Inspection on 04/12/07 for Bradley House

This inspection was carried out on 4th December 2007.

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 02/12/08

Bradley House 03/08/06

Bradley House 27/02/06

Bradley House 03/10/05

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

CARE HOMES FOR OLDER PEOPLE Bradley House Bradley Road Grimsby North East Lincs DN37 0AJ Lead Inspector Eileen Engelmann Key Unannounced Inspection 4th December 2007 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 DS0000065141.V355942.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. DS0000065141.V355942.R01.S.doc Version 5.2 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) DS0000065141.V355942.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd August 2006 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 accessed 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. 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. There is also a patio area with garden furniture. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home. A copy of the latest inspection report for the home is also available from the manager. Information given in the Service User Guide on 04/12/07 indicates the home charges a fee range of £345.00 to £490.45 per week depending on the type of care required. There is a top up fee of £10.00 for a single room and £12.50 for an en-suite room or a single with a lounge area. Day care fees are £28.00 per day. There are additional charges for hairdressing, private chiropody treatment, toiletries and newspapers/magazines. A full list of prices for these additional services is available from the manager. DS0000065141.V355942.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Information has been gathered from a number of different sources over the past 12 months since the last key visit in August 2006, this has been analysed and used with information from this visit to reach the outcomes of this report. This unannounced visit was carried out with the manager, staff and people using the service. The visit took place over 1 day and included a tour of the premises, examination of staff and people’s files, and records relating to the service. At the time of this visit the home was recovering from a serious bout of Diarrhoea and vomiting which had affected a number of people living in the home and the staff. As many people were still in their bedrooms getting over the illness we only spoke to a limited number of individuals during this visit; their comments have been included in this report. Questionnaires were sent out to a selection of relatives, people living in the home and staff. Their written response to these was poor. We received 0 back from relatives (0 ), 3 from staff (15 ) and 6 from people using the service (30 ). The Commission has received one formal complaint in the past 12 months around a vulnerable person leaving the home without staff being aware. The complaint was passed on to the provider to investigate and the issue was resolved. Two safeguarding of adults (abuse) allegations have been made since the last inspection in August 2006. The safeguarding of adults team at the local social services have investigated both allegations and one member of staff was referred to the Safe Guarding of Adults register. Since this time the Secretary of State has decided not to put the person on the register, as there was insufficient evidence to justify this action. What the service does well: People in the home are provided with a warm, safe and comfortable place to live that welcomes visitors and makes them feel at home. The home is clean and staff work hard to make sure the building is odour free. The home is welcoming and has a relaxed atmosphere. People living there said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. DS0000065141.V355942.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The person who owns the home must make the statement of purpose and service user guide better by making it into two separate documents, one that gives information to the funding authorities looking to place people in the home and the other for the people wanting to live in the home. People working in the home must make sure the information in the care plans shows the life history of those coming into the home, so activities and the care to be given reflects the needs, interests and likes or dislikes of each person using the service. The people working in the home should be talking to the residents more to find out what they like and how they want to be looked after. This helps the residents to have choice in how they are cared for and helps them stay as independent as possible. People working in the home must make sure that the way they record and give out medication gets better. This will make sure that the health and welfare of the people who live in the home is protected. People in the home who have dementia or sensory disabilities must be given a better choice of social activities to keep them happy and able to join in with others. People who are working in the home have to be given training around keeping people safe from harm, this helps them understand how to look after individuals and speak up if they think anything is wrong. People who are working in the home have to attend more training around safe working practices to make sure they look after their health and safety and that of the people living in the home. The person who owns the home must make sure that the service is looked at on a regular basis to see if it is meeting the needs of the people using it, is working within the guidelines of good practice and is looking after the wellbeing of the people living in the home and the people who work there. DS0000065141.V355942.R01.S.doc Version 5.2 Page 7 We would like to thank everyone who completed a questionnaire and/or took the time to talk to us during this visit. Your comments and input have been a valuable source of information, which has helped create this report. 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. DS0000065141.V355942.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 DS0000065141.V355942.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, 3, 4 and 6. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training is not robust and does not ensure that staff have the necessary specialist skills and abilities to meet the needs of people coming into the home. EVIDENCE: The Statement of Purpose and Service User Guide are on display in the entrance hall and copies are available from the manager. This information is combined as one document and the registered person must split this into two separate documents, as there are specific regulations for both the Statement of purpose and the Service user guide. The documents may be in the same folder, but each must contain the information asked for by the regulations. The information is provided to people in a large bold print, which makes reading it easier for those with visual impairment. DS0000065141.V355942.R01.S.doc Version 5.2 Page 10 At the last visit in August 2006 a requirement was made that: ‘The registered person must ensure that service users or their representatives receive formal written confirmation that the home, taking into consideration the assessment, is able to meet their needs’. Checks at this visit found that this has been partly met and the requirement will remain on this report. Checks of four people’s care records showed that each of them had a copy of a letter from the manager saying the home could meet their needs, but these were written and dated for the day of admission to the home. This formal written confirmation from the home should be completed and given to the person wishing to come into the home, before the person has made the decision to accept the placement. Each person has their own individual file and four of those looked at had a need assessment completed by the funding authority or the home before a placement is offered to the person. The home develops a care plan from the assessments, identifying the individual’s problems, needs and abilities using the information gathered from the person and their family. Those people at the home who receive nursing care have undergone an assessment by a NHS registered nurse from the local Primary Care Trust, to determine the level of nursing input required by each individual. The majority of people and relatives said they received sufficient information to make an informed choice about the service before accepting the placement offer. Staff members on duty were knowledgeable about the needs of each person they looked after and had a good understanding of their specific problems/abilities and the care given on a daily basis. Discussion with people showed that they were satisfied with the care they receive and have a good relationship with the staff. Information from the Annual Quality Assurance Assessment and discussion with the people living in the home indicates that all of the people are of white/British nationality, although there are a number of people with different faiths and religions. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. Information from the training files and training matrix indicates that the majority of staff are up to date with their basic mandatory safe working practice training, but they do not have access to a range of more specialised DS0000065141.V355942.R01.S.doc Version 5.2 Page 11 subjects that link to the needs of people using the service. A number of people using the service have conditions relating to dementia, diabetes, heart disease, depression, strokes, arthritis and other problems linked to old age. The responsible individual must make sure that staff have the skills and knowledge to deliver the services and care which the home offers to provide. This will help to develop a consistently high standard of care, which maintains and promotes the people’s health, safety and wellbeing. The employment records show that the manager is using a selective approach to recruitment; ensuring new staff have the right skills and attitude to meet the needs of people in the home. Checks of the staffing rotas and observation of the service showed that the home employs a number of staff are from different countries and cultures. People using the service are able to make a limited choice of staff gender when deciding whom they would like to deliver their care, as the home has one male care staff. The manager said that she would discuss this with people wanting to use the service during the assessment process. Discussion with the people living in the home indicates that they have no difficulties communicating with the staff and that they can express their preferences of staff gender for individuals giving their personal care. The home does not have any intermediate care beds and therefore standard six does not apply to this service. DS0000065141.V355942.R01.S.doc Version 5.2 Page 12 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 and 10. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the staff performance around recording within the care plans and medication system must be made, to ensure the peoples’ health and welfare are protected. EVIDENCE: At the last visit in August 2006 a requirement was made that: ‘The registered person must ensure that the specific assessed communication needs of one service user are addressed in their care plans and recording of daily care follows on consistently from shift to shift’. Checks at this visit found this has been met. Information from the surveys indicates that some of people who responded are not satisfied that the staff give appropriate support and care to those living in the home. Three individuals said ‘there are insufficient care staff and they lack supervision’, ‘the quality of care depends on who is on duty’ and ‘there is not DS0000065141.V355942.R01.S.doc Version 5.2 Page 13 enough staff to give people the physical help they need’. However, others in the home told us that ‘the staff are wonderful, very caring and supportive’. One person said ‘my relative’s health has improved since they came into the home, and the staff do everything they can to help us’. The care of four people was looked at in depth during this visit and included checking of their personal care plans. The content of the plans is very task orientated, and does not explore fully the personal wishes or needs of the people living in the home. Information about a person’s wishes regarding their care if they become seriously ill or are in the end stages of life is not recorded in the plans. The plans would benefit from additional information about the individuals abilities, strengths, weaknesses, personal preferences, likes and dislikes. Not all plans have a life history of each individual in place, and those that are done are not detailed enough to give a picture of the person at the centre of the plan. Until recently some of the care plans and risk assessments within them had not been evaluated on a monthly basis. The manager has taken action to make sure this practice is improved. However the evaluation process does not include the views and opinions of the person whose care is being reviewed. This was discussed with the manager and she said she would look at how staff could use a variety of different and creative methods to help people using the service to contribute to their own care plan. People said that they have good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Comments from people and relatives indicate that on the whole they are satisfied with the level of medical support given to the people living at the home. In all four care plans looked at during this visit the staff were not recording weights on a monthly basis even where individuals were seen as high risk of pressure sores, mobility problems and obesity. It is recommended that the staff carry out monthly weighing of people where a risk to their health has been recognised. The home is supplied with medication from the local pharmacy and this is provided in NOMAD cassettes. Information from the manager indicates that the pharmacy has a license to dispose of waste medication from the home, but there was no evidence of this within the home. It is recommended that the registered person obtains a copy of the license from the pharmacy and keeps it in the home with the other maintenance contracts. Checks of the medication records showed there are some aspects of practice that need improving and these include • Staff are putting dispensing stickers from the pharmacy onto the records, and covering over handwritten information. This is not acceptable practice and the manager was asked to stop this immediately. DS0000065141.V355942.R01.S.doc Version 5.2 Page 14 • • • Medication received by the home is not always being counted in and the quantities signed onto the medication records. This would make auditing of the stock very difficult especially those medicines not in the cassettes. Where staff are hand writing medication onto the sheets (transcribing), there should be two staff signing the entry to indicate they have both witnessed that the information on the sheet (name of medication, strength and administration methods) is correct. Stocks of medication held in the home, which are given on an as and when needed basis (PRN), should be brought forward onto each new medication chart so an accurate audit can be carried out. People and relative comments show they are satisfied with the care and support offered by the staff. Chats with people using the service revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Observation of the service showed there is good interaction between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. DS0000065141.V355942.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 and 15. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People with dementia or sensory impairment are provided with a limited choice of social events, giving them little opportunity for stimulation or recreational activities to suit their interests or abilities. EVIDENCE: At the last visit in August 2006 a recommendation was made that: ‘The Activity Coordinator should maintain ‘at a glance’ information of who has not participated, or who has only participated seldom, in activities in order to investigate the reasons and make adjustments to the programme’. Checks at this visit show this has been met. The home employs an activity co-ordinator for 15 hours a week and this person has introduced activity sheets into the care plans that show what activities have taken place on a daily basis. However, not all of these sheets are up to date and this person and other staff should ensure these are filled in daily. DS0000065141.V355942.R01.S.doc Version 5.2 Page 16 The home has a monthly activity sheet and December’s shows that outside entertainment and activities are planned, as well as Christmas festivities. Discussion with people and feedback from their surveys indicates some dissatisfaction with the variety of things to do within the home. One person wrote that ‘ activities are infrequent due to staff shortages and their workload. I enjoy the ladies who do a sing-a-long, but there is a lack of stimulation’. Another person said ‘activities are ‘so-so’, we do bingo on a weekend and a quiz on Wednesdays but things need to liven up’. The manager told us that although only four people in the home had been admitted with dementia, there were a number of older people with some memory impairment, roughly a quarter of the people living in the home. Given the large number of people who may have difficulty concentrating on group activities there is a lack of evidence of 1:1 input to these individuals, and the range of things going on in the home does not reflect their specific needs. The registered provider must ensure that appropriate activities are provided for those people with dementia and sensory impairment so they can enjoy social stimulation and interact with others in the home. Information from peoples’ files indicates that there are a number of individuals who follow different spiritual faiths, including Catholic and Church of England. People are able to attend a monthly church service in-house, and the catholic priest will visit as and when required. The home provides special meals and cakes for birthdays and helps people celebrate all major Christian festivals such as Easter, Harvest Festival and Christmas. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family or staff would take them into the town. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. People spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. The home has started to hold open meetings where the viewpoints and opinions of those living in the home can be expressed and the management team will listen and take action were needed. There is some information and advice on advocacy and this is on display in the entrance hall. The manager said she has attended training on the Mental Capacity Act, but there is no evidence that staff have received training around current legislation in equality, diversity and disability matters. The registered person should make sure that staff have sufficient knowledge about human rights legislation, DS0000065141.V355942.R01.S.doc Version 5.2 Page 17 so they understand individual rights within the care home and out in the community. The home has two dining rooms and offers people a choice of eating facilities. One dining room has more people requiring assistance with eating and drinking than the other, and staff were seen to be sat helping individuals with their lunch time meal. One visitor told us ‘the meals are very good, my relative has put on weight since coming into the home and is well looked after’. This individual visits every day and enjoys having the opportunity to help their relative eat their meals as it makes them feel they are contributing to their care. DS0000065141.V355942.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): People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a good complaints system with some evidence that peoples’ views are listened to and acted upon. Visitors and people using the service are confident about reporting any concerns and the manager acts quickly on any issues raised. The uptake of staff training in safe guarding of adults is unsatisfactory and does not ensure people using the service are protected and kept safe at all times. EVIDENCE: Checks of the records in the home showed that there have been eight complaints have been made to the service since the last visit in August 2006. These involved issues around food, staff and the care provision. The manager or provider has dealt with the issues formally, quickly and given a response in writing to the complainant. There are niggles and grumbles forms in the entrance hall for people to access and use if needed. People told us in the surveys that they are satisfied with the complaints process and individuals said ‘I am unable to communicate well, but the staff always try to find out the problem when I am upset’, ‘I rely on my family to speak on my behalf’ and ‘the manager does her best to address problems quickly’. DS0000065141.V355942.R01.S.doc Version 5.2 Page 19 The Commission for Social Care Inspection has received one formal complaint about the service since the last visit in August 2006. This was passed to the Registered person to investigate and was resolved by their actions. Two safeguarding of adults allegations (abuse) have been made since the last visit to the home. The police and the local funding authority (social services) team have investigated the allegations: one regarding possible financial abuse and one about poor staff actions. Following the investigations the authorities and the home have taken appropriate action to ensure the safety of the people living in the home is protected and promoted. At the last visit in August 2006 a requirement was made that: ‘The registered person must ensure that all staff receive training in the protection of adults from abuse’. Checks at this visit show that this has been partly met and will remain as a requirement on this report. Information from the staffing matrix shows that around 50 of staff have received safeguarding training in the past 12 months. The Annual Quality Assurance Assessment says that the home hopes to improve the uptake of staff training over the next year and plans to seek training from outside agencies. The registered person must also seek training for staff around dementia care and challenging behaviours so staff have the skills and knowledge to recognise and meet the needs of the people living in the home. DS0000065141.V355942.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): 19, 25 and 26. People who use the service experience good of evidence, including a visit to this service. The standard of environment within the home is good, providing people with a comfortable and homely place to live. EVIDENCE: At the last visit in August 2006 a requirement was made that: ‘The registered person must ensure that the courtyard area, the pathway surrounding the home and the conservatory are made safe for service users to use. The one or two tables in the dining area that are a little unsteady to be made secure’. Checks at this visit found the work has been done. Observation of the premises during this visit showed that there is a maintenance programme in place with redecoration and refurbishment taking place on a rolling system. The programme shows what has been done and what is planned and includes DS0000065141.V355942.R01.S.doc Version 5.2 Page 21 • • • • • • The manager’s office has been moved to the entrance area so she can see any visitors to the home. The main L shaped lounge and the entrance hall have had new carpets fitted and these areas are due to be redecorated. Corridors in the home are wide and have handrails in place, these areas have been painted and new carpets fitted. Two shower rooms have been provided on the ground floor, these facilities were originally bathrooms. One of the two dining rooms needs urgent redecoration and this is identified on the management plan. A small room in the home has been designated for those people who smoke and live in the home. All areas looked at during this visit were seen to be clean, tidy and odour free. At the last visit to the home in August 2006 a requirement was made that ‘The registered person must ensure that hot water outlets that record a low reading are adjusted to a more ambient temperature of 43°C’. Checks at this visit showed that water temperatures are being recorded from between 38.4 and 42.4, with all temperatures since September 2007 being above 40ºC. This requirement is met. At the last visit in August 2006 a requirement was made that: ‘The registered person must ensure that the corridor carpets are cleaned or replaced, the dining room cleaned and odours in two bedrooms eliminated’. Observations of the home at this visit indicate this has been met. At the last visit in August 2006 a recommendation was made that: ‘The registered person must ensure that the corridor carpets are cleaned or replaced, the dining room cleaned and odours in two bedrooms eliminated’. Observations of the home at this visit indicate this has been met. All areas within the home are warm, safe and comfortable. The domestic staff do a good job of keeping the premises clean and odour free. Comments from the day of this visit indicate that the people using the service find the home to be clean and they are satisfied with the laundry service provided by the home. The home has recently been affected by an outbreak of diarrhoea and vomiting amongst the people using the service and staff. The manager has worked closely with the Community Infection Control team and the infection was cleared within a week. Checks of the supplies in the home showed that staff are given Personal Protective Equipment such as gloves and plastic aprons to aid infection control and anti-bacterial gel is available in the bedrooms to clean hands after giving care. DS0000065141.V355942.R01.S.doc Version 5.2 Page 22 Infection control policies and procedures are in place, but few staff have attended training in this area of care. The registered person must make sure this aspect of staff training is promoted and more staff are given the opportunity to attend appropriate courses. DS0000065141.V355942.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): People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management practices of staff recruitment and staff training are inadequate and do not promote or protect the health, safety and well being of those people using the service. EVIDENCE: Comments from the relatives and people using the service indicate that the home is extremely busy at times and individuals may wait for attention at peak times, but the friendly attitude of the staff and their willingness to help make up for this. At the time of this visit there were 34 people in residence and the staffing rota showed that the following staffing levels are in use 7am to 2pm – 1 nurse and 5 care staff on duty 2pm to 9pm – 1 nurse and 5 care staff on duty 9pm to 7am – 1 nurse and 3 care staff on duty Information from the Annual Quality Assurance Assessment about the number of staffing hours provided, and information gathered during the inspection about the dependency levels of the people using the home, was used with the Residential Staffing Forum Guidance and showed that the home is meeting the recommended guidelines. DS0000065141.V355942.R01.S.doc Version 5.2 Page 24 There is an induction course for new members of staff, and 58 of the care staff have achieved an NVQ 2 or 3. The home has a mandatory staff training programme in place and information from the staff training matrix indicates that the majority of the staff are up to date with their moving and handling (85 ), food hygiene (70 ) and Health and safety (65 ), but some need to attend training and/or updates on basic fire safety training (51 ), Infection Control (18 ) and Safeguarding of Adults (46 ). There is no information to suggest that staff have access to COSHH safe working practice training or specialist subjects linked to conditions of old age and dementia. The registered person must ensure the staff receive basic mandatory training and more specialised training that reflects the different care needs of the people living in Bradley House. Checks of three staff employment files showed that there are some areas of employment practice that need to be improved. These include • The first file showed that one member of staff was previously employed at the home, then left for another job and has recently been reemployed by Bradley House this year. This person has not completed an application form nor has the manager completed any interview questions/notes. When asked why the manager said it was because she knew the individual. This is not acceptable practice and the manager told us that she would make sure everything was completed in the future, and follow the homes policies and procedures. The second file showed that a member of staff who was employed some years ago has only one reference. This was discussed with the manager who said she would audit the staff files and ensure everyone had two references in place. The third file was for an individual employed by the previous manager. Their Criminal Records Bureau (police) check was one completed for another employer. The manager said she would take immediate action to ensure an up to date CRB was obtained for this individual. • • It is recommended that the manager undertakes an audit of the staff files to make sure that all the checks and information required by Regulation 19 and Schedules 2 and 4 of the Care Homes Regulations are in place and up to date. DS0000065141.V355942.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, 35, 36 and 38. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems for quality assurance and quality monitoring within the home are not robust and must be improved to ensure the health, safety and welfare of the people who live in the home and staff are maintained and protected. EVIDENCE: The manager of the home is Ms Christine Erbil and she has been in post for six years. She has completed the Registered Managers Award training and has an active nurse registration with the Nursing and Midwifery Council. Ms Erbil told us that she keeps her skills and knowledge up to date by attending training updates and reading Nursing and Management Journals. Discussion with the manager indicated she has a job description and contract detailing her roles and responsibilities. She recognises that there is a need to improve the DS0000065141.V355942.R01.S.doc Version 5.2 Page 26 management of staff training and recruitment issues and told us that she would make these a priority in the next few months. At the last visit in August 2006 a requirement was made that: ‘The manager must ensure that service user consultation is increased by restarting service users meetings or smaller group discussions to run along side the quality assurance programme’. Checks at this visit found it has been met. At the last visit in August 2006 a requirement was made that: ‘The registered person must continue the start made to the quality assurance process and ensure action plans are reviewed for effectiveness. Results of surveys are to be forwarded to the CSCI’. Checks at this visit found that this is partly met and a requirement about quality assurance will be included in this report. The home does not have a recognised Quality assurance system in place within the home and checks of the records showed that formal quality audits for the service are not in place. Previous discussion with the operations manager indicates that this is something he is hoping to introduce within the next few months. The provider has improved the standard of policies and procedures within the home and these have been introduced into the service in recent weeks. The registered provider is completing monthly visits to the home and recording these on Regulation 26 reports, which are available in the home for inspection by the appropriate authorities. Staff meetings and meetings for those people using the service are taking place and offer individuals an opportunity to voice their opinions and ideas about the service. Satisfaction surveys are going out to people using the service and their representatives, and the feedback and action taken is recorded by the service on an Annual Development Plan. Checks of the financial records showed that people are able to have personal allowance accounts in the home. These records are hand written and detail the transactions undertaken and the money held for each person, the manager updates these each week. Information from the manager indicates that the majority of people have a family member or representative who looks after their monies and these individuals make sure the personal allowances are sent/brought into the home. One account was checked and found to be up to date and accurate at this visit. There is a supervision schedule in place and staff are receiving formal supervision at least once every 2 months. DS0000065141.V355942.R01.S.doc Version 5.2 Page 27 At the time of this visit we could not find evidence of water temperature checks, bed rails checks, the electrical wiring certificate and emergency lights contract. All this information was sent to us by the registered person within 48 hours of the visit and was satisfactory. Looking through the maintenance records it was seen that there is a fire risk assessment in place, also generic risk assessments and those for moving and handling, bed rails and daily activities of living. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff are able to access safe working practice training although uptake has not always been as good as it should be over the past year. The registered person must make sure all staff attend this training. DS0000065141.V355942.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 2 X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X 3 2 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 3 X 2 DS0000065141.V355942.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4, 5 Schedule 1 Requirement The registered person must produce and make available to people an up to date statement of purpose and service user guide, in their appropriate formats. Timescale for action 01/02/08 2. OP3 14(1)(d) So funding authorities and those people wishing to move into the home, receive appropriate information about the service and facilities. This will help inform their decision as to whether the home can meet the needs of a person, or not, before they decide to make/accept a placement. The registered person must 01/02/08 ensure that people using the service or their representatives receive formal written confirmation that the home, taking into consideration the assessment, is able to meet their needs. This must be given to people prior to their admission. This is so people can be assured their needs can be met by the service before committing DS0000065141.V355942.R01.S.doc Version 5.2 Page 30 3. OP4 12(1) themselves to placement within the home. (Given timescale of 30/09/06 was not met) The registered person must make sure that staff, individually and collectively, have the skills and experience to deliver the services and care which the home offers to provide. 01/04/08 4. OP7 15 So people can be confident that their needs relating to old age and dementia are recognised and managed appropriately. The registered person must 01/04/08 make sure that the care plans are detailed and individual to the person they are about, putting the person at the centre of it, and giving a picture of who they are as well as what their needs are and how to met them. The plans should meet relevant clinical guidelines produced by professional bodies concerned with the care of older people and those with dementia. This will make sure that staff have access to information that will help them to provide person centred care and support. Accurate records must be kept of all medications, received, administered, leaving the home or disposed of to ensure there is no mishandling. The registered provider must make sure that medications in the custody of the home are handled according to the requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society, the requirements of the Misuse of Drugs Act 1971. To make sure people receive DS0000065141.V355942.R01.S.doc 5. OP9 17 01/02/08 Version 5.2 Page 31 6. OP12 16(2)(m) (n) 7. OP18 13(6) their medication correctly and their health and safety is not put at risk. The registered provider must ensure that appropriate activities are provided for those people with dementia and sensory impairment. So they can enjoy social stimulation and interact with others in the home. The responsible individual must make sure that the staff attend appropriate training in Safeguarding of Adults procedures, management of challenging behaviour and dementia care. To prevent residents from being harmed or suffering abuse or being placed at risk of harm or abuse. (Given timescales of 31/05/06 and 31/10/06 were not met) The registered person must make sure that staff receive appropriate training on the control of spread of infection in accordance with relevant legislation and published professional guidance. So the health and well being of the people using the service is promoted and protected. The registered person must ensure that appropriate recruitment procedures are carried out by the home and staff personnel files include all of the information required by regulation 19, and schedules 2 and 4. This is so people living in the home are not put at risk of harm. DS0000065141.V355942.R01.S.doc 01/04/08 01/04/08 8. OP26 OP38 13(3)(4) (a)-(c) 01/04/08 9. OP29 19 (1)(a)-(c) (5)(a)-(d) 01/02/08 Version 5.2 Page 32 10. OP30 OP38 18 The registered person must ensure that there is a training programme in place that ensures staff fulfil the aims of the home and meet the changing needs of the people using the service. Specialist training on the elderly and diseases relating to old age and dementia must be included in the training programme. 01/04/08 11. OP33 24 So the health, safety and welfare of the people in the home is protected and promoted, and staff have the skills and knowledge to provide a high standard of care. (Given timescales of 30/06/06 and 31/12/06 were not met) The registered person must 01/04/08 make sure that effective quality assurance and quality monitoring systems are in place, which seek the views of people and measure the success in meeting the aims and objectives and statement of purpose of the home. So the home can demonstrate that it is offering a quality service and value for money to the people using the service, and is listening to their views and opinions and taking action to meet its aims and objectives and produce favourable outcomes for people. DS0000065141.V355942.R01.S.doc Version 5.2 Page 33 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 OP7 OP8 Good Practice Recommendations The manager should look at how staff could use a variety of different and creative methods to help people using the service to contribute to their own care plan. The manager should ensure the staff carry out monthly weighing of people where a risk to their health has been recognised around mobility, nutrition or pressure sore development. The manager should make sure that where staff are hand writing medication onto the sheets (transcribing), there should be two staff signing the entry to indicate they have both witnessed that the information on the sheet (name of medication, strength and administration methods) is correct. The manager should ensure that medication already held in the home when a new medication sheet is started is added to the supplies on the medication record sheets. This should be done so as to ensure a running total is available at all times and an audit of stock is easy to carry out. The manager should enable staff to access training around current legislation in equality, diversity and disability matters, to improve the staffs knowledge and understanding of a person’s individual rights within the care home and out in the community. The manager should undertake an audit of the staff files to make sure that all the checks and information required by Regulation 19 and Schedules 2 and 4 of the Care Homes Regulations are in place and up to date. The registered person should ensure that improvements to the management of staff recruitment and staff training are completed within the given timescales. 3. OP9 4. OP9 5. OP14 6. OP29 7. OP31 DS0000065141.V355942.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. Extracts may not be used or reproduced without the express permission of CSCI DS0000065141.V355942.R01.S.doc Version 5.2 Page 35 - 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. 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