Inspection on 12/12/07 for Bryher

This inspection was carried out on 12th December 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bryher 27/08/09

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Bryhers Post Hill Centre Blundells Road Tiverton Devon EX16 4ND Lead Inspector Dee McEvoy 12 Post Hill Nursing Home [aka Pine Lodge/Bryhers] th Unannounced Inspection & 21 December 2007 09:20 st DS0000071067.V358711.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 Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.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. Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bryhers Address Post Hill Centre Blundells Road Tiverton Devon EX16 4ND 01884 242457/242846 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) Guinness Care and Support Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Notice of Proposal to Grant Registration for staffing/environmental conditions of registration was issued 21/12/92 Service users should be over the age of 30 Date of last inspection 12 October 2006 Brief Description of the Service: Devon Community Housing Society (DCHS) has been the registered provider in respect of this care service in Devon until 30th September 2007. On October 1st 2007 DCHS amalgamated with Guinness Care and Support. Guinness Care and Support is to be the registered provider of this service. However, some staff are provided by Trust Residential Services, part of the Devon Partnership Trust (a National Health Service body). There have been a number of changes at the home since the last key inspection, for example Pine Lodge has closed, and some people have moved to Bryher, the home no longer provides nursing care and there has been a reduction in the total number of places, from 12 to 6. Bryher provides residential care for up to six people with learning and physical disabilities. The accommodation consists of a bungalow, with single room occupancy, shower room, bathroom, toilet facilities, laundry, kitchen, dining room and a sitting room. The home is accessible being on one level. The property stands in its own grounds, in a residential area on the outskirts of Tiverton. The fees at present are £949.36 per week of which the individual would normally have to pay £63.95; the rest of the cost is met by Social Services. Charges not included in fees include personal toiletries and transport. The inspection report is made available within the home; a copy is kept in the office for anyone to see. We have written an easy read version of this report. Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of this key inspection the appointed manager completed an Annual Quality Assurance Assessment (AQAA), which contained general information about the service and the people using it. With the information provided, CSCI surveys were sent to all people using the service, their relatives, 8 staff and 9 outside professionals, prior to our unannounced site visit. 4 people living at the home completed surveys with the help of their key worker, 3 relatives responded, 6 care staff and one social care professionals expressing their views about the service provided. Their comments and views have been included in this report and helped us to make a judgement about the service provided. We spent 11 hours at the service, over a period of two days. On the first day of the inspection we looked closely at the care planned and delivered to three people living at the home. On the second day, we announced our visit to ensure that records were available for inspection. To help us understand the experiences of people living at this home, we used the services of an ‘expert by experience”. These people have experience of using services, and they join some inspectors to help us get a good picture of the service from the viewpoint of the people who use it. Experts by experience can provide a unique contribution to the assessment of quality. On this occasion the expert by experience met with most of the people living at the home to get an idea of what life was like. She also spoke with staff, looked around the home and looked at some records. Some of her observations and findings are contained within this report. There were 6 people living at the home at this time, with no vacancy. Most people living at the home were seen during the course of our visit. People living here have limited communication skills and were therefore unable to give their views in any detail. However, time was spent observing the care and attention given to people by staff. During our visit we met and spoke with six members of staff including the appointed home manager and service manager. A tour of the premises was made and we looked at a number of records including assessments and care plans and records relating to medication, recruitment and health and safety. On the second day of our visit the outcome of the inspection was discussed with the appointed manager and the service manager. What the service does well: Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 6 The home has a thorough assessment process and people are encouraged to visit the home before moving in, which helps them to make a decision about whether it will suit their needs. People living at the home have a comprehensive plan of care, which recognises their uniqueness. People’s health needs are monitored and they have access to a good variety of health professionals to ensure health needs are met. One relative told us, “I think they do well with the resources available. It is basically down to the local management & staff who have been very good & caring”. Relatives and other visitors’ feel the home communicates well on the whole, keeping them informed of important events. Mealtimes appear relaxed and unhurried with well presented food. People are enabled to develop some independent living skills by assisting with the preparation of meals. Relatives and outside professionals told us that the home deals with any concerns or queries in an appropriate way, responding to them if concerns are raised. Staff are well informed about their role and responsibility to safeguard people living at the home from abuse or harm. People’s finances are generally protected by the arrangements in place, with the exception of safe storage (refer to ‘what they could do better’). A core of long serving care staff know people well and work extremely hard to provide a good standard of general care. A high number of staff at the home have obtained a nationally recognised qualification in care, which helps to maintain good standards of general care for people. Staff at the home are keen to develop their skills and competencies in order to fully support people at the home, many of whom have complex needs. The home has robust recruitment practices to ensure that new staff are suitable to work with vulnerable adults. The appointed manager and the organisation that run this home are working towards improving the service, to meet people’s individual needs and make it safer. What has improved since the last inspection? What they could do better: The home has been asked to ensure that important information such as the Statement of Purpose and complaints procedure are available in formats, which suit people’s needs. This will protect people’s rights and help them to make important decisions. Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 7 We looked at people’s lifestyle at the home – choice and social activities and opportunities could be improved upon to ensure that people enjoy their lives fully. At present activities are not person centred and do not meet the goals or aspirations of some people living at the home. People are not getting the one to one time they need to help them achieve goals and maximise independence. Staffing levels are having a negative impact on people’s lifestyles. The management of medication must improve to ensure that people are safe. Medication no longer prescribed should be returned to the pharmacy and the home needs to manage their stock of medicines in a more robust way. The home helps people to manage their personal finances and there are good systems in place, including an audit trail to protect people. However, monies are not always securely stored, which compromises the arrangements in place. Areas of the home require refurbishment, it is not well maintained and there are outstanding works/repairs to be addressed in order to ensure that people live in pleasant and homely surroundings. The home was not free from offensive odours and was in need of a deep clean in order to maintain a hygienic and clean space for people. The deployment and number of staff on duty is not always sufficient to ensure that peoples’ needs and preferences are met in a timely way. Staff do not appear to have sufficient time to fulfil people’s goals, spend planned one to one time with people, or undertake other responsibilities such as cleaning and decorating. Staff should receive relevant training and supervision to enable them to meet the needs of people with complex learning disabilities. A permanent manager, registered with the Commission, would ensure the home continued to make the necessary improvements. In order to ensure that people using the service ‘have their say’; the home must put into action the systems in place for monitoring the quality of the service. This would ensure the home is run in peoples’ best interests. The home must improve aspects of health and safety, for example, by taking action to ensure that a safe environment is maintained for people in respect of hot water temperatures and hot radiator surfaces. All chemicals, which are harmful to health, must be stored securely to reduce the risk to people living at the home, and appropriate fire exit signs must be fitted to maintain fire safety. Please contact the provider for advice of actions taken in response to this inspection. Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 8 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. Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 9 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 Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 10 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 & 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information about the home is available but not in a format which enables people with a learning disability to make a decision about moving into the home. People’s needs are assessed before they move into the home to ensure that they can be met. EVIDENCE: The home has a Statement of Purpose, which gives people information about the services offered at the home. The Statement of Purpose also provides people with details of their terms and conditions of residency, which helps to protect their rights. Some minor additions are needed, for example the age range, sex and type of needs for whom the service is intended to accommodate. This will ensure that people using the service, or considering using the service, have all the relevant information they need. Currently important pieces of information, such as the Statement of Purpose and complaints procedure, are not available in a format to suit the needs of people using the service. The appointed manager told us these key documents were being developed using things like widget and Picture bank, to help people with learning disabilities access this important information. Surveys returned from people living at the home showed that 2 of 3 felt they had received enough information about the home; one person did not respond to this question. Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 11 Relatives told us they “usually” have enough information about the home although two of the three responding with surveys expressed concern about the lack of information regarding the future of the home. The appointed manager for the home and the service manager said that the future of the home was secure and that relatives had been informed of this. People living at the home have done so for a number of years and there have been no new admissions to the home since the last inspection. However, detailed re-assessments were carried out with all people living at the home following the change to the home’s registration earlier this year, to ensure that people did not require nursing care. Assessments are completed prior to admission to enable the home to decide whether they are able to meet individual needs. People are invited to spend time at the home before moving in to give them an idea about whether it will meet their needs and expectations. Where the assessment has been undertaken through care management arrangements the home receives a copy of the assessment and care plan. One care manager told us that assessment arrangements “usually” ensure accurate information is gathered and that the right service is planned and given. The care manager recognised the “significant changes” at the home in the last months and felt that quality of information gathering and recording will need to be assessed over coming months. Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 12 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, 8 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans provide staff with valuable information to help meet peoples’ needs and risks are assessed and managed so that people can develop their skills and independence. However, current staffing levels do not always promote and support people to make choices about their lives or fulfil their goals. EVIDENCE: We looked at three care plans to see how care was planned and delivered. Where possible people living at the home, their family and relevant professionals are involved in the development of care plans and reviews. Everyone’s care assessment and care plan was reviewed as part of the changes to the home’s registration earlier in the year. A person centred plan is used to explore people’s needs and expectations. The care plan has specific headings to address health, personal and social care needs, including individual and diverse needs. Good information is available about people’s abilities, how they communicate, their preferences and emotional and psychological needs. Care plans identify individual specific goals to work towards, and inform and Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 13 direct staff in how to support people to achieve these goals to promote a good quality of life. However, current staffing levels have meant that some goals have not been achieved within the agreed timescale (refer to standards 12 & 33). Staff spoken with and those responding with surveys said they were “always” given ‘up to date’ information about people’s needs and that they were aware of the information in individual care plans. One member of staff told us, “Changes can happen on a day to day basis so handover is very important. Our manager is very good at letting us know”. Since the change in the home’s category of registration, care staff have taken on the responsibility of updating care plans, staff told us they were “getting used” to doing this, with support from the manager. Care plans contain information for staff about how to assist people to make decisions and choices. This includes information about people’s preferences and how to recognise non-verbal clues and choices. There is evidence that people are involved in some decision making, such as day to day living. Staff described how they promote choice and freedom for example, supporting people to spend time alone out doors or helping people to choose appropriate clothes for the weather. We saw some people making simple decisions about where to sit, and what to eat or drink. We saw some people helping themselves to tea, coffee and snacks in the kitchen and they decide when they want to do that. Surveys showed that most people responding felt that staff “always” listen and act on what they say. Surveys showed that people can do what they want to do during the day, the evening and at weekends. . However there was a mixed response to the question “Do you make decisions about what you do each day”. One person said “always”, two said “sometimes”, and one said “hardly ever”. During our visit we saw that the people whose communication styles were more easily understood by staff were given more attention. A lot of staff time was also spent with one person meaning that other people had little staff contact and attention. People with more diverse needs may find it harder to have their choices and opinions supported by current staffing levels. For example, two people had very little staff contact during our visit and were not engaged in any meaningful activity or stimulation for long periods. Both looked withdrawn and disengaged with no signs of positive mood. Most relatives and one care manager told us that the home “usually” supports people to live as they choose. The expert by experience commented, “There was very little evidence that residents got choice about what they do in the day”. During our visit there were two members of staff on duty with six people living at the home, this had an impact on the choices people could make, for example whether to go out. The care plan and risk assessment to avoid aggressive or disruptive behaviour for one person said that they liked to go out daily for long walks and that this had a positive outcome for them. During our Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 14 visit this person spent most of the day walking aimlessly around the home, sometimes disrupting or up-setting others. Staff did take them to garden for short periods of time but an opportunity to go out for a proper walk was limited by staffing levels. Staff told us told, “We can’t go out walking everyday as one carer can’t be left here with five people”. During the first day of our visit, several staff came to the home for fire training; some were to come from other homes managed by the provider, we were told in all up to 20 staff were expected. It was unclear whether people living at the home had been told about this and whether they had given consent for their home to be used for staff training. Only a hand full of staff attended training in the end but during the training access to the dining room was restricted for people living at the home. Risks to people are identified and clear guidelines for reducing and managing behavioural, situational and environmental risks are available to staff. Risk assessments enable people living at the home to be involved in activities that they enjoy such as riding, being alone in the garden and using the kitchen independently. Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 15 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, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are opportunities for people to take part in activities but activities do not always meet people’s needs, aspirations or expectations. People are respected by staff and supported to maintain links with family and friends. Meals at the home provide people with some choice, and are generally well-balanced, to meet people’s needs and preferences. People’s privacy would be better protected if bathrooms and toilets had appropriate locks. EVIDENCE: Until recent changes the home employed an activities co-ordinator but key workers are now responsible for organising activities and leisure time with people living at the home. Although people do have an opportunity to enjoy some activities such as horse riding, aromatherapy, trampolining and visits to places of interest, on the whole activities are not person centred at present. For example, one care plan showed that this person would like to go swimming regularly, take a train ride and visit the cinema. Daily notes and other records Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 16 showed that only swimming, on occasion, had been achieved since April 2007. Staff told us, and records showed, that the allocated one to one time planned for this person had not happened on a regular and consistent basis to enable them to achieve their goals. Another person’s care plan described ‘destructive’ behaviour and highlighted meaningful activity as a way of distracting them from these actions. A referral has been made to an occupational therapist in order to develop some interesting and meaningful things to do but meanwhile this person remains unoccupied for various periods and continues to spend considerable time engaged in activities, which are not fruitful. Two other care plans looked at showed that people needed one to one time with staff to fulfil their social care needs but again staff told us that due to current staffing problems there was limited time for one to one activities. Good details were available in the care plan about one person’s interests; the expert by experience noted that this person enjoyed listening to certain music and asked staff about the CD mentioned in the care plan. We found that the CD player in their room was broken and the staff could not find the CD initially. The expert notes “This resident is blind so audio is really important”. Staff said they would look at getting the CD player repaired and said that the home’s CD player could be used in the meantime. Staff said that spontaneous activities sometimes happen, for example drives out in the mini-bus. Staff said people living at the home often went out for a drive to town to get chips, or sometimes visits to the Moors were arranged. Staff described another routine of ‘taking’ people grocery shopping, which one staff member described as a “nightmare”. Due to the complex needs of some people, group shopping is very difficult so when the grocery shopping is needed, one staff member will go to the shop while the other either sits with or drives around with people until the shopping is finished. It is difficult to see how this could be enjoyable or enhance independent living skills. Staff said they sometimes get an opportunity to take people out shopping individually, which was much more enjoyable. No one living at the home at present is attending college, or has a job, or attends local clubs for people with learning disabilities. However two care plans show that people would like to attend local clubs and have an opportunity to work with animals. One staff member said these goals were still to be achieved. The expert by experienced observed, “There were only 2 members of staff on that day and one was new to the home. The interaction between the 2 staff and residents was not good on the day. The residents were just sat around not doing anything in particular. The TV was on but no one seemed interested. Staff said they take them out sometimes. There is a garden but this is not a nice place to sit in, it needs plants and flowers, perhaps fruit trees”. A relative Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 17 responding to a CSCI survey told us “Previously I had asked for more activities, which did not get great results. More activities seem to be taking place since the re-organisation”. One staff member wrote, “Lack of adequate staff may interfere with resident’s activities sometimes”. The manager and staff were aware that social activities and opportunities could be improved upon to ensure that people enjoy their lives fully. New staff are being recruited to improve staffing levels, key workers are to develop more individual activities with people and more group and individual activities are to happen inside and outside of the home. Care plans inform staff about people’s close relationships with family and friends and people in their “support circle”, this helps to ensure that people can be supported to maintain valued social and family relationships so that they are not isolated. Overall relatives felt well informed about events affecting their family member. Some of their comments included, “I was kept informed about an operation in a prompt and accurate manner”, “I think they do well with the resources available” and “The home always keeps in touch”. Staff recognised the importance of supporting people to maintain relationships, one wrote, “Family that are involved are always told about changes”. On the whole we found that staff respected people living at the home and had an understanding of their needs and characters. We saw some positive interactions between people and staff, which enhanced people’s wellbeing, for example giving assurance to one person and responding to the request of another. When we asked ‘what does the service do well’, one care manager wrote, “Communicates effectively with individuals”. People’s privacy is generally maintained however the expert by experience notes, “Keys were left in doors of resident’s rooms. Some use the toilet and leave the door open so anyone could walk in. Some residents wander around in and out of any room they can get into”. During our visit we saw one person open the toilet door whist another person was using the facility. We saw that this compromised privacy and dignity. Staff told us there was no lock, as most people living at the home could not use one. No assessment of people’s abilities to use locks had been undertaken to discover exactly who could and could not use a lock. This may enhance people’s independence and support their privacy and dignity. During our visit we observed lunch and supper. Staff prepare and cook meals and the expert by experience noted, “Residents help cooking, there was a rota for taking in turns. I could not say for sure who chooses the menu. Choice for the residents seemed very limited”. We spoke with staff about the choice at meal times. They told us that menus were prepared with people’s likes, dislikes and dietary needs in mind. Care plans tell staff about people’s preferences and needs with regards to meals. The menu is not produced in a format that people can understand, such as pictures, which may limit people’s ability to choose. Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 18 The menu offers fairly traditional meals such as two roast dinners per week, cottage pie, stews and pasta dishes. No alternatives were seen on the menus but one person ate a different dinner to that served to the other 5 people. Staff told us that they would prepare something different if people did not want the main meal. People living at the home were unable to comment on the food but seemed to enjoy the meals prepared during our visit, we saw empty plates and people were offered a second helping if they wanted it. Mealtimes were generally relaxed and staff assisted people discreetly where needed. During the day some people were able to help themselves to snacks and drinks in the kitchen. Others were offered drinks and snacks regularly during the day. Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 19 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 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s healthcare needs are met with evidence of good input from a variety of health professionals. The systems in place for the administration of medication are adequate but some improvement is needed to ensure that good practice is maintained and people remain safe. EVIDENCE: Care plans detail the level of support required by people in respect of personal care and during our visit staff attended to people’s personal care needs in a sensitive way, providing care in a way preferred by individuals according to their care plan. People’s needs about how they mobilise, and how staff support and transfer them are recorded. The expert by experience found that staff lift one person and felt this did not respect the person’s dignity. The care plan instructed staff to use a hoist but an up-dated manual-handling plan gave staff clear instructions about how to support this person without using the hoist. Staff said this person preferred to be supported by two people rather use the hoist, which caused distress. Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 20 Care plans clearly described individuals’ health care needs and one showed that changing needs were monitored and action taken to deal with any changes, such as weight loss. Specialist health professionals have been consulted where necessary, such as psychiatrist, speech and language therapist, dietician and dentist. People living at the home have a regular visit from the GP, and community nurses provide nursing care when needed. One GP spoken with before the inspection, spoke highly of the health care provided at the home and felt that people’s health needs were monitored. He described good communication between the surgery and the home. There was evidence that staff sought advice from other professionals when one person displayed behaviour, which challenged the service. Advice had been received but had not been fully implemented as yet. Relatives and one care manager responding with surveys felt that people “usually” get the support they need and people’s needs were “usually” or “always” met by the home. Until recently only trained nurses managed and administered medication at the home but since the change to registration care staff are now responsible for this. Care staff administering medicines have been trained to do so but this is a new role for them and they are still learning about good practice. There are a number of things the home needs to do to ensure that medication is managed safely. Medication is supplied in monitored dosage systems, and most medicines were stored safely with the exception of medicines needing refrigeration. Prescribed eye drops are kept in the kitchen fridge, they are not kept securely as there is no lockable space in the fridge. No accurate temperature record is kept to ensure that medicines are kept correctly, within the temperature range specified by the manufacturers. Medication with a limited life once open had not been dated to ensure it was used within the correct timescale. Medicine Administration Records (MAR) were looked at; where hand written entries had been made, two signatures had not been obtained to ensure accuracy, which is good practice and reduces the risk of error. It was noted that the home is holding a large quantity of medicines, which are no longer in use, and some have been in the home since March 2006. The management of these stocks was discussed with the senior carer on duty and with the manager at feedback. Some people are prescribed “as needed” medication to help during seizures but there are no guidelines within care plans for staff to follow and staff spoken with had not been trained to administer this type of medication. Although staff said that seizures are were they felt training would be beneficial so that they could deal with the situation safely. Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 21 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 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system, with evidence that concerns or complaints would be listened to and acted on. People are protected from abuse by good procedures and well informed staff. Systems are in place to ensure that peoples’ personal monies are correctly managed. However personal monies are not always kept securely. EVIDENCE: No complaints have been received by the Commission or the home about the service or care provided since the last inspection. The home has a written complaint’s policy but the complaints procedure is not currently available in a format that people using this service could understand. Surveys showed and staff told us that people living at the home would not be able make a complaint due to their complex learning disability. Some staff said they have a good knowledge and awareness of when people are not happy and work hard to resolve problems. Care plans also give staff clues about how people may respond if they are not happy about something. Most relatives knew how to raise complaints or concerns and two of the three said that complaints were “always” responded to appropriately. One care manager told us the home “usually” responds appropriately if they have raised concerns about care. All staff spoken with and training records looked at confirmed that they had attended adult protection training to help them understand the issues of abuse and what to do should they have any concerns. Staff were very clear about reporting any concerns they have. There are records to show that appropriate Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 22 checks are made on all staff to ensure they are suitable to work with vulnerable adults in a care setting. People’s finances are properly managed with good records of all transactions. Bank accounts are operated on behalf of people and monitored by the provider. This ensures people’s finances are fully protected. We looked at the accounts of three people. All were in order, with accurate records kept, including expenditure and receipts. All monies tallied. On the first day of the inspection monies were not kept securely as the cabinet drawers were left unlocked and accessible to many people who were in and out of the office. Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 23 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, & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most individual bedrooms are homely but communal areas are in need of attention if people are to live in pleasant surroundings. The home was not entirely clean or odour free. EVIDENCE: Bryher is a bungalow, with six single bedrooms, a bathroom, shower, toilet facilities, laundry, domestic type kitchen, dining room and a sitting room. The home has not been well maintained and is need of decoration and refurbishment. The expert by experience said, “There was not a ‘homely’ feel to this house”. Staff also raised concerns about the general environment, one wrote, “The home is becoming rundown & not a very nice place to live. Maybe a cleaner & odd job person to do things” and “It would be a nicer home if we had enough money to buy some paint, curtains, sofa & chairs”. Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 24 The carpet in the hallway is very stained and worn and does not present a very homely first impression of Bryher. Other carpets in communal areas such as the sitting room, dining room and corridor are equally dirty and worn in places. Staff told us they had used an “industrial” cleaner to try to improve the carpets but “this made no difference”. Staff recently painted the sitting room, and they are to be commended for their efforts. Staff explained that they were generally responsible for decorating people’s bedrooms and some communal areas. There is no maintenance and refurbishment plan for the home to ensure that it is kept is a good condition. The appointed manager said he hoped to develop one as part of the quality assurance reviews. Individual bedrooms are personalised and were decorated in a style, which reflected people’s interests and preferences. Staff had made a real effort to ensure most rooms were comfortable and bright and interesting for people. However one wardrobe had instructions written in pen on it about where staff should put clothes etc. This did not create a homely impression, the expert by experience felt this gave the impression of the home being “institutionalised”. One bedroom has been badly damaged by the activities of one person. There is no wallpaper or plaster left on the walls, there are no fixtures or fittings in the room, the window frame has been badly damaged and the window no longer closes properly. This presents a security risk as well as problems with maintaining the room temperature. The room was very cold and the radiator was freezing although staff said the heating was on. The carpet in this room was heavily stained and the room had a very unpleasant odour. The room was very bleak and ways of improving this environment should be explored. One bathroom had been re-decorated by staff recently and staff had ‘filled’ large holes in the walls of one toilet. There are no assisted bathing facilities but staff told us that people living at the home could use the bath without aids. They also said that most people like to use the shower. There is no cold running water from the bath tap and staff have to transfer water from the hand basin to the bath when people want a bath. This is unsafe and presents a risk to people (refer to standard 42). Care staff are responsible for cleaning and laundry. The home was not clean throughout. Some floors and carpets were dirty, as were some surfaces and sinks. The laundry facilities were generally clean and well organised. Staff described how they maintain infection control by using the appropriate equipment such as gloves and aprons. Dissolvable laundry bags are used for any soiled washing, which is good practice. Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 25 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): 32, 33, 34, 35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff on duty are not always meeting the diverse needs and aspirations of the people living at this home. People will benefit when staff have received specialist training and regular supervision. Good recruitment procedures ensure that people are protected from unsuitable care workers. EVIDENCE: We saw how the current staffing levels are affecting people’s lifestyle at the home (refer to Lifestyle outcomes, standards 12 –17) and staff told us that this was an area of improvement they would like to see. One wrote “With adequate staffing we could spend more time with the individuals we care for & not have to worry about activities being cancelled. We could arrange more things for residents to do”, two others wrote, “We are quite short staffed at times” and “We need more staff”. All staff responding to CSCI surveys commented on the staffing levels, and raised concerns about the impact on people living at the home. Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 26 As well as caring for people living at the home, staff are responsible for cleaning, laundry, cooking, shopping and some decorating. During our visit there were two members of staff on duty, which did not meet the individual needs of people living at the home. The expert by experience commented, “There seems to be a shortage of staff”. Staff told us, and rotas showed, that generally only two staff were on duty during the day. Staffing levels have been affected by sickness and leave more recently. The appointed manager told us that new staff were being recruited in the New Year. He would like to have three staff on duty throughout the day rather than two, and that is the aim. This should improve the quality of life for people living at the home, but should be monitored, as staffing levels should reflect people’s needs and preferences. Four of the six staff responding with surveys raised concerns about night time staff cover particularly, as did one relative. Comments regarding improvement included, “Better staffing, especially at night”, “I believe we do need more staff. This is my opinion definitely applies to working nights when at present there is only one carer and this can be an agency person sometimes. This must affect the Health & Safety of residents & carers”, “For Health & Safety reasons surely we should have more staff at night - 1 awake & 1 sleeping. At present we only have 1 awake”, and “To improve – sleeping arrangements for the sleepover staff person. 6 to 1 ratio observed 9.30pm to 7am” (relative). We spoke with one night carer, who said she had “no concerns” about being on duty alone at night. When asked how she would deal with emergencies, she told us of the on-call arrangements in place which support her, and described what she would do if someone was ill or there was a fire. The appointed manager told us that there was a budget for a sleeping member of staff, and this is what he would prefer. However the home has been unable to recruit staff to night duty posts. All staff responding to CSCI surveys told us that they had been given training related to their role, which help them understand how to meet people’s needs and kept them up to date with new ways of working. Staff get training in all core areas of health and safety, such as fire safety, infection control and moving and handling, to ensure they are competent to do their job effectively. The AQAA shows that 60 of staff hold or are working towards a nationally recognised qualification in care (NVQ 2), which means that staff have general competencies and skills. Staff spoken with and training records looked at showed that staff get little specialist training to help them fully understand people’s needs. One care plan advises that staff should attend ‘gentle teaching’ training to understand this person and how to respond to them; records showed and staff told us they had not received this training. Another care plan said that staff caring for this person should have training in Autism but again staff spoken with and records looked showed that this was not the case. Staff spoken with appeared caring and interested in learning more to develop their skills, one person told us, “I would love some learning disability training, I’m sure it would help me”, another wrote, “Training has been done in the past & I Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 27 hope it continues now. I am aware that working practices are constantly changing which in turn affects our residents & the way I work. It is also up to me to seek information & ask questions”. All staff responding to CSCI surveys told us that their induction training covered everything they needed to know to help them work safely. One staff member told us, “Induction was very good”. One new staff member has been recruited since the last inspection, so we looked at this recruitment file to ensure that people living at the home are protected. The file contained all the necessary references and checks, which were obtained before the person started working at the home. This protects people. Two staff told us they meet with the manager “regularly” for support and supervision; two others said “often” and two said they “sometimes” or “never” meet with the manager. There have been changes to the management at the home, which has meant that staff have not had supervision as often as is suggested. However, a new manager has been appointed and is planning to hold more frequent staff meetings and offer staff regular supervision. Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 28 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, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall the management of the home is satisfactory but a manager should be registered with the Commission to ensure the home is managed well in the long term. People feel they are listened to but a formal review of the quality of the service will ensure the home is achieving its aims. Not all aspects of health and safety ensure people living at the home and staff are safe and protected. EVIDENCE: The home has been without a registered manager since July 2007. A temporary manager was appointed but left shortly afterwards. The owners have now appointed another manager. The new manager is also managing another small care home within the organisation. Currently he is spending equal parts of his time between the two homes. The long-term management arrangements for the home should be agreed and an application sent to CSCI in order to consider whether the arrangements are suitable. Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 29 Staff said the new manager was approachable and that he tried to keep them informed of changes and passed on important information when needed. Staff on duty said that he was contactable when not at the home. The manager has some good ideas about how to improve the quality of information given to people living at the home, and is keen to ensure that people’s goals are met. Overall the organisation has a good management structure, which supports the manager and staff at the home. The home gets regular visits from the service manager to monitor and support the service. The manager told us that annual reviews with people about the quality of the care and supported given to them are undertaken. We were told that advocates would be used to assist people where needed. The home also sends surveys to relatives, outside professionals and staff to get their views. However, this has not been completed this year. Staff spoken with and training records showed that staff have up-dated mandatory training such as fire safety, infection control, moving and handling and food hygiene. This ensures that staff can work safely and that people are protected. There are a number of things the home must do to keep people safe. The regulation of the hot water caused some concern. During our visit a water technician came to check water temperatures and for Legionella. She reported that water temperatures were “too hot for skin contact”. She had reported this on a previous visit. On the second day of our visit it was confirmed that a thermostatic value was broken and that an urgent 5 day request had been made to the maintenance department of the company. The bath did not have cold running water; staff are transferring cold water from the hand basin. This increases risks of scalding. Most radiators are covered but the tops are not; during our visit the tops of radiators were hot, posing a risk. The risk assessment said that radiators should be set at 3 to reduce the risk of burns but the radiators were hot. One person is partially sighted and uses furniture and radiators to help mobilise; the uncovered radiators are a particular hazard for this person. No personal risk assessment had been completed for this person to ensure that hazards identified could be reduced. The home has a fire risk assessment, which highlights action to be taken to keep people safe in the event of a fire. For example three fire exit signs are required to guide people out of the building in the event of fire but these had not been fitted. The manager said he would do this as a priority. Some substances harmful to people’s health were not securely stored; a cupboard storing cleaning materials was left unlocked on the ground floor and the expert by experience notes, “There was an unlocked cupboard with Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 30 poisonous cleaning fluids which could be accessed by the residents and I felt was not safe”. Once brought to the attention of staff immediate action was taken to secure the cupboard. The AQAA and records at the home show that gas and electrical systems are tested and serviced as recommended. Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 31 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 2 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 2 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 1 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000071067.V358711.R01.S.doc 3 2 2 3 X LIFESTYLES Standard No Score 11 X 12 1 13 2 14 X 15 3 16 2 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Post Hill Nursing Home [aka Pine Lodge/Bryhers] Score 3 2 1 X 2 X 2 X X 1 X Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? YES 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 YA7 Regulation 12 (2) Requirement Timescale for action 28/03/08 2. YA12 16 (2) (m) 13 (2) 3. YA20 You must ensure that people living at the home are enabled to make decisions and choice and that their choices met. You must make arrangements to 28/03/08 enable people to fulfil their social interests and to engage in local and social activities. You must make suitable 12/03/08 arrangements for recording, handling, safe administration and safekeeping of medicines, including: Medicines must be stored securely and at the correct temperature to ensure they work effectively, and regular fridge temperatures must be recorded. Two staff must sign and date handwritten entries on medication records to verify the accuracy of such entries. The home must have written protocols for the use of “when needed” medicines, and staff must receive training in the safe administration of such medicines, particularly in relation to seizures. The home must ensure that DS0000071067.V358711.R01.S.doc Version 5.2 Post Hill Nursing Home [aka Pine Lodge/Bryhers] Page 33 3. YA24 23 (2) (b) 4. YA33 18 (1) (a) 5. YA39 24 (1) (a) (b) (2) 6. YA42 13 (4)(c) 7. 8. YA42 YA42 13 (4) (a) 23 (4) medication stocks are managed appropriately and that large quantities of un-prescribed medicines do not accumulate. (Previous timescale 31/01/06 & 31/01/07 not met) You must ensure that the premises to be used as a care home are of sound construction and kept in a good state of repair internally and externally. You must ensure that sufficient staff are on duty at all times to meet the needs and goals of the people living at the home and ensure their safety. The home must formalise their quality assurance systems and seek the views of people living at the home and their representatives and outside stakeholders involved in the home, to ensure the home is being run in the best interests of the people living there. In order to reduce the risk of harm to people, hot water temperatures must be checked and adjusted to ensure they are running at recommended temperatures. To help keep people safe, chemicals must be stored safely and not left unattended. You must take adequate fire safety precautions and implement the recommendations in the home’s fire risk assessment; in this case, ensure that fire exits are clearly signed. 21/05/08 28/03/08 23/04/08 27/02/08 27/02/08 27/02/08 Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 34 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 YA1 Good Practice Recommendations The Statement of Purpose should be produced in a format that people with a learning disability could understand to ensure they have access to important information. You should include in the Statement of Purpose the age range of people that can live at the home and type of needs for whom the service is intended to accommodate. Carried over from last three reports. People living at the home should be consulted with about all aspects of life in the home, where possible, for example whether it is acceptable for staff training to take place in their home. You should enable people living at the home to be part of the local community by helping them to use local facilities such as clubs, swimming pools, cinemas etc. In order to maintain people’s privacy and dignity, where possible suitable locks should be fitted to toilets and bathrooms, which people can use. You should ‘put into practice’ the advice given by outside professionals in respect of people’s emotional and psychological welfare. You should ensure that people’s personal monies are stored securely at all times. You should ensure that people have a bedroom that has furniture and fittings sufficient and suitable to meet their individual needs. You should ensure that the home is kept clean throughout and free from unpleasant odours. All staff should receive regular training update to ensure they have the knowledge and specialist skills to meet peoples’ individual needs. In order to ensure that people are cared for by an appropriately trained staff team, staff training and development should be linked to the home’s goals and people’s individual needs and plans of care. Staff should receive regular support and supervision to enable them to carry out their jobs well. A manager meeting the criteria for registration should be registered with the Commission as soon as possible. You should undertake individual risk assessments to DS0000071067.V358711.R01.S.doc Version 5.2 Page 35 2. YA8 3. 4. 5. 6. 7. 8. 9. 10. YA13 YA16 YA19 YA23 YA25 YA30 YA32 YA35 11. 12. 13. YA36 YA37 YA42 Post Hill Nursing Home [aka Pine Lodge/Bryhers] reduce the risk of burns from the tops of radiators, which are not covered and present a risk to some people. Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Post Hill Nursing Home [aka Pine Lodge/Bryhers] DS0000071067.V358711.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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