CARE HOMES FOR OLDER PEOPLE
Bristol North Rehabilitation Centre 20 Ellsworth Road Henbury Bristol BS10 7EH Lead Inspector
Sandra Garrett Unannounced Inspection 24th January 2006 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.V278001.R01.S.doc Version 5.1 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.V278001.R01.S.doc Version 5.1 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.V278001.R01.S.doc Version 5.1 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 21st August 2005 Brief Description of the Service: Bristol North Rehabilitation Centre is run by Bristol City Council Social Services and Health (SS&H) in conjunction with Bristol North Primary Care Trust. 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 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 an environment similar to a care home setting and includes occupational therapy assessments and physiotherapy. Bristol North Rehabilitation Centre DS0000037040.V278001.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection focussed on the care of service users and followed up requirements and recommendations made at the last visit. Nine service users were spoken with and a range of care and administrative records examined. Service users spoke highly of the service offered. What the service does well: What has improved since the last inspection?
Following a requirement made at the last visit, it was pleasing to note that service users communal living area was free from hoists and other equipment. Service users benefit from being entitled to stay in accommodation that is homely and resembles a home situation whilst they are being rehabilitated. Requirements in respect of clear photographs of both service users and staff were met met. Photographs of service users were seen at a follow-up visit on 21 February. These were of a size and clarity that enabled the service user to be easily recognisable. Photographs of staff were seen framed and hanging in the corridor outside the office. The photographs had been updated to include each staff member currently working in the centre. Photographs of each member of staff are also contained in individual personnel records that ensure service users are protected from harm. A requirement in respect of regular staff supervision was partly met. The manager said she is taking a more proactive responsibility for supervision to ensure all staff get opportunities to reflect on their work.
Bristol North Rehabilitation Centre DS0000037040.V278001.R01.S.doc Version 5.1 Page 6 Requirements in respect of care plans and risk assessments to protect individual service users were only partly met at this visit. Service users in ‘safe haven’ beds (that are used to admit people who may be too unwell to stay at home yet not need hospitalization) didn’t have clear plans that covered identified assessed needs in relation to their care. However it was pleasing to note at the follow-up visit that new care plans had been put in place that identified care needs and potential risks such as frequent falls. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bristol North Rehabilitation Centre DS0000037040.V278001.R01.S.doc Version 5.1 Page 7 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.V278001.R01.S.doc Version 5.1 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 the following standard(s): None of the standards in this section were assessed at this visit. Standards 2,3,4 & 6 were met at the last inspection in August ’05. EVIDENCE: Bristol North Rehabilitation Centre DS0000037040.V278001.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 7, 8, 9 & 10 Service users are well looked after in respect of personal and healthcare needs. Attention needs to be given to ensuring any health risks are identified and assessed. Service users benefit from clear advice and support on medications management for when they return home. Attention is needed to ensure service users dignity and privacy is maintained at all times. EVIDENCE: Care records are kept in each service user’s room. Three were examined at this visit although not every service user said they had taken the opportunity to read them. A requirement in respect of ensuring that each service user has a care plan that sets out assessed needs and how they are to be met was only partly met at this visit. A service user in one of the ‘safe haven’ beds (that are used to admit people who may be too unwell to stay at home yet not need hospitalisation) didn’t have a clear plan in place. This service user was quite unwell and needed full care. It was not clear how staff had identified or were meeting her/his needs. The manager said that she was having a meeting with her manager the day after this visit to discuss effective care planning. The requirement is therefore
Bristol North Rehabilitation Centre DS0000037040.V278001.R01.S.doc Version 5.1 Page 10 continued with a short timescale. It was pleasing to note that at a follow up visit on 21 February ’06 a new care plan had been developed and was seen in use. The care plan covered goals to achieve for the service user, who would work with her/him to ensure the goals were achieved and the date of outcome. Care needs included mobility, medication, personal care and domestic and support needs on returning home. The care plan seen was clearly documented and gave clear indications of the service user needs to be worked with. Further a requirement in respect of ensuring specific risk assessments are put in place was also partly met. Risk assessments in respect of pressure area care together with nursing care plans for treatment of pressure areas were seen. A ‘screening tool’ to assess risk of falling was seen. This had been developed by an occupational therapist at the centre and comprised a checklist of possible factors that could lead to falls in older people. These included among others: the history of recent falls, medication that could give rise to them happening, environmental issues, visual impairment, confidence levels and physical or psychological fitness. The tool has the capacity to inform accurate falls risk assessments and also shows clearly, areas to be worked on that could substantially reduce the risk when the service user returns home. The screening tool is very good practice and is to be commended for its use. However it was noted that a service user at risk because of swallowing difficulties had no risk assessment done in respect of this. This requirement is therefore continued with a short timescale. A rehabilitation worker was observed working with a service user in respect of enabling her/him to become self-medicating on return home. Good interaction between the service user and staff member was observed with clear discussion about reason for and use of prescribed medications. The worker was advised to ensure instruction leaflets are kept with medication administration sheets for ease of reference. The medication administration sheet was appropriately signed with no gaps. Further, records in respect of controlled medication was appropriately signed and witnessed by a second staff member. This is good practice. Notice boards were seen in each service user’s room. These each contained a copy of the Social Services and Health complaints leaflet and general risk assessments about possible hazards in the room. However a ‘bowel chart’ was seen in one service user’s room that was on display for anyone to read. In the inspectors opinion personal or healthcare records on display could be interpreted as a breach of service users privacy and dignity and also creates an institutional atmosphere. Bristol North Rehabilitation Centre DS0000037040.V278001.R01.S.doc Version 5.1 Page 11 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 the following standard(s): None of the Standards in this section were assessed at this visit. Standards 12, 13 &15 were met at the last visit in August ’05. EVIDENCE: Bristol North Rehabilitation Centre DS0000037040.V278001.R01.S.doc Version 5.1 Page 12 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 the following standard(s): None of the standards in this section were assessed at this visit. Standard 16 was met at the last visit in August ’05 and no new complaints have been received since then. EVIDENCE: Bristol North Rehabilitation Centre DS0000037040.V278001.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 19 Service users benefit from a homely environment that enables them to practice skills needed to return home. EVIDENCE: A requirement made at the last visit in respect of ensuring the communal living areas are kept free from equipment was met. The lounges that are pleasantly decorated and homely were free from hoists and other medical type equipment. However the manager said she sometimes has difficulty in ensuring all staff adhere to this requirement as some forget to put equipment away after use. Service users spoken with said they were pleasantly surprised at the homely nature of the centre when they arrived although one said s/he hadn’t liked it at first but had got used to it. The centre was clean and hygienic and smelled fresh and pleasant. Domestic staff were seen cleaning all areas. Bristol North Rehabilitation Centre DS0000037040.V278001.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 Service users benefit from being able to recognise staff available to care for them and appropriate actions are taken to ensure they are kept safe. EVIDENCE: A requirement made at the last visit in respect of ensuring staff records contain photographs and proof of identity was met. A board outside the office was seen that contained photographs and names of each member of staff. It was therefore very easy to recognise and name the staff member who first appeared to greet the inspector. This is good practice. Photographs of individual staff members were also seen in individual personnel records together with proof of identity. Bristol North Rehabilitation Centre DS0000037040.V278001.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 36 & 37 A trained, experienced manager who understands service user needs and the regulatory process provides effective management. Service users’ benefit from staff that get regular opportunities to reflect on their working practice and provide consistent care. Service users are protected from harm or risk of harm if they leave the building. EVIDENCE: Both the manager and deputy manager were on duty at this visit and were welcoming and open to the inspection process. A requirement in respect of staff supervision was met, as supervision records were available for inspection. These average at least four sessions take place for each staff member over the year and include formal performance appraisals. New staff have a six-week induction period that is common to all Social Services and Health staff. The manager said she recognised further supervision sessions are needed and is taking over responsibility for ensuring sessions take place for all staff.
Bristol North Rehabilitation Centre DS0000037040.V278001.R01.S.doc Version 5.1 Page 16 Clear colour photographs of service users were seen in each care file. However one or two photographs were very small and poorly photocopied that would make it hard to recognise the person if they went missing. It was pleasing to note at a follow-up visit on 21 February ’06 that clearer, larger colour photographs had been taken and attached to each service user’s file to ensure that they could be recognised if they left the building. Bristol North Rehabilitation Centre DS0000037040.V278001.R01.S.doc Version 5.1 Page 17 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X X 3 3 3 Bristol North Rehabilitation Centre DS0000037040.V278001.R01.S.doc Version 5.1 Page 18 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 OP8 Regulation 13(4)(c) Timescale for action Specific risk assessments in 31/03/06 respect of individual hazards for any service user must be put in place Requirement 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 OP10 Good Practice Recommendations In order to maintain privacy and dignity, records about service users personal care, hygiene or toileting should not be publicly displayed Bristol North Rehabilitation Centre DS0000037040.V278001.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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