This inspection was carried out on 27th September 2005.
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 8 statutory requirements (actions the home must comply with) as a result of this inspection.
CARE HOME ADULTS 18-65
Proctor Residential Home Ltd 40 Filton Avenue Horfield Bristol BS7 0AG Lead Inspector
Jacqueline Sullivan Unannounced Inspection 09:30 20th & 27 September 2005
th Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 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 Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 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. Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Proctor Residential Home Ltd Address 40 Filton Avenue Horfield Bristol BS7 0AG 0117 935443 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) Proctor Residential Home Ltd Mr Michael Edward Kendall Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. May accommodate up to 5 persons aged 18 - 64 years requiring personal care 12th January 2005 Date of last inspection Brief Description of the Service: Proctor House is a five bedded care home providing personal care for five service users aged between eighteen and sixty four years. The home is situated in a suburban area, and located on a bus route that gives access to local shops, leisure and other amenities. The home is in keeping with the local neighbourhood. The home has undergone re-registration with the Commission for Social Care Inspection as the business has moved from a sole trader to a limited company. In addition the manager of the home has changed from Mrs Kendall to Mr Kendall (the son). Mrs Kendall remains the registered provider. The home primarily provides personal care to service users with a mental disorder. The home currently has two vacancies. Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an annual unannounced inspection, the purpose of which was to check on residents’ welfare and ensure that the premises was being well maintained. There was a focus on the requirements and recommendations made at the last report. Evidence was primarily sought from discussion with staff and three residents. Some key records were inspected, including care plans and risk assessments. What the service does well: What has improved since the last inspection?
Since the last inspection all COSHH materials are locked away when not in use. This has meant that the residents benefit from a safer environment. The manager has ensured the information relating to COSHH is in one file. This means that the staff and the residents can easily find this information. The manager has revised the statement of purpose so that it includes information about the room sizes and the ages of the residents that can be accommodated. This means that new residents will have a better understanding of what the service can offer them. The staff have started to encourage the residents to complete daily chores themselves. This allows the residents to be more independent. There is an activity schedule for the residents. So the residents have the opportunity to spend time with the staff outside the home and develop new interests. Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 Page 6 A questionnaire has been completed by the residents about the activities they would like to do and how they could be more involved in the running of the home. This means that the staff team are more aware of what the residents like to do in their free time and how they can contribute to the running of the home. The hallway and kitchen are being decorated so that the residents can benefit from a brighter and more homely house. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 Page 7 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 Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 There is an admissions procedure in place so new residents can be assured that the home has the resources and specialist knowledge to meet their needs. However this could be further developed to ensure the details in the documents are correct. EVIDENCE: The home’s Statement of Purpose and residents guide has recently been reviewed and updated. This includes the aims and objectives of the home and the facilities and services provided. This needs to be further developed to include; staffing structures and actual staffing at the home on daily basis. The information states that a named key worker is in place but this staff member no longer works at the home. Therefore this must be amended accordingly. Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 67 Staff have a good awareness of individual needs and hold residents in high regard – which means they can expect to receive support in a sensitive and respectful manner. The residents care plans are detailed and comprehensive so the residents benefit from a staff team that understands their needs. Residents meeting ensure that their views about the home are known to staff. However the frequency of these meetings could be improved. EVIDENCE: The homes reviewing process is based on the individual program approach used by services for people with learning disabilities. The process includes meeting with the service user to find out what they want from the service. Care plans seen covered all aspects of daily living including individual’s mental health and emotional support. Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 Page 10 The care plan included a crisis management support network for the individual and included symptoms when the individual was unwell. This had been drawn up using a Care Program Approach and included the multi-disciplinary team. Care plans are reviewed at least every six months. All care plans were dated and all written care documentation was signed. Residents meetings take place every six months. This frequency means that there are only two meetings a year. This should be developed to include a meeting every three months. This will ensure that the staff team are more accurately aware of the resident’s views. One resident asked for cushions for the outside chairs, as they were uncomfortable. These were not seen to be in place. Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11 12 13 14 17 Residents are enabled to determine their own daily routines. They benefit from a wide variety of nutritious food. However the recording of the food eaten by the residents could be improved. An activities schedule is available but the residents regularly do not go on these trips, therefore they are not benefiting from opportunities to develop new interests. EVIDENCE: A residents survey had taken place to determine how they would like to be more involved in the running of the home. Although this didn’t elicit any information that would help the staff involve the residents more in the day-today tasks. The staff team therefore need to be more proactive about encouraging the residents to be more independent, starting with small tasks. Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 Page 12 The culture of the home appears to be that the residents stay in their rooms in the day and only use the downstairs dining room/lounge to eat. The staff stated they often don’t know if the residents are in or out of the home. This suggests the residents are not using the whole space in the house and spending long periods in their rooms. Evidence should be in the daily records that the staff are encouraging the residents to live more communally. However, if the residents choose to live in a more isolated fashion then this should be clearly stated in their care plans and in the daily recording. An activity plan was in place with weekly activities listed. The residents then tick the activities they want to attend. The daily records did not indicate that residents had declined to attend these events, although this was, in the main, the case. The manager and staff stated that residents indicate they wish to go out then decide not to on the day. A resident said he had gone to a concert with the staff. The staff said that this is unusual as the residents rarely go on the activities. In order to improve the attendance on the outings it would be useful for the staff team to record the reasons the residents decline to go out and then use this information to offer an alternative venue. There was no evidence that an annual holiday had been planned or offered to the residents. The residents should have the opportunity to go on a holiday. The dates and venue should be indicated on the residents’ files and, again, if the residents decline to attend then the reasons must be recorded. Holidays and outings should be a focus of the residents meetings and their views should be recorded. All the residents said they enjoyed the meals. One resident said that he didn’t know what the evening meal was going to be. The kitchen was well stocked and the staff stated that they ensure the residents ate healthily. However the recorded evidence is limited. The staff team must record the food that the residents actually eat and ensure that a menu is available in advance of the meals which ensures that there is an alternative meal on offer. Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21 The staff do not know the wishes of the residents in the event of their death therefore the staff cannot be certain that they are following the residents preferences. EVIDENCE: The home supports residents from the age of 18 and 64. There is a policy on death and dying. There was no evidence that the residents had been consulted on their wishes in the event of their death. The home needs to discuss this issue with the resident or their representative and then document the outcome. This was recommend at the last report and now must be completed as a matter of urgency. This will be a focus of the next inspection. Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The recording of the financial arrangements for the residents is not complete therefore the residents are not benefiting from a transparent and robust system, which will protect their financial interests. EVIDENCE: The manager has listed the amounts of benefit/allowances the residents receive and the residents sign these records. However this is not a robust system. There is no evidence from the DLA that the amount detailed in the recording is accurate. A copy of the most recent award needs to be included in the records. The manager said that Mr Kendall was the appointee for the residents but there was no documentation to support that this was the resident’s choice. There is an outstanding requirement for the home to review their policy on abuse to ensure it complies with the Bristol No Secrets Policy. This must include the role of social services and the Commission for Social Care Inspection. Abuse is discussed as part of new staff’s induction. There was no evidence of an induction for one of the new staff (this will be discussed in standard 35). The home has a question and answer booklet to accompany a video relating to issues around abuse of the vulnerable adult. One staff member had started the induction but had not completed it. Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 25 26 30 The resident’s bedrooms are spacious and well equipped to suit their needs and lifestyles. The house is clean and tidy. The house is in the process of being redecorated. Once this is complete the house will present as more homely for the residents. Residents independence is not fully promoted or encouraged. EVIDENCE: Each resident has a single bedroom containing a wash hand basin. All rooms seen were all above the spatial standard. The hallway and the kitchen were in the process of being redecorated. This is good practise. The contractor said the work should be finished in the next two weeks. He and the manager plan to lighten up the hallway with neutral colours. On entering the house it presents as dark and unwelcoming so this work should make the house more homely. Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 Page 16 There is a small quiet room that has a large institutional sign saying no smoking and eating in this room. In this room meetings take place or staff complete records. There was no evidence that the residents regularly use this room. This then leaves a small dining room/lounge. It was evident that the room had been cleared for the decoration, which was taking place whilst the residents were using the room. However, this room presents as institutional. Once it is decorated the room will be brighter. But it also needs a sofa, television and pictures to make it more homely. The next inspection will be after the work has been completed. The resident’s rooms had televisions or music systems in their rooms. The rooms were spacious and the impression was that they mostly spent their time in these rooms, leaving them for cups of tea or meals. Moreover the kitchen was locked. The manager said this was because there were knives in these rooms and concerns about hygiene. Whilst these are valid risks they can be surmounted. The knives could be stored in locked cabinets and residents encouraged to wash their hands, food preparation could be done with the staff so the staff can ensure standards of hygiene are maintained. Risk assessments would steer the staff team in the direction of identifying and reducing these risks. A recommendation has been made that the kitchen is open for part of the day with a view to opening the kitchen on a full time basis. The residents smoke in the garden in a small covered area. The gazebo is poor quality and needs replacing as it is covered in mildew. If the resident spend considerable time there then this needs to be a more comfortable space. Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 35 The recruitment policies and procedures are not being consistently followed by the manager therefore the residents are not being sufficiently protected. Staff inductions are in place. Therefore the staff team knows the resident’s needs. However this could be developed further to ensure that all the staff team have completed the induction in a timely fashion. EVIDENCE: A completed application form for new staff seen in the staff details folder is incomplete. The employee had not completed the section on previous employment. Therefore the manager could not establish if there were any unaccounted for gaps in employment. One staff member, who had been working at another establishment owned by the manager, had started work without completing an application form or providing references. The manager said that as he had known her for some time then he didn’t think this was necessary. He said a CRB had been sent to the Criminal Records Bureau. The domestic did not have a CRB. The manager said there had been a problem with this form and he had the documentation to resend the information. Whilst references and CRB’s and a POVA check are outstanding then staff members must be supervised by substantive staff at all times.
Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 Page 18 Staff training is taking place. Five certificates were in place for one staff member including first aid and training in challenging behaviour. This staff member intends to start NVQ2 shortly. To ensure that 50 of the staff team are trained then CSCI need a plan of action from the manager. The staff team had limited knowledge of the National Minimum Standards and how they apply to residents. A recommendation has been made about staff training in this area. The developments in the staff knowledge of the minimum standards will be a focus of the next inspection. Staff induction has started retrospectively. One staff member has nearly completed this training. There was no evidence that a recently employed member of staff had started the induction. Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 Although there are systems in place to maintain health and safety, this needs to be developed, as resident’s safety and welfare are not currently fully protected. EVIDENCE: COSH materials are securely locked away and appropriate policies are in place. This is practice. The manager has compiled a comprehensive folder on all the COSH documentation. Risk assessments have been started. However those in relation to the current decoration, manual handling, food hygiene (food hazardous analysis) and other matters relating to health and safety are outstanding. Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x x x Standard No 22 23 Score x 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 2 x x Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 3 x x x 3 LIFESTYLES Standard No Score 11 2 12 2 13 3 14 2 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x x x 1 2 x CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Proctor Residential Home Ltd Score x x x 2 Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x DS0000062466.V249844.R01.S.doc Version 5.0 Page 21 Yes Are there any outstanding requirements from the last inspection? Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 Page 22 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. Standard Regulation Requirement Timescale for action 1 YA1 4 The statement of purpose and 30/01/06 residents guide includes staffing structures and actual staffing. And includes a description of the actual key worker system in the home. 2 YA14 16 30/01/06 For service users to have an opportunity to an annual holiday For the home to maintain a record of activities offered and refusals. The home is required to document financial arrangements for each service user and who acts as the appointee For the home to ensure that all staff have had a CRB check and references before working unsupervised with the residents For all new staff to have a full induction within six weeks of appointment 3 YA23 17 30/01/06 4 YA34 19 30/01/06 5 6 YA35 YA42 18 13 30/01/06 To complete risk assessments for 30/01/06 the risks inherent in the current redecoration programme, the residents use of the kitchen, manual handling, food hygiene (food hazardous analysis) and other matters relating to health and safety To update the policy on abuse to ensure compliance to the DOH (Bristol) No Secrets Policy The Home to record the food eaten by the residents and ensure menus are available.
DS0000062466.V249844.R01.S.doc 7 YA23 13 30/01/06 8 YA17 16 30/01/06 Proctor Residential Home Ltd Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard YA8 YA21 YA23 YA34 Good Practice Recommendations The frequency of residents meetings is increased and there is evidence that the home has complied with the residents requests made at these meetings. For the home to seek the views of the residents on their wishes in the event of their death. To review the recording of the service user’s financial transactions For the Home to review the application to ensure that it details all previous employment including dates and enable the manager to assess the skills and qualities of the applicant For the Home to ensure that residents have access to the kitchen for part of the day. The dining room to be made more homely. 6 YA32 The staff team to read the National Minimum Standards and be able to demonstrate their understanding and application. 5 YA24 Proctor Residential Home Ltd DS0000062466.V249844.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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