Inspection on 24/08/05 for Bradley House

This inspection was carried out on 24th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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 23/01/08

Bradley House 21/09/06

Bradley House 25/02/06

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 Nicky Grayburn Announced 24 August 2005 09:30 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 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 D56_D05_S38920_BradleyHouse_V245647_240805_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Bradley House Address High Street Shirehampton Bristol BS11 0DE 0117 9235641 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) elisabeth.bradleyhouse@btopenworld.com Mrs Elisabeth Laycock Mrs Elisabeth Laycock PC Care Home Only 10 Category(ies) of Old Age, for 10 registration, with number of places Bradley House D56_D05_S38920_BradleyHouse_V245647_240805_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate up to 10 persons aged 65 years and over requiring personal care. Date of last inspection 10th March 2005 Unannounced Brief Description of the Service: Bradley House is a residential home which is registered to provide accommodation and personal care for up to 10 residents aged 65 years and over. The home is owned and managed by Ms Elizabeth Laycock. The home is situated in a residential area of Shirehampton. It is built over three floors and has a lift accessing the first floor. There are four bedrooms which are only accessible via a staircase. The home is well maintained and benefits from a large garden, which is secure and provides a quiet area for residents. The property is situated on the high street so benefits from the local amenties and bus routes. Bradley House D56_D05_S38920_BradleyHouse_V245647_240805_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out within one day lasting 6.5 hours with two inspectors. Evidence of the standard of care was obtained through a tour of the property; informal interviews with the manager, senior carer, carers and residents; and observation. Records of resident’s care, staff files, and health and safety files were also examined. Lunch was offered and the inspectors ate with the residents. All staff were helpful and welcoming. The focus of the inspection was to pursue the previous requirements and recommendations, and to ensure compliance with legislation. What the service does well: What has improved since the last inspection? 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. Bradley House D56_D05_S38920_BradleyHouse_V245647_240805_Stage4.doc Version 1.40 Page 6 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 Standards Statutory Requirements Identified During the Inspection Bradley House D56_D05_S38920_BradleyHouse_V245647_240805_Stage4.doc Version 1.40 Page 7 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, 4, 5 The home’s admission procedure ensures that residents have the information they need prior to admission and that the home can meet individual assessed needs. EVIDENCE: Residents now have a copy of the terms and conditions of the home. There have been two new residents since the last inspection. Opportunity was taken to view the personal file of one of the newest residents. This included a full assessment conducted by a social worker prior to admission. In addition to this the manager completed an initial assessment to ensure that the home would be able to meet his needs. This meets with requirements of the legislation. The proprietor is required to develop clearer guidelines about the identified mental health needs of one resident. The resident has a history of mental health issues, which needs to be monitored for his own personal safety. A community psychiatric nurse visits for support. Staff need to be aware of any possible triggers and to gain a knowledge of mental health issues. Risk assessments are required to be compiled in order to protect the resident. Bradley House D56_D05_S38920_BradleyHouse_V245647_240805_Stage4.doc Version 1.40 Page 8 The resident concerned said that both he and his family visited the home prior to him making a decision to move there. He said that this enabled him to make a more informed choice about whether to move there. He was also aware that he was living at the home for a month’s trial period and could choose to leave if he wished. All those residents spoken with expressed contentment with services they receive at the home and they spoke warmly about the staff team who they said would do any thing for them. Observation of interaction between residents and staff indicated the relationships are respectful and friendly. Standard 6 is not applicable. Bradley House D56_D05_S38920_BradleyHouse_V245647_240805_Stage4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 9, 11 The care planning system ensures that resident’s health needs are met and they are protected by robust medication procedures. Resident’s wishes regarding death may not be met unless more detailed information is obtained. EVIDENCE: One resident’s file was inspected in depth. This included information of personal details, initial assessments and care plans. As an additional mark of good practice care plans are reviewed and commented upon on a weekly basis. Residents also have six-monthly reviews with members of their family. Residents who are presenting confusion are to be assessed for possible diagnosis. The home operates a monitored dosage system for the administration of medication that is supplied at regular intervals by the local pharmacist. Records held in relation to this were found to be well maintained and met with the requirements of the legislation. Bradley House D56_D05_S38920_BradleyHouse_V245647_240805_Stage4.doc Version 1.40 Page 10 Stock records are kept of all medication given on an as and when basis. These were spot checked and found to be accurate. The senior carer, who is responsible for the medication system, displayed a good understanding of what the tablets were for and possible side effects. This is good practice. Within the application form for potential residents, there is a space for ‘specific last wishes’. However, this does not provide Mrs Laycock with sufficient detail and this was discussed. It is required that residents are asked about their wishes in the event of death so that the residents feel that when the time comes, their wants and wishes will be upheld, and also so that staff know what action must be taken. Bradley House D56_D05_S38920_BradleyHouse_V245647_240805_Stage4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13, 14, 15 Resident’s are well catered for with a balanced and wholesome selection of food, which allows for choice and variation. Social and religious interests are upheld. Resident’s are free to go out into the community as they wish. EVIDENCE: Church of England services are held at the home as many residents are of this belief. Mrs Laycock also takes one resident to communion. Staff confirmed that they provide a level of entertainment in the lounge, such as bingo, dominoes and skittles. Staff also read the newspaper to residents who are hard of sight. Mrs Laycock goes to the local library for one resident to borrow audio tapes. There is a sign on the hallway notice board stating that visitors are allowed to visit at any time. Mrs Laycock said that she has formed good relationships with the families. Due to the home’s location, residents are able to go into the local community at ease and do so when they wish. One resident confirmed that they go out to the local newsagent regularly. Bradley House D56_D05_S38920_BradleyHouse_V245647_240805_Stage4.doc Version 1.40 Page 12 Residents said they were able to get up and go to bed when they pleased and there did not appear to be any unnecessary house rules. They were observed having unlimited access to all communal areas of the home and some choose to spend the majority of their time in their bedrooms. Both inspectors ate lunch with the residents in the dining room. Two residents prefer to eat in the conservatory, which is catered for, and one resident was having a meal in their room because they felt unwell. The menu for the last few weeks was looked at and displayed the wholesome foods offered. Other choices of meals for lunch are provided if the resident so wishes. For tea, the residents have whatever they please. The many vegetables grown in the garden are eaten by the residents. Two residents have special dietary needs and are well catered for. Bradley House D56_D05_S38920_BradleyHouse_V245647_240805_Stage4.doc Version 1.40 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 There is evidence that residents feel that they can raise any issues with staff and that they are listened to and acted upon. Staff are not adequately aware of protection of vulnerable adults. Training is needed for staff concerning this area to ensure the residents are protected from abuse. EVIDENCE: There have been four complaints in the past twelve months regarding personal preferences, all of which have been substantiated and dealt with. Residents feel comfortable with raising any issues with staff. Some staff have completed ‘elderly abuse’ training and some have undertaken POVA training from previous employments. Staff were unsure about the procedures of POVA and No Secrets, and were unaware of the General Social Care Council. Details of this had been discussed with the manager and information has been sent to the home to aid further knowledge. The Code of Practice for care staff is to be obtained and explored with staff. Bradley House D56_D05_S38920_BradleyHouse_V245647_240805_Stage4.doc Version 1.40 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,23,24,25,26 The standard of the environment within this home is good, providing residents with an attractive and homely place to live. EVIDENCE: Residents enjoy the homely atmosphere within the home. The large quiet garden is accessible to residents, with one of them tending to a vegetable patch. Another area is being transformed for more home-grown vegetables. Two other areas are being paved over to increase the usage for residents, with one area having a built in barbeque. There is a large lounge with sufficient number of chairs and also a conservatory, which overlooks the garden. Bradley House D56_D05_S38920_BradleyHouse_V245647_240805_Stage4.doc Version 1.40 Page 15 The majority of rooms were entered and were very pleasing with many personal possessions and photos on display. All rooms are for single occupancy. Some residents had complained about the heating in the past, and in some rooms the temperature was quite fresh. This needs to be monitored especially as the colder weather approaches. All residents now have individual thermostats on their radiators in their rooms. The radiators of high risk have covers in order to protect the residents. The bathroom on the first floor is in need of refurbishment. Mrs Laycock is already aware of this and is planning with the maintenance staff when and how it can be done as it is the bathroom which is most used. This will be checked at the next inspection. The home is clean and hygienic and presents no odours. Bradley House D56_D05_S38920_BradleyHouse_V245647_240805_Stage4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28, 29, 30 Staff relationships are good resulting in a positive atmosphere for residents improving their quality of life. Clarity of training needs would improve the resident’s needs being met by having a more skilled staff team. EVIDENCE: A number of staff files were looked at and inconsistencies within the recordings were found. This was discussed with Mrs Laycock and is required to improve the records and recruitment practices. One member of staff does not have a CRB check. The manager is required to ensure that the member of staff is not to work solely until this arrives. Further, two written references from previous employers for all staff must be obtained prior to commencing work. The manager is required to ensure that the CRB checks contain POVA checks. Certificates of training are displayed on the wall in the kitchen and also some are kept in individual files. It would be good practice to keep a record on each file as to what training each staff has undertaken. All staff have just completed training in manual handling and are awaiting the certificates. A Food Hygiene course with Bristol City Council was planned recently but it was cancelled. Staff must attend this course as soon as possible. Mrs Laycock is devising a training matrix so that it is clear when staff are in need of training thus improving their competencies. Bradley House D56_D05_S38920_BradleyHouse_V245647_240805_Stage4.doc Version 1.40 Page 17 Only one member of staff has their NVQ in care. All staff spoken with are keen to start this to improve their knowledge and practice. It has been required that at least 50 of staff are to start their NVQ. One member of (part-time) staff is 16 years old. It was understood that she cannot undertake any personal care or administer any medication. Bradley House D56_D05_S38920_BradleyHouse_V245647_240805_Stage4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35, 36, 38 Resident’s best interests are safeguarded by the home’s management and staff team. Record keeping within the home regarding health and safety protects the residents. EVIDENCE: Mrs Laycock has achieved her NVQ Level 4 and Registered Managers Award. Mrs Laycock has been a registered manager since 2002 and remains to be fit to be in charge of the home. She lives next door and has a close relationship with all residents and staff. Staff and residents spoke with praise regarding Mrs Laycock and likened the home to a family. The issue of quality assurance was discussed with the manager and it is recommended that a more robust system is put in place. Previous attempts at gaining information through questionnaires has not been successful and informal chats are not sufficiently informative. It was discussed how the new Bradley House D56_D05_S38920_BradleyHouse_V245647_240805_Stage4.doc Version 1.40 Page 19 system could be posed to visitors and staff. This will be followed up at the next inspection. Mrs Laycock has no responsibility for individual’s finances. It was suggested that more information is sought regarding resident’s power of attorneys so that Mrs Laycock and staff are clearer about legal issues surrounding this. The fees are parallel to social services’ fees. This has resulted in some resident’s fees decreasing. Mrs Laycock said that this is so that the resident’s are able to avoid feeling that they may have to move when their money has reached the limiting threshold. Formal supervision is not taking place. Some staff were unsure what supervision entails and have never had such a meeting with the manager. However, due to the staff team having such good relations with each other, any issues or problems are dealt with on a day-to-day basis. Staff confirmed that Mrs Laycock is ‘super super approachable’ and is ‘the best manager I’ve ever had’. The team would benefit from formal supervisions and it is a recommendation that this should take place. No staff meetings are taking place. Staff spoken with confirmed that they would like staff meetings, but do understand that logistically it could be difficult. In the past, Mrs Laycock had given staff the opportunity to suggest what could be done regarding this matter but not many responses were returned. It would be beneficial for the entire team to hold such meetings to address issues as a team rather than on a day-to-day basis. The fire logbook evidenced that the home makes tests and checks of the system at the appropriate intervals. Staff have had re-fresher fire training and there was a workplace fire risk assessment There were numerous policies relating to health and safety issues – these were not looked at in detail during this visit. They covered a wide range of topics, including food hazard analysis and COSHH regulations. In addition to the above there were general risk assessments about manual tasks carried out on the premises. The gas boiler had been serviced on 15\10\04 and electrical equipment had been tested in March of this year. It was noted that the proprietor has recently obtained a new contract with a company to service the lift throughout the year. It was understood that they had recently serviced the lift but not left any documentation to evidence this. The proprietor was advised to ask them to leave a service sheet. The fridge and freezer temperature records were looked at and were correct and had regular daily recordings. Bradley House D56_D05_S38920_BradleyHouse_V245647_240805_Stage4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x 3 3 3 3 STAFFING Standard No Score 27 x 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x 3 x 3 2 x 3 Bradley House D56_D05_S38920_BradleyHouse_V245647_240805_Stage4.doc Version 1.40 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. 4. 5. Standard OP4 OP11 OP18 OP28 OP29 Regulation 12 (1) 12 (1) 13 (6) 18 (1) 19 Requirement To obtain, and inform all staff regarding mental health guidelines and advice. Manager to obtain information regarding residents wishes at time of death. To ensure that all staff receive POVA training. 50 of staff to be enrolled on NVQ in Care course. To ensure CRB checks are in place for all staff prior to start date. To ensure two references are attained for all staff. Ensure residents have appropriate risk assessments in place. Timescale for action 24/09/05 24/10/05 24/11/05 24/11/05 24/11/05 6. OP38 13 24/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP19 OP33 Good Practice Recommendations The first floor bathroom to be refurbished. Manager to implement a quality asssurance system to ensure the home is run in the best interests of the residents. D56_D05_S38920_BradleyHouse_V245647_240805_Stage4.doc Version 1.40 Page 22 Bradley House 3. OP36 Manager to commence staff meetings and regular formal supervisions Bradley House D56_D05_S38920_BradleyHouse_V245647_240805_Stage4.doc Version 1.40 Page 23 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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