Inspection on 22/11/06 for South Bristol Rehabilitation Centre

This inspection was carried out on 22nd November 2006.

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 but made no statutory requirements on the home.

Other inspections for this house

South Bristol Rehabilitation... 26/06/07

South Bristol Rehabilitation... 05/01/06

South Bristol Rehabilitation... 05/07/05

South Bristol Rehabilitation... 09/03/05

South Bristol Rehabilitation... 11/10/04

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE South Bristol Rehabilitation Centre 30 Inns Court Green Knowle Bristol BS4 1TF Lead Inspector Sandra Garrett Key Unannounced Inspection 22nd & 23rd November 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service South Bristol Rehabilitation Centre Address 30 Inns Court Green Knowle Bristol BS4 1TF Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0117 9038392 0117 9038395 Bristol City Council Mrs Sarah Leah Stone Care Home 20 Category(ies) of Physical disability (20) registration, with number of places South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate 20 persons over 45 years with a Physical Disability Date of last inspection 5th January 2006 Brief Description of the Service: The service operates through Bristol City Council Adult Community Care in partnership with the Bristol South & West Primary Care Trust and is based in the area of Knowle West. It provides short-term care and rehabilitation for up to 20 people over 45 years in the physical disability category. The aim is to give support and rehabilitation to people who need both specialist input and/or a period of respite after illness or trauma, so that they can return to their own homes. A residential programme of care is provided over a period of eight weeks, although this can be extended if necessary. The centre is situated on the first and second floors of a former older peoples care home. It is therefore accessible and has a number of aids and adaptations. The staff team includes a pharmacist, social worker, occupational therapist and physiotherapist, together with rehabilitation workers and health and social care assistants. Of the twenty beds registered, three are designated as safe haven beds. These enable care to be given to people who may be ill but don’t need hospital admission. The arrangements for these beds are made so that service users getting 24-hour personal care can recover quickly and return home. The average length of stay is 3-5 days but can be longer depending on recovery. Seven other step-down beds are for people who are discharged from hospital when they are fit enough to do so but who cannot return home immediately for some reason e.g. if their homes needs adaptation or they are waiting for care packages to be set up. People in the step-down beds are expected to be largely independent in respect of personal care and to stay up to two weeks. Again this can be extended if necessary. No fee is payable for the first eight weeks of the service. Thereafter a weekly fee of £39.10 is applied. No copies of the most recent inspection report were seen in the centre. South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection carried out over one and a half days that focussed on the care of service users in the safe haven and step-down beds (see brief description above). In addition three beds are used for assessment to decide what type of service is needed, that will enable service users to regain independence or make clear decisions about their futures. Four service users and two relatives were spoken with in depth. A number of staff were spoken with and a range of records was examined. These included: assessment and care records, together with complaints, staff supervision, training records and fire safety records. What the service does well: What has improved since the last inspection? South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 6 The step-down beds were, for a time, located and managed at a separate site in Stockwood, Bristol. Requirements were made in respect of assessments and information given to service users staying there. However the beds have now returned to the Knowle West location and are managed in the centre. The requirements above have now been met. Service users know what the service is about and what is available to them, by means of a clear service users guide and pack of information that is kept in their individual rooms. Trained staff employed at the centre carry out assessments and a number of these were examined. Service users can therefore be confident that their needs for information about the service will be met and their assessed care needs identified at the point of admission. A requirement to ensure all radiators are covered to protect service users from harm was nearly met. All radiators except one were covered and the manager made arrangements during the inspection for the remaining one to be covered within a short timescale. Service users can be sure that they will be kept safe from risk of injury. A good practice recommendation in respect of ensuring progress records didn’t just focus on rehabilitation and care needs was met. Care records were detailed and included information about the service user and their enjoyment of their stay at the centre. Service users can therefore be confident that they are treated not just as ‘patients’ but also as individuals with rights and choices of their own. What they could do better: It was very disappointing to note that after requirements made at previous inspections, service users in the safe haven beds still didn’t have clear care plans in place to ensure their assessed needs could be met. Service users in the step-down beds did have care plans but these needed improvement to ensure they matched the assessment information, so that all identified needs could be met. Further, no reviews of service users’ care had taken place for those in either safe haven or step-down beds. A new comprehensive requirement is therefore made. The registered person has been issued with a letter requesting the requirement is met within the timescale. Failure to do so could lead to enforcement action being taken. Service users’ may be at risk if no care plans are in place that show how their needs are to be met. A further requirement in respect of manual handling risk assessments was not entirely met. Whilst some service users did have such risk assessments, one service user did not. Specific risk assessments, e.g. in respect of falls where a history of falls had been identified, had not been put in place. Those that were in place were not fully completed and lacked information about the actions to be taken to reduce the risk of harm. A new comprehensive South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 7 requirement in respect of risk management is therefore made to ensure service users are kept safe from risk of harm. A requirement in respect of dementia awareness training was partly met. Four staff had attended such training since the last inspection but the majority had not. A new requirement is made to ensure that remaining staff are prioritised for this training in order to ensure they understand and can meet the needs of service users with dementia. A permanent manager has now been appointed, has taken up her post and is in an induction period. A requirement is made to ensure an application for her to become registered with The Commission for Social Care Inspection (the Commission), is received in a timely manner so that service users are protected. It was disappointing to note that fire safety records showed gaps in both fire safety testing and the carrying out of regular fire drills. It wasn’t clear if any fire drills had been carried out for over a year and if fire-fighting equipment was still safe to use. A requirement was further made to ensure fire safety records are kept up to date in an orderly manner so that it’s clear that service users are being protected. Two good practice recommendations were made: It was noted that service users’ preferred names weren’t being used. A good practice recommendation is made to ensure that service users’ preferred names are recorded and staff use those names at all times and when writing in care records. It was noted from sampling a meal, service user survey comments and speaking with service users, mixed views on the meals and the quality of those provided. A good practice recommendation is made to ensure service users are consulted on menus and meals to ensure that the type and quality of, in particular the lunchtime meal, is monitored. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3, 4 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information about the centre enables service users to be clear about all aspects of the service provided for them. Pre-admission assessments contain relevant information about service users assessed needs to enable care plans to be developed. Service users’ specialist and diverse needs are addressed and met wherever possible. The centre is well appointed to meet intermediate care needs of all service users. EVIDENCE: South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 10 Ring binders containing information about the centre and its service were noted in some service users’ rooms. The information kept in the file was comprehensive and included: A copy of the Statement of Purpose, facilities and staffing information, complaints information, fire safety procedure, address details of The Commission for Social Care Inspection and address details of private home care agencies. The manager gave a copy of a newly developed service users guide to the inspector (that covers all intermediate care services not just the rehabilitation centre). A leaflet about intermediate care services was also seen. However the guide didn’t contain all the information required under regulation. This included: information about fees –whether payable, when and how much and where to find copies of the inspection report. The manager was advised to ensure this information is put into the guide. The manager was further advised on how to make sure service users can have access to and read a copy of the latest inspection report. From responses to our survey done before this visit, some service users were unclear about information they should have been given i.e. ’never heard of the service users guide’ and ‘I wasn’t given any information really’. However another said that ‘someone came and visited me and told me all about it’ so felt their needs for information about the centre had been met. A requirement about ensuring assessments are done for service users in the step-down beds was met. Copies of initial and overview assessments were seen for service users in both safe haven and step-down beds. Either assessment team staff or rehabilitation workers had prepared these although it wasn’t clear whether the assessments had been carried out by people qualified to do so, as no designation of worker appeared on the form itself. Assessments were detailed and included information on past medical history, social circumstances, home environment and access issues, personal care and daily living tasks, among others. Assessment forms had a section on cultural and spiritual needs but these weren’t all filled in. It was clear that most of the assessments had been done in consultation with service users or their families and their views were included. This is good practice. The centre caters for specialist and diverse needs of service users through multi-disciplinary team working. This means that staff including rapid response nurses, occupational therapists and physiotherapists are able to assess and plan to meet needs in order to fully rehabilitate a person so that s/he can regain independence. Further, a community psychiatric nurse based in the intermediate care service on the ground floor of the building is able to help meet mental health needs and train staff in dealing with mental health and dementia. The manager said that very few service users from black and minority ethnic groups come into the centre for rehabilitation and few black or minority ethnic staff are recruited. The manager said that she felt this might be to do with the geographical area the service covers. South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 11 It was noted that all elements of Standard 6 of the National Minimum Standards is met at the centre and by staff. This includes: • Dedicated accommodation and specialised facilities including a gymnasium and domestic kitchens to practise meal preparation in • Equipment for therapies and treatment as well as those to promote daily living activities and mobility Trained, qualified and appropriately supervised staff to help service users regain confidence and independence are employed in sufficient numbers, and service users are not admitted for long-term or permanent care. Service users’ comments from our survey and during the visit were largely positive i.e. ‘It’s a wonderful place and its given me my confidence back’ and: ‘I fell in love with it straight away’. South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care planning for service users in ‘safe haven’ or ‘step-down’ beds is not well managed and needs improvement to ensure service users’ needs are met. Service users are adequately looked after in respect of healthcare needs. However service user safety is not well managed particularly in respect of mobility and risk. Service users in ‘safe haven’ and ‘step-down’ beds are not well looked after in respect of safety and management of risk. Medication is appropriately managed to ensure service users are kept safe from harm. Service users’ privacy and dignity is maintained although respect for use of their preferred name is not. South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 13 EVIDENCE: It was very disappointing to note that after requirements made at the last two inspections, service users in the safe haven beds still didn’t have clear care plans in place to ensure their assessed needs could be met. Service users in the step-down beds did have care plans but these needed improvement to ensure they clearly matched the assessment information, so that all identified needs could be met. It was noted that some information from assessments wasn’t being transferred that could put service users at risk e.g. if their need for supervision during personal care tasks wasn’t fully recorded. One service user had been admitted to the centre the day before this visit. Although an assessment had been done no care plan was available for inspection. Another service user who had been at the centre since mid-October had no care plan at all even though s/he and relatives visiting at the time made clear what her/his personal care needs were. The service user’s assessment had identified that pressure area care was needed but very little information was available to see how this was being managed. Further, the assessment showed a history of falls, confirmed by the service user and relatives and apparent from photographs that showed bruising following falls at home. No specific risk assessment was in place to show how the risk of falls was being managed and no manual handling risk assessment was available either. This was a requirement made at the last visit and not met. It was noted that a risk assessment for a service user with dementia being able to go out alone, didn’t give clear details of actions to be taken to reduce the risk and hadn’t been fully completed that could impact on her/his choice and independence. For all four service users case tracked at this visit no evidence of regular review of care needs was seen although blank review sheets were seen in each individual file. The manager said that reviews after 72 hours are carried out for service users admitted as emergencies but no review sheets were seen for anyone. It was therefore difficult to see how service users changing needs were identified and whether their assessed needs were indeed being met. Following this visit a letter was sent to the registered person outlining the issues and requesting compliance with a new comprehensive requirement made at the visit. Failure to meet this requirement could lead to enforcement action being taken. Overall, service users’ healthcare needs were met by regular contact with GP’s and district nurses and through contact with the nursing staff from the rapid response team that is based on the ground floor. Comments from our survey showed this: ‘I have a district nurse regularly because of my feet’, ‘Oh yes I’ve seen the nurse this morning, they are very kind’ and: ‘I had a visit from my GP yesterday and the physiotherapists are marvellous’. South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 14 A relative had organised a chiropody visit for a service user. Hospital discharge letters outlining care and medication needs were seen in service users’ records and hospital appointments were being kept. The entire intermediate care services in both South and North Bristol and encompassing the rehabilitation centres, has a newly developed medication policy. A copy was given to the inspector. It was noted that the policy is clear and comprehensive and advice from the Commission’s pharmacy inspector had been sought and incorporated. As far as possible service users in the rehabilitation centre are encouraged and assisted to become independent with medication. However medication can be administered if the service user is unwell or has dementia. Records of medication given by staff were seen that were appropriately signed and dated. It was seen that medication was kept in locked drawers in individual rooms and service users had keys. One service user admitted the previous day complained of pain to the inspector but had not been prescribed pain relief. The manager was advised to seek advice from the GP to ensure appropriate pain relief could be ordered. The manager confirmed on the second day of the visit that this had been done and the service user how had pain relief prescribed. Other service users confirmed that they were happy to self-medicate and were clear about medications to be taken. Medication errors were discussed with the manager who was able to give clear information about how potential errors are avoided. This included: responsibility for administering medication has now passed to the rapid response team of trained nurses and all staff have had medication update training this year. Evidence of this was seen in individual training records. Staff were observed treating service users with respect i.e. knocking on bedroom doors and waiting to be invited in. Comments from our service user survey showed high levels of satisfaction with staff relationships: ‘The majority of staff are absolutely wonderful’, ‘I get on well with all the staff’, ‘I’m well looked after – they do anything for you’ and ‘they’re most obliging and its very pleasant here’. Some service users had mixed views on whether staff were available quickly enough for them. However one service user raised an issue of lack of awareness about people with dementia and said s/he felt the attitudes were ‘belittling’. It was also noted that service users preferred names weren’t being respected. All service users spoken with were very clear about the name they wished to be known by. However it was noted that these weren’t being fully respected e.g. in nameplates on bedroom doors and in daily records. One service user’s name was referred to in at least three different ways, none of which was what s/he preferred. This could be interpreted as a failure to respect service users’ choice and their dignity. A good practice recommendation is therefore made to ensure that service users’ preferred names are recorded and staff should use that name at all times and when writing in care records. South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Routines of daily living and social activities are adequate for the service that is provided to service users. Appropriate community contact is made where service users’ needs are identified. Service users are enabled to maintain choices where possible about their rehabilitation needs. Menus and meals don’t always meet service users’ needs and choice and need revising. EVIDENCE: South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 16 As the centre focuses on rehabilitation, the emphasis is on ensuring activities are in place to ensure a speedy return to full independence i.e. physiotherapy and walking exercises, meal preparation and kitchen skills. A weekly group for service users who are prone to falls takes place. The inspector was told that because of this and the fact that service users may not get opportunities to fulfil social activities provided by the centre when they return home, social activities and entertainment are not provided. However a range of books, magazines and DVD’s were seen, together with puzzles, games and playing cards. It was noted that service users stay mainly in their rooms and only socialise together at mealtimes. Televisions are supplied in each room as well as in lounges. DVD, CD and music systems were also seen in lounges. Comments from the service user survey showed that activities are mainly rehabilitation focussed: ‘I like to go to the gym now and again’, I went to the gym yesterday – I like to get lots of exercise’, ‘ you can make your own entertainment, but we do exercise every day and there are books and games available’ and: ‘ there’s no entertainment as such but we all have a good laugh here’. Similarly community contact is more limited than in care homes. A notice giving information about local church services and giving phone numbers for contact was seen on the notice board in the service users’ corridor. The manager said service user requests for visits from a priest or vicar would be responded to and arranged. Service users are able to go out to the local shops that are very close to the centre. The shops include a grocery and newsagent store and a takeaway fish and chip shop. There is also a community centre that incorporates a small café area. It was noted that service users have a degree of choice whilst they are staying at the centre. They have choice of meals from the menu and if returning to independence are encouraged to prepare some meals for themselves when they are able. They can choose where to spend their days – either in their rooms or in the lounges. They can have visitors throughout the day without limit and relatives of one service user were met at this visit. It was disappointing to note a reduction in the quality of the midday meal sampled at this visit. The meal was lukewarm and vegetables overcooked. This was confirmed by service users’ comments from the survey and from those spoken with at this visit. Views about the quality of meals was mixed: One service user said they were ‘passable’ although another said they were ‘very good’. One service user said the food was ‘average’ and went on to say ‘its all bulk cooking’. Comments from the survey included: South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 17 ‘They are freshly cooked every day’ ‘The food is absolutely magnificent’ ‘They’re ok, they pass’ ‘It’s reasonable – it could be a bit warmer’ ‘Sometimes it’s something I’ve never heard of’ ‘Some are very nice, some not so good and I don’t see much fresh fruit about’. A good practice recommendation is therefore made to ensure that service users have an opportunity to be consulted on the quality of meals provided and have an input to menus so that their needs for appetising meals of their choice can be met. South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are well managed and service users are given clear information about raising concerns. Clear identification and management of abuse issues ensures service users are safeguarded from harm. EVIDENCE: Complaints information was seen in service users’ rooms although not all service users commented in the survey that they had seen a copy of the leaflet. Service users spoken with said they had no complaints and relatives spoken with said they were happy that the service user was being cared for at the centre. One service user commented: ‘ I’m never unhappy here, it’s a wonderful place to be’. Another said that: ‘the girls in the office ask me nearly every day if I’m all right’. The complaints file was reviewed and no new complaints had been made since the last visit. South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 19 It was noted from the pre-inspection questionnaire that three adult protection investigations had been carried out. The manager discussed one of these and the actions that had been put in place to protect the service user from risk of abuse. A social worker from the intermediate care service on the ground floor gave information about another situation and the subsequent investigation. Notices about each of these issues had been previously sent to the Commission as required. From training records examined it was noted that the majority of staff had done safeguarding adults training recently. South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment for all service users is comfortable, safe and homely as well as being clean and hygienic. Physical access issues for disabled service users and visitors are identified and well managed. EVIDENCE: South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 21 The rehabilitation centre was clean throughout this visit. Domestic staff were seen cleaning all areas and service user comments were very positive about the standard of cleanliness: ‘it’s wonderfully clean. I think the toilet is cleaned three times a day’; ‘It’s beautifully clean; a lady comes in and does it all the time’ and: ‘It’s wonderful and spotless here’. The centre smelled fresh and hygienic. Whilst the emphasis is on rehabilitation and regaining independence through therapies, the centre itself benefits from accommodation for service users that is homely. Each bedroom is decorated and furnished differently and the lounge and dining room facilities are also decorated and furnished in a homely way. The rehabilitation centre is already reasonably accessible for older and disabled people but the manager said that work was about to start to make it more so. The conditions of registration were recently changed following a request from the registered person. This means the centre can now accommodate up to twenty people over 45 years of age. This could mean that more disabled people would be accommodated although the manager said that the emphasis is likely to remain on rehabilitating older people. The work to improve access for older and disabled people includes: Provision of automatic opening main doors with re-positioning of the entry system to accommodate wheelchair users’ needs. Handrails to be made more accessible for visually impaired service users. Refurbishing the shower and toilet on the first floor and converting another bathroom into an accessible shower room. Converting a disused linen room into an accessible toilet Creating more accessible parking spaces for disabled drivers. South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvement in staffing levels ensures service users needs are appropriately met. High levels of staff trained in National Vocational Qualification in Care levels 2 and 3 ensure service users’ needs are identified and met. Training in dementia awareness and care must continue so that a well-trained staff group can meet service users’ needs. Specific equalities training is provided where necessary so that service users specialist needs can be met. EVIDENCE: From the pre-inspection questionnaire supplied before this visit it was noted that two staff had left and eight staff had been recruited since the last inspection. Further one member of staff working in another capacity had become a rehabilitation worker. Appropriate numbers of staff were seen on duty on both days and two new members of staff were spoken with. It was confirmed that they had induction when starting work and essential training. Rotas examined showed the difficulty of staffing the service and it was noted agency staff are still being used. South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 23 The ongoing programme of National Vocational Qualification in Care training for care and rehabilitation workers continues. Several rehabilitation workers have NVQ level 3 and others are currently doing it. Some staff also have NVQ level 2. From the pre-inspection questionnaire it was noted that the centre meets the minimum recommendation of 50 of staff trained to at least NVQ level 2. The arrangements for examining staff records has changed since the last inspection and this will now be carried out at the City Council’s offices later in the year. Two care staff whose records will be examined were identified at random at this visit. It was noted that staff have undertaken relevant training courses over the past year. Courses included: First Aid, basic food hygiene, safeguarding adults, medication, skin care and core competencies in occupational therapy and physiotherapy. In respect of equalities issues it was further noted that two staff were trained in British Sign Language stage 1 to assist communication with deaf service users. Cooks had been trained in preparing cultural meals and special diets are catered for e.g. gluten free. It was disappointing to note that a requirement first made at the July 2005 inspection regarding dementia awareness training for all staff, had not been met. From staff training records and confirmation from staff themselves only four had done a two-day training course. Staff said that they had found the training useful. One staff member said that the course covered symptoms, behaviours and effect on families. The manager said that further training is planned but no dates were available. The requirement is therefore continued. Failure to meet it could lead to enforcement action being taken. South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff that are experienced and trained manage the service properly. Gaining and reporting on service user satisfaction levels ensures continuing improvements benefit them during their stay at the centre. Supervision recordkeeping doesn’t reflect that all staff opportunities to discuss and learn from their working practice. have regular Individual and centre records are not kept updated and in an orderly manner to ensure they are protected from harm. Inadequate fire safety recordkeeping raises concerns about service users’ safety in the event of a fire in the centre. South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 25 EVIDENCE: Both the acting manager Ms Sarah Stone who is registered with the Commission and the newly recruited permanent centre manager Ms Kate West, were available over both days of this inspection. Ms West was going through her induction period and Ms Stone was therefore assisting with day-to-day management of the centre. Both were welcoming and open to the inspection process. Ms West said that she had worked in various care settings over a number of years and had previously worked as a team leader in the Intermediate Care Service situated on the ground floor of the building. She has therefore, experience in community rehabilitation and resettlement. Ms West confirmed she was doing NVQ level 4 in management and would go on to do the registered managers award. She has a City and Guilds qualification in Community Care. Ms West confirmed that she would be making an application to the Commission to become the registered manager of the centre. Ms Stone gave information about quality assurance done at the centre. Every service user and their relative are given exit questionnaires to fill in when they leave. These had been seen at previous inspections. Ms Stone confirmed that the latest round of questionnaires had been filled in and entered on to a spreadsheet. They are awaiting collation from which an overall development plan will be prepared. Ms Stone was advised to send a copy of the report and plan to the inspector as soon as it is available. It was pleasing to note that copies of the team manager’s visits to the centre had been sent to the inspector before this visit. The visit records showed that service users had been able to comment on their experience of the service to the manager. This is good practice. It was disappointing to note that a good practice recommendation in respect of ensuring care staff have supervision at least six times a year that is recorded, had not been implemented. From all supervision records examined it was noted that some staff had four supervision records over the year. Others examined showed only one or two. It was however noted that records showed if staff were unavoidably absent or on annual leave and the manager said that there had been a problem with staff sickness that could have led to infrequent or missed supervision sessions. The manager confirmed that all staff had had their yearly performance review and that these were due for half yearly review shortly. Inadequate recordkeeping in respect of care plans and reviews and risk assessments has been noted elsewhere in this report. It was disappointing to South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 26 note that further inadequate recordkeeping existed in respect of fire safety. Staff training in fire safety was well documented. However records in respect of fire drills, testing of fire alarms and fire fighting equipment were not up to date. It was noted that the last recorded fire drill was in July 2005. Testing of fire fighting equipment had not been recorded since 28 October ’06. The fire alarm system had not been tested for nearly two weeks although it was tested on the second day of this inspection. The manager said that there had been minor incidents that had led to fire safety evacuations but could give no dates of these, neither were they recorded and no one else could confirm that they had been treated as drills. South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 2 3 1 South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Timescale for action The registered person shall after 20/12/06 consultation with the service user or a representative of the service user, prepare a written plan as to how the service user’s needs in respect of health and welfare are to be met. (Care plans for all service users in ‘safe haven’ and ‘step-down’ beds must be further developed to ensure meeting of assessed needs). The registered person shall keep the service user’s plan under review. (Care plans developed must be reviewed at regular intervals and records of such review kept). The registered person shall 20/12/06 ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (Manual handling risk assessments must be put in place where mobility issues are clearly identified). (Timescale not met from January ’06 inspection) DS0000037003.V319740.R01.S.doc Version 5.2 Page 29 Requirement 2. OP8 13(4)(b) South Bristol Rehabilitation Centre (Specific risk assessments in respect of falls must be put in place where this has been identified as an assessed need. All risk assessments must give clear details of actions to be taken to reduce the risk to service users). 18(1)(c)(i) The registered person shall 31/01/07 ensure that the persons employed to work at the centre receive training appropriate to the work they are to perform. (Training in Dementia awareness and care must be provided for all staff who have not already attended such training. Dates for the remainder of staff to attend such training must be sent to the Commission by the due date). (Timescale not met A person is not fit to manage a 20/12/06 care home unless s/he is fit to do so. (An application to become registered with The Commission for Social Care Inspection must be made so that fitness to manage can be determined). The registered person shall 20/12/06 ensure by means of fire drills and practices at suitable intervals that the persons working at the care home, and so far as is practicable, service users, are aware of the procedure to be followed in case of fire including the procedure for saving life. (Fire drills must take place at least twice a year and outcomes fully recorded). The registered person shall 20/12/06 maintain in the centre the DS0000037003.V319740.R01.S.doc Version 5.2 Page 30 3. OP30 from the January ‘06 inspection). 4. OP31 9(1) 5. OP38 23(4)(e) 6. OP38 17(2)(3) South Bristol Rehabilitation Centre records specified in Schedule 4. The registered person shall ensure that the records referred to in paragraph 2 above are kept up to date and are at all times available for inspection at the centre. (All records of fire safety testing and fire drills must be kept up to date to ensure service users are kept safe). RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP10 OP15 Good Practice Recommendations Service users should be addressed by the name they prefer at all times, including in care records. Service users should be consulted on the quality of meals provided and menus so that their needs for appetising meals of their choice can be met. South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI South Bristol Rehabilitation Centre DS0000037003.V319740.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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