CARE HOMES FOR OLDER PEOPLE
North Bristol Rehabilitation Centre 20 Ellsworth Road Henbury Bristol BS10 7EH Lead Inspector
Sandra Garrett Unannounced 21 August 2005 09:30
st 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 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. North Bristol Rehabilitation Centre D56_D05_S37040_NorthBristolRehabCentre_V243301_070805_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service North Bristol Rehabilitation Centre Address 20 Ellsworth Road Henbury Bristol BS10 7EH 0117 3772430 0117 3772431 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Bristol City Council Ms Elizabeth Calway CRH-PC Care Home 20 Category(ies) of PD Physical disability [2] registration, with number OP Old age [20] of places North Bristol Rehabilitation Centre D56_D05_S37040_NorthBristolRehabCentre_V243301_070805_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: May accommodate 2 persons over 50 years with a Physical Disability. Date of last inspection 24 February 2005 Unannounced Brief Description of the Service: Bristol North Rehabilitation Centre is run by Bristol City Council Social Services and Health (SS&H) and registered with Commission for Social Care Inspection. The centre provides short-term support to older people who because of illness or trauma need a period of rehabilitation. The support is provided within a care home setting and includes: occupational therapy assessments and physiotherapy. The centre is registered in the older persons category for people over 65 years. However an additional condition of registration enables two people over 50 years plus one person over 45yrs with physical impairments, to be accommodated for short-term care. North Bristol Rehabilitation Centre D56_D05_S37040_NorthBristolRehabCentre_V243301_070805_Stage4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was carried out on a Sunday and focussed on the care of service users at weekends. Seven service users were spoken to and a range of care and administrative records examined. What the service does well: What has improved since the last inspection? What they could do better:
Three requirements made at the last inspection were not fully met, although progress was noted towards meeting them. These included: Photographs of each service user are in the process of being developed although some still need to be done. Photographs need to be of a size suitable for service users to be easily identified to ensure their protection.
North Bristol Rehabilitation Centre Version 1.40 Page 6 D56_D05_S37040_NorthBristolRehabCentre_V243301_070805_Stage4.doc Photographs and proof of identity of staff have not been done at all. Further, any evidence of staffing records was not available for inspection. Service users may be at risk if staff identities cannot be verified. Whilst supervision of staff is carried out, the frequency of this may not meet their needs or the protection of service users. A requirement for supervision to be carried out at least six times yearly is carried forward until the end of the year. It was disappointing to note that staff had chosen not to implement a good practice recommendation about storage of medical equipment and the situation was worse than it had been previously. Service users have the right to stay in a homely environment free from risk and that doesn’t give an institutional atmosphere. 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.
North Bristol Rehabilitation Centre Version 1.40 Page 7 D56_D05_S37040_NorthBristolRehabCentre_V243301_070805_Stage4.doc 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 Standards Statutory Requirements Identified During the Inspection North Bristol Rehabilitation Centre D56_D05_S37040_NorthBristolRehabCentre_V243301_070805_Stage4.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, 4 & 6 The admission process identifies care needs and full assessments ensure service users’ rehabilitation needs can be met. Contract arrangements, where needed, are satisfactory. EVIDENCE: Although copies of blank contracts were seen in individual files kept in service users rooms, the service is free for the first eight weeks of a period of rehabilitation. Some service users however stay for longer than eight weeks and therefore start to pay for their care. The weekly rate is £39.10p and service users can arrange how they want to pay this. Staff said that only one service user was in this position currently. Pre-admission referral information or assessments were seen from hospitals, nursing homes or social services. The information gave clear details of service users’ care needs and the history leading to admission. The centre occupational therapist then does an assessment with goals and action plans that form the basis for rehabilitation to begin.
North Bristol Rehabilitation Centre Version 1.40 Page 9 D56_D05_S37040_NorthBristolRehabCentre_V243301_070805_Stage4.doc Service users’ specialist needs are identified information or the centre’s own assessments. from the pre-admission The centre specialises in intermediate care and equipment, staffing and services are provided to ensure that service users identified rehabilitation assessed needs can be met, that enables them to return to independent living at home. North Bristol Rehabilitation Centre D56_D05_S37040_NorthBristolRehabCentre_V243301_070805_Stage4.doc Version 1.40 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 8 Attention needs to be given to ensuring health risks are identified and assessed. Care plans must be developed for any service user. EVIDENCE: Service users have their care files in their rooms. Care plans were seen for nursing tasks and for rehabilitation goals. These were comprehensive and detailed, reviewed weekly and reflected the quality of care given. However one resident recently admitted admitted as needing a ‘safe haven’, didn’t have a care plan and staff said ‘safe haven’ service users didn’t necessarily have them. Attention must be given to ensuring all service users have care plans that set out what their assessed needs are and how they are to be met. North Bristol Rehabilitation Centre D56_D05_S37040_NorthBristolRehabCentre_V243301_070805_Stage4.doc Version 1.40 Page 11 Service users at risk from pressure sores had nursing care plans in respect of this, written and evaluated by the centre nurse. However it wasn’t clear how nursing care plans fitted in with personal care needs and whether centre staff were aware of risks in respect of pressure sores. One service user commented that a pressure-relieving device caused more pain so wasn’t using it. It wasn’t clear how this was being managed or resolved. Another service user who had fallen frequently had no risk assessment in respect of this and no information appeared on the manual handling risk assessment. Attention needs to be given to reviewing specific risks such as falling and prevention of pressure sores and putting appropriate risk assessments in place. North Bristol Rehabilitation Centre D56_D05_S37040_NorthBristolRehabCentre_V243301_070805_Stage4.doc Version 1.40 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 Service users experience a varied and stimulating life at the home that is centred around them regaining independence. Improvements have been made to developing appropriate activities. EVIDENCE: As the focus is on rehabilitation, in order for service users to return home as soon as possible, social activities aren’t given a high priority within the centre. However service users were seen sitting in lounges reading newspapers and magazines that were available, together with books, videos and jigsaw puzzles. One service user commented that sitting and reading the Sunday newspaper was a ritual s/he was used to. Service users were seen sitting in their rooms or lounges, listening to the radio/watching TV or practising their exercises with rehabilitation staff. Staff said that no active physiotherapy takes place at weekends but service users are encouraged and helped to continue with their daily exercise routines. A few service users were going out for the day as it was Sunday and they were visiting their families. Some service users that are able to do so can go out for walks and to visit the local shops close by. One service user said s/he was looking forward to being able to visit the centre’s courtyard garden.
North Bristol Rehabilitation Centre D56_D05_S37040_NorthBristolRehabCentre_V243301_070805_Stage4.doc Version 1.40 Page 13 Visitors/relatives are able to come in at any time and a couple of service users’ partners were having Sunday lunch with them. All service users praised the food, both in quality and quantity. A main meal with two choices is provided at lunchtime. Service users who are able to do so can prepare their own breakfast, tea and supper. For others choice of meals is given and they said they can have what they like. North Bristol Rehabilitation Centre D56_D05_S37040_NorthBristolRehabCentre_V243301_070805_Stage4.doc Version 1.40 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Arrangements for responding to service users’ concerns are satisfactory. EVIDENCE: A requirement made at the last visit in respect of ensuring complaints information is current and correct was met. Each service user has a Social Services and Health (SS&H) complaints leaflet in their room that includes details of the Commission for Social Care Inspection and how to contact it if they have concerns. A complaints record was seen in the file that includes the details of the complaint, the investigation, whether upheld and timescales for responding to the complainant. No new complaints have been received either by the centre or the Commission. North Bristol Rehabilitation Centre D56_D05_S37040_NorthBristolRehabCentre_V243301_070805_Stage4.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 22, 24 & 26 A comfortable standard of accommodation is provided for service users. Attention is needed to ensure service users are kept safe when using communal areas and to avoid an institutional atmosphere. EVIDENCE: As the premises used to be a care home many of the homely features have been retained. The centre benefits from two lounges that are well-furnished, homely and light with large windows on one side overlooking trees and green areas. It was disappointing that the centre had chosen not to implement a good practice recommendation made at the last visit to make sure hoists and other medical equipment are not stored in service users’ communal areas. A storage room is available for equipment, although staff said that it is not always returned there after use.
North Bristol Rehabilitation Centre Version 1.40 Page 16 D56_D05_S37040_NorthBristolRehabCentre_V243301_070805_Stage4.doc At this visit three hoists and a flipchart easel were seen in one lounge and three wheelchairs in the other. Attention needs to be given to ensuring service users’ space is kept free from hazards and the homely atmosphere doesn’t give way to a feeling of institutionalization. The centre has a sufficient number of accessible toilets and bathrooms easily available to service users. The premises are accessible to disabled service users and visitors. Service users’ rooms are all individually decorated and homely. A requirement from the last visit in respect of ensuring service users have their own dedicated lockable space in which to keep personal items, was met. One service user said s/he was ‘very well impressed’ with the premises and ‘didn’t expect it to be as comfortable’. The whole centre was free from unpleasant odours and domestic staff were seen throughout the day ensuring all areas were kept clean and hygienic. North Bristol Rehabilitation Centre D56_D05_S37040_NorthBristolRehabCentre_V243301_070805_Stage4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 & 29 Centre staff are well trained, supported and employed in sufficient numbers to meet service users’ needs. Recruitment of staff procedures are not robust and don’t provide the safeguards to offer protection to service users staying at the centre. EVIDENCE: Staffing levels met the minimum standard and service users said they felt well looked after. One service user commented: ‘ Staff are very kind and helpful and very, very patient. Nothing is too much trouble’. The two rehabilitation workers on duty said that they had achieved NVQ Level 3 and were very pleased about this. They had also achieved training in occupational therapy and physiotherapy competencies that they said helped their understanding of rehabilitation. The health care assistant said she was doing NVQ Level 2 and hoped to be finished by the end of the year. Three staff have almost finished NVQ Level 3 and five others are doing NVQ 2. No staff records were available for inspection as they were locked away. A requirement made at the last visit was not met as staff said they hadn’t had their photos taken. North Bristol Rehabilitation Centre D56_D05_S37040_NorthBristolRehabCentre_V243301_070805_Stage4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36, 37 & 38 Limited progress has been made in respect of ensuring regular staff supervision in order to protect service users. Further, photographic records to ensure service users are protected from risk need attention. Recording of Health and safety matters to ensure protection of service users are managed satisfactorily. EVIDENCE: A requirement made at the last inspection in respect of staff supervision was partly met. Staff said that although they have supervision it doesn’t happen regularly. Supervision dates are recorded in the centre’s diary and from records seen two sessions had been recorded for each staff member up to the date of this visit. North Bristol Rehabilitation Centre D56_D05_S37040_NorthBristolRehabCentre_V243301_070805_Stage4.doc Version 1.40 Page 19 A requirement in respect of obtaining photographs of each service user was also partly met. Many service users had photographs although one photograph was too small to distinguish clearly, especially if needed for identification purposes. However not all service users had photographs and this needs attention. Health and safety checks are carried out and regularly recorded particularly in respect of fire safety and protection. The record of fire safety equipment tests were in good order and health and safety issues were well managed. North Bristol Rehabilitation Centre D56_D05_S37040_NorthBristolRehabCentre_V243301_070805_Stage4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 3 x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 x 3 3 x 3 x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x 2 2 3 North Bristol Rehabilitation Centre D56_D05_S37040_NorthBristolRehabCentre_V243301_070805_Stage4.doc Version 1.40 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP7 OP8 Regulation 15(1) 13(4)(c) Requirement Each service user must have a care plan that sets out how assessed needs are to be met. Specific risk assessments must be put in place for monitoring of pressure areas and frequency of falls Service users living accommodation must be kept free from storage of equipment that may prove hazardous to them Photographs and proof of identity for all staff must be obtained and kept on file in the centre(not met from the February 05 inspection) Formal supervision must be carried out with each staff member at least six times a year and records kept of this (not met from the February 05 inspection) Photographs of every service user must be kept that are of a size that is easy to distinguish clearly Timescale for action 30 September 05 30 September 05 30 September 05 30 September 05 31 December 05 3. OP19 13(4)(a) 4. OP29 19(1)(b) Sch 2,4 5. OP36 18(3)(b) 6. OP37 17(1)(a) Sch 3 30 September 05 North Bristol Rehabilitation Centre D56_D05_S37040_NorthBristolRehabCentre_V243301_070805_Stage4.doc Version 1.40 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations North Bristol Rehabilitation Centre D56_D05_S37040_NorthBristolRehabCentre_V243301_070805_Stage4.doc Version 1.40 Page 23 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos. BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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