CARE HOMES FOR OLDER PEOPLE
Bradley House Bradley Road Grimsby North East Lincs DN37 0AJ Lead Inspector
Beverley Hill Unannounced Inspection 27th 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 DS0000065141.V285436.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 DS0000065141.V285436.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Bradley House Address Bradley Road Grimsby North East Lincs DN37 0AJ 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) 01472 878373 01472 277548 Dryband One Ltd Christine Angela Erbil Care Home 44 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (44), of places Physical disability (2), Physical disability over 65 years of age (2) Bradley House DS0000065141.V285436.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 3rd October 2005 Brief Description of the Service: Bradley house is situated close to the village of Bradley and is approximately one mile from the centre of Grimsby. The home has a view of the surrounding countryside. The home is registered to provide residential and nursing care for older people including those with dementia, physical disability over 65 years and physical disability over 18 years. In addition the home provides a respite service and provides day care services for up to six people. The home consists of two storeys, the upper floor serviced by both stairs and a passenger lift. There are thirty-six single rooms, twelve of which are en-suite and a further four large rooms situated on the first floor which can be shared or be used as single. There are three sitting rooms, one of which is for people who enjoy smoking, and two dining rooms. In addition there is a quiet room for service users to entertain their visitors in private. The home has five bathrooms on the ground floor a shower room on the first floor. There are sufficient toilets throughout the home. The gardens to the front and side of the building are spacious and contain mature trees, shrubs and flowerbeds. The home has a small internal courtyard accessible from two separate corridors that appeared to be a suntrap. There is also a patio area with garden furniture. Bradley House DS0000065141.V285436.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day. The Inspector spoke to the manager and two care staff members who were on duty at the time of the inspection. Throughout the day the Inspector spoke to four people who lived at Bradley House and several relatives. The inspector looked at a range of paperwork in relation to care plans, medication records, staff recruitment, supervision and training records, staff rotas, complaints management, service user and staff meetings and quality monitoring. The Inspector also checked that people who lived in the home had the opportunity to suggest changes and were listened to. The Inspector completed a partial tour of the building and checked that all the things that needed to be done from the last inspection had been done What the service does well:
There was a group of nurses and care staff that had worked at the home for several years and knew the service users well. People who lived at the home said that the staff members were caring, looked after people well and made their relatives feel welcomed. The home always made sure that people had an assessment prior to being admitted to the home and all the care people needed was written down in care plans so that staff were aware of how to support people. The home was able to meet the health care needs of people. Service users and relatives spoken to were very complimentary about the meals provided. They had two choices at lunchtime and had plenty to eat and drink. People spoken to stated that if they didn’t like the choice on offer they could have an alternative. The home enabled people to make choices about their lifestyle. They provided a smokers lounge for those people who wished to smoke and bedrooms were personalised. The home provided a pleasant environment and had a welcoming, homely feel. It was clean and tidy in communal areas, although the carpets in corridors were in need of cleaning. There were areas throughout the home where people could sit quietly. The home had responded well to requirements made at the last inspection. Bradley House DS0000065141.V285436.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
The nursing staff could manage medication more effectively. They need to make sure that all medication delivered is signed into the home and when they administer it to service users. Some of the medication record sheets had signatures missing and there was confusion about the codes used as to why they omitted any medication. They also needed to write the full instruction on the record sheet when transcribing medication. The home provided activities for people but when checked it tended to be the same people each time who participated. The home could keep a closer check on who has not participated, find out why and alter the programme to meet everyone’s needs. For example, more one to one activity with those people who spend a large portion of their time in bed. One person spent time resting in the afternoon in their room and staff did not consistently make sure that they were wearing the appropriate attire. This had on one occasion compromised their dignity. Not all staff had received mandatory training and in the protection of vulnerable adults from abuse. This was really important to ensure that staff
Bradley House DS0000065141.V285436.R01.S.doc Version 5.1 Page 7 were competent to do their jobs and were aware how to recognise signs of abuse and what to do. The proprietor needs to produce a redecoration and maintenance plan for some areas of the environment. They are aware of the issues but a plan with timescales will ensure progress. Generally the way the home recruits staff has improved but gaps in employment were not consistently explored. The home monitored the quality of the care provided by questionnaires to people and audits of the environment. To complete the process they need to produce action plans for any shortfalls identified and review them for their effectiveness. Staff supervision has improved and this needs to continue to ensure care staff receive at least six sessions per year. 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 DS0000065141.V285436.R01.S.doc Version 5.1 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 DS0000065141.V285436.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Standard 3 was assessed and met at the last inspection. Bradley House DS0000065141.V285436.R01.S.doc Version 5.1 Page 10 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 and 10 Improvements have been noted in the documentation of the care provided to service users. Inconsistent care practices for one service user compromised their dignity. Deficiencies in the management of medication could place service users at risk. EVIDENCE: Requirements in relation to standards 7 and 8 were checked. Care plans were comprehensive and included assessed needs and risk assessments for moving and handling with guidance for staff. Documentation regarding the care provided had improved and staff stated that they had to sign the completion of charts to monitor fluid and pressure area care. A relative confirmed that the completing of fluid charts had improved. The manager had produced a new document to ensure staff communicated more efficiently with each other for example at handovers. Staff have been aware of the importance of following risk assessments, care plans and effective communication in supervision sessions.
Bradley House DS0000065141.V285436.R01.S.doc Version 5.1 Page 11 Qualified nursing staff completed the management of medication and some elements needed tightening up: All medication delivered in cassettes from the pharmacy was signed into the home and stored correctly, however medication not in cassettes was not signed into the home consistently. There was some confusion regarding the codes used for non-administration of medication. When staff transcribed medication onto the medication administration record the full manufacturers instructions were not consistently apparent. One service user was prescribed a weekly medication and whilst there was evidence they had received this weekly staff had been signing for this on a daily basis. During one particular shift a staff member had consistently omitted to sign for medication throughout several of the records examined. These issues were discussed with the manager to address. Discussions with service users and some relatives indicated that staff members treated people with respect. They used their preferred term of address, knocked on doors prior to entering bedrooms and delivered personal care in a sensitive manner. However during a discussion with a relative it became apparent that in one case a service users dignity had been inadvertently compromised as a result of undue attention paid to their attire when resting on their bed in the afternoon. This was mentioned to the manager to reinforce with staff members. Staff members spoken to described how they promoted privacy and dignity by knocking on doors prior to entering and reassuring and talking to people during personal care tasks, ensuring that people had appropriate amounts of time in the morning, and maintaining confidentiality. Bradley House DS0000065141.V285436.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 and 14 The range of activities provided by the home did not adequately meet the needs of all service users within the home. EVIDENCE: The home provided an activity coordinator who organised a range of activities. A diary was maintained with a heading of the activity and who had participated. During February activities ranged from bingo, reminiscence, exercises to music, watching films together, craftwork, visiting entertainers, manicures, games and quizzes and one to one chats. Church services were held monthly and Clergy visited specific service users. Some service users had attended the auditorium for a show. On examination of the records it appeared that the participants tended to be the same service users most of the time. The staff did not keep an, ‘at a glance’ monthly record of who has participated so this did not become immediately apparent. This record would keep a track of who has not participated in activities and enable staff to investigate why with perhaps an adjustment of activities to more suit their needs and abilities. The records could reflect what the outcome was for the participant, for example what enjoyment and stimulation the participant obtained from it. Bradley House DS0000065141.V285436.R01.S.doc Version 5.1 Page 13 There was an example of 1-1 chats with three service users on one particular day in February but this was not documented as a regular occurrence. A staff member spoken to stated that activities could be sidelined when the home became very busy as was evident on the day of inspection but staff tried hard to ensure that some activity went on most days. Service users spoken to stated that the amount of activities varied. This was born out by the records with more able service users participating regularly throughout the month and others in only one or two. There was an element of service user choice regarding the participation in activities but also motivation, ability and type of activity needed consideration. Service users spoken to stated that they were able to make choices about certain aspects of their lives and cited times of rising and retiring, (‘we can lie in if we want’), and meals, (‘we get everything we want’) as examples. Some service users had their own telephones and fridges installed and bedrooms were personalised according to individual choice and taste. One service user was very independent but had chosen to live at the home rather than on their own. They used local facilities as they chose. One relative was pleased that their loved one was given extra dessert to compensate as they chose not to eat too much of the main meal. Bradley House DS0000065141.V285436.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 and 18 Improvements were noted in the way complaints were managed and documented. Not all staff members had completed adult protection training, which could place service users at risk. EVIDENCE: These standards were assessed fully at the last inspection but requirements issued were checked for compliance. Since the last inspection all complaints have been formally recorded. Relatives and service users spoken stated they would go to the registered manager (they knew her name) if they wanted to complain. This was an indication that the manager was visible and approachable to people. The complaints procedure was on display within the home. The home had an adult protection policy and procedure and the manager was more familiar with the referral and investigation processes required should they be any allegations of abuse reported to them. The home had a copy of the local authority multi-agency policy and procedure. During the inspection it became apparent that not all staff members had received adult protection training. The proprietors were aware of this and had adjusted the training plan to accommodate it with an external facilitator. Bradley House DS0000065141.V285436.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): 19 Generally the home provided a comfortable and safe environment for service users, however areas of the environment affected some service users comfort and access to the home. EVIDENCE: The home was a mixture of old and new buildings, had wide corridors with handrails and was suitable for its intended purpose. There have been no changes to the environment since the last inspection, however the inspector was informed about plans to extend the building, which will impact on environmental issues. There were still some areas to address with regards to paintwork and carpets in the corridors and a small number of bedrooms and the uneven driveway. Some service users in wheelchairs found it difficult to negotiate the driveway, which was made up of small stones. The garden and courtyards were in need of attention to spruce them up. Generally the home was clean and tidy and service users and relatives spoken to were happy with the home.
Bradley House DS0000065141.V285436.R01.S.doc Version 5.1 Page 16 The proprietor needs to produce a redecoration/maintenance plan with timescales for completion of the workload. This needs to be forwarded to the CSCI. Bradley House DS0000065141.V285436.R01.S.doc Version 5.1 Page 17 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 and 30 Not consistently exploring gaps in employment history limited the robustness of the homes recruitment process. On the whole competent staff supported service users but not all had completed relevant training. EVIDENCE: The home had recruited more staff since the last inspection and deficiencies in night carer cover had been addressed. The home had five or six staff on during the day plus a qualified nurse and three care staff and a nurse at night. There appeared to be sufficient catering and domestic staff. Rotas were examined that reflected these figures. Service users and relatives spoken to were complimentary about the staff. ‘The staff are very good to me, they always knock on my door’, ‘staff treat me very much with respect’, ‘staff come in a lot and sort things out for me’, ‘they are polite’, ‘I feel well looked after’. One relative expressed that they go home at night confident that their loved one will be looked after and they felt the staff kept them well informed. Staff recruitment files were examined and although there had been improvements noted in the gathering of documentation prior to the start of employment, including criminal records bureau checks, it was noted that gaps in employment were not consistently explored. These needed to be explored to ensure the protection of service users.
Bradley House DS0000065141.V285436.R01.S.doc Version 5.1 Page 18 The home had a training plan for the coming year that included mandatory training and updates and staff members had access to a range of service specific training. Various modes of staff training were used including in-house sessions by the manager and qualified nurses, and also specific staff members who were trained as moving and handling instructors, external facilitators, local authority courses, videos and distance learning booklets. Individual records were maintained. Records and staff discussions indicated that not all staff had completed mandatory training, however the new training plan should address this. Not all staff had completed adult protection training. The home had thirty-one care staff out of which eight had completed NVQ Level 2 and 3. This equated to 25 of the care staff trained to this level and the home should be aiming for 50 . A further four staff members were due to start the courses. Staff members do not receive paid training days, which can limit the incentive to participate. Bradley House DS0000065141.V285436.R01.S.doc Version 5.1 Page 19 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): 31, 32, 33, 36, 37 and 38 Improvements were noted in management systems within the home. Further developments in quality monitoring and the continuation of staff supervision would provide greater protection for service users welfare and safety. EVIDENCE: The manager is a Registered Nurse and has completed a certificate in management. Service users, staff and relatives described the manager as very approachable. Since the last inspection the manager had reviewed some of the systems they had in place to manage the home. Improvements were noted in general communication, overall documentation, disciplinary procedures, reporting of incidents, the management of service users finances and staff supervision. Staff and service user meetings were held and people had the opportunity to offer suggestions as to how the home was managed. The proprietors visited the home regularly and spoke with service users, staff and relatives. The
Bradley House DS0000065141.V285436.R01.S.doc Version 5.1 Page 20 homes quality assurance system consisted of questionnaires and audits. Questionnaires were sent out to service users, relatives and professional visitors to the home and audits were completed in a range of environmental and safety areas. Some action plans were completed to address shortfalls indicated in the audits, however the inspector was unable to see evidence of the evaluation and review of the effectiveness of the action plans in addressing the shortfalls, in effect closing the loop of the quality monitoring system. The manager stated that service user meetings were used to check if people were happy with services and an annual service review was completed and placed on display in the entrance. A copy of the results of surveys needs to be forwarded to the CSCI for examination. Since the last inspection staff members were more aware of the need to consistently follow risk assessments with regards to moving and handling and all accidents were recorded appropriately. Bradley House DS0000065141.V285436.R01.S.doc Version 5.1 Page 21 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 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X X STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X X 2 3 3 Bradley House DS0000065141.V285436.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP19 Regulation 23 Requirement The registered person must ensure that a refurbishment plan with timescales is completed that addresses environment issues such as carpets in corridors and one bedroom, the driveway, garden and courtyard areas and some paintwork (previous timescale of 31/01/06 not met) The registered person must ensure that all medication is signed into the home and on administration. The registered person must ensure that reasons for nonadministration of medication are clearly defined and when transcribing medication full instructions are written on the MAR. The registered person must ensure that the dignity of one service user is not compromised by lack of appropriate attire. The registered person must ensure that the activities and social stimulation provided
DS0000065141.V285436.R01.S.doc Timescale for action 31/01/06 2. OP9 13(2) 31/03/06 3. OP9 13(2) 31/03/06 4. OP10 12(4) 31/03/06 5. OP12 16(n) 30/04/06 Bradley House Version 5.1 Page 23 6. OP18 13(6) 7. OP29 19 8. OP30 18 9. OP33 24 10. OP36 18(2) meets the range of needs of all service users. The registered person must ensure that all staff receive training in the protection of adults from abuse. The registered person must ensure that gaps in employment are consistently explored and documented during the recruitment process. The registered person must ensure that all staff members complete mandatory training and updates. The registered person must ensure that action plans are produced when shortfalls are identified through the QA process and these are evaluated and reviewed for effectiveness. Results of surveys to be forwarded to the CSCI. The registered person must ensure that the good start to supervision is continued to ensure six sessions per year for care staff. 31/05/06 31/03/06 30/06/06 30/04/06 31/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations The Activity Coordinator should maintain information of who has not participated in activities in order to investigate the reasons and make adjustments to the programme. The proprietor should fit privacy locks as standard when bedrooms become vacant. The home should continue to work towards 50 of staff
DS0000065141.V285436.R01.S.doc Version 5.1 Page 24 2. 3. OP24 OP28 Bradley House trained to NVQ Level 2. Bradley House DS0000065141.V285436.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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