Inspection on 06/12/05 for Stibbs House

This inspection was carried out on 6th December 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 2 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 03/06/05

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 6th December 2005 10:00 Stibbs House DS0000020256.V257295.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 Stibbs House DS0000020256.V257295.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. Stibbs House DS0000020256.V257295.R01.S.doc Version 5.0 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 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) Aspects and Milestones Trust Mr Russell John Geach Care Home 10 Category(ies) of Learning disability (10), Physical disability (10) registration, with number of places Stibbs House DS0000020256.V257295.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Manager must be a RN on parts 5 or 14 of the NMC register 10 Adults with learning disabilities which may include those with physical disabilities 25th June 2002 Date of last inspection Brief Description of the Service: Stibbs House is a registered care home with nursing offering 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 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 DS0000020256.V257295.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The following methods of evidence gathering have been used in the production of this report; observation, discussion with staff, relative, tour of the home and sampling policies, records and care plans. Only one client was present during the inspection but was not able to verbally communicate Stibbs House is a well run short stay home offering standards of nursing and personal care. What the service does well: What has improved since the last inspection? The general high standards have been maintained in the delivery and management of quality services to a wide range of families and clients. Stibbs House DS0000020256.V257295.R01.S.doc Version 5.0 Page 6 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. Stibbs House DS0000020256.V257295.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 Stibbs House DS0000020256.V257295.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 Prospective clients and their families are given relevant information 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 are as previously and include information about other day services provided by the Trust. 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 approximately 54 current clients currently registered. The general level of dependency of recent referrals has increased. A useful link and source of advice has been established with St Peters hospice, as clients with life threatening conditions are being more frequently referred to the service. All clients have a care management assessment by a social worker and health assessment. In addition the manger or one of the Registered Nurses carries out an assessment prior to the first trial visit. 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. A letter confirming the home’s ability to meet the assessed is sent to the prospective clients. Stibbs House DS0000020256.V257295.R01.S.doc Version 5.0 Page 9 Stibbs House DS0000020256.V257295.R01.S.doc Version 5.0 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 the following standard(s): 6,7,9,10 Clients and their families are involved with the assessment and care planning/goal setting process. Not all care plans were signed and dated. Some evaluations were overdue. The homes philosophy promotes client’s self-direction and empowerment within the limits of their disabilities. EVIDENCE: The ethos of the home is based on empowerment, maintenance of independence and choice for clients. Care plans are based on the activities of daily life and were well written holistic and detailed, however a number were not signed and dated by the accountable nurse. All clients have risk assessments to validate any restrictions on freedoms. The final care plan is discussed with the client and/or carer who are invited to sign it indicating their acceptance of it. All client families/carers were invited to the home to review the current care plans. Approximately 28 families came and took part in the review, which provided valuable information and feedback. This process will now be repeated annually. The named nurse, key worker and the client/relatives reviewed all care plans. Stibbs House DS0000020256.V257295.R01.S.doc Version 5.0 Page 11 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. Evaluations of care plans should take place roughly quarterly place, however four files looked at indicated this target was not always met. Three entries per day are made in the house report and each person’s 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. Only a small number of clients have verbal communication skills. Decisions and choice are explored with the clients through the staff’s experience of them and knowledge of their non-verbal communication. 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/family. There is a very low level of accidents in the home. Stibbs House DS0000020256.V257295.R01.S.doc Version 5.0 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 the following standard(s): 12,14,16,17 Clients continue to take part in a range of community and leisure activities. The recreational arrangements in the home are well organised and varied. The menus are varied and individually tailored. EVIDENCE: Stibbs House DS0000020256.V257295.R01.S.doc Version 5.0 Page 13 The manager and staff consider promotion of independence and maintenance of life skills to be of a priority whilst accepting that they only play a small part in the person’s life. The care regime 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 client’s homes and Stibbs House via the client diary, meetings with the family or home visits. As a respite care unit individuals 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 existing links with community services. At weekends the staff try to arrange social and leisure activities tailored to the individuals including trips out in the minibus to places such as Clarks village; 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. Client’s preferences are discussed as part of the initial assessment process. Recent purchases include floor basketball and skittles and craft items to make Christmas cards. A house Christmas party is being arranged prior to the holiday period. The house has an enclosed but large garden and patio. 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. Records of meals are maintained in the diary. Stibbs House DS0000020256.V257295.R01.S.doc Version 5.0 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 the following standard(s): 18,19,20,21 The staff provide appropriate personal and nursing care in a sensitive manner to maintain clients health and well being. Gender preferences for personal care are respected. Appropriate arrangements are in place for clients to access primary healthcare services if need be. The staff properly manages and administer medication. Proper arrangements are not in place to meet the new requirements for disposals. EVIDENCE: The named nurse and key worker system continues. Home visits and care plan evaluation meetings enhance links between staff and the families. 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 nursing staff have a broad range of clinical skills to meet the increasing health care needs and dependency of the clients. The home has recently started to accept clients with terminal illness and staff have received appropriate training from the Hospice regarding symptom control and will give general advice where needed. The nurses have been trained in the use of Medazalam for epilepsy. The staff have good communication skills and are aware that changes in Stibbs House DS0000020256.V257295.R01.S.doc Version 5.0 Page 15 behaviour for people without verbal communication can sometimes be indicative of a care need. 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 clients and for emergency cover. This service is rarely used. The staff have good working arrangements with local community learning disability and district nursing teams. 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 but new disposal regulations require a proper contract and new policy to be put in place. Stibbs House DS0000020256.V257295.R01.S.doc Version 5.0 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 the following 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 if needed. Complaints in the past have been satisfactorily resolved using the internal complaint procedure. There have been no recent complaints or POVA matters. The manager and staff have worked hard maintaining good relationships and open communication with carers and relatives. The client 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 clients 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 DS0000020256.V257295.R01.S.doc Version 5.0 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 the following standard(s): 24,27,28,29,30 The home is generally well maintained clean, safe and comfortable. The ground floor corridor requires redecoration. Bedrooms, bathrooms and communal areas suitable to meet the needs of the clients. EVIDENCE: The home is purpose built and is fit for its purpose. All bedrooms, communal spaces and facilities are fully accessible and suitable for disabled people. The fittings and furnishings are of good quality and of a domestic nature. The home was cleaned to a high standard and in general 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 provides only a limited laundry service. A copy of the infection control manual is available. Proper arrangements are in place to dispose of domestic and clinical waste. Stibbs House DS0000020256.V257295.R01.S.doc Version 5.0 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 to meet varying levels of risk. Some clients bring their own special equipment as required each time they visit. The home has a range of special baths, beds and lifting and handling equipment. A well-equipped multi sensory room is on the first floor. All radiators are of low surface temperature design. Bath and shower hot water outlet temperatures are regulated. The home has an appropriate number of toilets, bathrooms including a wheel in shower and hi-lo baths with Jacuzzi. As identified in the last report the main corridor is in need of repainting and installation of protection strips on the walls. Stibbs House DS0000020256.V257295.R01.S.doc Version 5.0 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 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): 32,34,35 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. The occupancy and dependency level remain high. The nursing and care staff are well experienced with the client group. 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. At present there are a number of staff from the Fairburn unit working at Stibbs whist building works are carried out. It is expected that the two units will work increasingly closely in the future. Where possible the manager uses additional staff at the weekend to facilitate social activities, as there are no day placements on these days. There are two care staff vacancies at present. The deputy manager post has been lost and an E grade nurse will be recruited. There is a large amount of routine admin work associated with a respite care service that was previously well managed on site until it was withdrawn. There have been a number of difficulties resulting from this but it is hoped to be resolved by the designation of 15 hours dedicated admin time at the Trust offices. The recruitment policies and procedures are of a high standard. Stibbs House DS0000020256.V257295.R01.S.doc Version 5.0 Page 20 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. Copies of all records as required by Schedule 4.6 (b), (c) are kept in the home. There are low levels of sickness and low staff turnover. The manager considers staff morale to be good. Any bank or agency staff undergo a detailed orientation to the home as well as a Trust induction programme. The trust has an induction and orientation programme for new employees who work through the LDAF induction process prior to completing NVQ level 3. There are to be five NVQ assessors in the home. The home has met the target of 50 of care staff NVQ trained. The RN training and clinical up dating was not reviewed on this occasion. There are appropriate supervision arrangements for student nurses who are on 2nd year or 3rd year clinical and management placements. PREP discussions are organised by the RN’s and staff meetings have elements of reflective practice built in. Stibbs House DS0000020256.V257295.R01.S.doc Version 5.0 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 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): 37,40,42 The home is well managed and supported. 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. The home has good Health and Safety arrangements. EVIDENCE: A comprehensive survey of service users/relatives views was carried out earlier in the year. The results overall were positive. Much helpful and positive feedback was gained from the care plan reviews in which 28 families took part. The general opinion is that Stibbs house offers a flexilbe , reliable and high quality service. The review meetings and surveys will be repeated in the new year. This process will feed into the annual plan, along with the identified learning needs from the staff appraisal process. All families have a feedback diary to assist communication between the home and family and allow for any concerns to be raised. Stibbs House DS0000020256.V257295.R01.S.doc Version 5.0 Page 22 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 is kept up to date. All doors have been fitted with automatic fire 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. Staff have receive update training annually which was supprted by the training records. Appropriate maintenance systems are in place for plant and equipment. The EHO carried out an inspection in the summer and requires the kitchen to be upgraded. Fitment of the new kitchen is due in January. The gas safety inspection was not done in accord with requirements of the last report, however a faxed up to date certificate has now been received at the CSCI office. The electrical installation safety certificate was been reissued in March. PAT checks are carried out annually. The lift and hoists have been load tested and serviced. The Insurance liability certificate was on display. Stibbs House DS0000020256.V257295.R01.S.doc Version 5.0 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 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 3 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 2 3 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Stibbs House Score 3 3 2 3 Standard No 37 38 39 40 41 42 43 Score 3 X X 3 X 3 x DS0000020256.V257295.R01.S.doc Version 5.0 Page 24 Yes. 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 2 Standard YA20 YA24 Regulation 13.2 23.2.d Requirement Set up proper arrangements to dispose of unwanted or waste medication. Redecorate the ground floor corridor Timescale for action 05/01/06 10/04/06 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 YA6 YA33 Good Practice Recommendations Ensure that all care plans are signed and dated by the accountable nurse and that care plan evaluations are carried out at least three monthly. Consider the re-instatement of admin time at Stibbs house rather than in the Trust offices. Stibbs House DS0000020256.V257295.R01.S.doc Version 5.0 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 © 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 DS0000020256.V257295.R01.S.doc Version 5.0 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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