Inspection on 15/08/06 for Brightbow Lodge & Brightbow Court

This inspection was carried out on 15th August 2006.

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

The inspector 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brightbow Lodge & Brightbow Court 23/11/07

Brightbow Lodge & Brightbow Court 04/01/07

Brightbow Lodge & Brightbow Court 16/12/05

Brightbow Lodge & Brightbow Court 29/06/05

Brightbow Lodge & Brightbow Court 10/03/05

Brightbow Lodge & Brightbow Court 30/06/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME ADULTS 18-65 Brightbow Lodge & Brightbow Court 11-16 Philip Street Bedminster Bristol BS3 4EA Lead Inspector Wendy Kirby Key Unannounced Inspection 15 & 16th August 2006 09:30 th Brightbow Lodge & Brightbow Court DS0000020271.V297394.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 Brightbow Lodge & Brightbow Court DS0000020271.V297394.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. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brightbow Lodge & Brightbow Court Address 11-16 Philip Street Bedminster Bristol BS3 4EA 0117 9636409 0117 9464470 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) The Lodge Rest Limited Ms Angela Sankey Care Home 57 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (57) of places Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. May accommodate up to 57 persons aged 18 - 64 years with mental disorder, requiring nursing care excluding persons detained under the Mental Health Act 1983 May accommodate up to 19 persons aged 18 - 64 years with mental disorder requiring personal care excluding persons detained under the Mental Health Act 1983 Manager must be a RN on parts 3 or 13 of the NMC Register Staffing notice dated 28/4/1994 applies May accommodate up to 10 people aged 65 years and over with mental disorder requiring nursing and/or personal care within the existing registered numbers, excluding persons detained under the Mental Health Act 1983 16th December 2005 Date of last inspection Brief Description of the Service: Brightbow Lodge and Court are located in Bedminster, close to the city centre, within walking distance of local shops and amenities. They are separate premises on the same grounds and have different staffing and managerial structures. Main bus routes and bus stops are close by. The homes offer 24-hour social and nursing care, and are able to meet a range of needs, providing active rehabilitation, low level rehabilitation and continuing care. The home has an activities organiser to work with individuals, develop activity programmes which have an emphasis towards social, recreational, educational or employment skills training. The cost per week to reside at Brightbow Lodge and Court will cost from £334.00 to £462.00. Fees are reviewed annually and if care needs increase. This weekly fee does not include provision for items such as hairdressing, chiropody, dental, ophthalmic, or audiology services. Prospective residents can be provided with information about the home by accessing the Service Users Guide, which detail the services and facilities available at the home. Brightbow Lodge & Brightbow Court DS0000020271.V297394.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 conducted as part of the annual inspection process. The inspection took place over two days. Prior to the visit the inspector spent some time examining documentation accumulated since the previous inspection, including the pre-inspection questionnaire, notified incidences in the home, (Regulation 37’s) and the unannounced reports conducted by the Registered Providers (Regulation 26’s). The inspector sent forty questionnaires “Have your say” to residents in the home prior to the inspection and thirty were completed and returned. Relatives and visitors “Comment Cards” were also sent and seven of these were completed and returned. Information from these has been collated and is detailed throughout the report. On the first day of the inspection the CSCI Pharmacist Inspector looked at medication procedures and policies in the home under Standard 19, details of her findings and subsequent requirements have been documented in the report. The inspector spent time throughout the inspection in discussions with the Operations Manager, Registered Manager and Unit Manager. A number of records and files relating to the day-to-day running and management of the home were examined. Four residents were case tracked. Their care plans, care files and medication records were examined. The inspector had discussions with the residents and observed them indirectly going about their daily routines. The inspector toured both premises. Members of staff were observed on duty and five were spoken with individually. Feedback was given to the Operations Manager and Registered Manager on the outcome of the inspection. What the service does well: Resident’s needs are assessed to ensure the home is suitable to meet individual requirements. Care plans accurately reflect the residents’ needs and how they will be met. Residents and their families are involved in this process wherever possible. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 6 Systems are in place to help ensure that there is consistency in assessing, planning, implementing and evaluating the resident’s care at the required times. Staff have a good awareness of individuals’ needs and treat the residents in a warm and respectful manner, which means that they can expect to receive care and support in a sensitive way. Residents benefit from a varied activities programme, which is both enjoyable, stimulating and meets individual preferences and expectations. Meals were well presented and menus verify a healthy well balanced diet for all residents who benefit from a wide variety of choice. All complaints or concerns are documented, dealt with effectively and outcomes are recorded. Adequate staffing levels help to ensure that resident’s needs are met. Staffing levels are increased when the dependency levels of the residents change. Staff training is well attended and should ensure that residents are supported by competent and qualified staff. The recruitment procedure is robust and serves to protect vulnerable residents. The home is managed by an effective, stable management team that promotes the views and interests of the residents. What has improved since the last inspection? Corridors in the Court have been redecorated following a previous requirement and they were found to light, bright, clean and welcoming. The Court has converted existing rooms into a self-contained bed-sit, including a bathroom and kitchen. Some bedrooms have been redecorated. New front door locks has increased the residents security in the home. By meeting requirements made at the previous inspection: There is now greater consistency in reviewing and updating care documentation and risk assessments have more detail. The home has developed a workplace fire risk assessment. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 7 An enrolling programme continues for all staff to receive first aid training. 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. Brightbow Lodge & Brightbow Court DS0000020271.V297394.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 Brightbow Lodge & Brightbow Court DS0000020271.V297394.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 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. Resident’s needs are assessed to ensure the home is suitable to meet individual requirements. EVIDENCE: The manager at the Court was able to describe the process that would be undertaken to ensure that a full assessment would be undertaken for prospective service users including obtaining the care plan and assessment from the placing authority where applicable. The prospective resident, family, carers other health care professionals and are involved in the pre-assessment wherever possible. Residents care files showed that their needs had been assessed pre-admission to the home and contained comprehensive, valuable information in order to determine the suitability of the placement and that the home was able to meet residents needs adequately. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 10 The manager at the Court through his assessments was able to demonstrate a good knowledge of the current residents, their medical history, personal background and their subsequent needs. The inspector looked at six preadmission assessments in total and the information gathered provided a sound benchmark of the resident’s ability and state of health prior to admission. Brightbow Lodge & Brightbow Court DS0000020271.V297394.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents have comprehensive, clear, individualised care plans. Staff have a good awareness of individuals needs and treat the residents in a warm a respectful manner, which means that they can expect to receive care and support in a sensitive way. Residents are encouraged and supported to make decisions about their daily routines and participate in all aspects of the life they live in the home. Residents are supported to take risks in their daily lives within their home and out in the community. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 12 EVIDENCE: Care files were examined for six residents in total both from the Lodge and the Court. All files had a photograph of the resident and an identification profile. Care plans were detailed and demonstrated knowledge and understanding of residents’ emotional and psychological needs. This information should enable staff to support the residents and assist them with their needs. Plans were written clearly and concisely and in a sense that the residents had contributed in the implementation of each plan. Signatures for consent to the plans had been obtained, wherever possible. Plans were reviewed monthly and at the Court it was evident that staff and residents did the reviews together. Both parties had written comments on an evaluation sheet relating to each individual care plan and details included residents’ progress and any changes in care. Care staff confirmed that they were involved in the care planning process and receive training, supervision and support in the development of individualised care plans and accurate record keeping. The key worker system was in place and relatives spoke positively about the relationships between the residents and staff. One relative stated in their survey, “I have been very impressed by the kindness and attention of my sisters’ key worker, she shows such care and enthusiasm”. Staff spoke positively about their roles as carers and had a clear understanding of their roles and responsibilities to the residents. Residents are fully supported and encouraged to make decisions about their daily routines. The inspector witnessed throughout her visits to the home that residents were always asked what they would like to do. Care plans evidenced that residents had preferred set routines including one resident who liked to go out to the shops every morning to collect the residents daily papers. Twenty-three residents surveys stated that they make decisions about what they do each day and twenty-seven residents felt that they were able choose what they did, during the day, evening and on weekends. One resident required assistance with making choices because of restricted mobility and one resident said, “I like to get advice from staff to help me decide”. Residents meetings are held in both homes and receive good attendance. The minutes for the meetings were examined. The content was informative and demonstrated the value of the meetings for the residents ensuring their ability to participate in all aspects of life in the home. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 13 At the last meeting residents were informed about new security measures in the homes and about the new locks that had been fitted. Residents were also reminded to tell a member of staff when they are going out. Residents were supported about menu choice at mealtimes where they discussed likes and dislikes, and requests for meals that reflect the seasons such as fresh fruit salad. It was apparent, through discussion with staff and observation, that residents are supported to take risks as part of independent lifestyles. Risk assessments were examined and demonstrated that staff were ensuring residents were safe within their home and out in the community. All residents had individual risk assessments detailing for example, how much supervision was required when visiting the GP and using public transport. The manager expressed that the staff were vigilant in empowering residents to promote as much independence as possible. Although risk assessments were very clear and detailed some had been written over a year ago. Written evidence must show that they have been reviewed regularly and remain up to date. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 14 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): 11,12,13,14,15,16,17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents enjoy a range of activities and are supported to live a fulfilling life in and out of the home. Residents are supported and encouraged to maintain firm connections with families and friends. Residents take an active role in promoting and maintaining a healthy well balanced diet. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 15 EVIDENCE: The activities coordinator continues to provide a varied programme of activities for the residents. She is a well-established member of staff who is knowledgeable of the residents’ needs and aspirations. The coordinator is responsible for documenting a record of any activities the residents have taken part in. The inspector examined four residents’ files, which evidenced that this is being done. The information was detailed and provided a very useful reference guide. The home has a large room dedicated for arts and crafts, which exhibited large colourful displays of the residents work, including painting and ceramics. The residents make beautiful cards, which were on sell to residents, staff and visitors to the home. Any money collected is used to purchase additional art material. The coordinator demonstrated commitment to the residents and her roles and responsibilities to them. During the inspection it was clear that residents rely on her imagination and expertise when supporting their needs. During discussions it was evident that she had worked with the residents individually over a period of time and supported them to experiment and explore their talents. Several residents had grown in confidence particularly in expressing themselves through their artwork. In conjunction with the residents the activities coordinator develops a monthly timetable of activities and forthcoming events. A copy of this is placed in communal areas throughout the home, to ensure that all residents and visitors are aware of the planned activities. The residents enjoy exercise classes, weekly film shows and bingo. The inspector watched residents take part in a bingo session, which was well attended, the atmosphere was fun and residents said that the prizes they won were lovely. The coordinator has a budget to help with supplies for all activities and relies on the goodwill of local traders who often give ex-display items and discontinued stock. Several photographic displays of memorable days and events are very popular with residents, visitors and staff and are on display in the corridor. The board is regularly updated and provides memories and topics of conversation for residents where they are able to reminisce. Daily routines and activity plans were discussed which included attending various day centres on weekdays. Care plans and discussions with staff demonstrated that the home was providing residents’ with opportunities to develop social, emotional, communication and independent living skills. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 16 There was information on levels of independence and the level of support that was required by staff to support the individual in and outside of the home. Activities are reviewed with the residents and staff to ensure that they remain relevant to the individual. All individual tastes and preferences are taken into account. Some residents enjoy attending a weekly local football group where they play football and others enjoy taking part in a local exercise class. Another resident is part of a social services community walking group. A mini bus takes residents to places of interest and the residents take part in organised walks. All residents regularly go out and enjoy the local community amenities by visiting pubs, restaurants, shops, and cinemas. Residents also access courses provided at the city farm, including pottery and ceramics classes and computer training. Several residents have voluntary jobs, one resident works in a local charity shop. Family and friend contact is encouraged and supported and the home operates an open door policy for visitors to the home. One relative stated that she wasn’t able to visit regularly and relies on telephone contact, “When I ring my son is always very happy and never has any complaints, he seems to get on well with all the staff”. Several residents were happy to share with the inspector that they had partners and one resident’s boyfriend visited during the inspection. One resident showed the inspector a photograph of their partner who lived in another home. Staff take the resident to visit their partner whenever possible depending on staff availability. The resident explained that they loved the visits but that they always felt sad when it was time to leave. It was very evident that the chef is flexible in providing a number of alternatives for residents who did not want the main alternative from the menu plan. With the exception of breakfast, which can be provided between the hours of 7am-10am there, are set mealtimes, however meals can be put back if residents are out. Several residents told the inspector that they would speak to the chef if they had any special requests. Staff remain vigilant in assisting the residents in maintaining a healthy balanced diet and evidence was seen in the care plans that residents weight is monitored. The kitchen was not inspected fully on this occasion however it was noted that it was clean, organised and well equipped. The chef keeps a limited amount of food stock on the premises and prefers to use a major food store close to the home daily to ensure freshness. Following a previous requirement fridge and freezer temperatures are now recorded regularly and the temperature of food is probed, meeting with health and safety requirements. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 17 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): 18,19,20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents can be re-assured that their personal and health care needs will be met. The homes policies and procedures for receiving, storing, administering and returning medication is not safe. EVIDENCE: Care plans contained good detail of the personal care needs of residents. Dependency levels in this respect vary considerably and are influenced both by physical disabilities and mental health needs. Staff continue in their efforts to support those residents who require assistance to dress more appropriately and to improve their personal hygiene. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 18 Care records demonstrated that service users had access to the relevant health professionals including GP, dentist, chiropodists and opticians. There was correspondence from health professionals in the residents’ files including consultants, which shows that advice is sought when necessary from specialists. Evidence in care records demonstrated that individuals had access to preventative health care, for example cervical smear tests and flu vaccinations. There was evidence that staff members have received training in first aid. The pharmacist inspector looked at Standard 20 on 15th August 2006 and this is her account. Brightbow Lodge During this inspection I spoke to the nurse in charge and observed some morning medicines being given to residents. I also looked at the records of medicines received, administered and disposed of. Medicines are supplied using a monthly monitored dose blister pack system. A policy for the use of homely remedies was seen, only Paracetamol was kept and records are kept of its’ use. Medicines are stored in locked cupboards in a locked room on the ground floor and in a locked medicine cupboard on the first floor. The ground floor room contains a medicine fridge but no thermometer was available to record the daily temperatures, which should be in the range of 2 to 8 degree C for the safe storage of medicines. Temperatures should be recorded daily using a minimum/maximum thermometer. A cream requiring fridge storage was moved to the fridge during the inspection. Packs of medicines in current use are kept in a metal medicines cupboard. Back up stock of medicines, including many items prescribed for use When required is stored in a padlocked cupboard. The security of this cupboard must be improved. A large amount of back up medication was seen and it is recommended that staff seek advice from their pharmacist about the need to keep so much stock. It is also important to review the medicines held to make sure prescription instructions are still relevant. Oxygen cylinders were kept in the downstairs room but were not secured to prevent them falling. The manager said that these are not needed and has since arranged for them to be removed. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 19 I watched some medicines administered from the downstairs medicine room. The nurse had put some medicines into labelled medicine pots and in some cases these were taken to the resident by a health care assistant. The nurse then signed the medicines administration record sheet when the assistant returned. This is not good practice and may increase the risk of mistakes in medication administration. The health care assistant had no check of the medicines administration record sheet or medicines before they went into the labelled pot and the nurse signing the record had no way of checking that the medicines had been given to the correct resident. The Brightbow medicine policy clearly states that for nursing services only trained nurses will administer medicines. Action must be taken to make sure that staff follow both the home’s medication policy and Nursing and Midwifery Council (NMC) guidelines for good practice. The pharmacy provides printed medicines administration record sheets every month. Several gaps in the administration record were seen although the medicines were missing from the monitored dose packs. The manager had already identified this problem a few days earlier when she did an audit check of the medication. The record for one resident’s medicines showed that although they were prescribed two tablets twice daily only one tablet was given. No record was made on the medicines administration record sheet or in their care plan of why this was. Nursing staff confirmed that this was the resident’s own choice and that their doctor had been informed. If regular medication is not given as prescribed a record must be made of the reason for this. A number of residents are prescribed medication to be given When required. I saw no guidance for the use of many of these medicines either on the medicines administration record sheet or in the residents’ care plans. This could result in medication being given inappropriately to residents and could damage their health. This is a particular problem if staffing shortages result in the use of agency staff that do not know the residents well. The nurse told me that verbal orders for the dose of one medicine are regularly accepted without written confirmation from the doctor. This does not follow the clear guidance in the home’s medicine policy. Written confirmation should always be received to avoid errors in verbal messages, which could harm the resident’s health. A record is kept of the medicines received into the home. A waste disposal company dispose of unwanted medicines, a nurse signs this disposal record. To increase security it is recommended that two nurses sign this. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 20 Some of the information concerning medicines in the home was old and needs to be updated to provide accurate information. The British National Formulary (BNF) was dated 2001 although the medicine policy states it should be no more than 2 years old. Brightbow Court During this inspection I spoke to the person in charge of this area and looked at the arrangements for receipt, administration and disposal of medicine. Medicines are supplied using a blister packed monitored dosage system. Medicines supplied in standard packs are kept in a metal medicine cupboard but blister packs are stored in a locked metal filing cabinet. This does not meet the requirements for a medicine cupboard and action needs to be taken so that all medicines are stored in secure cupboards attached to the wall. One resident is prescribed insulin. The insulin is stored in a fridge, apparently purchase for this purpose. This must be locked and a minimum/maximum thermometer should be used to record the temperature daily, temperatures should be in the range of 2 to 8 degree C. A small Oxygen cylinder and old mask was seen above the medicine cupboard. Staff are not trained to use this and no statutory warning signs were seen. Staff should review the need to keep this. A number of residents are able to self-medicate. At present care staff transfer medication to weekly compliance boxes which residents use and return each week for refilling. Staff need to discuss this with their pharmacist to see if they could supply the medication in a form suitable for self-administration. Wherever possible medicines should always be given from the labelled container supplied by the pharmacy. Re-dispensing the medicines increases the risks of mistakes being made and residents should always have their medicines in fully labelled containers. A number of residents are prescribed medication on a When required basis. As in Brightbow Lodge written guidance for the use of these medicines is not available. Staff have started to look at addressing this. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 21 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): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has procedures for residents to raise concerns about the service. Procedures to protect residents from abuse are in place and staff are made aware of the processes involved. EVIDENCE: Brightbow has a well-established complaints procedure that contains contact numbers and timescales for action. Residents and families have information provided in the Service Users Guide on how to make a complaint and voice concerns. Any concern raised by residents and visitors is dealt with immediately; information of the outcome is cascaded down to the staff, through hand over and recorded in the resident’s notes. There have been no complaints received since the last inspection. Staff demonstrated an awareness of all residents as individuals and that they would be able to recognise if a resident was sad or concerned about something. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 22 Residents are also able to express any concerns they may have in the residents meetings and on a one to one basis during their monthly care plan reviews. Twenty-eight residents stated in their surveys that they new who to speak to if they were not happy and twenty-seven said they new how to make a complaint. One resident said, “I have never had reason to complain”. Seven out of eight relatives stated that were not aware of the complaints procedure. This surprised the manager, as it did not reflect the policies and procedures followed in the home. The complaints procedure is discussed on admission and is included in the service user guide. Written contact was suggested to inform families and friends of the homes complaints procedure. There are policies and procedures as well as a range of guidance information on the topic of protection of vulnerable adults from abuse. The availability of this information should increase staff awareness and understanding of their role in protecting vulnerable adults who live at the home. The manager is qualified to start in house training for all staff in the protection of vulnerable adults and an enrolment programme is under way. The inspector will examine the effectiveness of the training at the next inspection. A number of staff are undertaking the National Vocational Qualification in care award, and a component of the award addresses issues around the topic of the protection of vulnerable adults from abuse. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 23 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): 24,25,26,27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents do not live in a safe and well-maintained environment and are at risk in some areas of the environment. They have limited access to the appropriate equipment needed to support mobility. There are not adequate bathing and toilet facilities. The hygiene and cleanliness of the home is not adequate. EVIDENCE: The outside of the Lodge premises was looked at. In particular the home was unwelcoming, shabby and unkempt looking. Paintwork was poor and net curtains were ill fitting and grey. The gate to the Lodge was rusty and the area to the front door was full of weeds. The outside of the home did not reflect that vulnerable young adults were living there and that they were being looked after by a caring competent staff team. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 24 At the back of both premises are small courtyards with well stocked planters displaying colourful bedding plants. Adequate seating for residents with sun screening was provided. The home has recently had a conservatory area built at the back of the Lodge and residents are encouraged to use this area for smoking. The inspector had a tour of the home and examined all communal areas, bathrooms, toilets and most of the residents’ bedrooms. As a result of the tour the inspector will make a number of requirements and recommendations regarding the environment and the safety and wellbeing of the residents. Some bedrooms had been decorated and others were in the process of redecoration the majority of these rooms were in the Court. The colours used were tasteful and gave warmth to the rooms; new bedroom furniture, carpets and curtains had also been supplied and residents had personalised their rooms with their own things. However the majority of the bedrooms particularly at the Lodge were at best very shabby and dirty. In most rooms curtains were not hung properly, were torn and dirty. Carpets were thick with dirt, worn and ripped in places. The décor was old, dirty and in some places wallpaper was coming off of the walls. Evidence was seen in one bedroom where staff had tried to wash the walls to improve their appearance. The walls had only been washed as far as the staff could reach and the difference above this was remarkable. Windows were also dirty and the paint on the frames and window seals was flaking. Rooms were cluttered with a variety of personal belongings because residents did not have enough storage to accommodate them. Wardrobe space was also not adequate for many residents and clothes were seen packed tight with limited hanging space, and no space for shoes. Bedroom furniture was poor in quality, flimsy and in places broken. Some residents had chosen to keep food in their rooms and had facilities to make hot drinks. These areas were dirty and kettles were perched on bedroom cabinets and even on the floors. All residents had lounge chairs in their bedrooms, which were badly stained, fabric was worn and in places ripped, one resident’s chair had springs protruding from the seat cushion. The chairs were so old and dilapidated they were beyond cleaning and should be condemned. Beds were low divans and the age and suitability of some of the existing beds were certainly questionable. Fabric on the divans were worn and torn in places and the headboards found on some beds were ingrained with dirt. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 25 Communal areas in the Lodge were of good size and provided adequate seating for all residents. However the seating was shabby, worn, and dirty with ripped fabric. The carpet in the downstairs lounge was ripped nearly the whole length of the room and required cleaning. The upstairs small lounge/dining room carpet was also dirty and badly stained. Next door to this room was a small kitchenette. The inspector was informed that some residents preferred to have their meals in the small lounge/diner and that meals were transported from downstairs and if necessary reheated in the microwave in the kitchenette. Residents were also able to make hot and cold drinks in this room and wash and wipe up. Medication is also dispensed from this room. The kitchenette was dirty, wallpaper was hanging from the walls curtains were dirty and tied in knots, to stop them hanging in the water that collects on the sills through condensation. The kitchen units were dirty and stained both in the cupboards and on the surfaces with foodstuff. When the inspector went to open one cupboard door it fell off into her hand. Apart from the top floor the corridors and stairways in the Lodge were dark and were in need of re-decorating. In addition to this the carpets in these areas were worn and stained. The bathrooms were institutional and cold in appearance, with dated décor, however they were clean. It was noted that one toilet seat was hanging off and the bathroom hoist was rusty, dirty with paint flaking off. There were no records to evidence that the hoist had ever been serviced and it was required that this was done. One bath seen was old with chipped enamel. The lounge/dining room in the Court had recently been decorated and was homely in appearance, however a previous requirement was made at the last inspection to provide alternative flooring in the dining area due to spills and food debris being trodden in. This had not been done. The Court had met a previous requirement to redecorate the corridors and they were found to light, bright, clean and welcoming. The inspector also viewed a self-contained bed-sit within the Court, which is used by residents in anticipation to rehabilitate themselves in all activities in daily living and possibly to find alternative accommodation in the future. The bed-sit was homely, clean and well equipped and it was evident that the resident was enjoying this new initiative. The home is not cleaned to an adequate standard, however it is difficult to assess the cleanliness of the home due to the poor décor/paintwork, dilapidated furniture and worn, ripped fabric on upholstery, curtains and carpets. Much of the dirt in the home is ingrained. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 26 There was no evidence of recent systematic high-level cleaning in bedrooms as there were strands of cobwebs/dust visible in many rooms. One resident in the home was asked if she was happy at Brightbow and replied, “it’s ok but it’s very dirty”. The Court was quite clean in comparison to the lodge, however care staff are maintaining this, which means that they are spending less precious time with the residents. As mentioned in the previous report residents are encouraged and supported in promoting independence and taking responsibility in this respect as they so wish, however a balance is required in order for the home to fulfil their “duty of care” to the residents in the home. The home needs to review work practice in this respect and to improve standards of cleanliness. The management and staff team are proactive in supporting residents and motivating them to make their rooms personalised and take responsibility for the upkeep of their rooms and possessions, which largely depends on their mental health and individual choice. One resident in particular has worked closely with their key worker in promoting a homely comfortable bedroom to spend quality personal time in and has expressed an interest in painting and decorating his room with some assistance. The home has a housekeeper and domestic staff team. The manager explained that she had introduced a quality audit form of the premises and of the environment that the residents live in, in order to identify areas of weakness. The housekeeper had been instructed to complete the form monthly but this had not been used consistently. The manager and her staff have raised concerns about the environment with the registered provider and some issues had been resolved. It was discussed with the inspector that some works had not been commenced because the home is currently waiting for planning permission. There are plans to make some alterations to the layout and accommodation in Brightbow Lodge. This will involve each of the three floors having a more specific use. For example, the ground floor will be for the use of frailer residents, the middle floor for those who are more independent and the third floor for those who require more support. These plans also include the provision of extra communal space and kitchen facilities. Once achieved, this will represent a considerable improvement. It will also lead to a reduction in registered beds in the Lodge from 38 to 33. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 27 However in discussions with the Operational Manager and the manager it was agreed that many of the issues identified during this inspection should not hinder any future plans for this work should it go ahead and that the dignity, health, safety and welfare of the residents cannot be “put on hold” whilst waiting for planning permission. Implications with regards to the health and safety of residents and staff were evident. The home will be required to conduct a full environmental audit and risk assessment of all bedrooms, communal areas and furniture and submit an action plan with timescales to CSCI on how they will address the issues identified during the inspection. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 28 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): 32, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Staff are well trained and supervised so residents receive a service from a confident and competent team. There is a robust recruitment procedure in place, which serves to protect vulnerable adults. EVIDENCE: Training records were examined and an action plan was seen detailing course updates. Discussions with staff demonstrated that they receive regular updates in mandatory training. The managers and staff are conscientious in attending training relevant to the care needs of the residents. This year the team are focusing on training in “Mental health awareness and emotional support”, “Managing Azeburgers and Schizophrenia”. Courses are also targeted for the managers, which should help them, acquire the skills necessary to promote their roles and responsibilities within the home for example, employment law and training in assertiveness. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 29 The home continues to support their staff with NVQ training and the enrolling programme continues. The recruitment process was examined and all staff records examined showed that the home follows correct recruitment procedure and policies. Records contained application forms, references, and a CRB (Criminal Records Bureau) disclosure. The inspector spent time talking with staff and looking at staff supervision records. A plan is devised for discussion relating to key residents, work issues, staff issues, personal development and training. The recorded outcomes of the supervision are comprehensive and evidence the effectiveness of the sessions. The inspector spent some time throughout the day sitting in the communal areas observing staff carrying out their duties and assisting residents. Staff were respectful, warm in manner, good humoured and sensitive towards the residents within a relaxed homely environment. All staff members spoken with demonstrated a true dedication to their roles and responsibilities to the residents and home. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 30 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, 42, 43 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents’ benefit from living in a well run home. The health and safety of the resident is not adequately promoted and protected. Residents and staff will benefit from a representative of the registered provider carrying out the required monthly visits. EVIDENCE: The home’s registered manager, Mrs Sankey is the overall manager of Brightbow Lodge and Court, and has made significant and positive changes to the home since she came into post and has continued to make improvements. The Lodge now has an appointed manager, Mr Maxfield who has worked at Brightbow for fifteen years. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 31 It was evident from discussions with the management and staff that the home now has a stable team that supports a commitment to providing quality care for the benefit of the residents. Some of the Health and safety records in the home were examined. Documentation showed that all relevant checks were maintained correctly and at the required intervals including all fire alarms and equipment, emergency lighting and the water temperatures. The homes records showed all necessary service contracts were up to date including, gas and electrical services and lift servicing, however as mentioned previously in the report the bathroom hoist had not been serviced. The fire logbook evidenced compliance to the weekly, monthly and annual checks alongside records of staff training and drills completed. Records need to clearly identify that all members of staff have been present during fire drills as recommended by the Fire Prevention Officer and that all night staff undertake this on a three-monthly basis, and day staff six-monthly Many residents had various items of electrical equipment in their rooms and evidence of PAT testing was seen. Throughout many of the rooms it was evident that there were not sufficient power points and that there was regular use of extension cables. Some residents had up to four extension cables in their rooms each with four power points. These cables were not fixed to skirting boards and were left trailing, creating potential electrical hazards and possible trips and falls. The home must carry out a risk assessment throughout the home, secure cables and identify where additional power points need to be installed. Mrs Martin is a long-standing employee of the organisation and has previously worked at Brightbow as the manager. She has recently been appointed as the Operations Manager and will work closely with the managers at Brightbow and conduct Regulation 26 visits to the home. These visits must be unannounced and include interviews with staff and residents and an audit of the premises to ascertain the quality of care provided. They will then be able to make a judgement of the standard of care provided in the home and address the evident issues that have been identified at this inspection. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 32 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 1 25 1 26 1 27 1 28 1 29 1 30 1 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X 3 X X 1 1 Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13(4)( c ) Requirement Risk assessments must evidence that they have been reviewed regularly and remain up to date. 1.All medicines must be held securely in medicine cupboards, or a medicine fridge. The temperatures of medicine fridges must be within safe limits for medicine storage. 2. To protect residents’ health staff must follow both the home’s medicines policy and NMC guidance for administration of medicines. 3. Staff must seek the advice of their pharmacist concerning supply of medication for residents who look after their own medicines. The following maintenance work must be carried out. Secure the identified toilet seat. Secure all trailing wires and cables to the skirting. Secure the unit door in the kitchenette. DS0000020271.V297394.R01.S.doc Timescale for action 13/10/06 2. YA20 13(2) 17/10/06 3. YA24 YA42 13(4)(a)(b) 17/10/06 Brightbow Lodge & Brightbow Court Version 5.2 Page 34 4. YA24 5. YA26 An action plan must be sent to CSCI detailing the timescales and priority areas; 1. Ensure that externally the Lodge is in a good state of repair. 2. Replace flooring in the dining area of Brightbow Court. Repeated requirement 3. Replace the flooring in the lounge and lounge/diner at the Lodge. 4. Provide good quality furnishings in the lounge areas at the Lodge. 5. Redecorate lounge areas and corridors at the Lodge and replace curtains where required. 6. Redecorate the kitchenette and replace flooring and curtains. 16(2)(c) An action plan must be sent 23(2)(b)(d)(m) to CSCI detailing the timescales and priority areas for Brightbow Lodge and Court; 1. Refurbishment and redecoration of all remaining bedrooms. 2. Replacement of any unsuitable beds, headboards, chairs, and bedroom storage furniture. 3. Provide adequate storage facilities for residents’ personal belongings. 4. Provide new flooring to all bedrooms where required. 5. Replace torn curtains, clean existing dirty curtains and ensure that all curtains are hung properly. 6.Make sufficient power points available for use. 23(2)(b)(d)(g) 13/10/06 13/10/06 Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 35 6. YA27 YA29 23(2)(c)(d) 7. YA30 16(2)(j) 8. YA42 23(4)(e) 9. YA43 26(4)(b) An action plan must be sent to CSCI detailing the timescales and priority areas for Brightbow Lodge and Court; 1. Refurbish/redecorate all bathrooms and toilets. Priority must be given to the identified bathroom with the chipped enamel bath and bath hoist. 2. The bathroom hoist must be serviced and replaced if deemed unfit for use. Improve standards of cleanliness in Brightbow Lodge and deploy domestic hours at the Court. Arrangements must be made for staff to attend a drill every three months for those on night duty and every six months for day staff. Monthly visits to the home must include an audit of the premises to ascertain the quality of care provided. 13/10/06 19/09/06 19/09/06 13/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA20 YA20 YA20 Good Practice Recommendations Minimum/maximum thermometers should be obtained and used to record the temperature of medicine fridges daily. Two people should sign the disposal of medication record. Staff should seek the advice of their pharmacist on the need to keep backup stocks of medication in particular medicines dispensed some time ago. Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brightbow Lodge & Brightbow Court DS0000020271.V297394.R01.S.doc Version 5.2 Page 37 - 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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