Inspection on 06/10/06 for Bradmere

This inspection was carried out on 6th October 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bradmere 08/05/07

Bradmere 07/03/06

Bradmere 22/09/05

Bradmere 10/02/05

Bradmere 26/05/04

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

CARE HOME ADULTS 18-65 Bradmere 16 Franklin Street Patricroft Eccles Gtr Manchester M30 0QZ Lead Inspector Val Bell Unannounced Inspection 6 October 2006 10:00 th Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 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 Bradmere DS0000008343.V297872.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 Adults 18-65. 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. Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bradmere Address 16 Franklin Street Patricroft Eccles Gtr Manchester M30 0QZ 0161 787 8631 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) Mrs Joan Rawlinson Mr Bradley Rawlinson Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 4 named individuals have a physical disability in addition to a mental disorder. 7th March 2006 Date of last inspection Brief Description of the Service: Bradmere is a care home providing personal care and accommodation for up to 12 adults with enduring mental ill health. The home has good links with the Forensic Psychiatric Service and provides accommodation to some people who have mental health needs and a forensic history. Admission for people with these needs is dependent upon a thorough assessment of risk. In addition, the home is able to provide a service for up to four named individuals who have a physical disability in addition to mental health needs. The main aim of the home is to provide a rehabilitation service for younger adults who have experienced a period of hospitalisation. Long-term care is provided dependent on the assessed needs and aspirations of the individual resident. Bradmere forms part of the Bradmere and Merrymeet Care Group, which includes a second care home and a domiciliary care agency. The home is situated in the Eccles area of Salford, close to local shops, pubs and public transport routes. The home is a large modern style house with car parking at the front and a pleasant garden at the rear. Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted during daytime hours on 6th October 2006. During the site visit various records, including care plans, were examined, conversations were held with staff and management on duty and the residents living in the home. A tour of the home was also undertaken to assess cleanliness, hygiene and the quality of the communal and private space provided for residents. Quality surveys and a request for pre-inspection information were issued prior to the site visit although none of these documents were returned to the Commission. What the service does well: What has improved since the last inspection? Since the last inspection steps had been taken to improve and make safe the system for administration of medication. The manager had made significant progress towards achieving NVQ 4 in care and management, having completed approximately six units. Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 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. Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents could be confident that their needs would be assessed and recorded in order for the home to decide if the service would be the right one for them. EVIDENCE: Three residents’ files were randomly selected to assess if individuals had received a full assessment of their needs prior to admission to the home. Care manager assessments of need and summary care plans had been obtained for these three residents. Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents are encouraged and supported to make decisions that affect their lives. Where decisions have to be taken on behalf of residents, the reasons for this are recorded in their care plans. Failure to undertake risk assessments and review care plans regularly potentially places the health, welfare and safety of residents at serious risk. EVIDENCE: Three care plans were examined during this inspection. Two of the care plans were out of date and had not been subject to review since 2005. Furthermore, it was evident that care plans were not being updated to reflect resident’s changing needs. For example, diary notes detailed that one of the residents had been referred for a reassessment of needs, due to symptoms of dementia. According to entries in the diary notes it was evident that the individual’s behaviour had been causing problems for staff and other residents for several weeks. There was no information in the care plan relating to this and no Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 Page 10 guidance for staff on how to manage the resident’s current behaviour. This is a cause for serious concern. The registered person must ensure that a strategy is in place to guide staff in adopting consistency in the way they respond to the resident and to minimise the disruption experienced by the other residents. Residents confirmed that their right to make decisions is respected and that they are always consulted about decisions that affect their lives. One of the care plans had been reviewed following a recent complaint received by the Commission. The provider had investigated the complaint with the outcome that the care plan had been reviewed and updated to address the concerns raised. As a consequence of this, decisions had been taken on behalf of the resident and it was pleasing to note that the care plan contained sufficient information to explain why this had taken place. A serious shortfall was found relating to risk assessments. Medication records and diary notes provided evidence that a resident had been refusing medication for several weeks and although the general practitioner had been consulted and a referral made for reassessment of need, there was no risk assessment in place. Additionally, the resident’s care plan had not been reviewed since April 2005. Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents had access to a variety of daily activities that enabled them to develop their potential. EVIDENCE: The home provided residents with information on opportunities available and they had access to education and training. Several of the residents were attending Cromwell house, which offered a variety of activity groups and therapeutic activities. The home encouraged residents to develop and maintain relationships with family and friends and to participate in the local community. Residents said they regularly went on shopping trips and several residents said they had enjoyed a holiday in Llandudno earlier this year. Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 Page 12 In-house activities included music, videos, and quizzes. On the day of inspection two residents had been to the local newsagent to buy newspapers and were discussing current events with their fellow residents. Residents said that they were encouraged to keep their bedrooms clean and tidy, although one resident said, “The staff will help if you need it.” The home did not operate a menu system, as meal planning was flexible and decided by the residents on a daily basis. Residents had chosen to express their cultural identity by opting to have fish on a Friday and a traditional roast dinner every Sunday. Meals at other times were according to residents’ individual choice. Residents helped themselves to breakfast and staff provided support in preparing the midday and evening meals. Residents were observed to help themselves to drinks and snacks throughout the inspection. Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents could be confident that if they experienced health concerns staff would take prompt action to ensure they were referred to the appropriate healthcare professional. EVIDENCE: The home had developed good working relationships with health and social care personnel and there was evidence to demonstrate that residents had access to specialist services according to their specific needs. Daily routines were flexible and personal support was provided in private. Daily records provided evidence that prompt referrals were made to healthcare services when residents experienced health concerns. A requirement made at the previous inspection for the home to implement a safe system of medication administration had been addressed and staff had received refresher training in this area. Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents were offered protection from robust policies and procedures in protecting vulnerable adults from abuse. Residents were confident that their concerns would be taken seriously and action taken to put things right. EVIDENCE: The Commission had received a complaint relating to the care of an individual resident since the previous inspection. This was referred to the provider for investigation who partially upheld the complaint. Steps were taken to ensure that improvements were made. During the inspection evidence was provided to confirm that progress had been maintained. Residents stated that they would approach either the manager or a member of staff if they had any concerns. One residents said, “I go and see the manager if something is wrong and he sorts it out for me. I get on well with the manager.” The home had adopted Salford Council’s policy and procedures for the protection of vulnerable adults from abuse. Staff working at the home had received training in the awareness of abuse since the last inspection. Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents are provided with a pleasant and comfortable living environment that was regularly maintained. EVIDENCE: On arrival at the home it was evident that the home’s rolling programme of replacement, refurbishment and re-decoration was ongoing. Several items of furniture and carpets had been replaced. The discarded items were stacked at the front of the house awaiting collection. The manager said that a skip had been ordered and was due to be delivered the week after this inspection. The manager also said that the kitchen was being refurbished prior to Christmas 2006. The residents said they were pleased with the improvements that had been made to the environment. A tour of the communal areas and two bedrooms was undertaken. The home was found to be clean and hygienic and no unpleasant odours were present. A conversation was held with a resident’s relative who was visiting at the time of inspection. The relative praised the standard of care that was delivered to her Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 Page 16 brother. She said, “My brother needs a lot of attention and takes up a lot of staff time. They are so patient with him and this gives me peace of mind. He has come on leaps and bounds since moving here. They let me know immediately if they are concerned about him. I can’t thank them enough.” Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The use of subjective and judgemental language denies residents rights to dignity and respect for their diverse needs. EVIDENCE: Standard 31 was not fully assessed during this inspection. However, it was noted that subjective and judgemental language had been used by one of the senior support staff in the daily records relating to the behaviour of one of the residents. This is unacceptable as it denies the resident the right to dignity and respect for his diverse needs. The registered person must ensure that use of such language ceases. Additionally, the registered person is required to produce a list of staff signatures confirming that individual staff have read and understood the General Social Care Council Codes of Conduct for Care Workers. A copy of this list must be forwarded to the Commission. No staff had been recruited since the last inspection when Standard 34 was assessed as met. Staff said that they had access to training and had recently undertaken health and safety refresher training and a course in the awareness of abuse. Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents and their representatives are given opportunities to comment on the quality of care provided by the home. Residents’ care is provided by a team of staff that have access to regular training opportunities. EVIDENCE: Since the last inspection the manager had made considerable progress towards achieving NVQ 4 in care and management. He said that he was approximately one third of his way through the course having completed 5 or 6 units. The home continued to monitor the quality of the care service it provided; by issuing satisfaction surveys to residents, their relatives and health and social care professionals on an annual basis. Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 Page 19 Since the last inspection staff had received refresher health and safety training such as fire awareness and food hygiene. The registered manager was implementing the ‘Safer Food, Better Business’ documentation produced by the environmental health department. He said that this would be completed by Christmas 2006. The home was displaying its certificate of registration and a certificate of public liability insurance, which was due to expire in May 2007. Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 2 32 X 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 1 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 Page 21 Yes 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 YA6 Regulation 15 Requirement Care plans must be subject to regular review. Previous timescale of 22/11/05 and 07/05/06 not met. The registered person must ensure that identified risks are assessed and that risk management plans are implemented minimise safety risks to residents. The registered person must provide evidence to the Commission that all staff have read and understood the General Social Care Council’s Code of Conduct for Care Workers. The registered person must ensure that staff do not use judgemental and subjective language in the residents personal records. Timescale for action 06/12/06 2. YA9 13 (4) 06/12/06 3. YA31 18 (4) 06/12/06 4. YA31 12 (4) (a) 06/11/06 Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 Page 22 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 Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ 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 Bradmere DS0000008343.V297872.R01.S.doc Version 5.2 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. 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