives. The residents are enabled to join in local events, make use of all local services and access specialist organisations. The relationships between residents and staff were based on mutual respect and trust. All personal care is carried out in the privacy of the residents’ own room. They all have their own shower and toilet facilities and most of the rooms have overhead hoist tracking from the bedroom to the shower room. The healthcare needs of the residents is well met by a group of well trained qualified nurses and care staff who are committed to their work and keen to
Bradbury Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 Page 6 continue to improve all aspects of residents care. There is a good working relationship with all other healthcare professionals and specialists and the home maintains links with the local hospital trusts. Visitors said that their relative’s health had improved tremendously since being admitted into the home. Another resident was preparing to leave the home and go into supported living. The complaints procedure is detailed and residents know how to complain and have access to outside agencies. The training and development for staff covers all statutory and specialist training. The home is comfortable, clean and pleasant for the residents. All of the residents’ rooms are large, bright and cheerful and reflect their lifestyle. The home has a vast range of disability equipment to ensure all residents’ needs are met. The staffing levels are regularly monitored to ensure the residents health and social care needs are met. Extra staff are on duty when residents needs change. There is a training and development programme in place, which ensures all staff have appropriate qualifications. The home ensures that the health, safety and welfare of residents, staff and visitors are protected as far as possible. What has improved since the last inspection? What they could do better:
Bradbury Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 Page 7 The residents who are funded by the Primary Care Trust still do not have contracts in place. This must be progressed so that all parties know what their rights and obligations are. The overhead tracking in the bathroom must be repaired so that residents can choose whether to have a bath or shower. The cracked glass in the roof must be replaced. There must be sufficient “bleeps” for staff to use at all times. The bedroom carpets should be replaced as part of the refurbishment programme. 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 Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection Bradbury Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 Page 9 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 standard(s) 2,5 The admission procedures are comprehensive and ensure that the staff can meet residents assessed needs. Without a Contract the rights and obligations for both parties is not clear. EVIDENCE: The home carries out a comprehensive preadmission assessment for all residents before they are admitted to the home. Information is gathered from health and social care professionals, relatives and the resident themselves. All records are available and form the basis of an individual care plan for that person. There have been ongoing discussions with the Primary Care Trust regarding the implementation of contracts both parties have still not agreed .The details. Bradbury Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 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 standard(s) 6,7,9 There is a clear consistent approach to the care planning, which ensures that the staff have the required information to meet residents assessed needs. The staff have a good understanding of residents support needs and enable them to make appropriate choices and decisions about their lives. The home has comprehensive risk management strategies in place, which enables residents to take responsible risks. EVIDENCE: The standard of record keeping has improved since the last inspection. The care plans are based on the preadmission assessment from the Care Managers and the homes own assessment. The plans follow a recognised nursing model of care and also include resident’s social care needs. There is a vast range of assessment tools in place to enable the staff identify individual needs. The plans set out in detail the care to be provided by staff to ensure the complex needs of residents are met.
Bradbury Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 Page 11 There was evidence of family, friends and resident involvement in the process. Regular reviews of the care plans are undertaken with the involvement of other professional and the plans updated according to changing needs. The care plans were organised, clear, up to date and signed by the author. The residents who live in the home are very dependent on the staff throughout a twenty-four hour period. Many of them cannot fully participate in the decisions about their care, however the staff support and enable the residents to seek independent advocacy and peer support. The care plans show how resident choices have been made and also records when and why others make decisions. The risk management for all residents is detailed and available in care plans. The records show that residents and families are involved in the assessment and they are asked to sign the records when necessary. Bradbury Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 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 standard(s) 12,13,16 The social care needs of residents currently meet their lifestyles and personal preferences. Links with the community are good and support residents social and leisure preferences. The staff enable the residents to exercise choices and maintain control over their lives as far as they are able. EVIDENCE: The residents living in the home have a high level of nursing care needs; there fore the development of independent living skills is not usually part of the assessed needs of individuals. Skills that residents have on admission are maintained and supported by staff. One resident has made good progress since admission and all staff, other professionals and representatives are enabling the resident to maximise his potential.
Bradbury Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 Page 13 The residents identify the activities they wish to take part in or access and the staff and volunteers support them to do this. The staff support residents who wish to go out and about in the local community. Two residents have 1 to 1 care to enable them take part in community living. The residents are enabled to have choices regarding daily life in the home as far as they are able. Due to the dependency of some of the residents the staff, other professionals and their representatives make choices for individual residents based on the assessment records and the knowledge of residents likes and dislikes. Bradbury Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 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 standard(s) 18,19 The staff have a good understanding of the residents’ support needs. This was evident from the positive relationships, which have been formed between the staff and residents. The health needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. EVIDENCE: Each resident’s level of support is recorded in the care plan. The resident, other professionals, representatives and staff are involved to ensure individual needs are met. On the day of inspection all personal care was delivered in the privacy of resident’s own rooms. The staff were sensitive to the residents needs and the relationships between staff and resident was seen to be professional and based on mutual trust. There is a vast range of technical aids and equipment available which staff are trained to use. The care plans show that specialist support from physiotherapists, occupational therapists, and speech therapists is sought as necessary.
Bradbury Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 Page 15 The care plans show that qualified nurses carry out a full physical, social, psychological and spiritual assessment for all residents on admission. Baseline nursing measurements are completed and recorded. Specialist assessment tools are used for pressure ulcer risk, tissue viability, continence and nutrition. Completed risk assessments are available for daily activities including falls and use of bedrails. A wide range of specialist equipment is in use for prevention of pressure damage and the home is able to access advice from other specialist nurses. The records show that all residents have regular input from GP’s and the Community Health Team. The home has links with the Palliative Care team and with the medical staff at St Oswalds Hospice. The Disability Team still carry out visits to the home to prevent residents having to attend an outpatient’s clinic. The partnership approach by the staff at the home and other professionals continues to develop the care provided in the home. Bradbury Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 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 standard(s) 22,23 The complaints process within the home is satisfactory. The staff have knowledge of Adult Protection and would be able to use the procedures if necessary. EVIDENCE: The home has comprehensive policies and procedures in place for residents to use should they have a concern or complaint. Any complaints are recorded with action and outcomes recorded. The Commission on behalf of a resident is currently investigating one complaint. There are comprehensive policies and procedures in place for staff to follow should there be any suspicion of Abuse. The training records show that 41 staff have completed the training 16 needs a refresher course and 8 staff are yet to be trained. An appointed trainer carries out the training. There have been no adult protection investigations in the home. The staff have access to specialist training for dealing with restraint and Challenging Behaviours. Bradbury Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 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 standard(s) 24,25,26,27,29 30 The standard of the environment is satisfactory and provides residents with a clean, comfortable place to live. EVIDENCE: The home is a single storey building, which is fully accessible to residents who use wheelchairs. The premises are leased from the City of Newcastle and they have the responsibility for the maintenance of the home. The home is pleasantly decorated and well maintained. The lounge is comfortable and there is a range of audio and television equipment for residents to use. There is a crack in the glass roof, which the manager confirmed was in the process of being repaired. The courtyard gardens are easily accessible and some residents were enjoying sitting out in the summer sun.
Bradbury Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 Page 18 All of the bedrooms are single and have en-suite facilities, which includes a shower. The bedrooms are nicely decorated and residents have been supported to decorate their rooms to reflect their individual preferences and lifestyles. The majority of the residents spent all of their time in their own rooms and several of the carpets are becoming worn through constant use and wheelchair damage. All of the bedrooms have their own en-suite facilities, which include a large shower room, and most of the bedrooms have a ceiling track hoisting system to access this facility. In addition to this there is one communal assisted bathroom, which is also fitted with a ceiling track hoist system and a height adjustable bath. The tracking system is currently awaiting repair. There are also three additional toilets around the building. Given the high dependency of the residents, the preference is to use their own shower and toilets. The home has a vast range of specialist equipment including profiling beds, pressure reliving mattresses, hoists, overhead tracking, and specialist nursing equipment. The emergency call system has been changed and staff carry “bleeps” to alert them when residents require help. The number of “bleeps” supplied is not sufficient to allow for breakdowns or loss. The home was clean, tidy and free from any odours. The staff were knowledgeable about all aspects of infection control and were observed to follow procedures at all times. The sluice was clean and tidy and the laundry although very small was clean and well organised. An external contractor launders linen and towels. Bradbury Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,35 The home is staffed to ensure that the assessed needs of the residents are met. There is a stable staff team who are well qualified and work positively with the residents to improve their quality of life. The training and development provided ensures residents are protected and their current and changing needs are met. EVIDENCE: Throughout the inspection staff were observed to have formed good relationships with the residents. They have knowledge of individual needs and are able to deal with a vast range of resident’s disabilities. The staff have good relationships with GP’s Care Managers, Psychiatrists, physiotherapists, speech therapists, and specialist agencies. The home continues to staff the home according to the dependency levels of the residents. Two residents have a one to one carer during the day and the roster shows that additional staff are on duty when residents are very poorly. . The use of agency staff in the home has reduced and a recent recruitment drive has been successful.
Bradbury Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 Page 20 Given the dependency levels of the residents the qualified nurses are given some supernumerary hours. The staffing levels are: 8am- 5pm 2qualified nurses 7 carers 5pm-8pm 1 qualified nurse 4 carers 8pm-8am 1 qualified nurse 2 carers. The home has a detailed training and development plan for all statutory and specialist training. All statutory training is up to date and other training has been sourced for staff. This includes managing Challenging Behaviour, Multiple Sclerosis and Head Injury. Bradbury Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,42 The manager has provided clear direction and leadership to all staff, which results in the effective management of the home. The residents, staff and visitors health, safety and welfare are promoted as far as reasonably practicable. EVIDENCE: The manager is an experienced first level nurse who has vast experience in caring for this resident group. She has also completed the Registered Managers Award this year. As a qualified nurse she undertakes regular training to maintain her registration with the Nursing and Midwifery Council. The records confirmed that all staff have received training in safe working practices including Fire safety, moving and handling, first aid, food hygiene and infection control. The accident recording and monitoring of accidents is satisfactory.
Bradbury Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 Page 22 There are comprehensive risk assessments available for the environment, which include the safe use of bed rails and fire risk. Bradbury Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 Page 23 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 3 x x 2 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 3 2 x 2 3 Standard No 11 12 13 14 15 16 17 x 3 3 x x 3 x Standard No 31 32 33 34 35 36 Score 3 3 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Bradbury Wing Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 x x x x 3 x B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 Page 24 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA 5 Regulation 5 Requirement All residents must have a contract in place which fully meets the criteria of Standard 5.2. OUTSTANDING SINCE 31.03.04 The home must replace the cracked glass in the roof. The overhead tracking in the bathroom must be repaired. The home must ensure that there are suffucient call bleeps in the home at all times. Timescale for action 1st November 2005 31st August 2005 31st August 2005 31st August 2005 2. 3. 4. YA 24 YA 27 YA 29 23 23 23 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 YA 24 YA 26 Good Practice Recommendations Consideration should be given as to how the home can be organised into clusters of up to 10 residents by 2007. It is recommended that the bedroom carpets are replaced as part of an ongoing refurbishment programme. Bradbury Wing B53-B03 S394 Bradbury Wing V235536 220605 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Northumbria House Manor Walks, Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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