Inspection on 23/01/08 for Bradley House

This inspection was carried out on 23rd January 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bradley House 14/08/09

Bradley House 19/01/09

Bradley House 21/09/06

Bradley House 25/02/06

Bradley House 24/08/05

Bradley House 10/03/05

Bradley House 19/10/04

Bradley House 30/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Bradley House High Street Shirehampton Bristol BS11 0DE Lead Inspector Sandra Garrett Unannounced Inspection 09:45 23 and 24 January 2008 rd th X10015.doc Version 1.40 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 Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bradley House Address High Street Shirehampton Bristol BS11 0DE 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) 0117 9235641 elisabeth.bradleyhouse@btopenworld.com Mrs Elisabeth Laycock Mrs Elisabeth Laycock Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 10 persons aged 65 years and over requiring personal care. Date of last inspection Brief Description of the Service: Bradley House is a care home registered to give accommodation and personal care for up to 10 people aged 65 years and over. The home is owned and managed by Ms Elisabeth Laycock. It’s situated in a residential area of Shirehampton, near Bristol. It’s built over three floors with a lift that goes to the first floor only. Two bedrooms are on the ground floor with four more accessible by the lift, on the first floor. However, four bedrooms in other parts of the building are only accessible by two separate staircases. The home is well kept and has a large, spacious garden mostly laid to lawn, but with a good size vegetable plot. The garden is secure and gives people a quiet area to sit in. The home is situated on the high street close to local shops and bus routes. Fees payable range from £359-£400. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key (or main) inspection that took place over two days. We (the Commission for Social Care Inspection or ‘the Commission’) had gathered information about the home before the visit took place, and drew up an inspection record in preparation for it. This record is used to focus on and plan all our visits so that we concentrate on checking the most important areas. Information looked at included: notices of incidents affecting people living at the home (known as regulation 37 notices), the recent Annual Quality Assurance Assessment (AQAA) that the owner/manager had filled in and returned to us, plus our own surveys that we had sent out before the visit. Nine people and four relatives had filled these in together with four local doctors. At the visit eight people living at the home and four staff were spoken with. A range of records was closely looked at. These included care records, complaints, health and safety, quality assurance and staff records. What the service does well: Bradley House gives people accommodation that because it’s a small place, is more like their own home. The number of staff per group of people is higher than in other larger places and the atmosphere is that of a family home. Bedrooms are of a good size and all are laid out differently. People spoken with frequently told us how happy they are living there. The service users guide has been updated to include photographs of each staff member and of the home itself so that people can see what it’s like and the people that will be looking after them. Care records show that the whole person is considered. They are detailed with lots of information gained about personal likes and dislikes in all areas of peoples lives. Each person has a risk assessment that covers possible abuse. Staff were clear about their responsibilities in identifying and reporting abuse if it happens. That means people are kept safe and protected. Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 6 Comments from our survey included: ‘(They) look after residents well and they seem friendly and caring’, ‘Bradley House are very prompt and careful to carry out their responsibilities’ and: ‘I don’t think they could do more for the residents than they do at present’. What has improved since the last inspection? What they could do better: A number of requirements and good practice recommendations are made to improve the administration and recordkeeping so that people are kept safe. These include: Care plans don’t always follow the pre-admission assessments done by social workers. Therefore care needs aren’t always picked up or recorded in a way that shows how they are to be met. Further, changing needs aren’t added into care plans. That may mean people don’t always get the care they need. Where people have individual needs to do with their medication these must be put into care plans so that staff are aware of those needs. This will keep people safe by reducing the risk of mistakes. Complaints records must be kept so that they are confidential to each person making the complaint. Further, records should show the timescale for responding to the complaint and whether they’re upheld or not. For each staff member taken on, the owner/manager must get two references before the person starts work so that people are protected from risk of harm. Information from the home’s own quality assurance survey must be analysed and put into a report that is then sent to the Commission so that we can see that the home is being run in the best interests of people living there. A development plan should be drawn up to address any issues that come out of the survey report, so that people can be confident their comments or concerns will be acted upon. Each member of care staff must have regular supervision at least six times a year. This will help them focus on their work, get support from the owner/manager and keep people protected from risk of harm. Water temperatures were found to be high in all areas of the home that we tested. The central heating system must be regularly serviced. Thermostatic water supply valves must be regularly tested to make sure temperatures are kept at a safe level in peoples rooms and bathrooms. All water temperatures in basins as well as baths must be checked regularly. Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 7 Activities records should show how people living at the home enjoy their leisure time, particularly where staff do activities with them. This will show the quality of life that people enjoy at the home. An access audit should be done to make sure the home meets the needs of older disabled people and doesn’t unknowingly discriminate against them. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 3 & 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from being given clear information about the home that includes a statement on equalities and diversity. Clear use of contracts that give information about room numbers and fees makes sure people using the service are aware of their rights and responsibilities. Clear and detailed pre-admission assessments make sure that the centre is the right place for people using the service and that staff are able to meet their needs. EVIDENCE: The owner/manager gave us a copy of the most recently updated service users guide that is given to each person when they come into the home. The guide gives a background history about the house itself and the owner. It goes Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 10 on to give information about care plans, staff, activities, meals and complaints among others. The guide also includes lots of photographs of the home, the owner/manager and senior carer, all staff and even the home’s pets. This makes it easier for people to recognise others when they come into the home, particularly if they have memory difficulties. The guide also includes a statement on discrimination, harassment and equalities and diversity. This states that the home will work to meet the specialist needs of people from other cultures or other groups in society without discriminating against them. From our survey eight people said they had been given enough information about the home before they moved in, although one person said they hadn’t. Comments included: ‘I knew all about Bradley House’, ‘Yes I had enough information before I moved in and consider myself very lucky to be here’ and: ‘I had a good look around before I came here so I could see what the home was like’. One relative commented: ‘It’s not a nursing home but it does become home for its residents as far as I can see’. The service user guide also includes a copy of the terms and conditions for staying at the home. These include: the total weekly and monthly fees payable, what the fee covers, the notice period, and what happens in the event of serious illness, among others. Copies of contracts for people that are selffunding were seen that clearly showed the fee payable and included the person’s room number. The people concerned or their relatives had signed these. For those assessed and partly funded by the local authority records were available to show the amount the person had to pay towards the fee, together with the authority’s contribution. From our survey eight people said they had been given a contract and one didn’t comment. Pre-admission assessments were seen in individual peoples files. These had been done by social workers and had also been used as a starting point for care plans. The owner/manager also said that she does her own needs assessment and copies of these were also seen in peoples files. These were detailed and covered every aspect of a person’s life, not just the basic care needs. Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Changes in peoples’ physical conditions and health aren’t always put into updated care plans. That may mean their needs don’t always get met fully. People living at the home are looked after well in respect of their medication needs. However peoples wishes about taking of medication aren’t always recorded. People benefit from being treated with dignity and respect by all staff. EVIDENCE: To the question in our survey ‘do you receive the care and support you need?’ eight said ‘always’ and one said ’usually’. To the question in our survey ‘do you receive the medical support you need?’ seven people said ‘always’ and two said ‘usually’. Local GPs that visit the home Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 12 also filled in our survey and commented: ‘My previous experience of the home has been satisfactory. The standard of care and staff have been excellent’ and: ‘The home provides a high standard of care and works well with our surgery’. Three peoples care records were looked at closely. The records included: The home’s own needs assessment form, The care plan (that includes emotional and physical needs plus an end of life plan), Weekly care review forms, Risk assessments, Healthcare forms such as eye prescriptions from opticians and records of dental treatment and: Progress records. Some people had care plans although others just had the needs assessment that was being used as the care plan. The six monthly reviews were detailed and covered personal and healthcare needs plus emotional needs, memory, leisure and money management among others. For those people whose records we ‘case-tracked’ (this means looking at all records associated with the person and tracking their care by talking both with them and staff caring for them), not everyone had a care plan based on their original social work assessment. One person had needs written in the assessment that hadn’t been transferred into the home’s care plan. This meant her/his needs might not all be met. An example of this was that the assessment included clear needs about continence. However this information didn’t match well with the home’s own plan that failed to address the need properly. Further, the assessment detailed the person’s hobbies but this was blank on the home’s care plan. We spoke to the person but s/he couldn’t tell us much about her/his needs except to say that s/he found it difficult to come to terms with needing residential care. The last care plan review done in August ’07 covered emotional needs and mobility only, rather than all of the needs assessed. Another person had come into the home after being at risk living in the community. S/he hadn’t been looking after her/himself and the assessment identified the need for regular weight checks. Records of monthly weight checks were seen and it was pleasing to note that the person was now gaining weight again. District nurses were visiting the home to treat one person on the first day of the visit. Records of GP visits were seen in individual records. People told us that they can also visit the local surgery themselves if they’re able to. For two people, healthcare needs hadn’t been added to their plans when they happened. One person had developed a pressure sore. Information about this was seen in the weekly review although this didn’t go on being recorded Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 13 regularly to show whether the sores had healed following treatment. The pressure sore and actions taken to deal with it hadn’t been added to the care plan. For another person, frequent bouts of diarrhoea were also recorded but again hadn’t been made part of the care plan. The owner/manager disagreed that the bouts had been frequent although regular notes of it were seen in both the weekly review sheets and progress records. However she was able to say why it had happened. This should have been added to the care plan. Medication records showed no medication given to help the diarrhoea despite it happening regularly. It also wasn’t clear if a GP had been asked for advice about it. The use of both the weekly care review sheets and progress records gave a lot of information about peoples needs and enjoyment of life in the home. Gaps were seen in the progress records but when put together with the weekly review sheets gave a clear record of how peoples needs were being met. The progress records gave more information about healthcare needs although the weekly reviews were more like statements of a person’s health and wellbeing rather than a check of individual care plan headings. Risk assessments were seen for each person that covered health issues, mobility and protection from possible abuse from people not living or working at the home. Moving and handling risk assessments were clear and detailed. Where people were at risk of falls this was recorded. For one person who had had a serious fall downstairs no risk assessment for use of stairs was seen although falls were included in the mobility care plan. Medication was checked. The home has its own medicines policy that is clear on actions to be taken when taking in or getting rid of unwanted medications, giving medicines to each person, dealing with mistakes, and dealing with controlled medicines (those subject to legal controls). Medication is kept in a secure, locked cupboard. There is no metal trolley as recommended by the Royal Pharmaceutical Society and medicines are put into labelled pots then taken to each person separately. This may mean people are at risk if staff are called away while they’re taking the medication around and could lead to mistakes being made. Medicines are signed for after giving and the policy says that staff must make sure people take the medicines before signing the Medication Administration Sheet. On the first day of our visit we saw that this didn’t happen for one person who was left with her/his medication. The owner/manager later explained that the person chose not to take medication in front of staff and s/he confirmed this to us. However this should have been put into the person’s care plan and a risk assessment done. Medicines that need to be kept in cooler conditions (such as eye-drops) are kept in the home’s domestic fridge. Eye drops had been opened but the date of Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 14 opening hadn’t been written on the box although the date they had been prescribed or dispensed was on the chemist’s label. This doesn’t mean the drops were opened on that date however. The owner/manager was advised to make sure boxes were dated as soon as the drops were started as many have only a short life. This was done immediately. A person living at the home had recently died. We were told however that medication had been quickly returned to the pharmacy instead of being kept for seven days, as the law requires. The owner/manager was advised to make sure this happens in the future. The returns book was unable to be looked at as it had been sent back to the pharmacy. Because of all the above we advised the owner/manager that we would ask the Commissions pharmacy inspector to visit. Such visits are helpful so that owners and managers are clear about their responsibilities under the National Minimum Standards and the law governing administration of medicines. During the two days of the visit people living at the home were seen and heard being treated with dignity and respect. It was clear that they enjoy living there and have good, affectionate relationships with the owner/manager and all staff. Call bells were answered quickly. One person told us that s/he is looked after better now than when s/he first came to the home as staff have got to know her/his ways. People told us that staff come when they’re needed. People are able to get up and go to bed when they want and only a few people were up and about when we arrived on the first day. Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from social and leisure activities that meet their needs. Encouragement of contact with the community helps people stay in touch with what is happening outside the home. Few restrictions placed on people living at the home gives them lots of choice in a relaxed atmosphere. Meals at the home provide daily variation, choice, good nutrition and social contact for people. EVIDENCE: To the question in our survey ‘are there activities that you can take part in?’ people commented: ‘I go to the shops once a week. I play board games; I’ve been swimming a lot in the summer’, ‘I enjoy a game of dominoes’, ‘I enjoy playing games with the other residents and staff’, Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 16 ‘I visit the shops with a carer’ and: ‘I go to the shops with a carer regularly and also enjoy playing board games’. One relative commented: ’They go out of their way and act beyond the call of duty to help my parent enjoy his day to day life. For example taking him out, giving lifts etc’. Others said: ‘The whole service at Bradley house is devoted to the comfort and well being of the residents which includes many social events throughout the year’ and: ‘Relatives visit regularly a few times a week’. The care plans looked at covered every part of a person’s life including activities and daily living routines i.e. likes and dislikes, choice of newspaper, radio and TV programmes, books, music and conversation. Other topics covered included games, activities, outings/clubs, meal size and presentation. A list of activities was seen. A lot of the activities are similar to those people would do if they were living in their own homes, rather than organised ones for large groups. They included: Games such as dominoes and board games, Watching videos, Going out to the shops or for a meal (either alone or with a care staff member), Puzzles, Reminiscence, Gardening and garden activities such as barbeques, Knitting, Baking and helping in the kitchen, among others. One person that likes to help in the garden showed us plans for setting out the vegetable patch that s/he had drawn up for the gardener/handyperson to follow. We saw and heard a lively game of dominoes being played in the lounge on the second day of the visit. People told us about going out to the shops in the high street and one person likes to go to the local golf club. People living at the home have a great deal of freedom and ability to choose what they want to do every day. Some people like to stay in their rooms while others spend the day in the lounge. We were given a copy of the minutes from the latest residents meeting (that was held on the first day of the visit). Games were discussed and people said they would like some new ones to play. However the minutes didn’t show what would be done about getting some of the new games people suggested. Some records of peoples daily living routines and activities were seen in their weekly reviews. An activities record is kept separately and this was looked at. The records showed that a lot of games are played and several were about people going shopping or staff going shopping for them. The last record was in November ’07. Few showed how people enjoy the activities they’ve taken part in. It’s not easy to see how much people enjoy the activities they have, Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 17 whether staff take part and what happens for those people who don’t regularly join in. Residents meetings are held regularly and we saw minutes from the last two held in November ‘07 and January ’08. Meetings cover things that go on in the home and a local police officer had attended the November meeting to talk about security. A list of pre-Christmas social events was also recorded in the meeting that some people had chosen to attend. Activities were also discussed at each meeting. The January minutes stated that the forthcoming inspection report would be kept for people to consult. As this forms part of the service users guide it must be made available for people and their relatives to look at at any time. A church service is held in the home on the third Wednesday of each month and one took place while we were visiting. People are also able to feel part of the local community e.g. going to the local shops and visiting their GP surgery nearby. To the question in our survey ‘do you like the meals at the home?’ seven people said ‘always’ and two said ‘usually’. One person said: ‘Yes they’re beautiful’ although one said: ‘More attention could be paid to the cooking of meals’. We saw in the complaints record that a person had complained in November ‘07 that plates weren’t being warmed before hot food was put on them. We had lunch with two people living at the home on the first day of the visit and also found the plates to be cold. The meal itself of sausage, mash and peas, was hot and tasty but cooled quickly because the plate was cold. Weekly menus aren’t displayed as people are asked their individual likes and dislikes – a list of which was seen on the notice board outside the dining room. Staff were heard on both days of the visit going to each person, telling them what the choices were for lunch and taking their requests. Everyone gets breakfast in their rooms, with a choice of toast and cereals or whatever they want. Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home have the necessary information and feel confident about being able to raise concerns or complain about their care if they need to. However, the recording of outcomes would be an extra check to make sure peoples complaints are dealt with fully. Arrangements for protecting people living at the home makes sure that they are protected from risk or harm as far as possible. EVIDENCE: Information about making complaints is found in the service users guide that each person has a copy of. A leaflet about the complaints procedure was also seen on the notice board in the entrance hall. From our survey all nine people who responded said they knew how to make a complaint. Seven said they ‘always’ knew who to speak to if they weren’t happy. Two people said they ‘usually’ knew who to speak to. One person told us s/he was very clear that if s/he had any problems or concerns s/he would tell the owner/manager straight away. Comments about making complaints included: ‘I’d speak with the manager’, ‘I would report it to staff or the manager’ ‘I go to the manager or I would write my complaint down’. A relative who filled in our survey also commented on handling of complaints: Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 19 ‘On no occasion has there ever been any cause or reason to complain’ ‘They are always ready to help’. The complaints record book was looked at. This doesn’t keep each person’s concern or complaint confidential as all are written on the same page. Further whilst every complaint however small is recorded and dealt with, outcomes and dates weren’t always filled in. These didn’t show whether complaints were upheld or whether people were satisfied with the outcome. Complaints recorded included issues with bathing, quality and choice of meals and laundry matters. Even those complaints that might be thought of as minor e.g. not having enough bubbles in a bath, were recorded. This shows that every concern is taken seriously and is good practice. In each person’s records that we looked at we found a risk assessment for protection from possible abuse from people not living or working at the home. These covered all types of abuse with action plans to stop it from happening. Almost all staff had done safeguarding adults from abuse training and the owner/manager said that it’s also covered in each new staff member’s induction. The owner/manager was reminded of the need to make sure that each staff member does the training as soon as possible after starting work. Staff spoken with were confident they would recognise abuse if it happened and gave details to us of a situation that could have led to financial abuse happening to one person. Quick action on the part of a staff member stopped the abuse from happening and the person was protected. This is commended. Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People benefit from living in a comfortable, clean, safe environment that is well decorated and homely. Physical access of the home for older disabled people may not meet all their needs and should be checked. Décor and furniture in individual bedrooms makes sure people are comfortable and have all they need. Good, proper cleaning and hygiene makes sure residents are protected from risk of infection as far as possible. EVIDENCE: Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 21 Because the home is small and used to be a farmhouse it offers people a more homely environment in which to live. The service users guide gives information about the history of the home that dates back to the eighteenth century. Although a listed building, it’s been properly extended to include two ground floor bedrooms and a toilet off the main lounge, together with a large garden room that is light and spacious. The service users guide also gives information about physical access within the home that might be difficult for some people. The guide stated that the home would do what it could to meet such needs where possible. However the home’s Statement of Purpose clearly states that only people that are mobile (although with either a stick or a zimmer frame) can be accepted at the home. The ground floor is level throughout although there is a small step between the dining room and kitchen that could be a hazard for people not able to see it. People have access to all areas of the ground floor including the kitchen and were seen visiting there to talk to staff. Some people like to bake as an activity and staff help them with this. The kitchen includes locked cupboards that house the medication, plus an office area for the owner/manager or senior carer. The large entrance hall has ample space for storing wheelchairs and houses the small passenger lift to the first floor plus a toilet. A notice board by the dining room had photos of staff, plus menu choices on display. There are four bedrooms on the first floor that are reached by either a main staircase or the lift. Above the first floor another staircase leads to two other bedrooms. A separate staircase between the kitchen and the dining room leads to a further two bedrooms. The lift is small and not accessible for wheelchair users. The owner/manager explained that if a person is unable to walk they are transferred from a wheelchair to a chair put in the lift and a member of staff travels with them. One person who has a bedroom upstairs that can’t be reached by the lift said that s/he had no problems with getting up and downstairs. Toilets and bathrooms aren’t accessible for wheelchair users as they aren’t wide enough for chairs to turn around. Raised toilet seats had been fitted in some bathrooms and the first floor bathroom had an ambulift chair – to help lower people in and out of the bath. No grab rails were seen that would help people get up from toilets, on the ground and first floors. Because of the above it’s recommended that the home has an access audit done by an organisation skilled in environmental disability issues. This will make sure that reasonable adjustments are made for disabled older people as required under disability legislation. Bedrooms seen were all of different sizes and layouts. All were of a good size and had been made homely for each person. Rooms were tastefully decorated and included all the fittings as recommended under Standard 24 of the Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 22 National Minimum Standards. These included comfortable seating for two people, a small table and a lockable space for people to keep their valuables or money in. Staff were seen cleaning areas of the home during the two days of the visit. The home was clean in all areas and smelled fresh and pleasant. No cleaning substances that could be dangerous were seen left around the home. To the question in our survey: ‘Is the home fresh and clean?’ eight people said ‘always’ and one said ‘usually’. One person simply commented: ‘excellent’. Another said that overall: ‘I think that anyone who comes here should consider themselves lucky as this is a lovely place and I’m happy here’. Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home’ benefit from sufficient numbers of care staff to meet their needs. Continuing progress with National Vocational Qualification in Care training makes sure people are looked after well. Not all newly recruited staff have thorough checks done to make sure people living at the home are kept safe. EVIDENCE: Three staff were on duty in the mornings on both days of our visit. One was responsible for cooking the midday meal and one was also doing domestic work as well as caring duties. A domestic worker was on duty on the second day. All staff were spoken with at this visit. They said they liked working at the home, that they didn’t feel that it was difficult to meet peoples needs and that they got enough time to do any necessary recording. Call bells were answered quickly and staff were seen about the home at all times. From our surveys all nine people said that staff were ‘always’ available when they needed them. One person commented: ‘There are always staff around when I wish to speak with them’. A relative commented: ‘On every visit the staff make you most Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 24 welcome and never fail to offer you light refreshments (tea/coffee, biscuits or a piece of home made cake)’ One GP surveyed wrote: ‘The standard of care and staff have been excellent’. To our question ‘Do the staff listen and act on what you say?’ people commented: ‘They are very good’ and: ‘They let you voice your opinions and if I have a concern they’re happy to sort it’. Progress continues with National Vocational Qualification in Care training. Of the ten care staff working at the home, three have Level 2 and their certificates were seen. The senior carer and one other both have Level 3. The owner/manager said two staff are currently doing the training but two others had said they don’t want to do it. A complete list of staff with their photographs and information about their training was seen in the recently updated service users guide. The home therefore meets the 50 minimum recommended number of people trained to NVQ level 2 at the moment. However staff should continue to be encouraged to do the training where possible. A sample of three staff files was looked at closely. All included an application form, Criminal Records Bureau checks, supervision and training records. Clear references were seen for two staff but none were available for the third. The owner/manager said this was because the person hadn’t worked before joining the staff team but also because she had known her since she was a child. It’s acknowledged that the owner is aware of the person’s character. However, legislation requires that two references are obtained before people start work. This helps to make sure that the people working at the home are suitable and makes sure people living there are kept safe. Staff said that they get regular chances to do extra training. From their records they had all done essential training in moving and handling, basic food hygiene, first aid and medication. Two staff had done training in dealing with violence and aggression. None of the staff records seen showed that staff had done any training in dementia awareness although one person said she may have done it before. Staff said that they hadn’t experienced any difficulties in dealing with the needs of people with dementia. Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A trained and experienced manager, who understands peoples needs and the inspection process, makes sure they are well cared for. Failure to write up the results of, or use a development plan following quality assurance surveys, means that people may not have a chance to help change the way the home is run, that will benefit them. Staff don’t get enough opportunities for regular supervision to reflect on their working practice, that could lead to poorer quality of care given to people. Failure to check that the central heating and water temperatures are kept at recommended levels may put people at risk. Further, irregular fire safety training and drills for night staff may not keep people safe from risk of harm. Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 26 EVIDENCE: The home is owned and run by Ms Elisabeth Laycock, assisted by her mother who is the senior carer. Both were available on the two days of this visit. They have owned the home since 1996. Ms Laycock has National Vocational Qualification in Care at Level 4 in care management and also holds the Registered Managers Award. It was evident that Ms Laycock has good, supportive relationships with both people living at the home and staff. She showed a lot of knowledge about individual peoples needs. Staff told us that she is a ‘brilliant manager’, very easy to talk to and tries to help with any problems they may have. People living at the home and their relatives fill in yearly surveys so that information can be gained about their satisfaction with the service. A number of questions cover areas such as choice, environment, care, privacy, housekeeping and administration. People can tick boxes on the form as to whether they agree with the questions being asked. A number of finished surveys were seen that showed high levels of satisfaction. These agreed with the findings from our own survey. However, the information gained from all the questionnaires hadn’t been analysed or put together in a report on the outcome of the survey (that should be sent to the Commission each year). Where comments raised a problem or were less than positive, there was nothing to show what had been done about it. The results of the surveys should therefore be collated to help the owner make sure that all comments are addressed. Further it will help her complete the annual quality assurance assessment that we require. Of the three care staff records that we looked at, each had records of supervision done by the owner/manager. Staff told us that they get supervision every three months or so and they’re able to talk about their work and get support. Records seen showed the issues discussed that included care, and training. However for each staff member only three sessions were recorded over the year. No yearly appraisals that give staff opportunities to reflect on their work over the year and plan for the future, were seen. Induction records for new staff (that includes supervision of tasks) were seen however. Health and safety records were looked at. Lift records showed that an outside contractor services it and routine visits are done regularly. The owner/manager checks all the fire safety equipment regularly and the checks had been recorded with dates. Fire drill records showed that they are carried out six monthly with names of people attending and comments on what happened. A risk assessment had been done for the security of the front door so that people are protected. Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 27 When checking the fire safety records we noticed that night care staff hadn’t attended the regular fire safety training or fire drills. Records showed that some had attended training every six months although others hadn’t. The owner/manager explained that night staff had attended the training and drills. However as only one staff member works at night, (‘sleeping in’ rather than being awake), it’s important for records to show that each staff member is trained regularly. This will make sure people are kept safe from risk of fire. We tested water temperatures of all the basins and baths in the home including in toilets, bathrooms and peoples bedrooms, after noticing that one basin ran very hot water. One person also warned us of the high temperature when we were checking her/his washbasin. We found some of the temperatures to be 50°c and some 47°c instead of the recommended 43°c. The owner/manager said that thermostatic valves had been fitted to taps to make sure the temperatures didn’t reach scalding. However there was no sign that these had been checked regularly. There were no records of regular water temperature testing except in bathrooms, where the bath temperatures were recorded on a sheet kept on the back of the door. Further, we found that the only record of the central heating boiler being serviced was in 2004. This must be done more regularly to make sure it’s not liable to break down suddenly. Water temperatures must be checked regularly to make sure older people who are more at risk from scalding are kept safe. Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X 2 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X X 3 X 2 Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2)(c) Requirement All care needs identified on admission must form part of a person’s care plan. Timescale for action 01/03/08 2. OP16 22(3) Changing needs especially about healthcare such as pressure sores, medication and recurring health issues must be put into care plans. This will make sure peoples care needs will be picked up and treated properly. Complaints records must be 01/03/08 kept in such a way that they are confidential to each person. Further, records must show the timescale for dealing with complaints and the outcome for the person. This will make sure people are confident their concerns will be dealt with quickly and to their satisfaction. Whenever new staff are taken on two references must be obtained. This will make sure that people are kept safe from risk of harm. DS0000038920.V354459.R01.S.doc 3. OP29 19(1)(b) 01/03/08 Bradley House Version 5.2 Page 30 4. OP38 13(4)(c) The central heating boiler must be regularly serviced and thermostatic water temperature valves checked regularly. Water temperatures in each room must be checked at least monthly and delivered at 43°c to make sure people are kept safe from risk of scalding. 01/04/08 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. 3. Refer to Standard OP12 OP15 Good Practice Recommendations Activities records should show how people enjoy their hobbies, social and leisure time. This will make sure that they get a good quality of life at the home. Dinner plates should be warmed before hot food is served on them. This will make sure meals stay hot for the length of time it takes people to eat them. An access audit by a person or organisation qualified in disability matters should be done. This will make sure the physical layout, aids, adaptations and equipment meet the needs of older disabled people. A development plan showing how issues raised from the home’s quality assurance survey are to be dealt with should be drawn up after each yearly survey. OP22 4. OP33 Bradley House DS0000038920.V354459.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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