CARE HOMES FOR OLDER PEOPLE
South Bristol Rehabilitation Centre 30 Inns Court Green Knowle Bristol BS4 1TF Lead Inspector
Sandra Garrett Unannounced Inspection 09:30 5th January 2006 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.V274944.R01.S.doc Version 5.1 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.V274944.R01.S.doc Version 5.1 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 Susan Ann Moore Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability (2) of places South Bristol Rehabilitation Centre DS0000037003.V274944.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. May accommodate 2 persons over 50 years with a Physical Disability Date of last inspection 5th July 2005 Brief Description of the Service: Bristol City Council Social Services and Health operate South Bristol Rehabilitation Centre based in the area of Knowle West (hereafter referred to as the Knowle West site), in conjunction with Bristol South & West Primary Care Trust. It provides short-term care and rehabilitation for up to 18 people who are 65 years and over. The centre can also provide support and care for two persons aged over 50 in the physical disability category. The aim is to give support and rehabilitation to older 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 second and third floors of a former older persons care home. It is therefore accessible and has a number of aids and adaptations. South Bristol Rehabilitation Centre has also recently taken over management of a separate six-bedded unit contained within Bowmead older persons’ care home, based in the residential area of Stockwood (hereafter referred to as the Stockwood site), that provides short-term care for older people who cannot return home from hospital immediately or who require respite care. Therefore it will be registered in its own right although managed and staffed from the Knowle West site. A request to take over management of the site has been applied for and is being considered by the Commission. Further the issue of use of all the beds at both sites in respect of age range and types of admission will be discussed directly with the Responsible Individual. South Bristol Rehabilitation Centre DS0000037003.V274944.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a dual inspection that focussed on both the Knowle West site that was last inspected in July ’05 and the recently acquired beds at the Stockwood site. These provide short-term care for up to six older people who don’t need full rehabilitation. This site had its first inspection since South Bristol Rehabilitation Centre took over management of it, in October ’05. Requirements and recommendations from both services will therefore be combined in this and future reports. Six service users were staying at the Knowle West site and six at the Stockwood site during the inspection that took place over two days. Several service users were spoken with and all praised the service they receive. A wide range of records was examined including care files, risk assessments, medication and complaints. What the service does well: What has improved since the last inspection?
Several requirements made at each site were met at these visits. These included: South Bristol Rehabilitation Centre DS0000037003.V274944.R01.S.doc Version 5.1 Page 6 Recruitment has proved an issue to be overcome and no new permanent rehabilitation or care staff have been recruited at either site since the last inspections. However clear personnel files of all agency workers provided for the Stockwood site showed that Criminal Records Bureau checks had been obtained to ensure service users are protected from harm. A requirement made at the inspection of the Stockwood site in October ‘05 to ensure visitors are made aware of the entry to the unit and its location within the care home, was met. Signs to direct visitors, a call system at the entrance to the home and a separate visitors book were all seen in use at the visit on 9 January ’06. A requirement to ensure appropriate numbers of experienced staff available to meet service users’ needs at the Stockwood site, was met. Whilst only one trained member of staff is on duty at any time, service users’ dependency levels are monitored to ensure that the number of staff is appropriate to meet their needs. Should service users’ needs change, swift action is taken to provide more staffing. A requirement to assess the safety of the lift at the Knowle West site had been met. Records of visits by lift engineers and an order to have the lift replaced in April ’06 were seen, that ensure service users will be protected from risk of harm when using it. A requirement made to ensure that any event adversely affecting service users at both the Knowle West and Stockwood sites is notified to Commission for Social Care Inspection, was met. Prompt reporting of accidents and events ensures that the Commission is made aware of actions taken to protect service users from harm. A requirement in respect of service user risk assessments being put in place if needed was met at both sites. Specific risk assessments, particularly in respect of falls showed clear actions to be taken to reduce the risks for service users involved. It was pleasing to note a number of good practice recommendations made at the July and October visits had been implemented. These included at the Stockwood site: making menus available for service users to see, enabling staff to take meal breaks, providing staff that are trained to NVQ level 2 and regular management visits to the site. At the Knowle West site one recommendation in respect of enabling service users to have full choice had been implemented. What they could do better:
A number of requirements made at both the Knowle West and Stockwood sites had not been met since the last inspections. These included:
South Bristol Rehabilitation Centre DS0000037003.V274944.R01.S.doc Version 5.1 Page 7 At the Knowle West site: It was noted work had been carried out to make sure radiators were covered to prevent risk of burns if service users fell against them. However some remained outstanding and the requirement is carried forward. Training for staff in dementia awareness and care had not been planned or carried out since the July ’05 inspection. Specific needs of service users with dementia may not be fully met if staff do not have training to help them identify these. The requirement is therefore carried forward. Two new good practice recommendations were made at the Knowle West site. One was to ensure staff are given supervision at least six times yearly so that service users receive a consistent approach to their care by having trained, experienced and supervised staff. The other was to ensure progress records positively reflect service users whole experiences in respect of maintaining a good quality of life whilst they stay there. At the Stockwood Site: The Statement of Purpose and Service Users Guide developed by the care home when it was running the site had not been replaced to reflect the new situation. Service users therefore may not be aware of their rights and responsibilities and the service provided by South Bristol Rehabilitation Centre. Attention is needed to make sure the Rehabilitation Centre documents are amended to include the new situation and are put in place at the Stockwood site. The requirement is therefore carried forward. A requirement to make sure staff working at the Stockwood site had training in medication administration was not met. An immediate requirement was made to ensure service users are protected from risk of harm. Whilst a requirement to carry out needs assessments by suitably qualified staff was met, those seen didn’t reflect the nature of service users needs. A new requirement is therefore made to ensure that health and personal care needs are identified prior to admission to the site, so that service users can be confident these will be met. A requirement in respect of developing care plans for each service user staying in either site was not met. Whilst the majority of the six service users staying at the Knowle West site had care plans in place, no plan was seen for service users in ‘safe haven’ beds. (Safe Haven beds are used for service users who need short-term respite or care but don’t require hospitalisation). The situation was replicated at the Stockwood site following a requirement made at the October ’05 visit. The requirement overall is therefore carried forward so that service users can be confident their assessed needs will be addressed and met. South Bristol Rehabilitation Centre DS0000037003.V274944.R01.S.doc Version 5.1 Page 8 It is very clear from this inspection that the two sites are not operating as one entity. This needs to be addressed urgently in consultation with Commission for Social Care Inspection. 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. South Bristol Rehabilitation Centre DS0000037003.V274944.R01.S.doc Version 5.1 Page 9 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.V274944.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Service users are not currently given the information they need about the service available to them. Attention must be given to ensuring clear needs assessments are carried out prior to admission, as service users cannot be confident that their needs will be met. EVIDENCE: From previous visits it was noted that much work had been carried out on the rehabilitation centre’s Statement of Purpose/Service Users Guide. These are comprehensive documents that give service users lots of information about the service available and their rights and responsibilities. From the first visit to the Stockwood site in October ’05 a requirement had been made in respect of changing the original Statement of Purpose/Service Users Guide (put in place when it was part of the care home), to reflect the new situation. It was disappointing to note at the visit on 9 January ‘06 that service users didn’t have access to the Guide nor was a Statement of Purpose available. South Bristol Rehabilitation Centre DS0000037003.V274944.R01.S.doc Version 5.1 Page 11 The acting manager said that both were in the process of being amended to ensure they fit with the South Bristol Rehabilitation Centre documents. The requirement is therefore carried forward with a short timescale. From records seen at this and previous visits the Knowle West site is able to demonstrate that clear pre-admission assessments are carried out before service users are admitted. Lots of information was seen including hospital discharge information, nursing care plans and an ‘overview of assessment’ carried out by the centre’s assessment team. It was noted that the centre now has responsibility for managing ‘safe haven’ beds that were previously contained within local authority care homes. These enable older people who may be unwell yet don’t require hospitalization, to get short-term care until they recover. However it was noted that for one service user being cared for in this way, no needs assessment had been done prior to or at the point of admission to the centre. This made it difficult to check how her/his needs were identified or being met and staff commented that they had to rely on verbal information being cascaded down to them. This is not good practice and cannot fulfil the aim of rehabilitation. Further, a requirement made at the Stockwood site in October ’05 also in respect of this was not met. Overview assessment sheets were seen. However the information seen in them was brief and gave no clear indication of assessed needs, that the rehabilitation worker had identified from discussion with the service user. The requirement is therefore carried forward with a short timescale. South Bristol Rehabilitation Centre DS0000037003.V274944.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Although service users are looked after well in respect of health and personal care and their privacy and dignity respected, inconsistencies in care recording may put them at risk and their needs may not be met. Attention is needed to ensure service users medication needs are met by appropriately trained staff. EVIDENCE: Care records at the Knowle West site were in the main clear, comprehensive and detailed at this visit. Records included: Manual handling risk assessments, overview of assessed needs, action plan with goals and outcomes, nursing care plans that covered medication and wound care, physiotherapy exercise sheets and occupational therapy assessments i.e. for using a kitchen and preparing own meals. A service user spoken with confirmed that the care plan had been discussed with her/him, that s/he had involvement with the process all the way through and found it ‘enjoyable’. The service user went on to say that following the rehabilitation plan and treatment s/he could now see ‘light at the end of the tunnel’ in respect of a return to fitness and going home. This is commended. South Bristol Rehabilitation Centre DS0000037003.V274944.R01.S.doc Version 5.1 Page 13 However the second inspector attending at this visit reviewed care records of service users in safe haven or ‘assessment’ beds on the first floor. It was not clear what this meant. The situation here was very different and was inconsistent with the clear service user records seen on the second floor. It was noted that for one service user no assessment information or care plan was in place. Staff said that they had to rely on information being ‘cascaded’ down to them verbally that made it difficult to check what may have occurred when they were off duty for any length of time. Further, the service user clearly had mobility issues that placed her/him at risk yet no manual handling risk assessment was in place for staff to be able to check what needed to happen when assisting with mobility. Following a requirement made at the Stockwood site during the October ’05 visit, new care plans were seen in the process of being drafted at the visit on 9 January ’06. However these lacked actions and outcomes to meet service users needs. The rehabilitation worker was advised on how to ensure the plans identify needs, give clear actions and show outcomes. Service users at the Knowle West site benefit from a variety of regular healthcare interventions and a GP was seen visiting there at this visit. A new locum physiotherapist was seen and the centre has its own gym so that service users can have daily treatments and exercises. Nurses from the Rapid Response team are available to ensure appropriate healthcare measures are put in place for service users where necessary. The second inspector carried out a check of medications and found records were consistently kept. Medication records had been documented clearly and continuity of administration was evident. The Intermediate Care Service pharmacist had given training to all Knowle West site staff about correct documentation of controlled medication. Further training is planned during January ’06. However a requirement made at the Stockwood site in respect of medications training was not met. Staff working alone there had not had training in medication administration. Therefore the capacity for error could be greater by having untrained personnel, placing service users at risk. An immediate requirement was made to ensure that any staff member working alone in the site undertakes medications training from an accredited trainer. It was pleasing to note that certificates of attendance at a training course in the subject on 11 January ’06 were sent to the Commission in respect of four staff. The requirement was therefore met in within the short timescale allotted. Service users commented to both inspectors that staff respect their privacy and dignity at all times. This is commended. South Bristol Rehabilitation Centre DS0000037003.V274944.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 & 15 Service users benefit from good quality meals that offer choice and meet their needs. Attention is needed to ensure that menu choices are made available to all service users. EVIDENCE: Service users at the Knowle West site made positive comments to inspectors about meals and the choices available to them. The rehabilitation worker on duty at the Stockwood site said that menu choices for the day are given to each service user every morning so that they can choose what meal to have. However it was disappointing to note that a good practice recommendation made at the October visit had not been implemented at the Stockwood site. This was in respect of ensuring the weekly menu is displayed in the service users’ dining room so that they can see what is on offer for the week. The worker said that a copy would be copied and put up on the notice board immediately. South Bristol Rehabilitation Centre DS0000037003.V274944.R01.S.doc Version 5.1 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18 Attention is needed to ensure service users are made aware of how to raise concerns about any aspect of their care. Service users can be confident that staff are satisfactorily trained in making sure they are safeguarded from abuse. EVIDENCE: No new complaints had been received at the Knowle West site since the last visit. An ongoing complaint had just been concluded with clear actions and timescales documented. Complaints leaflets were seen in individual service users rooms at the centre and one service user said s/he was made aware of how to make a complaint as soon as s/he arrived. This is good practice. However a requirement made at the Stockwood site in October ’05 was only partly met. Whilst a clear complaints procedure and system had been put in place, service users had not been given copies of the Social Services and Health complaints leaflet that includes details of the Commission for Social Care Inspection and how to make a complaint. It was agreed that a copy of the leaflet would be obtained and photocopied for each service user. Staff spoken with at the Knowle West site confirmed that they had done safeguarding Adults training and demonstrated good understanding of abuse and how to recognise/report it. South Bristol Rehabilitation Centre DS0000037003.V274944.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21,24 & 26 A good standard of the environment in both the Knowle West and Stockwood sites provide service users with attractive and homely places to stay that are clean and hygienic. Attention continues to be needed to ensure service users are protected from risk in respect of hot radiators. EVIDENCE: The standard of environment in both sites were noted to be very clean and homely with traditional yet fresh décor. At the Knowle West site many areas had been personalised in some way with ornaments, pictures and plants. Several of the domestic staff were seen cleaning all parts of the centre during this visit and the carpeting in one corridor had just been shampooed. Service users spoken with said they were pleased with the standard of accommodation. South Bristol Rehabilitation Centre DS0000037003.V274944.R01.S.doc Version 5.1 Page 17 Toilets and bathrooms seen were clean with toilet rolls, soap, paper towels and a bin in each. Toilets had been made as accessible as possible with grab rails and raised toilet seats, plus the emergency call system. A recently adapted toilet for disabled people was seen and was spacious enough for a wide turning circle for wheelchair users. Bathrooms also had equipment to assist service users in and out of the bath and were clean and uncluttered. However a requirement made at the last two inspections in respect of ensuring all radiators at the Knowle West site were covered, was still only partly met. A large, old-fashioned heated towel rail that included a radiator within it that wasn’t covered was seen in one of the bathrooms. It wasn’t clear if this was ever in use. The second inspector noted the radiator in the hairdressing room also wasn’t covered. This requirement is therefore continued with a short timescale. Failure to meet the requirement could lead to enforcement action. Both sites smelled fresh and pleasant, and cleaning facilities were seen throughout. At the Knowle West site a laundry room is situated on the ground floor and staff explained that laundry is taken down in the lift in appropriate linen bags i.e. red for soiled linen. These are then put straight into machines that have a sluicing facility and capable of washing at high temperatures. Domestic washing machines were seen in kitchens on both floors as service users undergoing rehabilitation need to be responsible for their own laundry when they return home, so independence is encouraged. South Bristol Rehabilitation Centre DS0000037003.V274944.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 & 30 Continued monitoring of service users needs ensures staffing is adequate to care for them. Effective personnel recordkeeping ensures service users are protected from harm. Attention is needed to ensure specific training in identified areas such as dementia so that staff can meet service users needs. EVIDENCE: It was noted that monitoring of service user numbers and dependency levels ensures the staffing available is adequate for both locations. A reduction in the number of service users admitted for rehabilitation has been in place at the Knowle West site, although the Stockwood site was full at the 9 January visit. A requirement made at the October ’05 visit in respect of staffing at the Stockwood site was met. The rehabilitation worker currently in charge of the site is trained and experienced and demonstrated clear understanding of service users’ needs and development of care plans. He said that the service users currently staying at the site had low dependency levels and in his opinion one member of staff on duty at each shift was adequate. The acting manager also confirmed that if needs deteriorate or change, extra staff can be put in place very quickly. Personnel records of regular agency staff were seen. Photographs, Criminal Records Bureau disclosure numbers and records of training, experience and previous work were seen. South Bristol Rehabilitation Centre DS0000037003.V274944.R01.S.doc Version 5.1 Page 19 A requirement made in July ’05 in respect of staff training in dementia awareness and care was not met. Staff said that this was due to the unavoidable delay in receiving the inspection report although it was sent in a timely manner. No training had been put in place, although one member of staff said she had previously done such training but would appreciate a refresher in the subject. The requirement is therefore carried forward. South Bristol Rehabilitation Centre DS0000037003.V274944.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 36, 37 & 38 Trained and experienced staff who understand both service users’ needs and the regulatory process provide effective management. Attention is needed to ensure staff get full opportunity through regular supervision to reflect on their working practices. Whilst care recording is objective and factual, attention is needed to ensure records reflect the quality of service users lives during their stay. EVIDENCE: Management at the centre remains uncertain due to changing circumstances. The acting manager who had just taken over running of both sites was welcoming and open to the inspection process. She demonstrated a clear understanding of rehabilitation and social care provision, having worked for several years with the permanent manager at the Knowle West site.
South Bristol Rehabilitation Centre DS0000037003.V274944.R01.S.doc Version 5.1 Page 21 Issues discussed at the visits to both sites were positively received and prompt action was taken to meet requirements. This is commended. Staff supervision dates were reviewed. It was noted that whilst staff are offered regular supervision this may not equate with the recommended guidance of at least six times a year. Although it was noted that unavoidable absences meant some staff had less frequent supervision, overall a large proportion of both rehabilitation workers and care staff were averaging no more than two to three sessions per year. As morale has been low due to change management and staff shortages it is recommended that efforts be made to ensure more regular supervision takes place so that staff can have more regular opportunities to reflect on both their work and the service provided. Daily records were examined and noted to be clear, factual and objective although written from a more medical model than a person-centred one. Records were informative about service users’ rehabilitation progress and care needs. However they lacked qualitative information that shows how service users enjoy their stay at the centre. Of particular note was the fact that although records reviewed covered Christmas Day, no mention of this whatsoever was seen for any service user. One service user commented that Christmas Day was ‘just like any other day’ although s/he ‘did have a nice dinner’. It is recommended that daily or progress records include qualitative information about service users stay at the centre rather than simply focussing on their health and personal care needs. A requirement made in respect of the lift at the Knowle West site was met at this visit. The acting manager said that it had been agreed to replace the lift, that is outdated and in need of regular maintenance and repair. An order for this work to be carried out was seen together with records of visits by lift engineers. The second inspector saw evidence of fire and electrical equipment tests. Health and safety checks were carried out regularly and no apparent hazards affecting service users were noted. A requirement in respect of informing the Commission of any event adversely affecting service users including accident, death, serious injury or ill health, was met. A number of notifications had been made and were followed up at this visit. All actions were promptly taken and were appropriate to meet service users needs. This is good practice. South Bristol Rehabilitation Centre DS0000037003.V274944.R01.S.doc Version 5.1 Page 22 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 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X X 2 2 3 South Bristol Rehabilitation Centre DS0000037003.V274944.R01.S.doc Version 5.1 Page 23 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 OP1 Regulation 4(1b) 5(1af) Sch1 Timescale for action The Statement of Purpose for the 28/02/06 Stockwood site must be amended to reflect the change in service provision. A Service Users Guide for the Stockwood site must be put in place that includes: A summary of the Statement of Purpose, any charges payable, the complaints procedure and details of Commission for Social Care Inspection. A copy of the guide must be given to each service user. (Timescale not met from the
October ’05 inspection) Requirement 2. OP3 14(1)(a)(c) A qualified person or persons 01/03/06 must carry out assessments that detail service user needs prior to any admission to the Stockwood site. (Timescale not met from the
October ’05 inspection) 3. OP7 15(1) Care plans for all service users in 28/02/06 both the Knowle West and Stockwood sites must be developed to ensure meeting of assessed needs (Timescale not met
from July and October ’05 inspection) South Bristol Rehabilitation Centre DS0000037003.V274944.R01.S.doc Version 5.1 Page 24 4. OP8 13(4)(b) 5. 6. OP19 OP30 13(4)(a) 18(1)(c)(i) Manual handling risk 01/02/06 assessments must be put in place where mobility issues are clearly identified All radiators at the Knowle West 01/03/06 site must be covered (Timescale not met from July ’05 inspection) Training in Dementia awareness 31/03/06 and care must be planned and provided for all staff. (Timescale
not met from July ’05 inspection) 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 OP36 OP37 Good Practice Recommendations Supervision should be carried out at least six times yearly for all rehabilitation and care staff. Progress records should be written from qualitative and holistic perspectives and include service users enjoyment of specific events e.g. Christmas and birthdays South Bristol Rehabilitation Centre DS0000037003.V274944.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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