Inspection on 22/02/07 for Bristol North Rehabilitation Centre

This inspection was carried out on 22nd February 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 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... 20/09/07

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 22nd & 23rd February 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.V330873.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.V330873.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.V330873.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 24th January 2006 Brief Description of the Service: Bristol City Council Adult Community Care runs Bristol North Rehabilitation Centre together with Bristol North Primary Care Trust. The centre is registered in the older persons category to care for sixteen people over 65 years. However an additional condition of registration enables two people over 50 years, plus two people over 45 years with physical impairments, to be accommodated for short-term care. The centre provides short-term support to older people who because of illness or trauma need a period of rehabilitation. This is provided in accommodation similar to a care home although it includes occupational therapy assessments and physiotherapy (with use of its own gym). The service is free for the first eight weeks of a person’s stay. After that fees are applied at a fixed rate of £5.59 per day (or £39.10 per week). The fees don’t vary and remain the same for however long the stay is. 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 current Public Liability insurance certificate. Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key or main inspection that took place over one and a half days. Thirteen service users were staying at the centre at this visit. Seven were spoken with and a range of documents looked at. These included: assessments, care plans, the centre development plan, training records, complaints and health and safety records. Service users spoke highly of the service they had received since coming to the centre. What the service does well: The centre provides a whole package of care and rehabilitation to older people who need it following illness, trauma or hospitalization. The package includes occupational therapy assessments and physiotherapy with the ability to exercise in a purpose built gym on site. The centre is housed in what used to be a residential care home. As such the rooms are homely and pleasantly decorated and furnished. Further, the centre provides kitchen facilities that have recently been updated, that mirrors what service users may have at home so that they can practise skills to regain independence. The standard of cleanliness and hygiene is high. Clear assessments done by specialised health and social care professionals’ makes sure service users needs are identified and met. Good use of detailed care records shows that service users get looked after well in respect of health and personal care. Service users’ medication needs are well managed and keep them safe from risk of harm. Staff treat service users with dignity and their privacy is respected. Continuing attention to improving choice and type of food for service users means they get a good standard of nutrition and meals that are satisfying to them. Good information about complaints makes sure service users know who to contact and are confident about making a complaint if necessary. Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 6 Service users are kept safe from any risk of abuse by clear procedures that are properly managed. Continuing progress with training particularly National Vocational Qualification in Care makes sure service users are looked after well by properly trained staff. The manager makes sure she keeps up her training and is keen to follow up issues that may affect service users well being whilst staying in the centre. Health and safety matters are well managed and regular checks make sure service users are kept safe from risk of harm. What has improved since the last inspection? What they could do better: Three requirements and one good practice recommendation were made. Disabled service users, particularly those with visual and hearing impairments must have their individual needs assessed and met in relation to this. Ways must be found to make sure these service users can access any social activity or daily living routine to stop them from becoming bored and isolated. Information about the centre must be put into an accessible format so that they have the same opportunities as other service users. Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 7 A requirement and good practice recommendation were made about the environment. The décor in the main corridors of the centre looked tired and faded and were in need of re-decoration throughout. Further, the area around the lift and manager’s office had a lot of notices, some of which were unnecessary or were for the benefit of staff. This detracted from the otherwise homely décor of service users’ accommodation and looked institutional. Although the centre does it’s own audit to measure the quality of the service, no records were available to show the results of service user questionnaires. A requirement was therefore made to make sure quality assurance is given priority within the centre to enable service users to comment about and have input into the way the service is run. 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.V330873.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.V330873.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): 3, 4 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Clear assessments done by specialised health and social care professionals’ makes sure service users needs are identified and met. However the centre doesn’t manage individual disabled people’s specialist needs, particularly in respect of hearing and sight, in a positive way that stops them from being isolated. EVIDENCE: Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 10 Assessments are done by a range of different health or social care professionals. These include: the manager, deputy manager, occupational therapist or physiotherapist. The manager said the decision about who would do the assessment could depend on individual needs i.e. if a service user needed physiotherapy the physiotherapist would do it. If the care needs were largely social rather than health the manager or deputy would assess. There is also an assessment team with an assessment and review co-ordinator who a does hospital assessments. The co-ordinator then discusses individual service users’ needs with the manager to make sure the centre can meet them. Copies of ‘overview’ assessments as they are called, were seen. These are done within one week of referral and are largely a checklist of capabilities, medical information and administrative information. A flowchart for the progress from referral to discharge and beyond was seen that gave clear details of what should happen once a person is referred to the centre. Details of initial reviews were also seen on case notes and were clear and detailed. The manager said that not all service users have a social work assessment done before they come to the centre. However a social worker is allocated if the service user’s needs show that, for example, they need more permanent residential care. Service users spoken with were able to confirm that they had had their needs assessed and agreed with the actions that had been decided. However one service user was spoken with who at this visit had been in the centre for several days but whose needs had not been fully assessed. The manager said that the initial meeting would take place that day and confirmed that it had the following day. Records of this forward planning meeting, as it’s called, were seen in the service user’s case notes. This service user said s/he was unable to see or hear very well and therefore was unable to read any of the information in her/his room that included the service users guide. S/he was quite isolated and had been given a room that was in a quieter part of the centre. The service user said that s/he couldn’t read or even watch TV and said she found life in the centre ‘very boring’. Because of her/his health s/he couldn’t walk about the centre to meet others. The manager said that she was aware of this service user’s needs and plans were being made to move her/him to a more lively part of the centre where there were more service users to chat with. However the centre must make sure it can meet service users’ specialist needs, particularly in respect of sight and hearing. Such assessed needs must be addressed from the time they are admitted to the centre to avoid isolation and lack of social contact with others. Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 11 The rehabilitation centre is designed specifically to give intermediate care for people who don’t need to stay in hospital but need extra care or treatment before going home. It also offers short-term care for people who cannot return to independent living at home and are waiting for a permanent care home place. It further offers two ‘safe haven’ beds for people who are too ill to stay at home yet don’t need to go to hospital. The centre therefore is a dedicated space that includes specialised facilities to enable people to get back their fitness and independence. The centre has a gym that is fully fitted out so that service users can practice their exercises and get treatment from the centre’s physiotherapist. Other facilities include kitchens that have either gas or electric ovens depending on what service users are used to at home so that they can practise getting their own meals. The centre has access to its own nurse and a pharmacist employed by the community intermediate care service (that’s housed on the ground floor of the building). A local GP has dedicated hours to spend at the centre so that service users don’t have to wait until after rounds have finished. All staff are trained to a higher level of National Vocational Qualification in Care. They also train to become competent with Occupational therapy techniques and physiotherapy exercises so that they can help service users daily with these. Service users confirmed the programmes of rehabilitation that they had been practising while in the centre. The GP and nurse were seen in the centre and staff were seen working with service users to help them practise their daily living skills. Bristol North Rehabilitation Centre DS0000037040.V330873.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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good use of detailed care records shows that service users get looked after well in respect of health and personal care. Service users’ medication needs are well managed and keep them safe from risk of harm. Staff treat service users with dignity and their privacy is respected. EVIDENCE: Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 13 The manager said that care records are now kept on the centre’s computer system and some of these were printed off as requested. Service users, following the initial assessment and forward planning meeting, have goals and action plans drawn up that give information about their individual care needs. These were seen on the computerised records. Records were very detailed and written by each person involved in service users’ care. These included the rehabilitation staff, physiotherapist, community mental health nurse and others. It was clear to see how individual issues were being managed and health conditions treated. Goals included actions needed to get back to a full state of independence following the period of ill health or trauma. The goals were around mobility, doing stairs, preparing meals and coping with the layout of their home to give them greater independence safely. Service users confirmed the actions taken to meet their needs and that they were working with staff to regain their independence so that they could go home. Case notes were respectfully written and used service users’ preferred names. A requirement made at the last visit about risk assessments for individual risks was met. A number of assessments were seen including use of oxygen, falls, self-medicating and declining to take medication. A service user with swallowing difficulties was due to come into the centre and the manager said a risk assessment for this would be done as soon as s/he arrived. A local GP was seen visiting service users at this visit. Case notes recorded health issues that needed GP input and these were recorded regularly. From the pre-inspection questionnaire it was noted that many of the health support services needed for service users were based within the service itself. These included: A registered nurse A pharmacist A dietician An occupational therapist A physiotherapist A community mental health nurse. Other services needed such as optician, chiropodist, dentist and audiologist are based within the local hospital or in the community and contact is made as and when necessary. Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 14 From our own survey that was done shortly before the visit service users spoke positively about getting the medical support they need: ‘I have a dossette (medication) box in my top drawer & I have my nebuliser regularly’. ‘They’re giving me support with my medication’. ‘I have to take tablets everyday & the Doctor comes in every week, I’ve just seen her today & she would come in, in an emergency’. ‘So far, we have a doctor come once a week, but in an emergency they would come straight away I would think’. ‘I could see the Doctor if I needed to & he comes at set times’. ‘I was supposed to go home today but the nurse here has decided I’m not fit enough. The Doctor has put me on some antibiotics and I might be able to go home next week’. ‘I’ve got a dossette box with all the correct tablets in it’. ‘I continue with my medication’. ‘Staff observe me at the moment with my medication and I believe I’d be able to see the Doctor if I needed to’. Medication is kept in service users’ individual rooms. It is kept in a locked drawer and depending on whether the service user can manage it themselves they keep the key. If they can’t, staff keep the key and the drawer is kept locked. The manager had recently attended training on the newly adopted medication policy and the nurse spoke about a new policy she had devised to manage the treatment of service users on blood-thinning medication. This was detailed and clearly designed to avoid errors that could lead to service users having too many tablets and losing blood. This is good practice. The medication training attended by the manager had covered getting, transporting and storing medication together with prompting and giving. The centre’s pharmacist had run the training. It included scenarios for staff to think about issues they may find when dealing with service users’ medication. A check of the centre’s medication cupboards was done but very little was seen stored there. A locked medications fridge was seen with a minimum/maximum thermometer that recorded the temperature of 5°c – within normal limits. The temperature-recording book was seen properly filled in. Service users confirmed that they are treated with dignity and respect and staff were observed doing this during the visit. Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 15 From our survey responses were positive about the way service users feel they are cared for: ‘I had to get used to their ways here, but I love it now’ ‘So far so good, I only came here yesterday’ ‘As far as I can see, they boost morale and get us back to where we need to be. No doubt about it’ ‘They’ve been very good here’ ‘Very good’ ‘I’m very happy with the care, they are very pleasant people’ ‘The staff are out of this world’. Further, the question ‘do staff listen and act on what you say?’ drew the following responses: ‘The staff are lovely’. ‘They’re first class’ ‘Everything is done eventually’ ‘They don’t just ignore you, they definitely listen’ ‘Anything I ask’ ‘Whatever I ask’ ‘They’re very good’. Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 16 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): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Daily living routines are geared to service users being able to practise their skills in order to return home quickly. However lack of attention to the needs of hearing and sight impaired service users means they could become socially isolated. Whilst contact with the local community is limited visitors are welcomed at any time. Service users get as much choice as they are able within the confines of the centre and the work being done there. Continuing attention to improving choice and type of food for service users means they get a good standard of nutrition and meals that are satisfying to them. EVIDENCE: Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 17 As the centre is set up to give intermediate care it isn’t run the same way as a care home, although it comes under the Care Homes Regulations. Therefore the same range of social activities, entertainment and outings isn’t available as would be found in a care home. The focus is on helping people regain their independence so a necessary part of the day is spent in practising skills or doing exercises. However the centre does have games and puzzles, books (including audio books on cassette) and videos/DVDs’. These are freely available for service users to choose if they wish. There are spacious lounges where service users were seen chatting together. More independent service users can visit the local shops at the top of the road and this may also be part of their individual rehabilitation programme. Service users spoken with were mixed in their views about social activities. Some were satisfied with what was available to them whilst others found days ‘a bit boring’. One service user said s/he had struggled to find suitable reading material and had asked relatives to bring in books. S/he said s/he had ‘found it difficult at first but I’ve settled down to it better now’. The service user with sight and hearing impairments was unable to do anything but sit in her/his room and said that s/he couldn’t even hear the audio books that were available. (Please also see Choice of Home above). The manager said she was looking into getting amplified infrared headphones that would help and some catalogues for these were seen. Comments from our own survey confirmed the range of daily living tasks and activities available: ‘I do my exercises - I did 39 steps yesterday’ ‘I do my physio, I don’t know of any others. There are some books and jigsaws around in the lounge. I meet up with friends here and can make my own breakfast’. ‘There is a lounge with puzzles and things in and I have my physio’. ‘I think there must be some but I don’t bother’. ‘I have some physio’. ‘We have a man that helps us with our physio support’. ‘Only with the physio at the moment, I’ve seen him 3 times so far.’ ‘There is but I don’t bother, I like to walk around all day. That’s enough for me’. Contact with the local community is made through visits with a local priest on request and if this need is identified through the overview assessment. There is no other local contact although the manager said that if a service user is used to going to a day centre this is continued during their stay. Visitors are welcome at any time and there is a good range of local shops close by that service users’ can visit if they are able to or with staff support. Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 18 Service users can choose to spend their days either in their rooms or in one of the two lounges. Two were met who were found chatting in one. Both were very positive about the centre and the service they had received: one said that ‘this is the best place I’ve been in – it’s an honest sort of place’. Another said that ‘it doesn’t have a hospital air - which helps’. They did go on to say however that ‘there’s not much to do apart from hospital things’. Service users spoke highly of the meals provided. One service user who was a vegetarian was very pleased with the range and choice of vegetarian meals that the cook had made for her/him. These included vegetarian pies, sausages and mince. Our survey report showed good responses to the question about meals and four service users said they were ‘excellent’. Others commented: ‘Very enjoyable so far’ ‘They’re perfectly all right & we are always given a choice’ ‘They’re very good & very accommodating’ ‘I couldn’t fault them’ ‘Very good and varied’ ‘They are exceptional’. The manager had received occasional publications from the Commission – one of which was about meals in care homes. From this it was clear the manager had worked hard to improve the range and choice of meals for all service users including those who were vegetarian or wanted a cultural diet. Information about her actions was incorporated in the centre’s development plan for the year and an action plan was seen that showed the work that needed to be done. The centre’s dietician and cook had become involved and part of a service user’s initial review was a meeting with the cook to discuss meal preferences and likes and dislikes. The cook visits service users daily to discuss their choice of lunch and tea for the day. The action plan included offering a hot meal at teatime and making sure snacks and fruit are freely available throughout the day. It also included meeting service users’ communication needs around food and making sure liquidised food is presented separately rather than being mixed together. The manager said a service user was identified as needing a vegan diet before arriving at the centre so she and the cook had made sure proper food was brought in so that the service user’s vegan diet could continue. This is good practice. Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. Good information about complaints makes sure service users know who to contact and are confident about making a complaint if necessary. Service users are kept safe from any risk of abuse by clear procedures that are properly managed. EVIDENCE: From the pre-inspection questionnaire three complaints had been made during the last twelve months. Two had been partly upheld and one fully upheld. All of the complaints had been responded to within 28 days. Complaints leaflets were seen either pinned up on notice boards in individual bedrooms or in the pack of information also contained in each room (‘the black file’). The complaints leaflet included details of how to contact the Commission if the person was not happy with the outcome. We had not received any complaints about the service since the last inspection. Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 20 Of the question from our survey ‘Do you know who to speak to if you are not happy?’ responses were mixed: ‘The team leader’ ‘I wouldn’t be confident’ ‘I would get hold of someone from the office’ ‘I’d speak to the manager’ ‘I would speak to the rehabilitation worker & if she wasn’t around there would be someone else’ ‘One of the ones in charge’. However most service users were clear about seeing information on how to make a complaint and where this could be found: ‘I’ll look at the leaflet now, it’s on my board but I can’t reach it’ ‘There is a leaflet on my board to read’. ‘We were given a notice all about that when we came in’. ‘There is a leaflet if I want to read it’. ‘I know there’s a leaflet available if I want to read it & I’d be confident to make a complaint if I really needed to’ ‘There’s a complaints leaflet on my board’ ‘I can’t remember anyone showing me the leaflet, but there might be one in my black file’ ‘I have a leaflet on my board’ ‘I have a black book with all the information in it including the complaints leaflet’ ‘Got a leaflet pinned up on my board if I want to read it’. From the pre-inspection questionnaire one safeguarding adults referral had been made during the last year where a service user was at risk of abuse or had experienced abuse in the community. The inspector had been kept fully informed about the situation and had recommended better use of information stored on the computer system that’s shared with healthcare staff. This had been done and the team manager for the centre had responded positively. A new procedure to follow if abuse is suspected had been put in place. Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. The décor in the main area of the centre is shabby and doesn’t reflect the good standard of care given to service users. Further too much use of notices gives an institutional feel to the main area that could be off putting to new service users or visitors. Continuing improvements to physical access will make sure disabled residents needs are met. The centre is kept exceptionally clean, hygienic and fresh that protects service users and gives them a pleasant place to stay. Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 22 EVIDENCE: Although used to help service users to recover from illness or injury the centre is decorated in as homely a way as possible. This means that individual bedrooms and lounges have comfortable furniture and fittings. Each bedroom is decorated differently and includes a TV. Equipment used is stored out of sight and kitchens have been refitted to the latest modern design. Good use of bookcases for books, DVDs and games also increases the homely nature of lounges. A good practice recommendation made at the last visit about notices of a personal nature being displayed in rooms had been carried out. No notices were seen in bedrooms that could breach service users’ rights to privacy and dignity However on coming out of the lift on to the main corridor of the centre (which is the way service users and visitors get into the centre) the impression is of an institutionalised setting. This is because there are lots of large notices about a variety of different subjects stuck on to the walls and doors. Most of these are for the benefit of staff e.g. fire procedure, health and safety and use of rooms. Some notices looked tatty and torn. Further the décor of the central corridors was shabby, torn and tired-looking and needed redecoration. The overall first impression is of institutionalisation with a lack of care for the accommodation. Therefore this doesn’t reflect on the otherwise high standard of care service users receive. The situation was discussed with staff member from the City Council’s property services department who was visiting at the time. It was pleasing to note that shortly after the inspection the manager told the inspector that work had started on redecorating the corridors. The centre has had some work done to make it more accessible to disabled service users and visitors. This includes new automated self-opening front doors to the building and a lift that tells visually impaired service users what floor they have reached. The manager is awaiting an access audit to be done for the building and showed the inspection the audit document that has to be filled in. This included: access needs of wheelchair users and people with hearing and sight impairments and covered both inside and outside of the building. One service user had commented that she couldn’t access the hand towels in the toilets as they were too high up and this was fed back to the manager to go into the audit. The audit will be carried out with the manager and a staff member from the property services department. Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 23 To the question from our survey ‘Is the home fresh and clean’? The following responses were noted: ‘Wonderfully clean’. ‘Perfect’. ‘They seem to be pretty good with the cleaning’. ‘Lovely & clean 24 hours a day’. ‘Amazingly clean’ ‘Definitely’. Staff were seen cleaning all parts of the centre and all rooms including toilets and bathrooms were hygienic and very clean. The centre smelled fresh and pleasant. Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 24 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 good. This judgement has been made using available evidence including a visit to this service. Low staffing levels are managed well to make sure service users’ needs are met. Continuing progress with training particularly National Vocational Qualification in Care makes sure service users are looked after well by properly trained staff. EVIDENCE: From the pre-inspection questionnaire, eighteen care staff that include rehabilitation workers and health and social care assistants, work at the centre. Agency staff are used to cover sick leave and annual leave and were seen working there at this visit. The manager said there was a lot of cover needed due to this and had managed the situation by e.g. reducing admissions, prioritising tasks as well as using agency staff. Two rehabilitation workers were on duty at this visit and were observed to be very busy working with service users. From our survey eight service users said staff were ‘always’ available when they needed them although three said ‘sometimes’. Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 25 One health and social care assistant was spoken with and said she had just started her National Vocational Qualification in Care level 2 training. She had discussed with the manager in supervision, taking on an additional role that would benefit service users and that she would enjoy. Rehabilitation workers are trained to NVQ level 3 and have additional responsibilities in working with service users to make sure they do their exercises properly and to assist them with regaining daily living skills. To the question in our survey ‘are the staff available when you need them?’ responses were mixed: ‘Sometimes no, I think they are trying to cut down’. ‘I haven’t come across any problems and I think they do the best they can’. ‘There seems to be plenty, I’m sure they can be a bit short sometimes - the same as anywhere else’. ‘You get the impression that they are sometimes short staffed’. ‘There has always been enough when I’ve needed them’. ‘I think they are stretched but very, very willing, they are very busy’. ‘As much as I need them’. ‘I’ve never had any bother and I don’t need to call on them a lot’. From the pre-inspection questionnaire 7 of the 18 staff have National Vocational Qualification in Care at level 2 or above and three are working towards it. This means that the centre nearly meets the recommended national minimum standard of 50 of staff trained to level 2. Eight staff hold a current first aid certificate and ten staff, including the manager and deputy are trained and responsible for administering medication. From staff training records all staff had done safeguarding adults training between 2004 – 2006. However not all staff had recorded the dates of this although the manager was able to confirm them. Very little training in dementia awareness and care was recorded but the manager said that the community mental health nurse’s were planning some sessions. The manager further said that staff had done lots of dementia care /mental health training over time but the records didn’t reflect this. Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 26 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): 31,33,35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager makes sure she keeps up her training and is keen to follow up issues that may affect service users well being whilst staying in the centre. Although service user satisfaction surveys are filled in to show the standard of care received, inadequate follow up means that issues raised may not be given proper attention. Service users money is looked after well and kept safe within the centre. Health and safety matters are well managed and regular checks make sure service users are kept safe from risk of harm. Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 27 EVIDENCE: The manager, Liz Calway who is trained to National Vocational Qualification in Care level 4 and has the Registered Managers Award, had kept up to date with training. She was able to show the number and type of training courses she had attended over the last twelve months. These included: Safeguarding Adults Health and safety Review and care planning Fair access to care training Basic life support. As detailed above, the manager had received copies of reports from the Commission that she was keen to work with to improve service users experiences of staying in the centre. This is good practice. The manager said that ‘exit questionnaires’ used to get service users comments about their stay at the centre are given to both service users and their relatives when they leave. Whilst this is good practice the manager was unable to produce any results of these questionnaires to show what trends or issues had been raised. Further, the manager showed good use of a development plan she had drawn up for 2007 but nothing had been included from results of the questionnaires. A new questionnaire is being developed by the intermediate care service together with the rehabilitation centre but this is not currently in use. The centre holds some service users’ cash for them while they are staying there. A random check was done and all records were found to be correct. The money is kept separately and securely for each person. Records of income and spending are kept and where possible two signatures for each transaction were seen. Receipts for items bought were attached to individual sheets. Health and safety records were looked at and all were found to be in order and up to date. A copy of the latest fire risk assessment was seen that showed all risks and how they are managed. Lots of fire drills had been held including when incidents had caused the alarms to go off. All had been written up well and included numbers of staff. Records showed drills had been held both during the day and at night to test staff reaction times. Fire alarms were tested the day before the inspection and all tests of fire safety equipment were regularly recorded. The last fire safety officer visit took place in August 2004 and was satisfactory. One service user had concerns about health and safety matters in one of the kitchens. On inspection the kitchen was found to be safe. Electrical appliances are regularly checked and all were in a good state of repair. Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 28 Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 29 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 X X 3 2 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 30 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 OP4 Regulation 12(4)(b) Timescale for action The registered person shall make 31/03/07 suitable arrangements to ensure that the care home is conducted with due regard to the sex, religious persuasion, racial origin, cultural and linguistic background and any disability of service users. (specific needs of hearing or visually impaired service users must be assessed and met during their stay at the centre to avoid isolation. This includes in particular: daily living and social activities and access to information). The registered person shall 31/03/07 having regard to the number and needs of service users ensure that – all parts of the home are kept clean and reasonably decorated. The registered person shall 31/03/07 establish and maintain a system for – (a) reviewing at appropriate intervals; and (b) improving, the quality of care provided. The registered person shall DS0000037040.V330873.R01.S.doc Version 5.2 Page 31 Requirement 2. OP19 23(2)(d) 3 OP33 24(1), (2) Bristol North Rehabilitation Centre supply to the Commission a report in respect of any review conducted by him for the purposes of paragraph 1 and make a copy of the report available to service users. (The quality assurance system in place must be improved and responses collated. Quality assurance audits must be carried out at least yearly and the results made available to service users and a copy sent to the Commission) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP19 OP30 Good Practice Recommendations The number of notices displayed in the centre should be kept to a minimum to avoid an institutional atmosphere for service users. All dementia care and mental health training should be recorded to show that staff are aware of the needs of this group of service users. Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 32 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 Bristol North Rehabilitation Centre DS0000037040.V330873.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!