Inspection on 19/10/04 for Humphry Repton House

Care Home For Older PeopleHumphrey Repton HouseBrentry Lane Bristol BS10 6NAAnnounced Inspection19th & 26th October 2004 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: · Promote improvement in social care · Inspect all social care - for adults and children - in the public, private and voluntary sectors · Publish annual reports to Parliament on the performance of social care and on the state of the social care market · Inspect and assess `Value for Money of council social services · Hold performance statistics on social care · Publish the `star ratings for council social services · Register and inspect services against national standards · Host the Childrens Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of establishment Humphrey Repton House Address Brentry Lane, Bristol, BS10 6NA Email address admin@aspectsandmilestones.org.uk Name of registered provider(s)/company (if applicable) Aspects and Milestones Trust Name of registered manager (if applicable) Mrs Deborah Jane Stone Type of registration Care Home No. of places registered (if applicable) 30 Tel No: 0117 9592255 Fax No: 0117 9709301Category(ies) of registration, with (number of places) Dementia (5), Dementia - over 65 years of age (30) Registration number D050000329 Date first registered 1st August 2002 Was the home registered under the Registered Homes Act 1984? Do additional conditions of registration apply ? Date of last inspectionDate of latest registration certificate 12th July 2004 YES YES 6\4\04 If Yes refer to Part CHumphrey Repton HousePage 1 Date of inspection visit Time of inspection visit Name of inspector Name of inspector Name of inspector 1 2 319th &26th October 2004 09:30 am Sam FoxID Code072854Name of inspector 4 Name of specialist (e.g. Interpreter/Signer) (if applicable) Name of establishment representative at the time of inspectionMrs D. Stone - ManagerHumphrey Repton HousePage 2 CONTENTSIntroduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspectors Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Methods & Findings National Minimum Standards For Older People: Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management & Administration Part C: Part D: D.1. D.2. D.3. Compliance with Conditions (if applicable) Providers Response Providers Comments Action Plan Providers AgreementHumphrey Repton HousePage 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the Commission for Social Care Inspection (CSCI), is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000. This document summarises the inspection findings of the CSCI in respect of Humphrey Repton House. The inspection findings relate to the National Minimum Standards (NMS) for Care Homes for Older People published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum Standards will form the basis for judgements by the CSCI regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the Standards. The report will show the following: · Inspection methods used · Key findings and evidence · Overall ratings in relation to the standards · Compliance with the Regulations · Required actions on the part of the provider · Recommended good practice · Summary of the findings · Providers response This report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000. The report is based on the findings of the specified inspection dates.Humphrey Repton HousePage 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED. Humphrey Repton is operated by Aspects and Milestones which is a non-profit making charity. It is registered to provide both personal and nursing care for up to 30 persons who have dementia, within these numbers they can accommodate up to five people who are 50 years and over. In addition to this the home can accommodate five persons for day services in the same category. Humphrey Repton is set on large grounds and is purpose built. There are three wings which are joined together in a cruciform style on the ground floor. Each have their own separate lounge and dining area as well as bathing facilities. There are proposals to extend Humphrey Repton and provide additional services for both intermediate care and separate accommodation for day services. This would involve significant building works which have not yet begun.Humphrey Repton HousePage 5 PART A SUMMARY OF INSPECTION FINDINGSINSPECTORS SUMMARY (This is an overview of the inspectors findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.) The findings at this announced inspection indicated that staff are committed to providing good standards of care at Humphrey Repton. They provide a specialist service which is based on an in-depth knowledge of issues in relation to dementia care and of supporting people whose behaviour may challenge conventional services. Many records seen during this visit were maintained to a good standard. There are two areas of weakness which are currently compromising the effectiveness of the service offered. At present a number of permanent staff are off on different forms of leave ­ this has lead to an increased use of agency staff. Whilst the home have been actively recruiting for new staff there have been delays. This has lead to increased pressure on the existing team and is beginning to have an effect on both morale and on the consistency of care provided. In addition to the above there are some areas of the home that are beginning to look jaded and require attention. This inspection was carried out over a two day period. Due to the complexity of the service provided not all standards were assessed and this report should be read in conjunction with others so that a fuller picture of the home can be gained. Choice of Home (Standards 1-6) 3 of 4 standards assessed were met There is a robust admissions procedure within the home and this means that new residents can be assured that the home has the resources to meet with their needs. Detailed assessments are carried out both by the home and health care specialists prior to admission. In addition to this staff have been provided with training so that they can provide a specialist service for people who have dementia. This is based on current good practice. The home has an up to date and detailed Statement of Purpose and service user guide which residents and their advocates can use to make more informed choices about their future care needs. There were some contracts available. These, however, require development to ensure that they meet with requirements of the legislation. Health and Personal Care (Standards 7-11) 3 of 4 standards assessed were met Humphrey Repton House Page 6 Residents can expect to receive an individualised service which takes into account their emotional, social and physical needs. Care plans are written to a high standard and continue to be regularly reviewed. These enable staff to provide a consistent service which is based on personal preferences. Relationships between staff and residents were respectful and friendly and personal care is given in a sensitive and thoughtful manner to preserve dignity. Action does, however, need to be taken by the home to change the locks on bedroom doors, as they do not lock on the inside. The inspector observed two occasions when privacy was compromised when residents went into other peoples rooms whilst they were receiving assistance with their personal care. Issues in relation to death and dying continue to be dealt with in a sensitive and appropriate manner. Residents can expect their final wishes to be adhered to. The medication systems will be the subject of a separate inspection by a pharmacist employed by the CSCI. Daily life and Social Activities (Standards 12-15) 2 of 3 standards assessed were met Residents benefit from a planned programme of activities throughout the week, which also includes the use of external entertainers. Daily routines are determined by their preference and they are supported to carry out tasks in their own time. Residents are assisted in a sensitive and unhurried manner to eat their meals. The food given to the inspector was luke warm. This made the meal unappetising. The manager was asked to check food temperatures and review meal times in general. Complaints and Protection (Standards 16 ­18) 2 of 2 standards assessed were met Humphrey Repton operates an open and transparent service and complainants can expect to be listened to if they have concerns. Members of staff are aware of behaviours displayed by residents which may be indicative of discontent. This is particularly important, as a number of residents cannot directly verbally communicate their wishes. Improvements have been made to homes policy on physical interventions and there are procedures in place to protect vulnerable adults against abuse. Staff have also been trained to ensure further protection. Environment (Standards 19-26) 5 of 8 standards assessed were met Humphrey Repton is the subject of significant ware and tare and the premises is beginning to look jaded, particularly in the corridors where the paintwork on doors and corridors have be chipped or stained. A formalised planned programme of redecoration needs to be implemented so that the home does not deteriorate further. Two carpets were identified as needing to be replaced. Humphrey Repton House Page 7 Laundry and sluicing facilities are not ideally suited for their purpose, are small and the washing machine is unreliable. This should be improved when the new building works commence. There are numerous infection control policies in place and residents can expect to receive care in a hygienic and safe environment. Staffing (Standards 27-30) 2 of 3 standards assessed were met Residents can expect to receive support from a well-trained and committed staff team. There are, however, a number of staff on long term leave which has led to an excessive use of agency staff. The home have been actively recruiting but have not always been successful. This is having a detrimental effect on consistency and staff morale. If allowed to continue it may lead to deterioration in standards. Management and Administration (Standards 31-38) 5 of 6 standards assessed were met The home is run efficiently and there are good systems in place for the maintenance of records. The management team are committed, work well together and have created an open door policy through which they include all members of staff in decision-making. Residents benefit from a safe and secure environment, which is checked regularly. Annual services take place of all major equipment. Records held in relation to fire safety were well maintained and there were up to date risk assessments.Humphrey Repton HousePage 8 Requirements from last Inspection visit fully actioned? If No please list belowYESSTATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report which indicate a non-compliance with the Care Standards Act 2000 and accompanying Regulations. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard Required actions Timescale for actionAction is being taken by the Commission for Social Care Inspection to ensure compliance in regard to the above requirements. RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented No. Refer to Good Practice Recommendations StandardCONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS).Met (Yes / No)Humphrey Repton HousePage 9 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report, which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001 and the National Minimum Standards. The Registered Provider(s) is/are required to comply within the given time scales. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard * Requirement Timescale for action Further develop statement of terms and conditions so it is more applicable to the service provided. It should include weekly charges and arrangements in relation to the nursing element of the fee. All residents to have a copy. Ensure that electrical cupboards are made safe Ensure that the two stained carpets are cleaned to an adequate standard or replaced Ensure that residents privacy in their bedroom is maintained. Action plan to be sent to CSCI Monitor food temperatures when being stored in hostess trolleys15(1)(b) (c)OP230\3\052 313(5)(a) 23(2)(d)OP38 OP1930\11\04 30\12\04412(4)(a)OP1030\12\04513(4)(c)OP1530\11\04RECOMMENDATIONS Identified below are areas addressed in the main body of the report, which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s). The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. Humphrey Repton House Page 10 No.Refer to Standard * OP31 OP26 OP15 OP16 OP19Good Practice Recommendations1 2 3 3 4Person in control reports to be written in more detail Monitor effectiveness of washing machine Review procedures during meal times Follow up to see if complainants are satisfied Ensure that there is a more formal planned programme of re decoration* Note: You may refer to the relevant standard in the remainder of the report by omitting the 2-letter prefix e.g. OP10 refers to Standard 10.Humphrey Repton HousePage 11 PART BINSPECTION METHODS & FINDINGSThe following inspection methods have been used in the production of this report Direct observation Indirect observation Sampling · Pre-inspection questionnaire · Records · Care plans / Care pathways · Meals · Activities · Other (Specify) `Tracking care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Service user survey Relatives/significant others survey/feedback Visiting professionals survey / feedback Tour of premises Formal interviews Document reading Additional inspection information: Number of service users spoken to at time of inspection Number of relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the responsible individual seen CRB check for the manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total number of care staff employed (excluding managers) Total number of staff with nursing qualifications employed Date of inspection Time of inspection Duration of inspection (hrs) YES NA YES YES YES YES NO NO YES NO YES NO YES YES YES NO YES YES NO YES 5 X X YES YES YES YES 23 15 19/10/04 9.30 11.5Humphrey Repton HousePage 12 The following pages summarise the key findings and evidence from this inspection, together with the CSCI assessment of the extent to which the National Minimum Standards for Care homes for older people have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met (Commendable) (No shortfalls) (Minor shortfalls) (Major shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable.Humphrey Repton HousePage 13 Choice of HomeThe intended outcomes for the following set of standards are: · · · · · · Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home.Standard 1 (1.1 ­ 1.3) The registered person produces and makes available to service users an up to date statement of purpose setting out the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the home; and provides a service users guide to the home for current and prospective residents. The statement of purpose clearly sets out the physical environmental standards met by a home in relation to standards 20.1, 20.4, 21.3, 21.4, 22.2, 22.5, 23.3 and 23.10: a summary of this information appears in the homes service users guide. Range of fees charged From (£) 467 To (£) 477Any charges for extrasYESIf yes, please state what the extras are: hairdresser 3 Key findings/Evidence Standard met? The manager has recently reviewed and updated the homes Statement of Purpose. This includes Humphrey Reptons admissions criteria and philosophy of care. They accommodate people who have a specific diagnosis of dementia and who have been referred by specialists. This document is wide ranging and includes all the information required by the legislation. In addition to the above there is a service user guide which can be used by relatives and their advocates to make more informed choice about their future care. There has been a recent amendment to Regulation 5 which requires homes to include information in the service user guide about whether a nursing contribution is to paid by the PCT to the registered person in respect of residents and whether these will be paid to them or deducted from their fees. The manager undertook to find out about this. This should then be included in the service user guide when it is reviewed.Humphrey Repton HousePage 14 Standard 2 (2.1 ­ 2.2) Each service user is provided with a statement of terms and conditions at the point of moving into the home (or contract if purchasing their care privately). 1 Key findings/Evidence Standard met? There home do hold some statement of terms and conditions. On examination, however, the inspector noted that these did not include all the information required by the legislation (as described in National Minimum Standard 2) and were not user friendly. The home must ensure that all residents or their advocates have a contract and copies should be retained on personal files.Standard 3 (3.1 ­ 3.5) New service users are admitted only on the basis of a full assessment undertaken by people trained to do so, and to which the prospective service user, his/her representatives (if any) and relevant professionals have been party. 3 Key findings/Evidence Standard met? Humphrey Repton have a detailed admissions criteria and procedure. This is included in the homes Statement of Purpose and includes the necessity of having a psychiatric and social worker assessment and referral prior to admission. In addition to this the manager confirmed they would conduct an in-house nursing assessment to further ensure that they could meet peoples individual need. This is good practice. Opportunity was taken to inspect three personal files. These included initial assessments by specialists which were obtained by the home prior to admission and in- house assessments. As a additional mark of good practice the inspector noted that all staff are given a brief personal profile\ biography of new residents which detail their history and interests before they move in. Standard 4 (4.1 - 4.4) The registered person is able to demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 3 Key findings/Evidence Standard met? The service that Humphrey Repton provide has evolved in that they also provide support for people who can display challenging behaviour resulting from their dementia. There were records to indicate that the home seeks specialists support to ensure they have the resources and knowledge to support residents with additional complex needs. At present the home are experiencing staffing difficulties. The manager explained that they would not be taking any new referrals until this situation has eased. She also said that they endeavour to ensure that levels of existing dependence are analysed so that they can maintain a balance in the levels of need within the home. This is good practice. Records provided evidence that staff have received specialist training in relation to dementia and to challenging behaviour. This is an area of practice which continues to change and it was evident that they take steps to ensure that work practice is based on new theoretical developments.Humphrey Repton HousePage 15 Standard 5 (5.1 ­ 5.3) The registered person ensures that prospective service users are invited to visit the home and to move in on a trial basis, before they and / or their representatives make a decision two stay; unplanned admissions are avoided where possible. 3 Key findings/Evidence Standard met? Members of staff confirmed that it would be standard practice for residents or their relatives to visit the home prior to moving there. The complex nature of dementia may mean that this would not be appropriate for all new residents.Standard 6 (6.1 - 6.5) Where service users are admitted only for intermediate care, dedicated accommodation is provided together with specialised facilities, equipment and staff, to deliver short term intensive rehabilitation and enable service users to return home. 0 Key findings/Evidence Standard met? This standard is not applicable to the service provided at Humphrey Repton.Humphrey Repton HousePage 16 Humphrey Repton HousePage 17 Health and Personal CareThe intended outcomes for the following set of standards are: · · · · · The service users health, personal and social care needs are set out in an individual plan of care. Service users make decisions about their lives with assistance as needed. Service users, where appropriate, are responsible for their own medication, and are protected by the homes policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect.Standard 7 (7.1 ­ 7.6) A service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. 4 Key findings/Evidence Standard met? Opportunity was taken to view three personal files. These continue to be written to a good standard and provide a meaningful description of the needs and support that individuals may require. The home has a philosophy of providing a person centred approach to the service they provides and as such all care plans are written in the I form. Three files were examined and found to contain the following information: · · · · · · · · Residents photograph and personal details Daily notes Care plans Assessments Personal handling policy Activity profile Risk assessments Doctors visits\ correspondenceEach wing has a clinically trained member of staff who takes responsibility for co-ordinating care plans, reviewing information and updating risk assessments. Care plans were clear, detailed and up to date. They focused on all areas of lifestyle including personal care needs, emotional and social needs. They provided evidence that the home takes a holistic approach to the provision of its services. The home operates a keyworking system through which each resident has named members of staff who play more of a central role in co-ordinating the services they receive. This enables the home to provide more consistent and individualised care. Members of staff spoken with displayed a good understanding of their role in this respect and were able to detail individual need as described in care plans. There was evidence that care plans are reviewed at regular intervals and that the home includes residents advocates and family where applicable.Humphrey Repton HousePage 18 Standard 8 (8.1 ­ 8.13) The registered person promotes and maintains service users health and ensures access to health care services to meet assessed needs. No. of incidents where service users have been taken to Accident and Emergency during last 12 months No. of service users with pressure sores at time of inspection (from information taken from care notes) 11 X3 Key findings/Evidence Standard met? Care plan files contained good detail about individual health care needs and described particular conditions which need close monitoring. An example of this was in relation to diabetes. Guidelines included signs and symptoms of coma and actions to be taken if there was a deterioration. Records are also maintained of visits to health professionals, including dentists, chiropodists and opticians. Files were found to contain waterlow assessments which risk assesses the likelihood of residents developing pressure sores. These included specialist equipment, such as pressure mattresses, which were needed. There were guidelines available in relation to dietary needs which included a provision for monitoring weight. The management team said they had a good working relationship with their GP who had an understanding of issues in relation to dementia and who visits the home weekly to review progress. They also confirmed that they consult with a number of specialists when necessary. This was confirmed through examination of records. There were personal handling policies which were written to good detail. Guidelines were given to the manager about the administration of flu jabs ­ something that, as a nursing home, clinically trained staff administer on the premises. Standard 9 (9.1 ­ 9.11) The registered person ensures that there is a policy and staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines, and service users are able to take responsibility for their own medication if they wish, within a risk management framework. 0 Key findings/Evidence Standard Met? The medication system was briefly discussed during this visit. The current system is complex and it was agreed that a pharmacist employed by the CSCI would make a separate appointment to inspect the system. This will result in another report.Humphrey Repton HousePage 19 Standard 10 (10.1 ­ 10.7) The arrangements for health and personal care ensure that service users privacy and dignity are respected at all times, and with particular regard to: personal care giving, including nursing, bathing, washing, using the toilet or commode, consultation with, and examination by, health and social care professionals, consultation with legal and financial advisors, maintaining social contacts with relatives and friends, entering bedrooms, toilets and bathrooms, and following death. 2 Key findings/Evidence Standard met? There were guidelines about personal health care needs in care plans. These were written to a good standard and demonstrated that the home proves an individualised service which includes personal preferences. It was apparent that staff have made strenuous efforts to observe behaviours to compile these and that they have used personal histories to gain further information. This is good practice. Members of staff were observed discreetly assisting residents with their personal care needs and relationships between them were respectful and friendly. Residents were observed having their own styles of dress and hair and it was clear that they are encouraged to retain their self-identity. Bedroom doors can be locked from the outside but not from the inside. The inspector noted two instances when residents receiving personal care were interrupted by other residents who had gone into their room. The current situation affords residents little privacy and does not enable them to lock their doors for extra security at night. Action needs to be taken to address this issue and there should be a planned programme of introducing appropriate locks on doors. Discussion took place about the type of locks which are needed ­ rooms should continue to be fully accessible via a master key in case of emergenciesHumphrey Repton HousePage 20 Standard 11 (11.1 ­ 11.12). Care and comfort are given to service users who are dying, their death is handled with dignity and propriety, and their spiritual needs, rites and functions observed. 4 Key findings/Evidence Standard met? Aspects and Milestones have a number of formal policies in relation to death and dying, including guidelines of action to be taken in the event of sudden death. Humphrey Repton provides nursing care and there are clinically trained nurses on the premises - as such those people who become terminally ill or whose death is approaching tend to remain at the home as opposed to going into hospital. Discussion with the management team and members of staff indicated that they try to place an emphasis on maintaining dignity and privacy of residents during this time. Care plans continue to include arrangements to be made in the event of death and of spiritual needs that should be taken into account, for example, due to religious persuasion. This knowledge is particularly important as, due to the nature of dementia, residents may not be able to directly express their wishes. At the last inspection one relative explained that he had discussed issue in relation to his wife dying and that the home had produced a pamphlet which he felt was helpful and sensitively written. At the time of this inspection one resident had recently died and members of their family had bought in gifts for staff. They clearly felt appreciative of the support and care given by members of staff during this difficult time.Humphrey Repton HousePage 21 Daily Life and Social ActivitiesThe intended outcomes for the following set of standards are: · · · · Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them.Standard 12 (12.1 ­ 12.4) The routines of daily living and activities made available are flexible and varied to suit service users expectations, preferences and capacities. 3 Key findings/Evidence Standard met? Members of staff explained that they have a philosophy of supporting individuals to maintain their identity and to determine their own routines. They said that this was why they use a person centred approach to the care planning process. This was apparent during the inspection. Residents were observed being able to get up when they choose and to eat their meals when they were ready to do so. They have unlimited access to all communal areas of the home and members of staff were respectful of individuals needs to walk around the home. The manager said that whilst there are some boundaries in place for the protection of residents, the home endeavours not to impose rules and that if they were to do so then this would have a detrimental effect on residents welfare. The inspector noted that there were biographies and personalised activity profiles for each resident. The home employs activity co-ordinators who have a planned programme of activities throughout the week. At the time of this visit there was a film show. Other activities include exercise groups and the use of external entertainers. Standard 13 (13.1 ­ 13.6) Service users are able to have visitors at any reasonable time and links with the local community are developed and/or maintained in accordance with service users preferences. 3 Key findings/Evidence Standard met? The inspector observed visitors having unlimited access to the home at the time of the visit. In addition to this family members are supported if they wish to help their relative \partner with their personal care needs. For example one relative was observed assisting their relative to eat, another relative visits the home daily and spends most of the day assisting with the care of his partner. This is commendable practice. Care plans provided detail of people who were significant in residents lives and the support needed by them to maintain these links.Humphrey Repton HousePage 22 Standard 14 (14.1 ­ 14.5) The registered person conducts the home so as to maximise service users capacity to exercise personal autonomy and choice. 0 Key findings/Evidence Standard met?Standard 15 (15.1 ­ 15.9) The registered person ensures that service users receive a varied, appealing, wholesome and nutritious diet, which is suited to individual, assessed and recorded requirements, and that meals are taken in a congenial setting and at flexible times. 2 Key findings/Evidence Standard met? The inspector joined residents with their lunchtime meal. Members of staff were observed discreetly and sensitively helping a number of residents who need support to eat. It was an unhurried process that was tailored to meet individual needs. The inspector noted that some residents did not wish to sit down at that time to eat their meal. They were enabled to follow their own routine and eat when they wished. The inspectors meal was not appetising because it was served luke warm and the vegetables were over cooked. The inspector also noted that there were no napkins available and all residents were not offered a drink until after their meal. Whilst it is appreciated that some residents, due to their dementia, may not be able to eat their food and have a drink at the same time, this should not be standard practice for all. The manager was asked to check the temperatures of the hostess trolley and to review meals in general.Humphrey Repton HousePage 23 Complaints and ProtectionThe intended outcomes for the following set of standards are: · · · Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users legal rights are protected. Service users are protected from abuse.Standard 16 (16.1 ­ 16.4) The registered person ensures that there is a simple, clear and accessible complaints procedure which includes the stages and time-scales for the process, and that complaints are dealt with promptly and effectively. No. of complaints made to the home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to CSCI Percentage of complaints responded to within 28 days 4 X 4 X X X 100 3 Key findings/Evidence Standard met? Aspects and Milestones have a complaints policy which includes the contact number of the CSCI to which concerns can also be made. The inspector noted that there was information in relation to this displayed on the homes notice board. The home has received four complaints since January, some of which have been upheld. The manager is now maintaining a logbook of these with actions taken to resolve concerns. This meets with a requirement made at the last inspection. It was recommended that the manager speak with some of the complainants to see if they were satisfied with the outcomes. Lengthy discussion took place about how the home enables residents, who are unable to directly verbally communicate their needs, to comment on the service they receive. Members of staff interviewed displayed an awareness of behaviours which mean that residents are anxious or unhappy. Information in relation to this is detailed on care plans.Humphrey Repton HousePage 24 Standard 17 (17.1 ­ 17.3) Service users have their legal rights protected, are enabled to exercise their legal rights directly and participate in the civic process if they wish. 0 Key findings/Evidence Standard met? This standard was not assessed.Humphrey Repton HousePage 25 Standard 18 (18.1 ­ 18.6) The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policies. The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the Department of Health Guidance No Secrets No. of staff referred for inclusion on POVA lists YES X3 Key findings/Evidence Standard met? Aspects and Milestones have a protection of vulnerable adults policy which works alongside a whistle blowing policy. This encourages staff to report bad practice. The inspector noted that there were also copies of Bristol City Councils no secrets which highlights their expectations in this respect. There was evidence to indicate that all clinically trained staff have their nursing qualification (pin number) checked for validity on an annual basis. Aspects and Milestones now expect all staff to attend protection of vulnerable adults training as part of their mandatory training and records indicate that many staff have benefited from this. This is good practice. Humphrey Repton provide a service for some people who can display challenging behaviour and, as such, may have to, as a last resort, use restrictive physical intervention. This has been the subject of lengthy discussion between the home and the CSCI. The manager has now reviewed the homes policy. It now includes expectations, legal restrictions and who should be informed if such an incident were to take place. The inspector noted that there were two policies held by the home of a similar nature in relation to enforced interventions. It was recommended that these be consolidated. Some staff have had positive response training and they displayed a clear awareness of the need to diffuse potentially challenging situations and of looking at individual trigger points to reduce the risk of them occurring. All those staff interviewed said that they were aware that Aspects and Milestones had a whistle blowing policy which encourages and supports staff to report bad practice. Many said that they felt that residents were treated with respect and if they were not then they would report this. The inspector gained the impression that there were high standards in this respect.Humphrey Repton HousePage 26 EnvironmentThe intended outcomes for the following set of standards are: · · · · · · · · Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic.Standard 19 (19.1 ­ 19.6) The location and layout of the home is suitable for its stated purpose; it is accessible, safe and well maintained; meets service users individual and collective needs in a comfortable and homely way and has been designed with reference to relevant guidance. 2 Key findings/Evidence Standard met? Humphrey Repton House is situated in large grounds and is purpose built. It has an enclosed court yard and the garden provides a secure area to which all residents can have unlimited access. In addition to this there is a sensory garden which provides further stimulation for residents These areas continue to be well maintained. The living area of the home is situated on the ground floor ­ there is a second storey which is used by staff and administrators. It has three wings which are distinct and identified by colour. Each are accessible and follow in a circle around a court yard. The inspector observed that residents have unlimited access to all communal areas of the home. The home continues to be cleaned to a good standard, comfortably furnished and homely in appearance. The premises, however, suffers from significant ware and tear and as a consequence is beginning to look jaded. This is most notable in chipped paintwork and stained walls. Aspects and Milestones are preparing to extend the premises and staff expressed concern that decorative works for the original building have been delayed because of this. It is the inspectors opinion that there needs to be a more formal planned programme of decoration in place to halt this deterioration. There were two carpets that were stained and identified as in need of bringing up to standard or replacing.Humphrey Repton HousePage 27 Standard 20. (20.1 ­ 20.7) In all newly built homes and first time registrations the home provides sitting, recreational and dining space (referred to collectively as communal space) apart from service users private accommodation and excluding corridors and entrance hall amounting to at least 4.1 sq. metres for each service user. 3 Key findings/Evidence Standard met? Each wing has its own communal area which consists of both a dining facility and lounge area with television. These areas were found to be adequately decorated, homely in appearance and comfortably furnished.Standard 21 (21.1 ­ 21.8) Toilet, washing and bathing facilities are provided to meet the needs of service users. 3 Key findings/Evidence Standard met? Humphrey Repton has sufficient bathing and toilet facilities to meet with the needs of those residents currently accommodate. These include a specialist bath, sensory bathroom and shower. It was noted at the last inspection that these rooms were also being used as a storage space (housing wheelchairs and lifting equipment). There have been improvements in this respect and the home now uses a garage to store some of these. Standard 22 (22.1 ­ 22.8) The registered person demonstrates that an assessment of the premises and facilities has been made by suitably qualified persons, including a qualified occupational therapist, with specialist knowledge of the client groups catered for, and provides evidence that the recommended disability equipment has been secured or provided and environmental adaptations made to meet the needs of service users. 3 Key findings/Evidence Standard met? The manager said that she was satisfied with the resources at her disposal to obtain aids and adaptations. Records indicated that they seek the advice of health care specialists when obtaining new and specialised equipment. The corridors are wide and accessible by those in a wheelchair. The home has electrical hoists, electric beds and various manual handling equipment. Humphrey Repton has an emergency call bell system.Humphrey Repton HousePage 28 Standard 23 (23.1 ­ 23.11) The home provides accommodation for each service user which meets minimum space as prescribed Total number of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing homes only (1 April 2003) - single bedrooms below 10 sq.m usable space or additional compensatory space Total number of wheelchair users accommodated for in rooms at least 12sq.m Total number of wheelchair users accommodated for in rooms at less than 12sq.m Total number of shared rooms at least 16 sq.m Total number shared rooms less than 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total number of single bedrooms Total number of single rooms with en suite Total number of double rooms Total number of double rooms with en suite YES NO NO 30 X X X 30 XX X X X3 Key findings/Evidence Standard met? Humphrey Repton meets with this standard although no rooms have ensuite facilities.Humphrey Repton HousePage 29 Standard 24 (24.1 ­ 24.8) The home provides private accommodation for each service user which is furnished and equipped to assure comfort and privacy, and meets the assessed needs of the service user. 2 Key findings/Evidence Standard met? Opportunity was taken to view a number of bedrooms. These were found to be personalised and to reflect individual tastes. It was apparent that residents are encouraged to bring in small items of furniture to make their rooms more homely. Bedroom doors are only lockable from the outside and this can have implications for maintaining privacy (refer to Standard 10). Standard 25 (25.1 ­ 25 8) The heating, lighting, water supply and ventilation of service users accommodation meet the relevant environmental health and safety requirements and the needs of individual service users. 3 Key findings/Evidence Standard met? All areas of the home were found to be bright with both natural light and domestic style lighting. It was well ventilated and heated to a suitable temperature. There is emergency lighting throughout the home. A hand test of hot water indicated that temperatures are being kept to within safe limits. This is monitored by the home as part of regular health and safety audits.Humphrey Repton HousePage 30 Standard 26 (26.1 ­ 26.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation and published professional guidance. 2 Key findings/Evidence Standard met? The home was generally found to be cleaned to a good standard and there were no unpleasant smells. The inspector noted that the home has an infection control policy which was written on 10\8\04. There was also a number of guidelines available issued by Avon Health Authority. Discussion took place about the recent publicity surrounding MRSA ­ the home at present does not accommodate anyone with this. The management team displayed an awareness of infection control polices which needed to be in place if there was. The home has a small laundry area which is not ideally suited to the levels of washing generated. In addition to this there have been some frustrations with the homes washing machine which, it was understood, has broken down on several occasions. The home accommodates many residents who have continence difficulties and they need to have reliable laundry equipment. A recommendation is made that this be replaced if difficulties continue. The home have a number of separate sluicing facilities. These, however, are small rooms and not ideally suited for their purpose. The inspector noted that they were cluttered and did not leave care staff with much room to manoeuvre. It was understood that when the extension to the property takes place there will be separate laundry and sluicing facilities that will be more appropriate to the needs of the home.Humphrey Repton HousePage 31 Humphrey Repton HousePage 32 StaffingThe intended outcomes for the following set of standards are: · · · · Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the homes recruitment policy and practices. Staff are trained and competent to do their jobs.Standard 27 (27.1 ­ 27.7) Staffing numbers and skill mix of qualified/unqualified staff are appropriate to the assessed need of the service users, the size, the layout and purpose of the home, at all times. Number of staff /hours in respect of service user needs based on guidance recommended by Department of Health. Personal Nursing Care No. service users High No. staff hours 27 X X needs allocated No. service users Medium needs No. service users Low needs No. of staff hours required No. of full time equivalent first level registered nurses No. of care staff No. of ancillary staff Key findings/Evidence X X X No. staff hours allocated No. staff hours allocated No. of staff hours provided X X X X X X15 23 8 Standard met? 2Humphrey Repton HousePage 33 Staffing rotas provided evidence that there are, as a minimum , seven staff on duty throughout the waking day. Two support workers are based on each wing and a qualified member of staff oversees the shift. In addition to this there are ancillary staff including housekeepers, administrators and activity co-coordinators. These staffing levels meet with the homes staffing notice. There has been a high use of agency staff and this was discussed at length with the management team. It was understood that one of the main reasons for this is that there are five members of staff on maternity leave. There have also been two members of staff on long term sick leave. In addition to this there have been recruitment difficulties and delays in starting staff whilst the home awaits checks. The managers expressed concern that this was affecting staff morale and inevitably made it hard for them to ensure consistency. This was re-iterated by members of staff whose main concern was the current difficulties with recruitment and the high use of agency staff. They said that this has led to increased stress and frustration. The inspector gained the impression that if this situation were to continue for any length of time then this would have a serious impact on staff morale. Standard 28 (28.1 ­ 28.3) A minimum ratio of 50 trained members of care staff (NVQ Level 2 or equivalent) is achieved by 2005, excluding the registered manager and/or care manager, and in care homes providing nursing, excluding those members of the care staff who are registered nurses. No. care staff (excluding registered nurses) with NVQ level 2 or equivalent of care staff with NVQ level 2 9 31 3 Key findings/Evidence Standard met? Humphrey Repton has NVQ trained assessors on site and they continue to make steady progress towards supporting staff to achieve this qualification.Standard 29 (29.1 ­ 29.6) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 0 Key findings/Evidence Standard met? This standard was not assessed during this visit and will be a focus of the next inspection.Humphrey Repton HousePage 34 Standard 30 (30.1 ­ 30.4) The registered person ensures that there is a staff training and development programme which meets the National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 3 Key findings/Evidence Standard met? Generally staff said they were satisfied with training opportunities. They confirmed that they had statutory training and some have recently attended a four day course relating to dementia which they found stimulating and interesting. Some staff confirmed that they were doing their national vocational training. One member of staff said that the behaviours of residents were becoming more complex and they wished to have more training about challenging behaviour. This comment was passed on to the management team. Aspects and Milestones have an established induction procedure in place which includes formal statutory training, including manual handling, first aid and fire. This was confirmed through discussion with staff and examination of records, which were well maintained.Humphrey Repton HousePage 35 Management and AdministrationThe intended outcomes for the following set of standards are: · · · · · · · · Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users financial interests are safeguarded. Staff are appropriately supervised. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. The health, safety and welfare of service users and staff are promoted and protected.Standard 31 (31.1 ­ 31.8) The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. 3 Key findings/Evidence Standard met? The manager is a registered nurse and has had several years senior experience at Humphrey Repton. Since the last inspection she has successfully passed the fit persons process to become registered under the Care Standards Act. Both the manager and deputy responded well to the inspection process and displayed an awareness of their responsibilities under the legislation. It was apparent to the inspector that they work well together and have common aims and objectives. Aspects and Milestones appoint a senior member of the organisation to oversee the day to day running of the home. They visit the home on a monthly basis, write a report of this and send it to the CSCI. The inspector saw that whilst these visits are happening, the reports contain little detail and do not evidence discussions that actually take place during this time. It is recommended that these are more detailed.Humphrey Repton HousePage 36 Standard 32 (32.1 ­ 32.7) The registered manager ensures that the management approach of the home creates an open, positive and inclusive atmosphere. 3 Key findings/Evidence Standard met? Opportunity was taken to speak with seven members of staff. They all spoke positively about the senior management team and said there was an open door policy and they could go and discuss their concerns at any time. They also said they felt there were generally good communication systems within the home. The inspector noted that some staff have delegated tasks and a number of them said they enjoy the added responsibility. There are a series of formal handovers throughout the day during which time developments and residents welfare are discussed.Standard 33 (33.1 ­ 33.10) Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. 0 Key findings/Evidence Standard met? This standard was not assessed.Standard 34 (34.1 ­ 34.5) Suitable accounting and financial procedures are adopted to demonstrate current financial viability and to ensure there is effective and efficient management of the business. 0 Key findings/Evidence Standard met? This standard was not assessed.Humphrey Repton HousePage 37 Standard 35 (35.1 ­ 35.6) The registered manager ensures that service users control their own money except where they state that they do not wish to or they lack capacity and that safeguards are in place to protect the interests of the service user. Number of service users subject to Power of Attorney processes Number of service users subject to Enduring Power of Attorney processes Number of service users subject to Guardianship Orders X X X3 Key findings/Evidence Standard met? Three personal files were inspected in detail and discussion took place about the financial arrangements in place. One resident has no next of kin and Aspects and Milestones hold a re account on their behalf. This resident also has a solicitor who acts as an external advocate. Another resident has her family who support her to pay fees and who provide her with a weekly allowance. The home holds some monies on behalf of residents for safekeeping. Records held in this respect were found to be accurate and receipts are kept of any purchases made. Standard 36 (36.1 ­ 36.5) The registered person ensures that the employment policies and procedures adopted by the home and its induction, training and supervision arrangements are put into practice. 3 Key findings/Evidence Standard met? All staff spoken with confirmed that they receive regular formal supervision from senior members of the staff team and this system is working well within the home. Staff said that they felt these were useful as a forum for discussing concerns and talking about training. They said they felt listened to and that they could be open and honest. As an additional mark of good practice staff said they received yearly appraisals. Aspects and milestones have grievance and disciplinary procedures. Discussion with the management team and records provided evidence that the home is not afraid to use these to challenge poor practice.Humphrey Repton HousePage 38 Standard 37 (37.1 ­ 37.3) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 3 Key findings/Evidence Standard met? The inspector noted that record keeping within the home is maintained to a good standard and that the there are efficient systems in place to ensure that the home meets with its legislative responsibilities. The home employs an administrator who plays a valuable role within this. Aspects and Milestones have a number of generic policies and some of these have been translated into local policies which reflect actual practice within the home. As an additional mark of good practice these are dated and reviewed regularly.Humphrey Repton HousePage 39 Standard 38 (38.1 ­ 38.9) The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 2 Key findings/Evidence Standard met? The manager explained that there is one senior staff on each wing who is delegated the responsibility for health and safety of that area. They are required to fill out monthly monitoring audit forms through which a series of checks are carried out. Information in this respect was well maintained and up to date. The fire logbook provided evidence that the relevant tests and checks take place of the alarm systems and fire fighting equipment. The inspector noted that there were some minor inconsistencies to the checking of fire doors and the management team were advised to monitor this. There was a workplace fire risk assessment in place which was due for review on 20\11\04. in addition to this there was evidence to confirm that staff receive regular re fresher fire training and that they take part in fire drills. The home had a query in relation to some cupboards which contain electrical switches. They were unsure whether these needed to have specifically fire proof doors. Subsequent discussions with the fire brigade indicate that they do not have to do so. It was noted, however, that the doors to these cupboards were not secure and when opened had a tendency to fall off. Action needs to be taken by the home to ensure that they are safe and that residents do not have access to the electrical switch board. Aspect and Millstones have a number of health and safety policies and these were available for staff to read on the premises. Service certificates were viewed for the following: · · · · · · · Wheelchairs ­ 4\6\04 Dishwasher ­ 14\9\04 Hoists ­ 7\7\04 Gas safety check ­ 29\3\04 Fire extinguishers ­ 9\9\04 Portable electrical appliance tests ­ 7\4\04 Air conditioning - 9\7\04Some members of staff commented that the lack of storage space within the home created health and safety issues. The management team are aware of these and have sought means to obtain additional storage space. It was apparent to the inspector that the home has well organised systems in place for the monitoring of health and safety issues. Information was easily accessible.Humphrey Repton HousePage 40 PART C(where applicable)COMPLIANCE WITH CONDITIONSCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceLead Inspector Second Inspector Locality Manager DateSam Fox Lyn Davis 31st December 2004Signature Signature SignatureHumphrey Repton HousePage 41 Public reports It should be noted that all CSCI inspection reports are public documents.Humphrey Repton HousePage 42 PART DD.1PROVIDERS RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTSRegistered Persons comments/confirmation relating to the content and accuracy of the report for the above inspection.Please limit your comments to one side of A4 if possible This is a fair account of the above visit. We continue to actively recruit new care staff and at this moment we are slowly increasing our numbers. We will replace carpets where specified but due to the very dirty building site next to us, we are having lots of dirt brought in on peoples shoes. We are going to start a programme of contract cleaning as an interim measure until new building completed. A more secure locking system is being installed at this moment which will ensure our residents privacy and security. Our hostess trolleys are now regularly checked for temperature to ensure food is served at a desired temperature. As yet no contact has benn made from a CSCI pharmacist to assist us with our medication procedure.Humphrey Repton HousePage 43 Action taken by the CSCI in response to provider comments: Amendments to the report were necessary NOComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection report Provider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The inspector believes the report to be factually accurateYESYESYESNote: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. Status of the Providers Action Plan at time of publication of the final inspection report: Action plan was required YESAction plan was received at the point of publicationYESAction plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action planYESNONOOther: enter details here Humphrey Repton HousePage 44 D.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.D.3.1 I of confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date Or D.3.2 I of am unable to confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) for the following reasons:Print Name Signature Designation Date Note: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable.Humphrey Repton HousePage 45 Humphrey Repton House / 19th & 26th October 2004Commission for Social Care Inspection 33 Greycoat Street London SW1P 2QF Telephone: 020 7979 2000 Fax: 020 7979 2111 National Enquiry Line: 0845 015 0120 www.csci.org.ukS0000020250.V191308.R01© This report may only be used in its entirety. 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