Inspection on 08/11/05 for St Brigas

This inspection was carried out on 8th November 2005.

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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Brigas 31/10/06

St Brigas 14/03/05

St Brigas 17/06/04

St Brigas 16/12/03

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 St Brigas 2-3 Jesmond Road Clevedon North Somerset BS21 7SA Lead Inspector Barbara Ludlow Announced Inspection 09:30 8 & 16 November 2005 th th St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Brigas Address 2-3 Jesmond Road Clevedon North Somerset BS21 7SA 01275 870653 01275 879900 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) Mrs Lynne Whitehouse Miss Anne Ball, Mr David Whitehouse, Mrs June Lloyd Mrs Lynne Whitehouse Care Home 17 Category(ies) of Learning disability (17), Learning disability over registration, with number 65 years of age (17) of places St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th July 2005 Brief Description of the Service: St Brigas provides care and support to seventeen people who have learning disabilities. Situated on a hillside overlooking Clevedon, it comprises two Victorian houses. One quarter of the accommodation is used as an activity centre for people with learning disabilities and is not regulated by the CSCI. The accomodation is located over three floors and access is by means of various staircases. The lounge and dining room overlook the well maintained garden at the front of the building. The home is located close to a park and the town centre is 10 minutes walk away. Four partners own St Brigas, one of whom is the manager, and another provides the maintenance support. They meet regularly to review and discuss the home. St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. B Ludlow Regulation Inspector for CSCI undertook this announced inspection. The Registered Manager/Business Partner, Mrs L Whitehouse and Business Partner, Mr D Whitehouse who also works at the home, were both present throughout the day and assisted with the inspection process. The homes Deputy Manager was on duty and assisted the inspector with a tour of the premises and introductions to service users, staff and the care planning records system. The day centre was included as part of the tour as many St Brigas service users attend during the day. Records were sampled, these included care plans, home maintenance and the financial accounts with records of fees and contracts. A follow up visit was agreed and the homes allocated Environmental Health Officer (EHO) was able to attend on 15th November. All matters relating to environmental health and safety were discussed with Mr and Mrs Whitehouse, the outcome was very positive and some good practice was identified. One recommendation was made by the EHO. This was a very positive inspection and the overall impression was of an excellent care service. What the service does well: Service users are well cared for. The staff team is very stable and service users are known to them. Observed interactions and relationships between service users and staff were friendly and helpful. Service users were treated with respect and dignity. The home offers a secure environment for service users. Access to the road is restricted by gate locks for the assessed safety of one service user. This was not seen as detrimental to other service users. Service users looked well kempt and it was apparent that they get along well together. Activities are encouraged and supported. Feedback was sent to CSCI from service users, their families and visiting professionals. This was positive and praised staff and the service offered at St Brigas. St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Service users are assessed before admission. Visits are welcomed and there is a trial period of three months. Written contracts are issued. EVIDENCE: It was confirmed that new service users are given terms and conditions of residence and user friendly designed brochures. An example of the brochure is held by CSCI. An updated copy of the homes statement of purpose was requested at the inspection. The inspector was informed that service users are invited to visit the home and can stay overnight if they wish, at no cost. One new service user had attended the day centre and had stayed for tea before a decision was made to come and live at St Brigas. Accommodation can be personalised and one room was seen that had been decorated to meet the service users personal preferences, relatives had also been consulted. The current fees payable range from social services base payment up to £1086 per week. Contracts were sampled to confirm fee rates and details. All records seen were held safely, with access restricted and stored securely. St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Service users have care plans. There is support for service users to live with the assistance required to remain both independent and safe. EVIDENCE: Service users seen were confident and were accepted by each other, there was free access around the home. The gates were secured for the safety of one service user who is unable to negotiate the roads safely if alone. Staff and management are skilled and able to detect changes in their service users. Service users, some of who require a very skilled knowledge of their ability and means of communication from staff caring for them; were all seen to be well cared for as individuals. There is a family atmosphere within the community of St Brigas. Care planning review records were seen written in pencil; this practice had been adopted following a previous inspection. Care records are legal documents and as such should be legible, unalterable, non judgemental, factual, have no abbreviations and be dated and signed. It was recommended St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 10 that recording in pencil should cease. This recommendation was confirmed for all future practice, at the second visit. St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 The home operates with a philosophy of care that supports personal development. Service users can make choices in their daily lives and are offered a range of activities both at the home and in the community. Feedback from relatives was very positive. EVIDENCE: The philosophy of the homes management and staff promotes personal development to enable service users to make progress with their life skills. Activities are organised to meet individual needs and provide social integration and develop skills. Service users eat together in the dining rooms at teatime. 8 service users indicated that they liked the food and 1 said sometimes. St Brigas has a day centre that service users can access; others attend outside community day centres that better meet their needs. Service users from other local homes attend the St Brigas day centre. There is a dedicated staff team that offer a whole range of opportunities for the day service users. A weekly evening club is held in the day centre for the homes resident service users. St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 12 Craft classes are held and the home is developing a ‘Snoozelam’ next to the craft room for service users to enjoy sensory (audio/ visual) relaxation sessions. None of the resident service users at St Brigas have employment or are on work-based placement. Holidays are offered with the staff team supporting on a one to one basis or as required. Two service users had recently been to stay London, the photographs were seen and trip was reported to have been successful. Other holidays this year for either two or three service users at a time have included a stay at a health spa, a caravan holiday in North Devon and a stay at Pontins Holiday centre. The catering process appeared to be well managed and there is an emphasis on healthy eating. Fresh fruit is served as a dessert with yogurts and other healthy options. Fresh vegetables were being prepared for the evening meal. Likes dislikes and special nutritional requirements are catered for. Care plans contained nutritional information and identified the individual risks assessed, such as eating too quickly and choking. Relatives responding to CSCI in writing confirmed that all felt welcomed when visiting and all could see their relation/friend in private if they wished. For families of service users who are not able to make decisions, all said they were consulted about their relatives care. St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 St Brigas takes care of service users in a holistic way. No service users were self-medicating. EVIDENCE: Service users needs are met by an individual approach. This is risk assessed and reviewed in the care planning system. Service users were treated sensitively and with respect by staff in all observed and overheard interactions. The routine for service users is geared towards how they choose to spend their time and is not regimented. Care giving is discreet and privacy is respected at all times. The approach by staff is considerate and is consistent. The inspector heard that staff support service users with activities and sometimes give up their own free time to offer assistance. No service users were identified as self-medicating in the records inspected. The death of a service user was discussed with the manager at the inspection, there are policies and procedures in place to support staff and ensure St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 14 appropriate actions and contacts are made in an emergency situation. Staff response at such times was reported to have been very good. St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The home has a complaints procedure. There have been no complaints made to CSCI about the home. The homes policies and procedures and staff recruitment protect service users from harm. EVIDENCE: There have been no complaints to CSCI or the home since the last inspection. Service users appeared comfortable and confident with their surroundings and with staff, the feedback gathered indicated that they feel safe at the home. The feedback from relatives indicated that 10 of the 12 respondents knew how to make a complaint. Three people had made a complaint. Nine Service Users responding to CSCI indicated that they liked living at the home felt safe and were treated well by the staff. 8 said they would know who to speak to if unhappy and 1 said sometimes. St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,30 St Brigas has a homely and welcoming atmosphere. The home was clean and is hygienically maintained. Bedrooms are individually personalised and are respected private spaces. Communal areas are spacious and meet the service users needs. EVIDENCE: St Brigas is a warm and welcoming place. The gates to the home are locked for the health and safety of one service user, who is unsafe alone on the potentially busy roads. Environmental health and safety was discussed at the inspection and a follow up visit with the homes Environmental Health Officer was arranged to conclude the inspection. It was agreed that individual accommodation risk assessment should be considered in line with current available guidance for best practice for St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 17 particular environmental factors, which include hot surfaces, hot water, window restrictors and Legionella prevention measures. Mr Whitehouse had addressed the safety of widely opening windows on levels above ground floor after the first inspection day and before the EHO visit. Gaps for the opening had been reduced down to the HSE recommended maximum of 100mm. Supporting risk assessments be to be written where there is any variation from this. Hot surfaces in bedrooms will be individually risk assessed and protective covers will be applied if determined by the findings. Hot water was found to be appropriately hot at the boiler and the water delivery at bath hot water tap outlets was reported to be delivered below 43 degrees Celsius. Regular checks are made and all bathing is supervised. The EHO recommended that the cleaning policy should include the measures required for protection against Legionella bacteria in showerheads. This involves weekly cleaning with antibacterial spray and compliance was agreed at the time of visiting. All accommodation is single with one exception; this room is shared by two service users who became good friends at the home. There is screening and the room is spacious enough to accommodate the two persons comfortably. St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36 Staff are trained and the staff group know the service users well. There are sufficient day staff and two night staff sleep in each night. EVIDENCE: Staff had very clear understandings of their roles and worked alongside service users very positively. Staff receive training and supervision for their roles. The perception of 2 out of 9 relatives was that there is not always sufficient staff on duty. The home was adequately staffed at the inspection both for care and ancillary staff. There are however no waking night staff, 2 staff sleep in and are available if needed during the period between 11 pm and 6am. The inspector was informed that none of the current resident service users require night time checks or supervision once settled. Staff would respond to the call bells overnight, if sounded. St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42,43 The home is well managed. Health and safety and the welfare of service users are safeguarded by good care practice. Service users confirmed that they feel safe and are well cared for. EVIDENCE: Mr D Whitehouse confirmed that the home has strong financial management. The input from Mr and Mrs Whitehouse throughout the inspection process demonstrated their commitment to the home and the service offered at St Brigas. Both are involved on a day-to-day basis and are responsive to advice and recommendations made. There is clear and open management of the service. Staff and management know the service users well and relationships were seen to be friendly and appropriate. Staff training is encouraged to ensure that staff have skills appropriate to their work and insight into the medical conditions affecting their service users. St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 20 Policies and procedures are in place and best practice was evidenced in discussion regarding the cleaning procedures where good practice reduces the risk of cross infection at the home. Health and safety environmental issues have been considered with specialist input from the EHO and a recommendation was made see Environment p17. Records are kept for the management and maintenance of the home. Care plans and financial records seen were up to date and appropriately stored. The home has a skill mixed staff team; there were adequate numbers of staff on duty at the inspection. The home has good links with the local health care specialists such as the Psychologist and the Learning Difficulties Specialist Nurse. Supportive input was demonstrated for individual service users. Staff recruitment practice was not sampled. Servicing records sampled included: Fire records demonstrated that the weekly fire alarm test is carried out and the zones tested was varied each week. Fire extinguishers were serviced in May 2005. Emergency lights are inspected monthly and fire door closures were last checked on 4.11.05. Smoke detectors and the servicing of the alarm as completed in May 05. The last fire drill was held on 24.8.05 Water tanks are inspected every six months by Mr Whitehouse. The homes electrical inspection was completed in May 2004. A PAT check on electrical goods was completed on 16.10.05. Call bells are checked each week. St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 X 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 St Brigas Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 2 3 DS0000008090.V254609.R01.S.doc Version 5.0 Page 22 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. 1 Standard YA42 Regulation 13(4)(a) Requirement The individual room risk assessments must be completed to include the environmental hazards: • Hot surfaces • Opening windows above ground floor level Environmental Health Officer recommendations must be followed. Timescale for action 22/12/05 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 YA6 Good Practice Recommendations All written care records are regarded as legal documents and as such should be legible, unalterable, non judgemental, factual, have no abbreviations and be dated and signed. St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 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 St Brigas DS0000008090.V254609.R01.S.doc Version 5.0 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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