Inspection on 20/09/07 for Bristol North Rehabilitation Centre

This inspection was carried out on 20th September 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bristol North Rehabilitation... 22/02/07

Bristol North Rehabilitation... 24/01/06

Bristol North Rehabilitation... 21/08/05

Bristol North Rehabilitation... 24/02/05

Bristol North Rehabilitation... 24/08/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Bristol North Rehabilitation Centre 20 Ellsworth Road Henbury Bristol BS10 7EH Lead Inspector Sandra Garrett Key Unannounced Inspection 20th & 21st September 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bristol North Rehabilitation Centre Address 20 Ellsworth Road Henbury Bristol BS10 7EH 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) 0117 3772430 0117 3772431 Bristol City Council Ms Elizabeth Calway Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (16), Physical disability (4) of places Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate 2 persons over 50 years with a Physical Disability. May accommodate 2 persons over 45 years with a Physical Disability Date of last inspection 22nd February 2007 Brief Description of the Service: Bristol City Council Adult Community Care and Bristol North Primary Care Trust run Bristol North Rehabilitation Centre. The centre is registered in the older persons category to give rehabilitation to sixteen people aged over 65 years. An additional condition of registration enables two people over 50 years, and two people over 45 years with physical impairments, to be accommodated for short-term care. The centre gives short-term support to older people that because of illness or trauma need a period of rehabilitation. This is provided in an environment similar to a care home, although it includes occupational therapy assessments and physiotherapy (with use of its own gym), plus on site nursing support if needed. The Centre is situated in the residential area of Henbury, Bristol and close to a number of shops and a pub. The service is free for the first eight weeks of a person’s stay. After that a fee of £308 per week (or £44 per day) is payable. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk The most recent inspection report was seen pinned up on a notice board outside the manager’s office together with the certificate of registration and a Public Liability insurance certificate that was out of date. Copies of inspection reports were also seen in the files of information held in each room. Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was carried out over two (half) days. Twelve people were staying at the centre and four were spoken with at length. A visit was also made the day before inspection to gain peoples views for the Commission’s own survey. Six people spoke about their experience of the service and their comments are included throughout this report. The service had commissioned an independent quality assurance survey that was done by an outside organisation in June ’07. Comments from this report are also included. The manager and two staff were spoken with and a range of records was closely looked at. These included: assessments and care records, complaints, staff training, supervision and health and safety. What the service does well: What has improved since the last inspection? Two out of three requirements were met and one out of two good practice recommendations had been adopted: The two corridors had been redecorated in neutral colours that made them lighter and fresh looking. In addition some bedrooms had also been decorated and new digital televisions installed for peoples comfort. The number of notices had been reduced which made it feel less institutional. A quality assurance survey had been done by an outside organisation and the report was available to look at. This showed good levels of satisfaction the service and the manager said she would be using information gained from it to develop the service further. Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 6 A third requirement about making sure specialist needs of people with hearing or sight impairments was unable to be checked as no-one with these needs was staying at the centre. However the manager said she is continuing to work on an access audit (that shows what needs to be put in place for disabled people). It was clear that the needs of disabled people staying at the centre during this visit were being properly met wherever possible. What they could do better: This visit showed up some problems with record keeping that indicates the manager and deputy manager are under pressure. The manager said that where staff shortages occur both she and the deputy work directly with people using the service. This leaves little time to do the essential management tasks. It has also led to several new requirements being made: The centre’s Statement of Purpose needs to be looked at and reviewed so that it meets the Care Homes Regulations 2001. The current statement is detailed but doesn’t include all the information people need to know about the centre. Further, it doesn’t include information about meeting specialist needs such as those associated with culture, religion, disability, sexuality or age, so that people from these groups feel welcome and are not discriminated against. Risk assessments must be put in place where people are clearly known to be at risk. Where specific health conditions such as dehydration and risk of pressure sores are known, information must be gained and recorded. This will show how the conditions are being managed so that people are kept safe. Some complaints had not been recorded. This could mean peoples concerns aren’t taken seriously. Further, information about serious concerns of possible financial abuse hadn’t been passed to the Commission. This meant we were unaware of the effect on people using the service and what was being done to protect them. From looking at training records it wasn’t clear if staff had done recent training in how to care for people with dementia or behaviour that challenges. Inadequately trained and experienced staff may not be able to meet the needs of people with dementia that may affect their rehabilitation. Across the staff team supervision records showed that they are not getting opportunities to discuss their work and concerns regularly. This may have a negative effect on people using the service if staff are not able to regularly talk about and get support for their work. A requirement was also made to make sure that essential records particularly about staff training and supervision (but also including complaints), are kept regularly. Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 7 Three good practice recommendations were made: When people using the service are assessed, the forms used should include the designation of the people doing them. This will make sure that staff that are suitably trained and experienced assess people. Menus should be displayed so that people using the service have the opportunity to see what meal choices are on offer each day of the week. Staffing levels should be reviewed to make sure that there are proper numbers of rehabilitation and care staff available to meet the needs of people using the service. The manager and deputy’s tasks should also be included in the review so that they have time to complete essential records required under regulation. This will make sure that people using the service are cared for by sufficient numbers of staff and that records show how they are protected and kept safe. 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. Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 & 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Out of date information doesn’t keep people fully informed. Further, people from minority groups may not feel welcome at the home without positive information available about this. Good use of contracts that give clear information about room numbers and fees makes sure people using the service are aware of their rights and responsibilities. Clear and detailed assessments make sure that the centre is the right place for people using the service and that staff are able to meet their needs, including specialist needs. Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 10 EVIDENCE: There are two Statements of Purpose. Copies of one were seen pinned up on a notice board on the ground floor of the building and also on a board outside the manager’s office. This statement is one that’s combined with the Intermediate Care Service, which is situated on the ground floor. The manager gave us another Statement of Purpose that’s just for the rehabilitation centre. This, although detailed, doesn’t include all the information as set out in the Care Homes Regulations and needs to be amended. Some of the information already included in the statement was also out of date. Further, no information about how needs arising from culture, race, disability, sexuality, age or religion is managed so that people aren’t disadvantaged, was seen. The whole document must therefore be reviewed so that people are aware of what services are provided for them. Staff spoken with said they were aware of the Statement of Purpose and are reminded of it regularly. From our own survey people were asked about whether they received enough information about the centre before they came to it. Comments were mixed: ‘I knew nothing about it’ ‘I knew from previous experience what it was going to be like’ ‘Yes. They gave me a leaflet to read and someone visited me at the hospital’ ‘Only what I heard (because I live nearby). I came here from hospital’ and: ‘I’ve been here before’. Copies of the service users guide were seen in files kept in each bedroom. This includes a summary of the Statement of Purpose. Contracts were also seen in peoples’ files kept in their rooms. The contracts are for short stay and included information such as room numbers, rights and responsibilities and details of the fees payable after eight weeks. People using the service had each signed a copy of the contract although from our survey they were unclear about this. Comments included: ‘I’ve signed a few things’ ‘No, not here’ ‘I’ve signed two or three papers’ ‘I can’t remember but I expect I did’ and: ‘Yes. It’s on my notice board’. Assessments that are done before people come to the centre were looked at. Some of these were confusing as there are different kinds of assessments and each health or social care professional does their own e.g. physiotherapist, occupational therapist or a member of the assessment team. Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 11 In addition some assessments were duplicated as files included both handwritten and typed copies. Further, signed assessments didn’t have the person’s job title to show whether they were suitably experienced and trained to do them. Those looked at however were clear and detailed. They gave information about the person’s needs for rehabilitation and how these would be met at the centre. They also included information about the person’s home situation and what aids and adaptations would be needed to make sure s/he could manage on going home. A requirement made at the last visit about making sure people’s needs in relation to sight and hearing impairment, was unable to be checked fully. However, the manager said she had now bought infra-red headphones so that people can better hear the TV and personal loop systems are also available to use in bedrooms if necessary. New digital TV’s that are wall mounted, remote controlled and give clear, sharp pictures were seen in several rooms. Some people using the service were using wheelchairs and had rooms large enough so that they could move and turn in them properly without obstruction. Other equipment to aid people that can’t walk was seen including a stand-aid, hoist or walking frame. One person had had an amputation and was seen doing well with equipment that helped her/him to stand, regain balance and start walking. Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good management of care and action plans means people are able to benefit from rehabilitation more quickly. Management of identified health risks to people living at the home are not always recorded properly. Clear management of medication keeps people safe and protected. EVIDENCE: Two types of care plan are used at the centre. A nurse is employed to do any nursing tasks needed. Some nursing care plans were seen that were mainly for pressure area care and wounds. These were well written and included clear details of dressings used and daily actions. Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 13 Other care plans showed the goals people had to regain their independence e.g. to improve walking, deal with medication and make their own meals etc. Action plans are then drawn up and reviewed weekly. Goals and action plans seen were detailed and clearly written. People spoken with confirmed their involvement in the plans and were able to say what actions were being taken to make sure they were carried out. From the centre’s quality assurance survey care plans scored 81 . Lots of comments were seen that showed people were aware of their goals and felt a sense of achievement when goals were reached. To the question in our survey: ’Do you receive the care & support you need?’ people gave the following answers: ‘They are wonderful’ ‘They couldn’t give me more’ ‘Yes definitely, they are very kind’ and: ‘Very well’. Manual handling risk assessments were seen in each person’s file looked at. One person at risk of falling had a ‘falls screening tool’ that outlined the risk and the actions to be taken to keep her/him safe. However there was a lack of recording for things such as dehydration and management of health conditions. One person at risk of dehydration had no record to show what drinks were being offered and taken so that staff were able to see how much s/he was drinking day and night. Further, the person needed turning at night to avoid further pressure sores, but no turn chart was seen and daily records didn’t show that this was being done or that the person was being checked regularly. The centre nurse confirmed that a new mattress was being delivered that day that would mean the person didn’t need to be turned but until then no records showed that this had been happening. Whilst at the centre people are able to see a local GP and are temporarily registered with the practice. Chiropodists visit the centre and other appointments such as for audiology (hearing) and dental are made as and when necessary. Clear records of healthcare professionals visits were seen. Management of medication is part of the rehabilitation service and people are helped to regain confidence in dealing with their own medicines. Some people spoken with weren’t at the stage of being able to deal with their own medicines and staff were giving them. Others were starting to take them. Medication was kept safely locked in peoples rooms or in the centre’s medication cupboard. Records of controlled medication were looked at and found to be properly witnessed and signed and amounts correct. In answer to our survey question ‘Do you receive the medical support you need?’ people gave a range of answers: ‘They look after my tablets & make sure I take them on time’ Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 14 ‘They’ve been absolutely brilliant, my wounds are dressed every day & they are getting better & they do give me painkillers beforehand’, ‘They’ve got the works here’, ‘My medication is put up for me in the mornings’ and: ‘I’ve got a drawer with all my medication in & with their help I’ve just started doing it myself’. From the centre’s own survey, healthcare scored 82 . Both people using the service and their relatives commented favourably on meeting of healthcare needs. Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines are geared to people being able to practise their daily living skills in order to go home quickly. People using the service get as much choice as they are able within the confines of the centre and the work being done there. Whilst meals are well managed and give daily variation, good nutrition and social contact, menus aren’t displayed weekly so that people can see what’s on offer. EVIDENCE: In answer to our survey question: ‘Are there activities arranged by the home that you can take part in?’ people said the following: ‘Only being here a few days. I’m not sure but the physio has been in to see me to let me know that that will start soon,’ ‘At the moment I am cooking my own meals ready to go home’, ‘We can go into the lounge & there are games & all sorts to do in there & if not the physio soon catches up with you’, Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 16 ‘I don’t personally take part in any but I’m sure they do some because I can hear it’ and: ‘There is something every other day & it involves our rehabilitation’. Whilst activities weren’t assessed as part of the centre’s own quality assurance survey some comments were made that showed people don’t feel socially stimulated: ‘Nothing to do for much of the time – boring. Need more activities (four similar comments)’, ‘staff to have more time to chat’ and: ‘Stimulation with bingo or cards, getting people to interact with each other would be good (four similar comments from relatives)’. Almost all of those people spoken with were in their own rooms. Lounges were not being well used at this visit. New TV’s have been installed in some rooms that are wall mounted and of the latest digital technology that gives clear, sharp pictures. Some people were watching daytime TV. People told us about their daily routines: some people like to stay in their rooms and one said s/he liked to chat to others in the lounge, read or join in with the armchair exercise group (that s/he said was ‘a real laugh’). People spoke positively about this group, which is run by the physiotherapist. One person said that s/he felt that it was a ‘very long day here’. S/he went on to say that s/he passes the time by reading or watching TV. People have choices that again are geared to their rehabilitation. Once they become independent with making meals they can choose when to have breakfast, tea or supper and what to have. The kitchens are stocked with foods that they can use to make breakfast or sandwiches. Everyone spoken with said that they could get up when they choose and are not persuaded otherwise. This is good practice. Positive comments were made in our survey about the cooked meals at the centre: ‘The food has been wonderful, far better than hospital food. It’s like being in a hotel’ ‘They’re o.k & the best they can do, I just prefer my own’. ‘They are very good’ (Two similar comments) ‘They are very nice & there are usually 2 choices on offer’ and: ‘The food is lovely’. Food and drink scored highly in the centre’s own survey with lots of positive comments: ‘Very good – can make my own breakfast, cup of tea, supper’ and: Lunch good and enough – get my own breakfast and tea’. The midday meal was sampled with people using the service and found to be hot, tasty and nutritious. People with diabetes using the service get diets suitable to meet their needs. Attention is given to trying to make sure meal choices (especially desserts) are similar to those other people can have. Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 17 One person with diabetes commented favourably on the choice of meals available to her/him. However we noticed during the visit that menus were not displayed anywhere in the centre. People are asked the day before, what they would like for lunch. However some people couldn’t remember what they had asked for and wanted to change their choice. Weekly menus should be displayed so that people know what’s on offer throughout the week and can remind themselves of what they’ve chosen. Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lack of proper attention to recording complaints fails to make sure peoples concerns will be taken seriously. Failure to record all safeguarding adults issues or staff training in the subject means people may not be fully protected from risk of abuse happening to them. EVIDENCE: People spoken with were clear who to speak to if they’re not happy: ‘I’m sure any of them would help’. ‘I would press my buzzer & talk to whoever comes & if more serious ask them to fetch the relevant person’. ‘I would go to Liz’ (the manager), ‘I would talk to my key worker’ and: ‘Yes because I have my own key worker & they are there when you want them’. Further, they were clear about the procedure to use to make a complaint: ‘I have a leaflet on my board but I haven’t felt the need to read it’, ‘I have no reason to think of that’, ‘Yes I would if I needed to, otherwise things would never be right’, Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 19 ‘If I thought the staff were being really unfair about something I would ask to see the senior person in charge’, ‘I can’t see how there would be anything to dislike here’ and: ‘All have the leaflet on their own notice boards’. Copies of the local authority complaints procedure were seen pinned up on notice boards in bedrooms or in individual files. Staff said they sit down with people when they come in and go through the leaflet, making sure they feel able to raise any concern they may have. The complaints file was looked at: One person we had lunch with spoke of a situation that disturbed her/him at night and had made a complaint about it. This had been quickly dealt with but the complaint hadn’t been recorded at all. Further there had been a series of incidents that gave rise to complaints. The last of these had also not been recorded. It wasn’t clear therefore what had been done about it and in what timescale. The manager said that the former complaint hadn’t been recorded because it was dealt with quickly. She was unable to say however why the last one hadn’t been recorded. Failure to record complaints could lead to ‘gate keeping’: i.e. staff deciding what is or isn’t important. The series of incidents that had been partly recorded were to do with alleged financial abuse. The manager had taken proper action to try and make sure that people were kept safe but the incidents kept happening over a period of time. The safeguarding adults co-ordinator for the City Council and Police were contacted and were aware of the situation. However the Commission hadn’t been notified about any of the incidents. Therefore we were unaware of the actions taken to protect people at the centre from further risk of abuse happening to them. When looking at training records for all staff it was clear that not everyone had safeguarding adults training recorded. At least nine people’s records showed no such training. The manager said that she felt sure everyone had done the training and the staff spoken with confirmed that they had done it. One person had done it in 1998 but had no further training recorded since. Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service benefit from staying in a comfortable, clean, safe environment that is properly decorated and looked after, physically accessible and meets their needs. EVIDENCE: A requirement made at the last visit about re-decoration of the public areas of the centre had been met. The corridors had been redecorated in neutral, light colours that looked fresh and bright. The number of notices had been reduced although there were still some that were either unnecessary or were being ignored. Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 21 A number of bedrooms had also been redecorated in fashionable wallpapers that made them look clean, fresh and light. Each room was decorated differently and gave a homely look to the centre. The manager said that more work was planned to update all toilets and bathrooms. The home was exceptionally clean at this visit. Staff were seen cleaning all areas on both days of our visit. No unpleasant odours were noticed and no substances that would be dangerous to people using the service were left out. In answer to our question about the cleanliness of the centre people said: ‘It’s beautifully clean’ ‘They come & clean everyday’ ‘They’re always cleaning’ ‘It was the first thing I noticed when I came here, how clean it was’ and: ‘It’s spotless, it’s cleaned everyday’. Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Low numbers of permanently trained rehabilitation staff and reliance on agency and management staff to do tasks, affects the management of the centre. Progress with National Vocational Qualification in Care training makes sure people are looked after well. Insufficient training in mental health, dealing with behaviours that challenge and dementia awareness means peoples needs for support with these issues may not be met. EVIDENCE: In answer to our survey question: ‘Are the staff available when you need them?’ people gave the following comments: ‘They are very good’, ‘I’ve never had to use my panic button yet but so far no complaints at all’, ‘They are ever so quick they really are marvellous’, ‘I might have to wait a while if they are with someone else but they always get here in the end’, ‘They come straight away when I need them. I have to have a bit of give & take when they are short but I still don’t wait long’, and: ‘They are here on the dot’. Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 23 Further, to the question ‘Do the staff listen & act on what you say?’ comments were positive: ‘It’s a marvellous place they really are wonderful’, ‘Yes definitely’, ‘They look after me very well & are very quick when I need something’ and: ‘Scott the physio is absolutely fantastic’. Staff spoken with were generally positive about the centre but said they felt there weren’t enough staff. They went on to say that there is a lot more paperwork that they have to do and more to be done on the computer that takes up time. Staff said that they feel they don’t always get everything done when it needs to be done. Agency staff were seen in the centre during the visit but the manager said she tries to only use them for domestic work. She went on to say that finding agency staff trained to give rehabilitation is difficult so both the deputy manager and herself do shifts ‘on the floor’ when short staffed. The manager went on to say that she hoped to recruit more staff in the near future and acknowledged the difficulties of making sure shifts are covered properly. As documented elsewhere in this report, staffing issues have had an impact on making sure records are kept properly up to date. Whilst this is the responsibility of the manager, staffing levels should be reviewed. This will make sure that there are enough staff to meet peoples needs rather than relying on the manager and deputy to cover, that distracts them from their own work. Health and social care assistants are being enabled to do National Vocational Qualification in Care level 2 and one spoken with said she had finished unit 1. The deputy manager is an NVQ assessor but doesn’t always have time to meet with staff to go over their work with them. Staff also said that they hadn’t had a staff meeting for some time but had previously had team building sessions that helped them understand each other’s roles. All staff training records were looked at. These showed regular task or medical based training e.g. medication, swallowing, how lungs work, breathlessness, observations and oxygen and basic life support. Much of this had been done in 2007 and most of the staff had attended sessions. However very little training in dementia awareness and care was seen. The manager said sessions with the intermediate care service’s community mental health nurse were being planned for November. An outside training session on communication in dementia was also being organised for October. However no staff names were seen booked to do any of this training. Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32, 33, 36, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the manager is properly trained and experienced, failure to deal with specific issues doesn’t make sure that procedures necessary to show people are kept safe are carried out. Further, failure to make sure records are kept up to date could lead to a decline in the quality of the service provided. Suitable ways of making sure people can comment about life in the home helps them to be sure their views and opinions will be taken note of. Staff don’t get full opportunities through regular supervision to think about and discuss their working practices, that could lead to poorer quality of care given to people. Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 25 Failure to report events that affect people using the service doesn’t make sure that actions are taken to protect people from harm or abuse. However, good management of fire safety makes sure everyone at the home is kept safe from the risk of fire. EVIDENCE: The manager, Ms Liz Calway, is trained to National Vocational Qualification in Care Level 4 and also holds the registered managers award. She has been a manager with Adult Community Care for several years. Ms Calway was welcoming and open to the inspection process. She is responsive to occasional guidance issued by the Commission on various topics that helps make sure people using the service get good quality care. However we noted at this visit failure to: notify us of serious incidents affecting people, making sure complaints are recorded and making sure essential staff training and supervision records are up to date. These could show that management pressures are leading to a reduction in both the quality of management provided and the care given to people using the service. A requirement made at the last visit was met: quality assurance surveys are now carried out by the same organisation that surveys other local authority care homes. A copy of the report was given to us that showed people using the service and their relatives feel they get high levels of care and support. The survey report also includes ‘action points’ that show when people or their relatives feel aspects of the service could be improved. The manager has a development plan that will help her to work towards improving the service. Records showed that instead of six times a year (as per the City Council’s own policy and the National Minimum Standards) some staff had supervision sessions recorded only once or twice in two years. None of the records seen showed that staff were having sessions every two months as recommended. Staff said that they don’t get regular supervision. The manager said she thought that supervision was happening more regularly and that the records don’t give a true picture, but none were available to show this. Each member of staff had received a yearly appraisal however. Fire safety records were looked at. Regular checks of all fire safety equipment and fire alarms were properly recorded. Staff had done regular fire safety training and an updated fire safety risk assessment had been done in 2006 that showed actions to be taken to make the centre safer. Fire drills were happening regularly. The last one recorded was in June 2007 and involved fifteen people both staff and people using the service. Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 2 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X X 2 2 3 Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 6(a) Schedule 1 Requirement Timescale for action 31/12/07 2. OP8 13(4)(c) 3. OP16 22(8) The Statement of Purpose must be reviewed to include all the elements of Schedule 1 and to include a statement as to how needs of people from diverse groups in society are to be met. This will make sure people are given all the information they need about the service. Where specific health issues are 20/10/07 identified for people using the service records must be kept. These include health conditions such as dehydration and pressure sores. Records must be put in place to show how the conditions are being properly managed. This will make sure people are protected from further risk of harm. 20/10/07 All complaints and concerns received from people using the service must be recorded to show the investigation and outcome within set timescales. This will make sure people using the service can be confident their concerns are taken seriously. DS0000037040.V346474.R01.S.doc Version 5.2 Bristol North Rehabilitation Centre Page 28 4. OP18 37(e) 5. OP30 18(1)(c)(i) 6. OP36 18(2) 7. OP37 17(2) Details of any event that adversely affects people using the service must be sent to the Commission as soon as possible particularly where the event involves possible abuse. This will make sure that the Commission is aware of incidents and the actions taken to make sure people are properly protected. All rehabilitation and care staff must be given updated training in dementia awareness and care. This will make sure that they can meet the needs of people with dementia. All rehabilitation and care staff must have supervision at the frequency as set out in their organisation’s policy (at least six times yearly). This will make sure staff have opportunities to talk about their work that will benefit people using the service. Records required under regulation must be properly kept for inspection. Such records must include: evidence of regular training including safeguarding adults and evidence of regular supervision of staff. This will make sure that people using the service are cared for by properly trained and supervised staff. 20/10/07 31/12/07 31/12/07 31/12/07 Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations Forms used for assessing people using the service should include the designation of the person doing the assessment. This will make sure that people using the service are assessed by people trained and experienced to do so. Weekly menus should be displayed in the centre for people using the service to see what choice of meals is on offer each day of the week. A review of staffing should be done to make sure that there are sufficient numbers of rehabilitation and care staff to meet the needs of people using the service. The review should also make sure that the manager and deputy have time to carry out management tasks including those required under regulation. 2. 3. OP15 OP27 Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Bristol North Rehabilitation Centre DS0000037040.V346474.R01.S.doc Version 5.2 Page 31 - 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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