Inspection on 26/06/07 for South Bristol Rehabilitation Centre

This inspection was carried out on 26th June 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

South Bristol Rehabilitation... 22/11/06

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 Unannounced Inspection 26th & 27th June 2007 09:00 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 DS0000037003.V337299.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. DS0000037003.V337299.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 Catherine West Care Home 20 Category(ies) of Physical disability (20) registration, with number of places DS0000037003.V337299.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 22nd November 2006 Brief Description of the Service: Bristol City Council Adult Community Care runs the service in partnership with the Bristol South & West Primary Care Trust. It’s based in the residential area of Knowle West. The centre gives short-term care and rehabilitation to up to 20 people aged over 45 years in the physical disability category. The aim is to give support and rehabilitation to people who need either specialist support or to be able to recover after illness or injury. A residential programme of care is provided over a period of eight weeks, although this can be extended if necessary. Of the twenty beds registered, three are used as safe haven beds. These enable care to be given to people who may be acutely 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 times. Seven other beds are for people discharged from hospital when they are fit enough but who cannot return home immediately for some reason e.g. if their home needs adaptation or they are waiting for care packages to be set up. People in these beds are expected to be largely independent with their personal care and to stay up to two weeks. Again this can be extended if necessary. The centre uses the first and second floors of a former older peoples home. It’s accessible for disabled people and has a number of aids adaptations. The staff team includes a nurse, occupational therapist physiotherapist, together with rehabilitation workers, health and social assistants, administrator, cooks, domestic staff and a handyperson. care and and care No fee is payable for the first eight weeks of the service. Thereafter fees of £308 per week (for rehabilitation) and £460 for the other seven beds are applied. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local DS0000037003.V337299.R01.S.doc Version 5.2 Page 5 Authority fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk DS0000037003.V337299.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one and half days. Five people using the service and one relative were spoken with in depth. Nine people and one relative filled in surveys before the visit so that we could find out what people thought of the service. The manager was welcoming and open and gave lots of information about progress since the last inspection. A number of staff were spoken with and a range of records was looked at. These included assessment and care records, together with complaints, training records, quality assurance and fire safety records. What the service does well: What has improved since the last inspection? All requirements made at the last visit were met. These included: Care plans are now in place for each person and are regularly reviewed. People using the service were aware of their plans and had signed them. Staff are now more aware of peoples individual needs and how to meet them. Each person now has a moving and handling risk assessment that shows whether there is any difficulty with mobility and what help they may need with it. Further, risk assessments for specific matters e.g. falls were also being put in place to make sure people are protected from risk of harm. A requirement about training for staff in dementia awareness and care that had not been met at the previous visit in November 2006 was now almost fully met. Staff confirmed that they had done the training and a list of sessions was seen. Properly trained staff help make sure the needs of people with dementia are understood and met. The centre now has a permanent manager, Mrs Catherine West, who is registered with The Commission for Social Care Inspection. Mrs West was able to show that she had picked up the needs of people using the service and staff DS0000037003.V337299.R01.S.doc Version 5.2 Page 7 and was working to improve both the meeting of peoples needs and staff morale. Two fire drills had happened since the last inspection, one of which was witnessed by the inspector at this visit. Both drills were recorded properly and showed how people using the service were kept safe in the event of a possible fire. Two good practice recommendations had been adopted: People using the service confirmed that staff were using their preferred name and this was also seen in records. This shows respect for the person and helps them feel more at ease. People using the service had been asked about the meals they would like to have and this had led to greater choice being offered at each meal. The quality of meals is fed back from questionnaires given to people when they return home. From comments given improvements will be made as and when necessary. 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. The summary of this inspection report can be made available in other formats on request. DS0000037003.V337299.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 DS0000037003.V337299.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, 2, 3 & 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Continuing work to improve information given to people when they come into the centre helps them understand the nature of the service and what their rights and responsibilities are. However the Statement of Purpose doesn’t make sure how people with different needs or from different backgrounds get the information they need. Information about fees helps people using the service be clear about what they may have to pay. Clear assessments show needs to be met and cover all aspects of care for each person. Specialist needs are picked up and met as far as possible. However equalities and diversity issues aren’t fully addressed to make sure people using the service aren’t discriminated against. EVIDENCE: DS0000037003.V337299.R01.S.doc Version 5.2 Page 10 The Centre’s Statement of Purpose was in the process of being amended at the time of this visit. A copy was given to the inspector. The Statement meets all elements of the Care Homes Regulations and its aims and objectives were clearly set out. The conditions of registration were checked and found not to have changed. The Statement had been amended to include full details of the responsible individual (the person that has overall responsibility for the service and to whom inspection reports are sent) and the newly registered manager. Further amendments included information about the seven beds (that are not used for rehabilitation) with an explanation of reasons for admission to these beds. However the Statement doesn’t include information about equalities and diversity (responding to needs of people that may be disabled or of different gender, sexuality, or from different backgrounds and cultures), that may make people from these groups feel more comfortable about using the service. (Please also see Standard 16 for more about this). The service users guide had also been amended. A copy of this is kept in each person’s room for them to read if they wish. The guide includes: A summary of the Statement of Purpose Terms and conditions of each person’s stay Details of fees and payments and how these are calculated A copy of the contract where necessary A copy of the complaints procedure that includes the Commission’s address and telephone number. Further amendments were needed to both the Statement of Purpose and service users guide and the manager was in the process of finishing these. These included information about what’s not included in the fee and review of fire safety procedures to be put in after the manager attends training on the new fire safety regulations. From comments made by people that had left the service following a stay at the centre, the manager had picked up a regular trend showing that people aren’t given enough information before admission about their stay at the centre and what that fully involved. From these comments the manager had drawn up an action plan e.g. to adapt the current intermediate care service information leaflet to include better information about the rehabilitation centre, to make this available in hospital wards and to be discussed with senior ward staff/discharge liaison teams. This will make sure staff are aware of their responsibility to discuss the service with people being considered for referral to the centre before the assessment is done. DS0000037003.V337299.R01.S.doc Version 5.2 Page 11 Different fees are payable depending on what type of service people are admitted for. For rehabilitation and the seven other beds different fees are payable i.e. for rehabilitation the total fee is £308 per week and for the others it’s £460 per week (in line with local authority care homes fees). Fees apply after the 56th day of a person’s stay, when people using the service have to have a financial assessment done by the council’s customer liaison team. The manager said that staff at the centre aren’t involved in this and don’t get copies of individual contracts. However copies of short-stay contracts were seen in individual peoples rooms. For ‘safe haven’ beds no fees are payable as they are used to give short-term intensive support to enable people to return home quickly. Different people do care assessments. Some assessments seen were done by social workers, some done by the intermediate care service’s social worker and some by the rapid emergency assessment care team (REACT). Assessments were detailed and included all information needed to make sure peoples needs could be met. The assessments seen confirmed all that people spoken with had said about their reasons for admission and the needs they had. Individual assessments also included information about age, disability, gender, ethnicity, culture and religion and any specific needs arising from them. However not all equalities and diversity issues such as sexuality are routinely picked up as part of the assessment process. The manager said that she had been made aware that people using the service are not comfortable about being asked personal questions about their sexuality. However she agreed that assessments could be used to capture this information. Staff have training about equalities issues and those spoken with said that they had attended or had sessions planned. One person using the service had filled in a survey we sent out before this inspection and commented: ‘Attitudes are generally kind and without prejudices’. The centre is run to help people with more specialist needs e.g. for intensive physiotherapy or those who need an occupational therapy assessment before they can return home. Rehabilitation workers are trained to a higher level than care staff and also do training in rehabilitation competencies such as physiotherapy and occupational therapy. This enables them to work with people following a course of exercises to help them regain skills and independence. Care records clearly showed how people were being helped by this intensive work and people spoken with confirmed this. DS0000037003.V337299.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 good. This judgement has been made using available evidence including a visit to this service. Better care planning makes sure each person’s needs are picked up and met. However different care plan formats and the focus on rehabilitation means that not all care needs may be picked up. People who use services are looked after well in respect of their healthcare and medication needs. Being treated with dignity and respect makes people using the service feel valued as individuals. EVIDENCE: DS0000037003.V337299.R01.S.doc Version 5.2 Page 13 The manager said that a new dependency scoring system was being used to decide how much care people need on a daily basis and to decide the numbers of staff needed. Dependency is worked out on admission by means of a detailed questionnaire filled in by staff and discussed with the manager who decides the initial score. A daily checklist is then used. This includes: Eating and drinking Washing and dressing Toilet and continence Emotional and mental health needs Medication Rehabilitation needs Mobility and transfers Social needs Any other matter not covered above. From the checklist, scores against each heading are worked out according to how much time staff spend helping people e.g. no help needed, 15 minutes, 15-30 minutes etc. Scores are then added up to a possible total of 30. The tool therefore shows daily care needs and whether the care they get is helping them improve. Staff spoken with had some comments about timing e.g. when the checklist is filled in, but overall felt was positive and clearly showed improvements or deterioration in a person’s condition. A requirement made at the last inspection about making sure care plans are put in place for each person in the centre had been met. Care plans were seen for each person in a ‘safe haven’ bed. Some people had centre care plans and nursing ones - for medical issues. Care plans included all the headings as above in the dependency checklist. They also included help with daily living tasks, religious and cultural needs if applicable and nutritional needs e.g. for people on special diets or who were vegetarian. The plans also included peoples comments and they had signed them. The plans were written from the person’s own perspective. However care plans weren’t consistently written and it was difficult to work out what they were because they had different names e.g. ‘forward planning meeting’ or ‘weekly review sheet’. One person had an action plan that was done by the occupational therapist but this was for occupational therapy needs only. Further, because of the different plans seen it wasn’t always clear if all needs were being picked up although those seen did match the original assessments and people confirmed the actions being taken. People using the service benefit from having their healthcare needs met by a team of staff that includes a nurse, physiotherapist and occupational therapist, DS0000037003.V337299.R01.S.doc Version 5.2 Page 14 plus a pharmacist and rapid response team from the intermediate care service based on the ground floor of the building. Healthcare records included nursing care plans, wound evaluation assessments and pressure area care. A nursing care plan was seen for use of Warfarin, a blood thinning medication. The plan was detailed and showed clear evidence of blood testing with results that led to frequent changes of dose. A ‘wound evaluation assessment’ (that shows type, extent and progress of wounds on the body) clearly showed the progress and improvement of a leg wound with evidence of healing. The nurse and rapid response team liaise with GPs who visit when needed. Outpatient appointments are arranged and transport organised. Medication is dealt with separately for each person and they keep their own in their rooms in locked drawers. Some people are able to handle their own medication and this was seen on care plans. Risk assessments are in place for this. Some people were having medicines given by the rapid response team. The manager said that the only time rehabilitation staff give medication is when the out of hours team are out of the building at night. Otherwise staff prompt or assist people only. Medication charts were seen in individual files and were all properly filled in. Medications given at different times were signed for and the time given written on the sheet. The centre has a proper locked medications cupboard for controlled drugs. However this was almost empty and only held some antibiotics and medications of a person who had gone home. Medications fridges are kept on each floor of the centre. These are kept locked. Temperatures are recorded daily with a minimum/maximum thermometer. These were well within normal range (between 2°c - 5°c) for each fridge. The inspector was given a copy of a newly developed intermediate care medication policy that’s comprehensive and detailed. The policy clearly sets out the responsibilities for medication giving, assisting and prompting and in what circumstances. The intermediate care service pharmacist and managers have developed the policy and the Commission’s own pharmacy inspector had been consulted on it. From our surveys people commented: ‘I don’t need medical support. I do it myself and I do what the doctor tells me’ and: ‘they look after my medicine very well’. People spoken with and from surveys received before the visit confirmed that privacy and dignity is respected. Staff were observed knocking on doors and waiting to be invited in. A good practice recommendation made at the last visit had been adopted: people using the service confirmed the names they wanted to be addressed by and that staff used these names. Evidence was seen in individual files and on a notice board in the manager’s office. DS0000037003.V337299.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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Adequate opportunities for social activity and access to the local community stops people using the service from getting bored or frustrated. Improvement in meal choices helps people get the meals they like. EVIDENCE: Activities and social outings aren’t put on, as they would be in a care home, because the focus is on helping people return to fitness so that they can go home. The centre’s Statement of Purpose states what is available e.g. television in all bedrooms, radio, videos and DVD’s available together with books and magazines. Comments from our surveys about activities were largely positive: ‘I’m going to the gym this afternoon to do a few exercises & then we’ll play a few games afterwards.’ ‘I go to the gym once or twice a week but that’s it.’ ‘I’ve been once but never since, but I could if I wanted to.’ ‘I like to watch my TV. They do have skittles & games here & I do exercising.’ DS0000037003.V337299.R01.S.doc Version 5.2 Page 16 ‘There are various things to do, I’ve just come back from doing my physio’. Those people spoken with at the visit were also positive about activities: ‘ I don’t do anything really, I spend the day in my room watching TV and reading but I don’t really get bored’ although one person with limited mobility admitted to being bored because s/he couldn’t do very much. A good range of books, DVD’s and videos is available and people said they enjoyed the exercise group that meets weekly. Each room has its own TV. A payphone is available for use or people can bring in their own mobiles. For those that are independent and mobile there are shops close by that includes a general store and fish and chip shop. However if staff are needed to go with a person to make sure they are safe, this may limit opportunities for them to go out because there may not be enough staff on duty. The Statement of Purpose also gives information about religious needs and how these can be met. There is a Church of England church immediately opposite the centre and on Sundays members of the church will call at the centre to escort any person who would like to attend a service. If people are fit enough, relatives are able to take them to their own place of worship. If a person isn’t able to go out and wishes to see a religious leader of their choice, arrangements can be made for this. To the question from our survey: ‘Do you like the meals at the home?’ all answers were positive. Comments included: ‘It’s lovely food’, ‘very good food’, ‘It’s really good’, ‘they are always pretty good’ and: ‘the meals are very nice’. A good practice recommendation made at the last visit in November 2006 had been adopted. The inspector had lunch with two people using the service and both said they enjoyed the food. The quality of the hot meal (of faggots, potatoes and vegetables) was good and it was hot and tasty. A third choice (of salad) was now being offered that both people chose for the meal that day. However they did comment that sometimes portions were too large. This was also commented on in answers to questionnaires done by people that had gone home after a stay at the centre. Comments were mostly positive although some people thought there was ‘too much food’ and had comments about the timing of supper and different varieties of tea-time sandwiches. The manager was able to show what actions were being put in place to improve this i.e. menu choice sheet to be updated to tell cooks what portion size individuals want in relation to meals, whether hot meal or salad and: cooks to be given copy of questionnaires that people fill in after having been in the centre for week, re what they feel about food offered and their specific choices. Also Rehab workers are to discuss food choices/preferences with individuals as part of the care plan. This is good practice. DS0000037003.V337299.R01.S.doc Version 5.2 Page 17 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. Satisfactory complaints management and recording ensures people using the service can feel confident in raising concerns about any aspect of their care. However lack of information in suitable formats may disadvantage blind or sight impaired people. Good arrangements for protecting people who use services makes sure that they are protected from risk or harm as far as possible. EVIDENCE: The Statement of Purpose includes details of the complaints procedure used. This follows Bristol City Council’s policy. Leaflets about it were also seen in each person’s room. Details about being able to contact the Commission were included in the statement although not in individual leaflets. The statement says that people are informed of their right to complain on admission. However no information is given about making sure the complaints leaflet is available in different formats e.g. for people who are blind or have impaired sight. Three people spoken with at this visit gave mixed responses to our question about complaints. One person said s/he was aware of the complaints leaflet and would be confident if s/he needed to complain about anything. DS0000037003.V337299.R01.S.doc Version 5.2 Page 18 Another person who had a sight impairment couldn’t read the leaflet but would ‘speak to the manager If I was unhappy about something’ and the third person said that no-one had spoken to her/him about making a complaint and s/he wouldn’t know who to speak to. However s/he said s/he had ‘no cause for complaint’. From our survey in answer to the question: ‘Do you know how to make a complaint?’ each person said ‘always’ and also that they knew who to speak to if they’re not happy. Comments included: ‘I’d be happy to make one if I needed to & the leaflet is on the back of my door’ and: ‘I would know how to make one & I’ve read all the leaflets’. However a couple of answers showed that not everyone was aware of or had read the information: ‘I would be confident in making a complaint but I’ve not seen the leaflet’, and: ‘yes, but I haven’t seen the leaflet’. The complaints file was looked at but no new complaints had been recorded since the last inspection. A file of positive comments was seen that included seven letters or cards praising the centre and the care given to people. Information about alleged abuse issues affecting vulnerable people had been sent to the Commission. Staff at the centre had properly dealt with two incidents (although the alleged abuse had happened before people had arrived). The manager was able to give clear information about how people were protected. This had led to satisfactory outcomes for both themselves and other people using the service who could have been at risk. All staff spoken with said they had done safeguarding adults from abuse training and had each been given a copy of Bristol City Council’s version of the Department of Health guidance ‘No Secrets’. Records showed training dates for individual staff that had happened since the last inspection. Staff were clear about their responsibilities in making sure people using the service are kept safe from abuse or risk of it happening to them. DS0000037003.V337299.R01.S.doc Version 5.2 Page 19 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. People using the service benefit from living in a comfortable, clean, safe standard of accommodation that is well decorated and maintained, physically accessible and meets their needs. EVIDENCE: All areas of the centre were exceptionally clean at this visit and staff were seen cleaning bedrooms and communal areas. Toilets and bathrooms were clean and hygienic and the whole centre smelled fresh and pleasant. To the question from our survey: ‘Is the home fresh & clean?’ all said ‘always’. Comments about the environment included: ‘I like my room very much’, ‘It’s spotless here’ and: ‘It’s always kept nice’. As the premises had been used as a residential care home before, the rooms had been kept homely with different wallpapers and furniture that avoids the DS0000037003.V337299.R01.S.doc Version 5.2 Page 20 feeling of an ‘institution’. From the centre’s own questionnaire that people had filled in one person had said: ‘thought it was another kind of hospital and was surprised how nice it was’. The manager said that some changes to the physical environment had been made since the last inspection and others are planned. It was pleasing to note that a bid for a grant of £10,000 from the Department of Health to improve the centre premises had been successful. The manager said this would be used to make the centre more accessible for people with sensory impairments (hearing and sight) and to improve facilities for visitors so that they can make drinks and be with their relatives more comfortably. Changes already made included: increasing the number of bathrooms to make one wheelchair accessible and to include walk in showers, as well as making toilets more accessible for disabled people and decorating two bedrooms throughout. A phone line has also been put in between the office and the kitchen so that peoples dietary needs and preferences can be quickly given to the cook. All staff are trained in infection control and there are policies on this and Control of Substances Hazardous to Health. No harmful substances were seen around the centre that could cause harm to people using the service. DS0000037003.V337299.R01.S.doc Version 5.2 Page 21 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): 27,28,29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient numbers of care staff are employed to make sure peoples’ needs are met. Proper staffing checks make sure people who use services are kept safe from risk of harm or abuse. People who use services’ benefit from a well trained and qualified staff group that are able to meet their needs. EVIDENCE: It was pleasing to find that the atmosphere in the centre had improved since recent inspections. The manager and staff commented on this and said that the use of the new dependency tool had helped with making sure staffing levels are able to meet peoples needs. More staff including health and social care assistants are being taken on and at this visit there were enough staff to care for the fourteen people currently staying at the centre. The maximum number of people that can be cared for is 20. For this number four staff were available during the day and three during the evening with two night staff. DS0000037003.V337299.R01.S.doc Version 5.2 Page 22 From our survey a comment was made: ‘Staff are kind, understanding and patient. They don’t complain about being called at any time of the day or night. The physiotherapy is consistent and the atmosphere gives the feeling that the aim of the care is geared to getting you back home and independent’. From the answers to the centre’s exit questionnaires similar comments were seen: ‘they have been excellent here. It has been marvellous. I don’t think we can change anything. Nothing too much trouble’, ‘all the staff were very helpful. I couldn’t grumble at anybody’ and: ‘ I was very well looked after during my stay. I would like to thank everybody who works here’. The centre has already met the recommended minimum number of staff trained to National Vocational Qualification in Care Level 2 or equivalent. Rehabilitation workers are trained to Level 3. Newly recruited health and social care assistants are starting to do Level 2 and some already have it. The range of staff training done this year was good. Training already done included: First Aid – two staff in June and a further two in October ‘07 Safeguarding Adults – three staff in April and a further one person in November ‘07 Oral health – four staff in January ‘07 The new medication policy – eleven staff in April ‘07 Medication – three staff in March ’07 and seven staff also did Controlled medication in the same month. Control of Substances Hazardous to Health – nine staff did this training in May ’07. Since the last inspection a requirement about dementia awareness and care training was met. Between November ’06 and May ’07 twelve staff had done a mixture of in-house training from the intermediate care service community mental health nurse or the city council’s training department. For this training spaces are limited to two people per course and remaining staff are to be booked on future sessions. Staff confirmed that they had done the training and found it helpful. They also said they had done other training such as equalities and moving and handling. Future courses to be run also included respiratory skills and basic food hygiene. An inspection of the City Council’s (Adult Community Care) personnel department was done in March ’07. A sample of staff files were looked at. It had been found that one rehabilitation worker had no valid Criminal Records Bureau disclosure on file at the personnel department offices. However the manager was able to show clear evidence that a disclosure had been done with the issue date and disclosure number. DS0000037003.V337299.R01.S.doc Version 5.2 Page 23 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, & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A trained and experienced manager who understands peoples needs and the inspection process provides good, supportive management. Suitable ways of making sure people who use services can comment about life in the centre enables them to be sure their views and opinions will be taken and acted upon. The health and safety of people using the service is promoted by clear policies and procedures that keep them safe. EVIDENCE: DS0000037003.V337299.R01.S.doc Version 5.2 Page 24 The appointment of a permanent manager, Mrs Catherine West and her registration with the Commission gives a feeling of permanency to staff and has enabled her to focus on areas that need work and change. Mrs West was able to show that she has picked up the main issues that need to be worked on and it was pleasing to note that all requirements from the last inspection had been met and good practice recommendations had been adopted. Staff spoken with made positive comments about Mrs West’s management style and said that they feel supported and can go to her about anything. Mrs West is trained in City and Guilds Community Care (to the equivalent of National Vocational Qualification in Care Level 4) and showed evidence of having done a wide range of management courses. Further she has done essential training such as safeguarding adults (with yearly updates), administration and control of medicines, dementia, mental health, First Aid, complaints and managing staff. When speaking with people using the service during this inspection, they were not always clear who the manager is. Ms West was advised to make time to meet with people and discuss their stay, noting any comments or concerns that could form part of the internal monitoring of quality. As reported above the centre uses a system to find out the quality of the service it provides. This is done by giving people and their relatives ‘exit’ questionnaires when they leave. At the time of this visit the completed questionnaires dating from October ’06 hadn’t been looked at or worked on. However immediately following the inspection the manager did this and wrote to us on 3rd July with outcomes and an action plan. This is commended. Comments from this have been used throughout this report. The manager said that an independent firm of quality assurance assessors would be visiting the centre to carry out a yearly survey later in the year. A service delivery development plan for the centre was also seen but this didn’t reflect aims and outcomes for people using the service. A requirement about fire drills made at the last inspection had been met. A planned fire drill had been done in May’07 and comments had been written up. An unplanned one took place at this visit when the alarm was set off. This was managed quickly and calmly and people using the service were reassured and well looked after. The drill was written up by the second day of inspection. The manager also said that there had been two previous alarms that had been treated as drills but neither had been written up. Regular Fire safety training was recorded – five staff did the training in March ’07. New staff and agency staff are given fire safety induction and this is DS0000037003.V337299.R01.S.doc Version 5.2 Page 25 recorded. Fire alarms and equipment is tested every week and recorded. The last fire safety officer visit was done in December 2005 and no recommendations made. The fire safety risk assessment was seen but this wasn’t dated. It showed evidence of updating but it wasn’t clear when this had happened. The manager said she would be attending training on the new Regulatory Reform Order that replaces fire safety legislation later in the year. DS0000037003.V337299.R01.S.doc Version 5.2 Page 26 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 2 3 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X X X 3 DS0000037003.V337299.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP4 Good Practice Recommendations A way of properly monitoring equalities issues must be found and information about it put into the Statement of Purpose. This will make sure that people from different equalities groups can be confident their needs will be met and that they will not be discriminated against. All care plans should be in a form that is clear and easy to recognise and should include all care needs, not just rehabilitation ones. This will make sure that clearly identifiable care plans show that peoples physical, emotional and social needs will be picked up as well as their rehabilitation ones. Information about complaints should be made accessible to people that are blind or sight impaired so that they have the same rights as others. Information about this should be included in the Statement of Purpose. 2. OP7 3. OP16 DS0000037003.V337299.R01.S.doc Version 5.2 Page 28 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. 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