Inspection on 04/01/07 for Brightbow Lodge & Brightbow Court

This inspection was carried out on 4th January 2007.

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 2 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 15/08/06

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 4th & 5th January 2007 09:30 Brightbow Lodge & Brightbow Court DS0000020271.V325146.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.V325146.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.V325146.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 9636409 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), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (57) Brightbow Lodge & Brightbow Court DS0000020271.V325146.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 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 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 57 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 May accommodate up to 20 persons aged 18 - 64 years with mental disorder requiring personal care excluding persons detained under the Mental Health Act 1983 15th August 2006 5. 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 details the services and facilities available at the home. Brightbow Lodge & Brightbow Court DS0000020271.V325146.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 questionnaires “Have your say” to residents in the home prior to the inspection and eighteen were completed and returned. Relatives, visitors and health/social community professional “Comment Cards” were also sent and thirteen of these were completed and returned. Information from these has been collated and is detailed throughout the report. The inspector spent time throughout the inspection in discussions with Mr Paul Bliss, Company Director, Mrs Cilla Martin, Operations Manager and the Unit Manager of Brightbow Court. A number of records and files relating to the dayto-day running and management of the home were examined. An extensive tour of both premises was also undertaken due to the poor environmental issues resulting from the previous inspection and subsequent requirements. Nine 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. Members of staff were observed on duty and five were spoken with individually. Feedback was given 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. 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. Brightbow Lodge & Brightbow Court DS0000020271.V325146.R01.S.doc Version 5.2 Page 6 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. 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. Residents’ benefit from living in a well run home. The health and safety of the resident is now adequately promoted and protected. What has improved since the last inspection? Risk assessments now evidence that they have been reviewed regularly and remain up to date. The home has met all the requirements and recommendations around medication policies and procedures including the following: All medicines are now held securely in medicine cupboards and medicine fridges. The temperatures of medicine fridges are taken and recorded daily and are within safe limits. Residents’ health is further protected now that staff follow both the home’s medicines policy and NMC guidance for administration of medicines. The pharmacist now supplies medication for those residents who look after their own medicines. Externally the Lodge is in a fairly good state of repair and further improvements are being developed. All flooring needing replacement has been provided including, dining rooms, communal lounges and bedrooms. Brightbow Lodge & Brightbow Court DS0000020271.V325146.R01.S.doc Version 5.2 Page 7 Bedrooms have been redecorated, refurbished and new soft furnishings have been provided. Communal areas have been redecorated, refurbished and provided with soft furnishings. Adequate storage facilities for residents’ personal belongings have been provided. Refurbish/redecoration of bathrooms has been completed and a new bath hoist has been provided. The standards of cleanliness in Brightbow Lodge have improved and additional domestic hours at the Court have been deployed. There is evidence in place to confirm that 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 now include an audit of the premises to assist in assessing the quality of care provided. The home has been consistent in making every effort to meet previous requirements within the timescales set with efficiency and effectiveness. 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. The summary of this inspection report can be made available in other formats on request. Brightbow Lodge & Brightbow Court DS0000020271.V325146.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.V325146.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs are assessed to ensure the home is suitable to meet individual requirements. EVIDENCE: The unit manager at Brightbow 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 plans and any assessments carried out by the placing authority where applicable. The prospective resident, family, carers and other health/social care professionals are all involved in the pre-assessment wherever possible. Brightbow Lodge & Brightbow Court DS0000020271.V325146.R01.S.doc Version 5.2 Page 10 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. The unit manager through his assessments continues to demonstrate a good knowledge of the current residents, their medical history, personal background and their subsequent needs. The inspector looked at nine pre-admission 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.V325146.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): 6,7,8,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this 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.V325146.R01.S.doc Version 5.2 Page 12 EVIDENCE: Care files were examined for nine 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. Discussions with 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 is in place and staff spoke positively about their roles and had a clear understanding of their 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. All residents surveys stated that they make decisions about what they do each day and felt that they were able choose what they did, during the day, evening and on weekends. Some residents said that they required assistance with making choices for varying reasons e.g. restricted mobility and memory problems, one resident said, “I like to get advice from staff to help me decide”. Residents meetings are regularly 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. At the last meeting residents were informed about new staff members in the home and topics for discussion included, “Taking responsibility for personal possessions” and menu choice at mealtimes where they discussed likes and dislikes, and made requests for less chips on the menu. Brightbow Lodge & Brightbow Court DS0000020271.V325146.R01.S.doc Version 5.2 Page 13 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. The unit manager expressed that the staff were vigilant in empowering residents to promote as much independence as possible. Brightbow Lodge & Brightbow Court DS0000020271.V325146.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. 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 this 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. 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. Brightbow Lodge & Brightbow Court DS0000020271.V325146.R01.S.doc Version 5.2 Page 15 The coordinator is responsible for documenting a record of any activities the residents have taken part in. The inspector examined nine 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 has recently been decorated. The room exhibits colourful displays of the residents work, including painting and ceramics. The coordinator demonstrates commitment to the residents and her roles and responsibilities to them. During the last two inspections it is clear that residents rely on her imagination and expertise when supporting their needs. Through 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. In the last year residents have enjoyed shows at the Hippodrome, a visit to the Fleet Air museum, and trips to Longleat and Weston-Super –Mare. Over Christmas and the New Year period the residents have enjoyed various parties with, buffets, dancing and traditional party games. The residents enjoy exercise classes, weekly film shows and bingo. One residents survey stated, “I really enjoy outings, playing bingo and making arts and crafts during the day”. 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 home. The displays are regularly updated and provide 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. 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. Brightbow Lodge & Brightbow Court DS0000020271.V325146.R01.S.doc Version 5.2 Page 16 Activities are reviewed with the residents and staff to ensure that they remain relevant to the individual. Individual tastes and preferences are taken into account and one resident at the home is currently enjoying a course in IT. Residents access courses provided at the local City Farm, including pottery and ceramics classes and computer training. All residents regularly go out and enjoy the local community amenities by visiting pubs, restaurants, shops, and cinemas. Family and friend contact is encouraged and supported and the home operates an open door policy for visitors to the home. All relative and visitors comment cards evidenced that the staff welcome them into the home at any time and that they can see them in private if they so wish. Several residents have partners and maintain personal relationships with people inside and outside the home, which are fully supported by the staff in a respectful manner. One resident has a partner who lives in another home and staff take the resident to visit whenever possible depending on staff availability. Time was spent talking to the chef during the inspection and it was very evident that the chef continues providing a number of alternatives for residents on a daily basis. The chef explained that he had been on a recent course, which focused on areas around menu planning. The course has proved very valuable and comments included “It has opened my eyes”. Following the course the chef met with the residents and reviewed the menu plans with them; several advantages to this included greater variety and healthy balanced meals. So far the new menu plans have been running for two weeks with very positive outcomes. The chef often attends residents meetings and asks residents daily after mealtimes if they enjoyed their food. 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 confirmed 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 inspected, it was clean, organised and well equipped. Various new appliances have been provided including a new freezer, deep fat fryer and a combination cooker. New crockery and cutlery has also been ordered. The chef has recently become responsible for his own budget. This is proving an exciting challenge and he is vigilant in accessing good quality foods at a reasonable price. The manager is supporting the chef during this new initiative. Brightbow Lodge & Brightbow Court DS0000020271.V325146.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this 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 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.V325146.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. Visiting health/social care professionals gave positive accounts in the comment cards and stated, “I have been visiting Brightbow for seven years. I have always enjoyed a good working relationship with the care team and feel fully able to recommend them for their caring, experience and expertise in serving their client group” and “ Staff do a good job, the unit manager at the Court is excellent”. Some visitors said it would be useful if staff wore name badges as they didn’t wear uniforms and sometimes it was difficult to identify who were trained staff, care staff and residents. This was discussed with Mr Bliss and Mrs Martin who agreed it would be useful for visitors to the home and they would therefore look into it. At the previous inspection the lead inspector was accompanied by the CSCI pharmacy inspector, due to various concerns that had been raised prior to the visit. As a result of her inspection major shortfalls were identified around medication policies and procedures within the home and subsequent requirements were made. All of these requirements have since been fully met within the stated timescales and are as follows: A new drugs trolley has been purchased and was seen chained to the wall. Insulin is now stored in a new locked fridge and a minimum/maximum thermometer is used to record the temperature daily. At the last inspection it noted that procedures for administering some medicines were unsafe increasing the risk of mistakes. This practice has now ceased and the 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 (MAR) sheets every month. At the previous inspection several gaps in the administration records were seen although the medicines were missing from the monitored dose packs. The management team had identified this problem a few days earlier and now there are weekly audits and regular spot checks. The inspector examined the MAR sheets against stock balances and continuity of signatures and administration was seen. Brightbow Lodge & Brightbow Court DS0000020271.V325146.R01.S.doc Version 5.2 Page 19 A number of residents are prescribed medication to be given When required. Previously there was no guidance for the use of many of these medicines either on the medicines administration record sheet or in the residents’ care plans. This can result in medication being given inappropriately to residents and could damage their health. This is a particular problem when staffing shortages result in the use of agency staff that do not know the residents well. Since this was identified the staff have developed individual profiles for each resident about medicines they may be given on an as required basis. The profiles give clear explanations about why a medication has been prescribed and what the drug will achieve, when and for what reasons the resident may require it. At the previous inspection it was noted that on occasions orders for the dose of medicines are regularly accepted without written confirmation from the doctor. This does not follow the clear guidance in the home’s medicine policy. Written confirmation is now always sought to avoid possible errors from 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 and one nurse was signing the disposal record. It was recommended to increase security that two nurses sign this record and this is now being done. A new British National Formulary (BNF) has been provided to ensure that staff have up to date information. A number of residents are able to self-medicate. At the previous inspection it was suggested that the home discuss with their pharmacist if they could supply the medication in a form suitable for self-administration. The home now has arrangements in place whereby the pharmacy is dispensing medication to individual residents in fully labelled containers. Brightbow Lodge & Brightbow Court DS0000020271.V325146.R01.S.doc Version 5.2 Page 20 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): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has good policies and procedures in place for residents to raise concerns about the service, however not all relatives and visitors aware of the home’s complaints procedure. 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.V325146.R01.S.doc Version 5.2 Page 21 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. All residents stated in their surveys that they knew who to speak to if they were not happy and said they knew how to make a complaint. One resident said, “I would write a letter”. At the previous inspection it was noted from the comments cards that seven out of eight relatives/visitors 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 and it was suggested that it could be possible that longstanding residents and visitors to the home may have forgotten the information they had received on admission. Written contact was suggested by way of updating and refreshing peoples knowledge and understanding of the homes complaints policies and procedures. This has not been done and again only two out of the seven relatives/visitors comment cards received prior to this inspection stated that they were aware of the home’s 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 conduct in house training for all staff in the protection of vulnerable adults and an enrolment programme continues. 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.V325146.R01.S.doc Version 5.2 Page 22 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): 24,25,26,27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, comfortable, well decorated and furnished. With the exception of the flooring in the corridors and stairways at the Court it provides a safe, peaceful and well-maintained environment for the residents. The bedrooms and communal rooms and facilities are suitable and well presented for their purpose and meet the resident’s needs. EVIDENCE: At the previous inspection the home had a number of good quality outcomes under various standards. Unfortunately it had failed considerably over the environment that residents were living in. Brightbow Lodge & Brightbow Court DS0000020271.V325146.R01.S.doc Version 5.2 Page 23 Ultimately the health, safety and well being of residents were at great risk and subsequently numerous requirements were made and an improvement plan with agreed timescales was requested by CSCI. Since the previous inspection the management team and staff have worked relentlessly to improve the standards around the environment within a very short space of time and should be commended on its progress so far. The inspector will continue to monitor the home until all requirements are met. The inspector had a comprehensive tour inside the home with Mr Bliss and Mrs Martin and examined all communal areas, bathrooms, toilets and most of the residents’ bedrooms. The inspector was informed that any of the outstanding works to be completed were mainly due to the time constraints from the manufacturers supplying the large amount of furniture and soft furnishings that had been ordered. With the amount of work involved the decorating programme continues. The residents at Brightbow have diverse needs and personalities and the staff team were mindful that any home improvements would have to approached sensitively to ensure minimal upheaval and anxiety to each resident. Each resident was spoken with individually about the results of the previous inspection and what the home was required to do. Discussions were held whereby residents were asked to tell the staff what they were not happy about in their home and what would they like to see changed and how. Generally most residents agreed that their rooms should be redecorated, completely refurbished, new curtains, bedding and carpets should be provided and more storage and in some cases additional power sockets. The whole procedure meant that residents were empowered to make decisions and choices and all individual requests were respected, including personal taste in colours and honouring requests such as replacing flooring but not changing the bed. Some residents had not been inspired by the opportunity to change their rooms but it was thought by staff that once they had seen the improved standards in the other residents’ rooms they may change their minds in the future. The inspector looked at most of the bedrooms and the transformation was excellent. Rooms were fresh, bright, well equipped with good quality furnishings, including, bedroom furniture, lounge chairs and storage. New bedding, curtains, nets and bedside lamps were also provided. The inspector talked to many residents in their rooms during the tour and all expressed how much they like their rooms and the work that had been done. Brightbow Lodge & Brightbow Court DS0000020271.V325146.R01.S.doc Version 5.2 Page 24 Communal areas at Brightbow are a good size and provide adequate seating for all residents at any one time. Since the last inspection, all rooms have now been redecorated with fresh colours, tasteful pictures, canvasses and ornaments, new carpeting and new lounge furniture has been provided. Many residents were seen enjoying the social advantages of these rooms throughout the inspection. Upstairs the small kitchenette for the residents use has been redecorated and new flooring has been provided, this room is now clean, safe, and hygienic meeting all the requirements for its intended purpose. With some exceptions most the corridors and stairways in the Lodge have now been painted and artwork has been hung throughout to give that homely feel. The carpets in the corridors of the Court require replacing where the carpets are rippling, and are coming away from where they were originally stuck down. Mr Bliss informed the inspector that this was on their outstanding list of things to do and would be replaced as soon as possible. A requirement will be made to risk assess all areas and remind residents of potential areas of risks where they could trip, fall or stumble, a further requirement will be made that these carpets are replaced as a matter of urgency. Previously the bathrooms were institutional and cold in appearance, with dated décor. They have now been redecorated in a fresh lemon colour and the inspector was told that some additional soft furnishings, such as blinds were being purchased. The bath hoist has been replaced and appropriate servicing checks are in place under LOLER. This cleanliness in the home has vastly improved since the last inspection not only due to the overall improved standard of décor but also due to regular environmental audits and robust cleaning schedules carried out by the housekeeping staff. At the previous inspection it was noted that the Court was quite clean in comparison to the lodge, however care staff were maintaining this, which meant that they were spending less precious time with the residents. This has now been resolved with the deployment of additional domestic hours. Residents are encouraged and supported in promoting independence and taking responsibility for their rooms and personal belongings. 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. Brightbow Lodge & Brightbow Court DS0000020271.V325146.R01.S.doc Version 5.2 Page 25 Residents surveys stated that the home was clean and fresh and included comments, “It is getting much better as everything is being decorated and new furniture is coming”. At the previous inspection it was noted that the outside of the Lodge premises in particular 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. Since then the home has developed plans to refurbish the porch and reception area of the home to make it more welcoming to all people who live, work and visit the home. All the net curtains have been replaced with fresh white nets, the gate and fence have been repainted and weeds have been cleared and overall this has had a dramatic effect already. During the inspection outside contractors were seen cleaning the windows. At the back of both premises are small courtyards with well-stocked planters. Adequate seating for residents with sun screening is 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. A permanent position for a maintenance operative is being developed covering approximately twenty hours per week. An agreed programme will be developed to maintain the standards within the home and work on future improvements identified. Brightbow Lodge & Brightbow Court DS0000020271.V325146.R01.S.doc Version 5.2 Page 26 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, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are trained so residents can expect to 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 continues to focus on training in “Mental health awareness and emotional support” and “Managing Schizophrenia”. Brightbow Lodge & Brightbow Court DS0000020271.V325146.R01.S.doc Version 5.2 Page 27 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. 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 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 dedication to their roles and responsibilities to the residents and home. All residents’ surveys confirmed that they were treated well by the staff and one resident said, “ They are all very kind to me”. Generally residents felt that staff listened and acted on what they say, comments included, “Staff spend lots of time with me as I like a good chat”, “Sometimes things are very busy and they may have to come back to me a little later, but always try to help” and “ I have good company from the staff and other residents” Brightbow Lodge & Brightbow Court DS0000020271.V325146.R01.S.doc Version 5.2 Page 28 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, 42, 43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from living in a well run home. The health and safety of the resident is now adequately promoted and protected. Residents and staff now benefit from a representative of the registered provider carrying out the required monthly visits. Brightbow Lodge & Brightbow Court DS0000020271.V325146.R01.S.doc Version 5.2 Page 29 EVIDENCE: Prior to the completion of this report the inspector was informed that the registered manager had left, however it was evident from discussions with all the existing management team and staff that the home has a stable team that supports a commitment to providing quality care for the benefit of the residents. The home continues to develop formal quality assurance systems. Currently the home gathers information about the standards of the services they provide by way of questionnaires given to all residents and staff. Information from the surveys is collated and documented effectively. The results have enabled the home to identify all strengths and any weaknesses within the service they provide, and to produce an action plan where necessary. The last staff surveys identified a need for a mobile hoist and this has been provided. 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. The fire logbook evidenced compliance to the weekly, monthly and annual checks alongside records of staff training and drills completed. Following a previous requirement the records now 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 have various items of electrical equipment in their rooms and evidence of PAT testing was seen. At the previous inspection many of the residents rooms did have not sufficient power points and 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 has carried out risk assessments throughout the home, secured cables and assessed if additional power points needed to be installed and adequate provision has been made. 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 has been working closely with the managers at Brightbow to meet the requirements set at the last inspection. She will continue to conduct Regulation 26 visits to the home on a monthly basis. Brightbow Lodge & Brightbow Court DS0000020271.V325146.R01.S.doc Version 5.2 Page 30 These visits will be unannounced and include interviews with staff and residents and an audit of the premises to ascertain the quality of care provided. This continuity of auditing the home will assist in making judgements of the standard of care provided in the home, address any issues that may have been identified and help ensure that the standards met are maintained. Brightbow Lodge & Brightbow Court DS0000020271.V325146.R01.S.doc Version 5.2 Page 31 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 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 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 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 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 3 Brightbow Lodge & Brightbow Court DS0000020271.V325146.R01.S.doc Version 5.2 Page 32 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 YA22 Regulation 22 (1) Requirement Provision must be made to ensure that all people using the service are aware of the homes complaints procedure. Ensure that the corridors and stairways identified are risk assessed and urgent provision is made to replace the poor flooring identified in the Court. Timescale for action 09/04/07 2. YA24 12(1) (a) 23(2)(b) 09/04/07 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 Brightbow Lodge & Brightbow Court DS0000020271.V325146.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brightbow Lodge & Brightbow Court DS0000020271.V325146.R01.S.doc Version 5.2 Page 34 - 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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