CARE HOME ADULTS 18-65
Bradmere 16 Franklin Street Patricroft Eccles Gtr Manchester M30 0QZ Lead Inspector
Ann Connolly Unannounced Inspection 8th May 2007 10:00 Bradmere DS0000008343.V335738.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.V335738.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.V335738.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.V335738.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. 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. Fees for the home range from £340.00per week to £595.00 per week. There are no additional charges. Bradmere DS0000008343.V335738.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 8th May 2007 at 11:15 over a four hour period. During the site visit a selection of records, care plans, policies and procedures were examined. Discussions took place with the manager, staff working in the home and the people living there. Prior to the inspection, questionnaires were sent out to all the people who live in the home, asking them to comment on how the home is run and managed, and for their views about how the staff supported them. None of these questionnaires were returned. Five of the eight people living in the home were spoken to during the visit, and discussions took place with them to find out what they though about the home and what they felt about how the staff supported them. Since the last inspection visit, which took place on 6th October 2007, the Commission for Social Care Inspection has not received any complaints about this service. The home’s manager has not received any complaints since the last visit. What the service does well:
During this visit there was a relaxed and informal atmosphere, and people living in the home appeared settled and at home in their environment. People who were spoken to spoke highly of the staff team, and the way in which they supported them. Staff were observed as they engaged in meaningful conversations with people living in the home, and where appropriate, they offered support and reassurance in a sensitive and caring manner. One person living in the home said, “ You can talk easily to the staff, have a laugh and a joke with them. No one has a problem with my visitors coming to see me, it’s so relaxed and homely”. Another person said, “Staff- they are here for you if you need them”. There is a useful guide that provides people with useful information about the service and helps them to decide if the home is the right place for them, and can support them with their care needs. The environment was well laid out, providing several places for people to sit and relax. There is a large spacious lounge, a pleasant conservatory, and the spacious dining room also provided a quiet area consisting of comfortable seating arrangements. Encouragement is given to people to develop and maintain relationships with family and friends, and to participate in the local community. There was evidence e during this visit that there are established relationships with a
Bradmere DS0000008343.V335738.R01.S.doc Version 5.2 Page 6 variety of community resources, and that the staff support people living in the home to access these social and leisure opportunities. There are clear procedures in place that enable people using the service to make their views known, and there are policies and procedures to protect these people from abuse. People using the service said they felt confident in expressing their views, and in talking to the manager and staff about any concerns or complaints. What has improved since the last inspection? What they could do better:
The manager has stated his intention to ensure that people using the service are reminded about the Service User Guide, and it’s purpose, in providing useful information about the service and the facilities offered by the home. This is a well laid out home, and there was evidence of an ongoing routine maintenance programme. However, there were still some areas that required improvement so that all areas of the home offer a clean and pleasant environment for the people living there. Some shower areas needed refurbishment or cleaning and re-grouting of tiles, and the hall and landing carpet, which was badly stained required re-placing or at least deep cleaning on a regular basis. The kitchen was in need of refurbishment, however, the manager stated that this was prioritised and scheduled for a re-fit this year. Bradmere DS0000008343.V335738.R01.S.doc Version 5.2 Page 7 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. Bradmere DS0000008343.V335738.R01.S.doc Version 5.2 Page 8 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.V335738.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service had a full assessment of need prior to admission, and they are provided with information about the home, so that they can make an informed choice about their living arrangements. EVIDENCE: There was an up to date Statement of Purpose and service User Guide, which had recently been reviewed and updated. Information provided in these documents was detailed and comprehensive, and provided any prospective person who wants to use the service with plenty of useful information. This enables people to make an informed choice so that they can be confident that the home can meet their needs. The manager said that he intended to develop the information further so that information is made available in a range of other formats, for example, large print, and summarised versions. Bradmere DS0000008343.V335738.R01.S.doc Version 5.2 Page 10 The brochure informs interested people that introductory visits can be arranged so that people can ‘get a feel of the place’, meet staff and other people in the home, and find out what services and facilities would be available to them. One person living in the home said that they couldn’t remember being given information about the home, but expressed confidence in talking to the manager and staff about any issue of concern, or to raise any queries. Another person remembered visiting the home prior to admission, and getting information. The manager filled in a questionnaire about this service prior to this site visit. In the information he provided, he stated that the home intended to make improvements to the service, by ensuring that all people in the home were provided with the up to date details about the services and facilities available to them. This would also apply to any prospective people who showed an interest in using the service. Three files of people living in the home were sampled. All of them contained a full assessment of their care needs prior to admission to the home. In the Statement of Purpose, the information is very specific that the home does not accept emergency admissions. The information explains that the assessment is a vital part of the admission process in ensuring that the staff in the home, fully understand the needs and aspirations of the individual. Bradmere DS0000008343.V335738.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning is person focused, and reflects the needs, and goals of the individuals in the home. EVIDENCE: There had been a lot of improvement in the care planning since the last inspection visit. All care plans had been reviewed and updated and there was a strong emphasis on involving people using the service. Two care plans were examined in detail, and these had been drawn up with the individual and included a lifestyle assessment, which focused on seeking individual’s views and preferences. It was evident from the recordings that people had been consulted about how they wanted to be supported. This was a balanced approach and was linked to risk assessments. It was evident from discussions with the manager and staff that people in the home were supported to make their own decisions and to achieve, and work
Bradmere DS0000008343.V335738.R01.S.doc Version 5.2 Page 12 towards an independent lifestyle. Where restrictions were imposed, these were clearly explained and agreed with the individual concerned, and documented appropriately. During observations made during the visit, there was evidence of care plan and lifestyle agreements being implemented appropriately with positive outcomes for the people using the service. One person living in the home said that his life had improved since moving into the home. He explained that he now had a sense of purpose, and listed a number of activities that he was involved in. He said, “I know what I’m doing here, the staff, well, they are here for you”. Another person explained how well supported he was, and that with the support of the staff team he had achieved things he didn’t think was possible. All people spoken to were positive about the support from the staff team and the management. One person said, “It’s so relaxed here”. From observations made during the visit, it was evident that the people living in the home benefited from a relaxed and homely environment, where they could come and go as they pleased, and enjoy ordinary domestic comforts, such as brewing up, making a snack etc. Staff who were interviewed, demonstrated a good understanding of care planning, and of the importance of involving people who used the services. One member of staff said that one of her roles was to support people if they wanted to access and read their plan, and that she worked with them to develop and change their plan if this was appropriate. Bradmere DS0000008343.V335738.R01.S.doc Version 5.2 Page 13 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. 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 this service. People using the services are supported to achieve independence and participate in, and contribute to the communities where they live. EVIDENCE: People living in the home are given information on opportunities available to access training and activity centres. Some of the people in the home attend Cromwell House drop in Centre, which offer a variety of activity groups and therapeutic activities. Staff encourage people to develop and maintain relationships with family and friends and to participate in the local community. People in the home said they regularly went out on shopping trips, and some of these activities were going on at the time of this visit.
Bradmere DS0000008343.V335738.R01.S.doc Version 5.2 Page 14 Staff recognise the need to support people to achieve their goals and aspirations. In the pre inspection information provided by the manager, there was evidence that the manager and staff had identified changing circumstances of one individual, and made appropriate referrals in an attempt to meet these changing needs. One person in the home receives one to one support on a weekly basis as part of the strategies and plan to meet specific individual needs. Staff in the home recognised the importance of supporting people to access community facilities and resources. At the time of this visit, one member of staff was supporting one person on a shopping trip. Staff have established links with other community resources, and made referrals to the Start project, which offers a range of therapeutic services. Some people in the home attend the Links Centre, which offers a range of social activities. In house activities included music, videos and quizzes. People are encouraged to keep their own rooms tidy with appropriate staff support, and some people help around the home with small cleaning tasks. A menu system is not used, as meal planning was flexible and decided by the people in the home on a daily basis. People helped themselves to breakfast and staff provided support in preparing the midday and evening meals. People were observed helping themselves to drinks and snacks during the visit, and one person helped to put away the weekly shopping and appeared to enjoy participating in one of the organisational aspects of running the home. Bradmere DS0000008343.V335738.R01.S.doc Version 5.2 Page 15 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. 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 this service. The home is responsive to the changing needs of people using the service, and policies and procedures are in place to ensure the health and well being of these people. EVIDENCE: The manager and staff had developed good working relationships with health and social care personnel and there was evidence to demonstrate that people in the home had access to specialists services according to their specific needs. Daily routines were flexible and personal support was provided in private. Information in care plans provided evidence that appropriate referrals were made to healthcare services when people experienced health concerns. There was evidence during this visit that people in the home received appropriate support from external healthcare support services. One person received treatment in the privacy of their room.
Bradmere DS0000008343.V335738.R01.S.doc Version 5.2 Page 16 There was evidence that staff provided support to help people manage the practical aspects of attending healthcare appointments. One of the people in the home said, “ One of the staff come with me for my hospital appointment”. And went on to say that this helped him and gave him confidence. The manager and staff have made significant improvements to the way they manage and handle the administration and storage of medication. Two staff who were spoken to said they felt that the medication practices in the home had improved significantly, and that this was as a direct result of receiving refresher training which had highlighted good practice, and safe handling of medication. All staff are currently receiving a twelve week training course on the safe handling of medication. During this visit medication was seen to be administered and stored appropriately, and medication records were in order. Bradmere DS0000008343.V335738.R01.S.doc Version 5.2 Page 17 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. 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 this service. The home has clear procedures in place that enable people using the service to make their views known, and policies and procedures to protect them from abuse. EVIDENCE: The manager had not received any recent complaints about the service. However, records showed that the provider maintained records of complaints; which demonstrated that these had been investigated and that procedures had been followed, this ensured that complaints were taken seriously and responded to in a timely manner. People in the home stated that they felt confident in approaching the manager or the staff with any concern or complaint, and that they could also raise issues at the ‘in house’ meetings. The organisation had adopted Salford Council’s policy and procedures for the protection of vulnerable adults from abuse. The manager stated that staff had been given training in handling complaints and that additional training in Adult Protection was scheduled in the near future.
Bradmere DS0000008343.V335738.R01.S.doc Version 5.2 Page 18 During discussion with the staff team, it was evident that they had a good understanding and working knowledge of issues surrounding abuse, and that they were knowledgeable about the procedures to follow in the event of an allegation of abuse. The ability of staff to demonstrate this knowledge base ensures that people using the service are protected from abuse. Since the last inspection the Commission has not received any complaints about this service. Bradmere DS0000008343.V335738.R01.S.doc Version 5.2 Page 19 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. 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 this service. People living in the home are provided with a pleasant and comfortable living environment. EVIDENCE: All people spoken to expressed satisfaction about their environment. One person said she like to spend a lot of time in her bedroom, she said, “I am a private person, and it suits me”. People were observed freely accessing and using all parts of the home. One person said he enjoyed using the conservatory and spending time in the garden. The home is well laid out and there was evidence of an ongoing routine maintenance programme. However, there were still some areas that required
Bradmere DS0000008343.V335738.R01.S.doc Version 5.2 Page 20 improvement so that all areas of the home offer a clean and pleasant environment for the people living there. Some shower areas needed refurbishment or cleaning and grouting of tiles, and the hall and landing carpet which was badly stained required re-placing or at least deep cleaning on a regular basis. The kitchen was in need of refurbishment, however, the manager stated that this was prioritised and scheduled for a re-fit this year, and that the garden was going to be finished to provide pleasant outdoor space for people to use in the summer months. Bradmere DS0000008343.V335738.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home can be confident that staff are competent and skilled to support their needs. EVIDENCE: Policies and procedures are in place for the recruitment of staff. Staff files were examined and most contained all the necessary documentation, although some Criminal Record Checks (CRB) had been removed from the files. These were supplied to the Commission the following week. The manager stated that all files were due to be audited to check that all the necessary documentation was available on all staff files. Staff files provided evidence that staff received regular supervisions and appraisals, which examined staff performance in delivering care, and identified any training needs. All training was documented on files. Staff who were spoken to confirmed that they were provided with training and development
Bradmere DS0000008343.V335738.R01.S.doc Version 5.2 Page 22 opportunities and that they received support and guidance as required from management staff. The home experiences a low staff turnover, which provides continuity of care for those living in the home. Bradmere DS0000008343.V335738.R01.S.doc Version 5.2 Page 23 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. 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 this service. People in the home benefit from a management structure that is consistent, accountable and listens to the views of people using the service. EVIDENCE: The people in the home benefit from a committed staff team, and from the low turnover of staff. The manager operates an open management style, and encourages residents and staff to make use of the ‘open door’ policy. At the heart of this style of management is a person centred approach where the focus is on how the individual person wants their care needs to be met. All people spoken to during the course of this visit expressed satisfaction on the way the home was run and the quality of the services delivered by the staff
Bradmere DS0000008343.V335738.R01.S.doc Version 5.2 Page 24 in the home. During the visit, people living in the home called into the office to discuss issues with the manager. The manager welcomed all enquiries, and it was evident that people felt confident and comfortable in approaching him. It was evident that people ‘popping in’ was a natural and regular occurrence in the daily events in the home. In the pre inspection information, the manager stated that he was currently undertaking NVQ level 4 in management. Both this information and information in the statement of purpose stated that the views of people and professionals were obtained by using satisfaction surveys. The manager provided information stating that policies and procedures have been updated, and that staff had completed training in health and safety, fire, food handling and first aid, ensuring that the well being of people and staff were protected. Bradmere DS0000008343.V335738.R01.S.doc Version 5.2 Page 25 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 3 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 X 32 3 33 X 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 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.V335738.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 YA1 Good Practice Recommendations All people in the home, and any new people making enquiries should be provided with up to date information about the service enabling them to make an informed choice about the care and support arrangements. Standards of maintenance in the home should be maintained so that all areas of the home offer a clean and pleasant environment for the people living there. 2 YA24 Bradmere DS0000008343.V335738.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection North West Regional Office 11th Floor West Point 501 Chester Road, Old Trafford Manchester M16 9HU 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
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