Inspection on 25/02/06 for Bradley House

This inspection was carried out on 25th February 2006.

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

The inspector 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 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 E. Jones Unannounced Inspection 25th February 2006 09:30 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.V283743.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V283743.R01.S.doc Version 5.1 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 elizabeth.bradleyhousetopenworld.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.V283743.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 10 persons aged 65 years and over requiring personal care. 24th August 2005 Date of last inspection 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 amenities and bus routes. Bradley House DS0000038920.V283743.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second unannounced inspection for the home. It was conducted over one day lasting 6.5 hours. This inspection was based on examining key standards of care. Outcomes for residents were assessed through records and feedback from staff and residents. The service provider, staff and residents were helpful and open with their views about the provision of care and conduct of the home. Lunch was offered and joining residents at the mealtime presented an opportunity to discuss decisions made about living at the home. The number of requirements are not a sign of poor practice. What the service does well: What has improved since the last inspection? Since the last inspection, the service provider has begun to develop a person centred approach to meeting resident’s needs. In developing this approach, residents will be enabled to maintain their independence, lifestyle and pursue hobbies long after their admission to the home. Bradley House DS0000038920.V283743.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bradley House DS0000038920.V283743.R01.S.doc Version 5.1 Page 7 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.V283743.R01.S.doc Version 5.1 Page 8 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 the following standard(s): The requirement that the proprietor is required to develop clearer guidelines about the identified mental health needs of one resident is repeated through this inspection. EVIDENCE: Bradley House DS0000038920.V283743.R01.S.doc Version 5.1 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 the following standard(s): 7,8,9&10 Residents health care needs are well met and the current move towards person centred planning will help to enhance good practice. Attention needs to be given to medication procedures and manual handling risk assessments to ensure that the risk of harm to residents is reduced to a minimum. The staff respect residents rights to individuality including privacy and dignity. EVIDENCE: A Person Centred approach to meetings needs is being developed at the home. The service provider has used good practice guidelines from NAPA to develop a framework that places the individual at the centre of their care. One resident is currently developing the plan with the service provider. Daily routines are being sought, with likes and dislikes on meeting the identified need. The care planning process should be adopted for the residents accommodated. Care plans currently identify the person’s needs with a brief description to meet the need. Weekly care review sheets are completed by the staff on their observations of the person, activities undertaken and outcomes of visits. One person currently exhibits “dementia characteristics” which focuses on communication needs which must be incorporated into person centred plans. Bradley House DS0000038920.V283743.R01.S.doc Version 5.1 Page 10 Current care plans briefly list the assessed needs. The introduction of a person centred approach, personal care will incorporate key elements of rights, choice, inclusion and independence. Two residents have continence difficulties and input from the continence advisor was sought. Continence aids were provided appropriately. One person has dialysis three times weekly and renal services are used. One person has a history of self-harming and a risk assessment is in place on the triggers, signs and preventative measures. Additional information on the staff’s action, in the event that the preventative measures is unsuccessful, must be included in the assessment. This individual is also a haemophiliac and staff are instructed to contact the haemophiliac clinic in the event of an injury. One person requires assistances from one staff with standing and moving around the home. While a risk assessment is in place for manual handling, the information held should be further developed in line with the risk assessment for the person that self-harms. It is evident from the documentation held within individual files that specialist support is sought on behalf of the residents. Residents access local NHS facilities, regular appointments are organised for residents to visit opticians and dentists. Individual medication profiles that list the purpose and side effects are in place. Information leaflets appended, ensure staff have full information about medications administered. Medications are administered from a monitored dosage system by the staff. Gaps in the records of administration indicated that staff do not sign the records immediately after administration. The records of administration must be signed immediately after administration to endorse safe practices. A record is kept of medications no longer required at the home, countersigned by the pharmacist to evidence receipt for disposal. The Privacy policy describes the approach towards residents right to privacy. It was also understood that residents rights including privacy and dignity is integrated into all home’s policies and procedures. Care plans instruct staff to leave the individual in the bathroom indicating that rights are considered when providing personal care. Residents were consulted on the manner in which their rights are observed at the home. Their comments indicated that staff respect their rights as individuals including privacy and dignity. Staff knock on bedroom doors before entering, their mail is handed unopened and personal care is provided in private. Resident’s wishes regarding death may not be met unless more detailed information is obtained, was a requirement from the last inspection. The service provider reported that the requirement was partially met. Bradley House DS0000038920.V283743.R01.S.doc Version 5.1 Page 11 Bradley House DS0000038920.V283743.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 12&13 There is an emphasis towards enabling residents to maintain their lifestyle after admission to the home and not to provide structured organised activities. Staff attitude towards visitors facilitate the strengthening of relationships between residents their friends and family. EVIDENCE: Residents consulted gave feedback on the standards of care at the home. It was understood that a member of staff has delegated responsibilities for 1:1 with residents. A daily record is maintained of the activity conducted with the individual, which confirms that residents can maintain their lifestyle. One residents consulted stated that privacy and independence from other residents is a lifestyle choice. Structured organised activities do not occur at the home. The emphasis is towards enabling residents to retain their social and recreational interests since admission to the home. Comments made about where meals can be eaten, social relationships and times to rise and retire endorse the opportunities that exist at the home to make choices. Bradley House DS0000038920.V283743.R01.S.doc Version 5.1 Page 13 Residents confirmed that their visitors to the home are welcome by the staff . Visits can take place in community areas or private space for additional privacy. Bradley House DS0000038920.V283743.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 16&18 Residents feel able to raise concerns and complaints and their comments expressed confidence with service provider in resolving their concerns. It is clear that the service provider takes protective issues seriously. However, the staff training in this area will ensure that staff working directly with residents are able to recognise forms of abuse and take appropriate action. EVIDENCE: There were no complaints received at the home from residents and relatives for investigation since the last inspection. Residents giving feedback were clear about the procedure and would approach the service provider with complaints. Their comments suggests that concerns raised are taken seriously and resolved promptly. Available to staff are the Abuse, No Secrets and POVA pack, which must be read and signed by the staff employed. While the information is available for staff to read, external training for the staff must be considered to clarify procedures in line with “No Secrets” in Bristol. Since the last inspection, the service provider discovered an incident of alleged financial abuse involving a resident. In line with the “No Secrets” policy the service provider has alerted the lead agency for POVA in Bristol. A copy of the report was sent to the individuals’ care manager and action from them is awaited. CSCI will monitor the process followed and outcome of the investigation. Bradley House DS0000038920.V283743.R01.S.doc Version 5.1 Page 15 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 the following standard(s): These standards were examined at the previous inspection. EVIDENCE: Bradley House DS0000038920.V283743.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29&30 The staffing ratio meet the needs of the current residents. NVQ registration for staff will increase their skills and competency to meet residents needs. The current recruitment system does not fully protect residents from harm and must be addressed. Training relevant to the registered category of needs must be considered to ensure staff have increased insight into the specific needs of older people. EVIDENCE: The rota in place establishes that two staff are rostered with the service provider from 9:00 am to 4:00 pm. Staffing levels are then reduced to one person until 7:00 pm when two people are rostered until sleeping staff arrive. One person sleeps in the premises at nights, with ancillary staff rostered during the week for cleaning the home. The service provider is aware of the responsibilities to meet residents changing needs and should residents needs increase an assessment of the staffing levels must take place. Three members of staff were working at the home during the inspection. As one person is under 18 years, two staff were rostered to provide assistance with personal care. Staff meetings are held monthly and relate to the residents, house routines and staffing issues. From the meetings the service provider prepares a memo for display on the home’s notice board. Staff employed at the home complete a detailed induction programme during the initial period of employment. Since the last inspection, members of staff Bradley House DS0000038920.V283743.R01.S.doc Version 5.1 Page 17 have registered onto NVQ level 2. From the training records held at the home, it is evident that the staff complete statutory training. Training that is specific to the needs of the residents needs must be considered. Additional training that reflects the residents category of needs will ensure that staff have the skills and capabilities to meet residents changing needs. Members of staff’s personal files were examined at the inspection. Completed application forms, terms and conditions of employment, supervision minutes, crb’s and references. A recent photograph of the person must be included in their personnel files. Two written references were missing in the personnel files of four staff and evidence of a crb was missing in three files. In order to protect residents from abuse crb and POVA First checks need to be in place. This is a requirement under Regulation 19 and staff must not commence employment until either a full crb is received or a POVA First check has been successfully undertaken. This was a requirement at the last inspection and failure to comply will result in enforcement action. Standard request for references are used and the service provider must seek authenticity from referee. To establish staff suitability to work with vulnerable adults, crb must be sought in advance of commencing work at the home and the referee must validate references. Bradley House DS0000038920.V283743.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,35,36&37 Systems are in place that create a homely and positive culture for residents. Quality Assurance is based on the residents experience and measures needed to improve the service at the home. Residents accommodated control their finances. Individual supervision ensures staff are supported to complete tasks that maintain high standards of care. Members of staff must attend fire drills at the stipulated frequencies to ensure fire safety. Other records examined are up to date and well-maintained safeguarding residents best interests. EVIDENCE: Surveys were used to assess the residents experience of the care provided at the home. Surveys were completed by residents and where necessary with staff assistance. Residents experience of choice, environment, care and other aspects of daily living at the home was sought through the survey. There are opportunities for residents to make additional comments about improving the care. Additional comments on improving the care can be added to the survey. Bradley House DS0000038920.V283743.R01.S.doc Version 5.1 Page 19 One stated that a longer time in the bath, would be improve their quality of life at the home. The survey is being extended to friends and family and at the time of the inspection, two surveys had been returned. Two members of staff agreed to give feedback on the conduct of the home. One person stated that the atmosphere is homely and less intimidating because of the size of the home. The service provider is approachable and systems that ensure consistency of care are operational at the home. Staff meetings and individual supervision were described as providing consistency of care at the home. A record of the fees charged at the home is in place and the Local Authority currently funds seven residents. The records in place lists the weekly charge paid by each person along with and the sources that contribute to the fees. It was understood from the service provider that the current residents manage their own finances and cash is not held in safekeeping. Since the last inspection, the service provider introduced individual supervision with the staff. Members of staff on duty confirmed that supervision takes place. Copies of supervision, with staff, indicated that discussions are based on personal developments, performance and unresolved issues. There was a recent inspection conducted at the home by an Environmental Health officer. From the record of the visits, changes in legislation were discussed. A Record of fridge and freezer temperatures is maintained and demonstrates compliance with Food Safety legislation. A record of food provided is maintained, with alternatives provided to each person. Residents comments about the food were complimentary and confirmed that meals are sufficient in quantities. The records that relate to fire safety checks and practices were examined. While the checks and training take place at the stipulated frequencies, staff must attend fire drills. Bradley House DS0000038920.V283743.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 x x x x x x x x 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 x 3 3 x 3 3 2 x Bradley House DS0000038920.V283743.R01.S.doc Version 5.1 Page 21 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 OP4 Regulation 12 (1) Requirement To obtain, and inform all staff regarding mental health guidelines and advice. (Previously required 24/08/05) Manager to obtain information regarding residents wishes at time of death. (Partially met, previously required 24/08/05 To ensure CRB checks are in place for all staff prior to start date. To ensure two references are attained for all staff. (Previously required 24/08/05) Medications records must be signed immediately after administration Members of staff must attend fire drills at six monthly intervals Staff’s personnel files must include a current photograph Members of staff must attend external POVA training Referee must validate references, where request for references formats are used. Risk assessments must be DS0000038920.V283743.R01.S.doc Timescale for action 30/06/06 2. OP11 12 (1) 30/05/06 3. OP29 19 30/04/06 4 5 6 7 8 9 OP9 OP38 OP37 OP18 OP29 OP8 13(2) 23(4)(e) 7,9,19 Sch.2.1 13(6) 19(4) (c) 13(4) 30/03/06 30/04/06 30/04/06 30/05/06 30/04/06 30/06/06 Page 22 Bradley House Version 5.1 10 OP7 12(2) clearer in terms of the actions to be taken to reduce the level of risk Care plans must incorporate likes, dislikes and preferred routines. 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bradley House DS0000038920.V283743.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Bristol North LO 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. Extracts may not be used or reproduced without the express permission of CSCI Bradley House DS0000038920.V283743.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!