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Inspection on 05/06/07 for Broomfield

Also see our care home review for Broomfield for more information

This inspection was carried out on 5th June 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Each family who responded by survey said their relative`s needs were met and the home supported them to live the life they chose. Each healthcare professional who responded by survey said the home seeks and acts upon their advice and meets each person`s healthcare needs.The service is focused upon the people who live in the home. A person centred approach to support is promoted by the service. The home is appropriately adapted to meet the needs of each individual who lives in the home. A wide range of professional expertise is actively used in order to support and maintain each individual`s lifestyle, health and well-being. Staff have a good understanding of individual`s needs and continue to maintain positive working relationships.

What has improved since the last inspection?

The home`s Statement of Purpose has now been updated. This ensures all readers of this document are provided with accurate information. Organisational monitoring and support of the service has now been improved. This helps to improve service delivery and support the manager and staff team within the home. The planned maintenance has now been completed and internal redecoration is kept on a rolling programme in anticipation of the inevitably high levels of wear and tear. This helps to ensure a homely environment for individuals. The home has now obtained support to maintain the garden/grounds. This has improved this area for each person who lives in the home.

What the care home could do better:

The improvements in the care planning and review process must be completed for each individual. This will ensure consistent approaches in supporting each person, which are regularly reviewed. One individual`s healthcare needs must be reviewed and the environment adapted accordingly if necessary. This will ensure a good quality service continues to be provided. The ventilation in the communal shower room must be improved. This would help to ensure a safe and homely environment for each person who lives in the home. All core and other relevant specialist training must be completed by each member of the staff team. This will ensure staff have sufficient knowledge and skills to support each individual and promote their safety and welfare.The improvement of the Risk Assessment processes must be completed. This will ensure safe working practices are present within the home to promote the welfare of individuals and staff. The improvements in the collation and storage of all information within the home needs to be completed. The home should also consider implementing a concerns, complaints and compliments record. These measures would help to ensure that all files are user friendly, information is easily located and would help to ensure effective management systems are in place to support individuals.

CARE HOME ADULTS 18-65 Broomfield 40 Gladstone Rd Combe Down Bath Bath & N E Somerset BA2 2HL Lead Inspector David Smith Unannounced Key Inspection 5th June 2007 09:30 DS0000008196.V338985.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000008196.V338985.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000008196.V338985.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broomfield Address 40 Gladstone Rd Combe Down Bath Bath & N E Somerset BA2 2HL 01225 830047 01225 830047 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) www.dimensions-uk.org Dimensions (UK) Ltd To Be Appointed Care Home 3 Category(ies) of Learning disability (3) registration, with number of places DS0000008196.V338985.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 3 persons aged 22 - 50 years May accommodate up to 3 persons with Physical Disabilities Date of last inspection 21st September 2006 Brief Description of the Service: Broomfield is a care home operated by Dimensions (UK) Ltd, an independent voluntary organisation, to accommodate up to 3 people with profound learning and physical disabilities with varying degrees of sensory impairment. The home is a large bungalow situated in a quiet cul-de-sac in Combe Down, on the outskirts of Bath. It has access to local amenities such as shops, pubs, local surgery and a post office. The city centre of Bath is approximately 3 miles away. The home has three single bedrooms; two comply with the space standards for wheelchair users, as set out in the national minimum standards. The third bedroom is a smaller room. Two of the bedrooms share en-suite bathroom facilities. The third has easy access to a specialist shower for wheelchair users. There is also a spacious lounge, kitchen, utility, two staff sleep in rooms and a conservatory. The current fee for this service is £1511.52 per week. DS0000008196.V338985.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit to the home as part of a Key Inspection of this service. I gathered information during my visit through discussions with the Manager and Support Workers. Interaction and communication between staff and individuals who live in the home was also observed during my visit. Care plans and associated records were examined together with accident and incident reports, medication administration, staffing records, Risk Assessments and health and safety records. I was also provided with a tour of the home. The home was provided with a Pre-inspection Questionnaire and a range of survey forms for relatives and healthcare professionals, prior to my visit. The Questionnaire was completed and returned together with seven surveys. Other sources of evidence have been used as part of the Key Inspection process. These include the home’s action plan in response to the last CSCI Key Inspection, notifications of significant events which have occurred within the home and reports of the provider’s own monthly auditing of the service. The home was also subject to a Random Inspection by the CSCI on 14/02/07, which focused on the Statutory Requirements and Recommendations made following the Key Inspection visit on 21/09/06. As a result of this later visit, the Commission wrote a letter of concern to the organisation regarding the extremely poor quality of both the care planning/review and risk assessment practices within the home. In accordance with the person centred approaches within the home, the people who live at Broomfield are to be described as “people who live in the home”, or “individuals”, rather than ‘service users’. Dimensions (UK) Ltd uses the term “people we support”. This terminology has therefore been acknowledged and replaced the term “service user” in this report. What the service does well: Each family who responded by survey said their relative’s needs were met and the home supported them to live the life they chose. Each healthcare professional who responded by survey said the home seeks and acts upon their advice and meets each person’s healthcare needs. DS0000008196.V338985.R01.S.doc Version 5.2 Page 6 The service is focused upon the people who live in the home. A person centred approach to support is promoted by the service. The home is appropriately adapted to meet the needs of each individual who lives in the home. A wide range of professional expertise is actively used in order to support and maintain each individual’s lifestyle, health and well-being. Staff have a good understanding of individual’s needs and continue to maintain positive working relationships. What has improved since the last inspection? What they could do better: The improvements in the care planning and review process must be completed for each individual. This will ensure consistent approaches in supporting each person, which are regularly reviewed. One individual’s healthcare needs must be reviewed and the environment adapted accordingly if necessary. This will ensure a good quality service continues to be provided. The ventilation in the communal shower room must be improved. This would help to ensure a safe and homely environment for each person who lives in the home. All core and other relevant specialist training must be completed by each member of the staff team. This will ensure staff have sufficient knowledge and skills to support each individual and promote their safety and welfare. DS0000008196.V338985.R01.S.doc Version 5.2 Page 7 The improvement of the Risk Assessment processes must be completed. This will ensure safe working practices are present within the home to promote the welfare of individuals and staff. The improvements in the collation and storage of all information within the home needs to be completed. The home should also consider implementing a concerns, complaints and compliments record. These measures would help to ensure that all files are user friendly, information is easily located and would help to ensure effective management systems are in place to support individuals. 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. DS0000008196.V338985.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000008196.V338985.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides individuals with information to enable them to make an informed choice about where to live. EVIDENCE: The home now has an up to date Statement of Purpose. This is detailed and covers areas such as the aims and objectives of the home, each individual’s rights and responsibilities whilst living at Broomfield, how to complain, fee levels, the layout of the home and room sizes, emergency procedures and full details of the staff who work in the home. It also contains many pictures of both internal and external areas of the home. Also included are copies of the provider’s own auditing visit reports and the last CSCI inspection reports. There have been no new admissions to the home since the last inspection. DS0000008196.V338985.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is making efforts to ensure that the service provided to those that live in the home takes into account personal preferences and is supported by written information in care plans and risk assessments that are subject to ongoing review and updating. EVIDENCE: The home has now reviewed and improved the care planning process and format. This was an area of particular concern to the CSCI following the Random Inspection visit on 14/02/07. I examined all three individual’s revised care plans in detail. Each person now has a file called ‘My Support Plan’ and a separate ‘Daily File’. The ‘My Support Plan’ folders, where the main care planning records are now stored, are a significant improvement on the poor quality care plans I examined during my previous visits to the home. DS0000008196.V338985.R01.S.doc Version 5.2 Page 11 These new documents are clearly divided into sections and the index makes them very easy to navigate. Each file contains both a full needs assessment and life history plus an individual plan which describes how each person’s support needs are to be met. This covers relevant areas of support such as making decisions, communication, culture, education, routines, personal and health care. The ‘Daily File’ provides a summary of each person’s day and includes health care monitoring charts, which staff need to complete regularly. Although these plans are not yet complete, they new care-planning format does ensure there are consistent methods for staff to follow and that care plans no longer contain out of date or misleading information. The Manager told me that each care plan would be completed in the near future. Each individual now has named Keyworkers, who have played an active role in implementing the new care planning system and writing each new plan. Part of their role will be to ensure that care plans are regularly reviewed and that any changes to these plans are clearly communicated throughout the service. One review meeting has taken place since my last visit, this being on 28/02/07. The records for the other two individuals who live in the home show that their last reviews with their Funding Authorities were held on 04/08/04 (although a further meeting was held on 24/02/05 but no records were present in the home for this meeting) and 13/04/05 respectively. One individual also requires an urgent review of their personal care and mobility needs as staff feel their support needs have changed. This is being addressed by the home. The home must ensure that each care plan is dated and regularly reviewed, as this will provide staff with accurate and up to date information to enable them to provide a good quality service to each person who lives in the home. Due to the nature of the disabilities of the people who live in the home it can be difficult for them to clearly communicate choices/wishes. Staff continue to use a number of methods to ensure people are supported to make choices and decisions. For example staff use observation of body language, behaviours or gestures of individuals as indicators of choice/wishes. This is now clearly reflected in each person’s care plan. Staff spoken with and observed during my visit demonstrated a good knowledge of the support needs and communication methods of each person who lives in the home. They were also clear on the important advocacy role they have in supporting each individual. There are person-centred Risk Assessments in place for each individual, which support them to take risks as part of their lifestyle. All of these assessments have been reviewed and updated in May 2007 by the Manager and form part of each person’s support plan, using the organisations’ risk assessment materials. This is a significant improvement on the quality of risk assessments previously used in the home DS0000008196.V338985.R01.S.doc Version 5.2 Page 12 DS0000008196.V338985.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each individual has sufficient opportunities and appropriate support to access leisure and educational facilities in the wider community including holidays, day trips and visits to family and friends. The rights of each individual is recognised and promoted. A healthy, balanced and varied diet is promoted. EVIDENCE: Each individual is supported to access community based facilities for both education and leisure purposes. Each person has their own timetable of activities. This includes regular access to local community facilities such as shops, cinema, pubs as well as Local Authority Day Services where they are DS0000008196.V338985.R01.S.doc Version 5.2 Page 14 involved in a number of sessions including music, crafts, physiotherapy and hydrotherapy. The staff team also support individuals within the home with activities such as massage, aromatherapy, music and ‘Intensive Interaction’ where a member of staff will spend time with an individual on a one to one basis and often ‘mirror’ their movements or expressions. Individuals are supported to choose and attend a holiday or day trips, if these are better suited to their needs. I did note that during the most recent team meetings, staff had discussed supporting individuals to organise holidays for this summer. Staff continue to support those living at the home to maintain family links and friendships inside and outside of the home. Each individual’s support plan contains information of significant and important relationships and their contact details. Discussions with staff and examination of records show that one individual visits their family each week, while the other two individuals receive visits from family members. The relatives who responded by survey said the home ‘always’ provided the care and support they expected for their relative, helped them keep in touch and kept them informed of important issues. One relative said “Broomfield is a very good home” and another that the home “looks after the residents well and respects their dignity”. Observation during my visit and discussion with staff evidenced that each person who lives in the home is treated with respect and dignity. Each person is seen as an individual and treated as such. Each individual’s rights and responsibilities whilst living in the home are also now clearly described in the home’s new Statement of Purpose. The menus show that each individual is offered a choice of healthy and nutritious food. The home has accessed specialist support from the Dietician in relation to individuals’ dietary requirements and from the Speech and Language Therapist to ensure each person is offered appropriate support in both eating and drinking. This is good practice. The dining area, previously used as office space, is now being used for dining once again. The office equipment and files have been removed and a new smaller dining table purchased to enable individuals who use wheelchairs to have more space to enable them to sit at the table comfortably. The Manager told me it is hoped one individual may now be able to regain their eating skills due to the change in dining arrangements. DS0000008196.V338985.R01.S.doc Version 5.2 Page 15 DS0000008196.V338985.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The ongoing review and improvement of care plans ensures that people who live in the home have their personal and healthcare support needs met and that the administration of medication ensures their welfare and safety. EVIDENCE: The support plans in place for each individual provide clear guidance for staff on how they should support those living at the home with their personal care. The home ensures that each individual’s healthcare is closely monitored by using daily records described earlier in this report. Although some aspects of health care plans require completion, such as developing detailed Epilepsy Protocols, there has been a significant improvement since my last visit. DS0000008196.V338985.R01.S.doc Version 5.2 Page 17 The health needs of individuals are well met with evidence of good multi agency working taking place on a regular basis. All of those living at the home are registered with a general practitioner and are supported with their primary healthcare needs such as optician, dentist and chiropody. Other specialist services are contacted when an identified need arises. These are provided by Bridges Community Learning Disability Team. Care records show the home is regularly supported by the Physiotherapist, Occupational Therapist, Speech and Language Therapist, Dietician, Hearing Therapist and Consultant Psychiatrist. Contact with each professional is recorded and forms part of each persons care plan. The home continues to have a close working relationship with Bridges CLDT. This provides a valuable resource to assist the home in planning and providing a specialist service for individuals with complex needs. The healthcare professionals who responded by survey said the home does meet each person’s health care needs and seeks their advice and acts upon this to manage and improve individual’s health care. Each survey also reflected the improvements since the new Manager started working in the home In December 2006. One professional said the “change in management has improved all aspects of resident’s life and care” and another said, “with the change of manager it has been easy and successful to identify needs”. It was evident that the management and staff spoken with are sensitive to the healthcare and emotional needs of those living at the home and through observation and discussion demonstrated respect to the wishes of individuals living at the home. The home now uses the Boots monitored dosage system of medication administration and all medication is stored securely. The Manager has changed this recently from Lloyds Pharmacy, as she felt the Boots system is better suited to the people who live at Broomfield. The medication records contain the home’s medication policy, profiles of each individual, a recent photograph, details of their medication, times of administration and manufacturers notes on all of the prescribed medications administered within the home. Stock levels are checked regularly and clear records are kept of all medication entering or leaving the home. Two staff members are required to sign records each time medication is dispensed. Staff are now being provided with formal training in relation to medication administration. Each staff member attended training on the Boots system in April 2007 and have now commenced ‘Protocol Training’, which is accredited by the City of Bath College. This is in the style of an NVQ unit and contains four elements; introduction to medicines, care workers role, administration and medicines of differing client groups. In addition to this formal medication DS0000008196.V338985.R01.S.doc Version 5.2 Page 18 training, staff will also be assessed internally every six months by the Manager, as she has recently been trained to do. The home’s GP said that the home works in partnership with them, has a clear understanding of each person’s healthcare needs and manages their medication appropriately. DS0000008196.V338985.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home are protected from abuse, neglect and self harm and supported to communicate their views and they can be confident that they will be listened to and their views acted on if necessary. EVIDENCE: There have been no complaints recorded since the last inspection. There have been no complaints or concerns received by the CSCI direct regarding Broomfield. The home has a formal complaints policy. This process is described as ‘Making a complaint or speaking out’. Staff also have a whistle blowing policy, which enables them to raise any concerns they have in a safe, confidential manner. The home currently does not have a complaints register. I discussed with the Manager that the home should consider implementing a system to record complaints, concerns and compliments. Due to the vulnerability of the people living in the home, they would rely on staff raising concerns on their behalf. Staff continue to demonstrate a strong commitment to advocating for each individual and a have good knowledge of the action they would take if they suspected or witnessed abuse. DS0000008196.V338985.R01.S.doc Version 5.2 Page 20 They also use their daily interactions and observations when supporting people who live in the home to help alert them to any physical signs or changes in behaviour, which may cause them concern. Individuals observed who are unable to communicate verbally or manually seemed relaxed and happy in the company of staff during my visit. The relatives who responded by survey said they knew who to speak to if they were not happy with the service provided by the home, although one said they did not have any details about the formal policy. Two relatives said that the home had responded appropriately to any concerns they had raised. The healthcare professionals who responded by survey said the home does respond to any concerns about individual’s health or aspects of their care. One professional said the staff are “open to different ideas and suggestions to improve the care” of each individual. All staff have been provided with training in the Protection of Vulnerable Adults and the Manager is also being trained to ‘Investigator’ level. Staff are subject to Enhanced Criminal Record Bureau Disclosures, prior to commencing employment. The home maintains clear records regarding all accidents and incidents which occur within the home. The Commission is also informed of any significant event, which occurs in the home. DS0000008196.V338985.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, safe and clean environment for each individual to live in. EVIDENCE: Broomfield is a large bungalow situated in a quiet cul-de-sac in Combe Down, on the outskirts of Bath, which blends in well with the local community. It has gardens, a garage and car parking spaces at the front of the home and large gardens to the sides and rear of the home. There is a large patio area, which is accessible to wheelchair users. The home provides level access to ensure accessibility as each person who lives in the home uses a wheelchair or adapted seating. The home has three single bedrooms; two comply with the space standards for wheelchair users while the third bedroom is a smaller room. Two of the DS0000008196.V338985.R01.S.doc Version 5.2 Page 22 bedrooms share en-suite bathroom facilities. The third has easy access to a specialist shower for wheelchair users. There is also a spacious lounge, kitchen, utility, two staff sleep in rooms and a conservatory. There are ceiling track hoists in many rooms and one mobile hoist is also available. The home also has specialist equipment such as a height adjustable bath and an accessible shower room to ensure the dignity and comfort is maintained for each person who lives in the home. Individual’s bedrooms have been personalised to reflect their personal taste, age and preferences and rooms were seen to be well furnished. Many personal items, pictures and photographs were also displayed. One individual’s bedroom has recently been redecorated, which has greatly improved the look of this room. Due to the changes in one person’s needs, they are not able to use their ensuite shower facilities and they are sharing the home’s bathroom. This is not an ideal situation, as they need to access the bathroom through another individual’s bedroom. The Manager told me this person’s needs are currently being re-assessed, as mentioned previously in this report, and any changes required in their own en-suite facilities would be carried out as quickly as possible following this assessment process. There have been a number of improvements to the home since I last visited. The dining area is now back in use, the lounge has new furniture, curtains, lampshades, pictures, mirror and shelving unit. The communal corridors have been redecorated and had protective covers secured to the lower half of the walls to guard against damage from wheelchairs or other equipment. The gardens have been tended to, trees and bushes cut back and other areas cleared. This is a significant improvement since my last visit and two individuals who live in the home spent some of the afternoon in the garden on the day of my visit. The Manager told me the home wish to develop the garden area further by adding some sensory items and making better use of the newly cleared areas. The Manager explained one shower room still suffers with mould growth on some of the wall tiles caused by insufficient ventilation within this room. The contractor is due to visit the home once again in the next few weeks to try to remedy this situation. All areas of the home were clean and tidy on the day of my visit and were free from any malodours. The staff team remain active in ensuring the home is clean. DS0000008196.V338985.R01.S.doc Version 5.2 Page 23 DS0000008196.V338985.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each person that lives in the home is supported by a cohesive staff team that is committed to providing a good service. The clarity of staff roles and responsibilities along with ongoing staff training and supervision helps to provide a more consistent approach to the support of staff and individuals. EVIDENCE: There have been some recent changes within the staff team, however a core of experienced staff remain who have a good knowledge of individuals and their support needs. Staff were observed interacting with people who live in the home and discussions with staff showed they had a good knowledge of each individual and how to offer them appropriate support. One new member of staff has been recruited and will start work in the home once all satisfactory employment checks have been carried out. Any vacant DS0000008196.V338985.R01.S.doc Version 5.2 Page 25 shifts are either covered by the home’s staff team or members of Dimensions’ Bank Staff. Staff have recently been given additional responsibilities by the new Manager, as well as Keyworking duties. Staff members therefore take a lead in areas such as medication administration, assisting with staffing rotas and health and safety checks within the home. Staff spoken with liked working in the home and felt well supported in their role. Some members of staff have worked in the home for a number of years and have a very good knowledge of each individual’s support needs and how they communicate. The relatives who responded by survey said the staff team have the right skills and experience to support the people in the home live the life they choose. One relative said, “The carers are well trained and genuinely caring, looking after the residents and respecting their dignity”. The healthcare professionals who responded by survey said that the staff team ‘usually’ had the rights skills and experience to support each individual. Where staff members need additional support, this is being provided through formal training sessions. Staff are provided with a variety of training opportunities. Training is provided either by the organisation or external training providers. Records examined show that staff are provided with mandatory training such as First Aid, Food Hygiene, Protection of Vulnerable Adults and Health and Safety. In addition to statutory training staff have attended other more specialist training courses such as Sexuality, Bereavement and Loss, Communication, Stroke and Epilepsy and Risk Assessing. Since my last visit additional training has been organised by the Manager, which includes Fire Safety (which is now delivered by an accredited trainer), Manual Handling and Communication. Training in Supporting People to Eat and Drink, Medication, Communication and Mental Health is also planned during June and July 2007. During my previous visits staff told me they felt distanced from the Dimensions organisation and at times, felt there was a lack of support. The current Manager has worked hard to ensure staff are supported within the home and also re-establish a good relationship between the home and the organisation. The Manager told me that although morale in the team had been low at times, this is now steadily improving. The staff team continues to meet regularly. Records of each meeting are kept and a variety of topics are discussed. The team also spent a day together in May 2007 planning the developments and improvements in the service using a DS0000008196.V338985.R01.S.doc Version 5.2 Page 26 person centred planning tool known as a ‘path’. This contains both short and longer-term goals. Staff are provided with regular, formal supervision. Although supervision records were not examined in detail, the dates when each supervision meeting took place were noted and these show that all staff are supervised every six to eight weeks. DS0000008196.V338985.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 41, 42 and 43. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The leadership of the staff team within the home has now improved. This provides an improved support network for each person who lives in the home and the staff team. The management systems and practices in place continue to be improved and are now used consistently. This helps to develop the quality of the service provided to each individual. The roles, responsibilities and accountabilities of staff are now clearer. This helps to ensure an effective and accountable management of the service. The procedures to promote and protect health, safety and welfare of the individuals are being reviewed and improved. DS0000008196.V338985.R01.S.doc Version 5.2 Page 28 EVIDENCE: The previous Registered Manager left the home in November 2006. The current Manager, Mrs.Snelgrove, has only been in post since December 2006. She has worked for the Dimensions organisation for thirteen years and does have some knowledge of the people who live at Broomfield, having worked to support them approximately seven years ago. She holds a Certificate in Counselling Skills, is a qualified NVQ Assessor, has attained NVQ Level 2 and 3 and is now working towards NVQ Level 4. She is in the process of submitting her application to be registered by the CSCI. Since her appointment she has attempted to address and improve several management issues, together with the Requirements and Recommendations from the Commission’s last inspection reports. The Management approach appears open and positive about the developments made within the service. There have been many changes made by the Manager since her appointment, which have led to significant improvements in the record keeping within the home as well as other management systems and structures. All of these systems and structures continue to be reviewed and improved upon. There are a number of examples such as care planning, Keyworking duties, staff training and assessing risks. Each development is clearly focused on improving the service for the people who live in the home and the working environment for the staff team. The Manager told me that although she is happy with her progress in her new role, she is aware that there are several areas which still require further improvement or completion, although it is clear the improvements have been prioritised well. Healthcare professionals who responded by survey said there have been significant improvements since the Manager started work in the home. One said “the new Manager has turned things around in a very short time” and another said “it is a pleasure to work jointly” with the new Manager and “to see their enthusiasm, knowledge and skills being used to develop and improve the lives of the people” who live in the home. A person centred approach is adopted in the provision of care and support of each person who lives in the home. All staff spoken with felt that each person was seen as an individual and that their wants, needs and wishes were respected. The registered provider’s representative makes regular visits to the home, and produces a report of her findings, which is send to the Commission on a DS0000008196.V338985.R01.S.doc Version 5.2 Page 29 monthly basis. The Manager told me that the support she receives from her line Manager is excellent. Organisational monitoring and support is an essential element in the development and improvements within this service to ensure individuals are provided with an effective and accountable service. There are recording systems in place to support Health and Safety within the home, which are generally being used consistently. Records examined included water temperature checks, electrical wiring checks, portable electrical appliance testing, gas appliance safety and checks on manual handling equipment. All of these checks were up to date. The Manager has developed a comprehensive ‘Emergency Contingency Pack’ which details the action to be taken in the event of a fire, power failure, gas leak, a flood or an individual being admitted to hospital. This is a positive development. Fire safety within the home has been improved. Staff are now provided with accredited training, the Fire Risk Assessment has been reviewed and updated and each individual now has an emergency evacuation plan. The alarm system is now checked weekly and regular fire drills are conducted. The home has a number of generic Risk Assessments in place, however these have not been reviewed recently and are not in the new improved Risk Assessment format. The Manager told me she is aware of this and will complete the review of each of these assessments as soon as possible as the person centred assessments took priority on her arrival. DS0000008196.V338985.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 X 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 3 3 X X 2 2 3 DS0000008196.V338985.R01.S.doc Version 5.2 Page 31 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 YA6 Regulation 15(1)(2) Requirement Each care plan must be updated and subject to regular review. A clear record of each review process must be maintained. 2. YA18 12(4)(a) The home must conduct a review of the health/personal care needs of one individual. The home must review this individual’s bathing/washing facilities following this process. 3. YA27 23(2)(p) The home must satisfactory resolve the issue of insufficient ventilation in the home’s communal shower room. All staff must be provided with/complete training: Which meets all Dimensions core standards. Which provides all staff with additional relevant skills to support each individual. 05/09/07 Timescale for action 05/09/07 05/09/07 4. YA35 18(1)(c) 05/12/07 DS0000008196.V338985.R01.S.doc Version 5.2 Page 32 5. YA42 13(4) Risk assessments on all safe working topics must be updated and subject to regular review. 05/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA41 YA22 Good Practice Recommendations Complete the improvements in the collation and storage of individuals records and staff personnel files. Consider implementing a concerns, complaints and compliments register. DS0000008196.V338985.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000008196.V338985.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. 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