Inspection on 03/06/05 for Stibbs House

This inspection was carried out on 3rd June 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stibbs House 28/01/08

Stibbs House 01/11/06

Stibbs House 06/12/05

Stibbs House 22/12/04

Stibbs House 24/05/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Stibbs House 74 Stibbs Hill St George Bristol BS5 8NA Lead Inspector Andrew Pollard Unannounced Inspection 3rd June 2005 9:45 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 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 Stationary 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. Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Stibbs House Address 74 Stibbs Hill St George Bristol BS5 8NA 0117 9619137 0117 9476786 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Aspects Milestones Trust Mr Russell John Geach Care Home with Nursing 10 Category(ies) of PD Physical disability registration, with number LD Learning disability of places Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 10 Adults with learning disabilities which may include those with physical disabilities Manager must be a RN on parts 5 or 14 of the NMC register Date of last inspection 22/12/2004 Brief Description of the Service: Stibbs House is a registered care home offering personal and nursing respite care for up to 10 people who have learning disabilities, in particular those who have profound multiple disabilities. The majority of service users are in need of nursing care.The care staff are experienced in this type of care and are led by a team of Registered Nurses.The house is situated in a suburban area and is easily accessible by car or bus. There is easy access to local shops and community facilities.The home is a modern purpose built including a recently completed extension to create extra rooms. There is a large secure garden and new patio. There are 10 single rooms on two floors accessible by a lift. There are two lounges, a dining room and a multi sensory room. Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The following methods of evidence gathering has been used in the production of this report; observation, discussion with residents and staff, relative and residents comment cards, tour of the home and sampling policies, records, care plans, meals. Stibbs House is a well run short stay home offering a good standard of care and quality of life. The inspector’s overall impression was that the residents were happy, settled and secure which was evident from observations and conversations during the inspection. Only one person was able to verbally communicate. Two relatives were spoken to who were full of praise for the service and care of the staff. Staff were observed talking with residents in a sensitive and friendly manner. Some staff have been working with the residents for many years and have an in depth knowledge and understanding of their needs. It was apparent that the staff have a good rapport with the residents and their families. What the service does well: What has improved since the last inspection? What they could do better: Send a letter to prospective clients with a summary of the assessed need and confirmation that those needs can be met. Redecoration of the ground floor corridor. Arrange a gas safety inspection. Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 6 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. Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 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 standard(s) 1,2,4,5 Prospective clients and their families are given relevent information in written or verbal form about the home. The assessment process is rigorous and detailed. Introductory visits are arranged for prospective clients. Contracts and terms and conditions of services are provided to all clients. EVIDENCE: The statement of purpose and service user guide have been reviewed and include information about other day services provided by the Trust. A copy of the revised documents will be sent to the Commission after printing. The service user guide is also available on audiotape but not used to date. Aspects and Milestones Care Trust issue a standard set of terms and conditions and have contracts with various local Authorities. There are 54 current clients currently registered. Two new clients have been admitted since the last inspection. All residents have a care management assessment by a social worker and health assessment. In addition one of the Registered Nurses carries out a home assessment prior to the first trial visit if the family agree. The assessment documentation in the files of the most recent admissions were detailed and full. The Roper model of care is the basis of the assessment and care documentation. Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 9 All residents have risk assessments to support any restrictions on freedoms. The final care plan is discussed with the service user and/or carer and they are invited to sign it indicating their acceptance of it. No letter confirming the home’s ability to meet the assessed need had been sent to the most recently admitted residents. Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 10 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 standard(s) 6,79 Residents and their families are involved with the assessment and care planning/goal setting process. The homes philosophy promotes resident’s individual development and selfdirection and empowerment. EVIDENCE: The ethos of the home is based on empowerment, independence and choice for their clients. Care plans are based on the activities of daily life and were well written detailed, signed and dated by the accountable nurse. All clients were offered a home visit to review the current care plans. However 28 families came to the home to take part in the review process, which provided valuable information and feedback. The named nurse, key worker and the resident/relatives have now reviewed all care plans. Reassessment and regular evaluations of care plans are taking place. In practice it is the families who sign off the care plans as in general the clients are profoundly disabled and unable to do so. Three entries per day are made in the house report and each person’s Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 11 continuing care notes. A communication diary is maintained with families, which goes back and forth with the client. The home has good liaison with Social Workers, community nurses and day services or schools. Decisions and choice are explored with the clients through the staff’s experience of them and knowledge of their non-verbal communication. Only a small number of clients have verbal communication skills. None of the current clients are able to manage their own money. Following recent staff training at St Peters hospice, a useful link and source of advice has been established as clients with life threatening conditions are being more frequently referred to the service. All service users have individualised risk assessments but it is accepted that reasonable risk taking is part of normal life. Risk is managed in consultation with the client if practical but more usually with their families. There is a very low level of accidents in the home, there being only 2 minor incidents since the last inspection. Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 12 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 standard(s) 12,13,14,17 Residents have opportunities to take part in a range of community and leisure activities. The recreational and occupational arrangements in the home are well organised and varied. The menus are varied and individually tailored. EVIDENCE: Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 13 The manager and staff consider promotion of independence and maintenance of life skills to be of the highest priority whilst accepting that the staff only play a small part in the person’s life. Evidence from discussion, observation and records shows that care delivery is person-centred and individualised. Where possible people continue to attend their day care placements and social activities whilst having respite care. The home has good liaison and working arrangements with day centres. Every effort is made to maintain continuity of care between home and Stibbs House via the client diary and regular contact with the family or home visits. As a respite care unit individual clients are not seeking integration in the local community, however the service is well accepted within the local area. The staff and clients make use of local facilities and help them maintain links with community services. At weekends the staff try to arrange social and leisure activities tailored to the individuals including trips out in the new minibus; walks and shopping trips. Choice is central in the way the home is run but it is accepted that many clients are unable to express their wishes in any formal sense and understanding their likes and dislikes is through experience, building relationships and good communication with families. The house has an enclosed but large garden and patio. Clients are free to participate in household jobs if they wish to although always with staff support, however few are able or wish to do so. Client’s preferences are discussed as part of the initial assessment process. Mealtimes are flexible. Meal choices are individualised and planned day to day. Many people eat a main meal at their day centres on weekdays. Special and culturally appropriate diets are catered for. Staff can manage all types of feeding regimes including peg feeds and nasal gastric tubes. Good liaison arrangements are in place with the Fresenius support nurse. Records of meals are maintained in the diary. Fridge freezer and probe temperatures are checked. Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 14 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 standard(s) 18,19,20 The staff provide appropriate personal and nursing care in a sensitive manner to maintain residents health and well-being. Gender preferences for personal care are respected. Appropriate arrangements are in place for residents to access primary healthcare services if need be. The staff properly manage and administer medication. EVIDENCE: The named nurse and key worker system is in place and the links between these staff and the families is enhanced by home visits and care plan evaluation meetings. Appropriate staffing arrangements can be put in place to meet individual clients needs. The manager considers the skill mix to be appropriate to meet the needs of the clients. The staff are aware that changes in peoples behaviour can sometimes be indicative of a health care need. The staff have good working arrangements with local community learning disability and district nursing teams. In general people stay with their own GP during their respite care. However there are arrangements in place with local surgeries at Airballoon Rd and St George to provide care for people as temporary residents and for emergency cover. This service is rarely used. Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 15 None of the clients are able to self medicate. The relevant GP sends a letter detailing medication and any changes; in addition the family will provide information where recent changes have been made. Everyone has a medication profile. The records of drugs received and sent home were in order. The MAR sheets were up to date and in order running stock totals are maintained. The disposal record was in order. The home has recently started to accept clients with terminal illness and the staff have received appropriate training from the Hospice regarding symptom control. Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 16 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 standard(s) 22,23 There are robust and comprehensive policies in place to manage complaints or allegations of abuse. There are good arrangements in place for staff training and awareness of POVA matters. EVIDENCE: The complaint procedure is clearly set out and reference to CSCI is included. There is an audio version available as part of the service user guide. Complaints in the past have been satisfactorily resolved using the internal complaint procedure. The manager and staff have worked hard maintaining good relationships and open communication with carers and relatives. The resident and two relatives spoken to were fulsome in their praise and had no complaints. The Trust has appropriate policies for the protection of vulnerable adults “No Secrets” and “Whistle Blowing”. The manager and staff are aware of the NMC and GSCC code of conduct and copies of such are available to staff. Any aspects of challenging behaviour are addressed as part of care planning. At present no one exhibits behaviour that seriously challenges the service. The home does not manage client’s finances. If residents bring any money in with them staff record what money has been received and spent on a ledger sheet and detail it in the person’s home diary. Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 17 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 standard(s) 24,25,27,30 The home is generally well maintained clean, safe and comfortable. The corridor requires redecoration. Bedrooms bathrooms and communal areas suit the needs and tastes of the residents. EVIDENCE: Stibbs House is located on a main bus route and has nearby shops. The home is purpose built and is fit for its purpose. All bedrooms, communal spaces and facilities are fully accessible and suitable to meet the client’s needs. The fittings and furnishings are of good quality and of a domestic nature. Appropriate maintenance systems are in place. The home was cleaned to a high standard and in good order. There were no malodours. The laundry arrangements are satisfactory, however consideration needs to be given to relocate the spare machine from the sluice. The home now provides only a limited laundry service. The home has a copy of the infection control manual. Proper arrangements are in place to dispose of clinical waste. Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 18 Rooms are basically equipped and adequately furnished as the home offers only respite care. Bedrooms have electrically adjustable beds and pressure relieving mattresses. People bring their own special equipment required each time they visit. All radiators are of low surface temperature design. A wellequipped multi sensory room has been created. The home has an appropriate number of toilets, bathrooms including a wheel in shower and hi-lo baths with Jacuzzi. The main corridor is in need of repainting and installation of protection strips. Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33, The home is adequately staffed with appropriately trained and experienced staff. The recruitment procedures and records are in good order. Proper training arrangements are in place for care staff and clinical updating for RN’s. EVIDENCE: The staffing levels accord with the staffing notice. Care staff are well experienced with the client group. However it is the case that overall the general levels of dependency and occupancy have increased. When the house is full and dependency indicates the need, four staff are on duty during the day and a minimum of two waking night staff. The manager is always supernumerary. The skill mix is satisfactory. If possible the manager loads staff at the weekend to facilitate social activities. There are 60hrs of care staff vacancies at present but interviews have been arranged. There are low levels of sickness and low staff turnover. The manager considers staff morale to be good. Any bank or agency staff undergo an induction and orientation to the home. The manager is involved in all staff interviews. The personnel department carries out the Nursing & Midwifery Council and CRB/POVA checks of RN’s and care staff. Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 20 Copies of all records as required by Schedule 4.6 (b), (c) are kept in the home. The trust has a satisfactory induction and orientation programme, staff work through the LDAF induction process prior to completing NVQ level 2. Records of such are kept. A detailed induction programme has also been produced locally for the home. There are NVQ assessors in the home. Three Care Assistants (CA’s) have thus far completed NVQ level 2/3. Three staff are working toward level 3. Mr Geach continues his role in co-ordinating training arrangements within the community services part of the Trust. The RN training in clinical areas is sparse in the Trust prospectus and the manager is seeking out of house sources. There are appropriate supervision arrangements for student nurses who are on 2nd year or 3rd year management placements. PREP discussions are organised by the RN’s and staff meetings have elements of reflective practice built in. Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39,42 There are various methods and systems in place to obtain clients/relatives views. There are appropriate arrangements in place to service and repair plant and equipment. However the gas safety inspection is overdue. The home has good Health and Safety arrangements. EVIDENCE: A comprehensive survey of service users/relatives views was carried out recently. The results overall were positive. Much helpful and positive feedback was gained from the recent care plan reviews in which 28 families took part. The general opinion is that Stibbs house offers a flexilbe , reliable and high quality service. It is intended to repeat this process each year which will feed into the annual plan, along with the identified learning needs from the staff appraisal process. Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 22 All families have a feedback diary to assist communication between the home and family and allow for any concerns to be raised. Regular visits are made by the Trust manager and the quality of services reviewed. Regulation 26 reports are submitted regularly. A full Health and Safety policy is in place for which the manager has special responsibility. Monthly H&S audits take place. A fire risk assessment has been carried out. The fire log book was in order. All doors have been fitted with automatic door closers. The Trust has a good system to deliver training and updates in Health and Safety, First Aid, load handling, fire safety and food safety. Ms Burton is the load handling instructor for Stibbs House. Staff have receive update training annually. All staff have received food safety up dates. First Aid training is booked for September. The EHO carried out an inspection in January 2004. The gas inspection was carried out in May. The electrical installation safety certificate has been reissued in March. PAT checks are carried out annually. The lift is inspected on a standing contract. Hoists have been load tested and serviced in April. There was no current gas safety certificate having expired on 19/05/05 The Insurance liability certificate was on display. Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 23 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 2 x 3 2 Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 x 3 x x 3 Standard No 11 12 13 14 15 16 17 3 x 3 3 x x 3 Standard No 31 32 33 34 35 36 Score x 3 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Stibbs House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 2 x D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 24 Are there any outstanding requirements from the last inspection? 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 YA2 Regulation 14 Timescale for action Send a letter to the prospective From client / representative confirming 3/06/05 the service can meet the assessed care needs. Redecorate the ground floor By corridor. 11/07/05 Arrange for a gas safety From inspection to be carried out. 3/06/05 Requirement 2. 3. YA24 YA42 23.2 (d) 13.4 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 Good Practice Recommendations Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 25 Commission for Social Care Inspection 300 Aztec West Almondsbury South Gloucestershire BS32 4RG 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 Stibbs House D56_S20256_StibbsHouse_V230478_030605_Stage4.doc Version 1.30 Page 26 - 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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