Inspection on 17/08/05 for The Elms [Stapleton]

This inspection was carried out on 17th August 2005.

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

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

Other inspections for this house

The Elms [Stapleton] 21/10/08

The Elms [Stapleton] 05/11/07

The Elms [Stapleton] 13/11/06

The Elms [Stapleton] 20/06/06

The Elms [Stapleton] 03/03/06

The Elms [Stapleton] 18/08/04

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 The Elms Park Road Stapleton Village Bristol BS16 1AA Lead Inspector Sandra Jones Unannounced 17 August, 5 & 16 September 2005 9:30 th th th 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. The Elms D56_D05_26632_The Elms_241864_120805_Stage2.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Elms Address Park Road Stapleton Village Bristol BS16 1AA 0117 9584506 0117 9699000 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) The Brandon Trust Mrs Tanya Abbott Care Home only 14 Category(ies) of LD Learning disability,12 registration, with number LD(E) Learning dis - over 65, 2 of places The Elms D56_D05_26632_The Elms_241864_120805_Stage2.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The Home may accommodate nine named residents whose primary focus of care is their mental health needs (Registration will revert to LD with no additional mental health care needs when these residents leave) The manager must be supernumerary at least three shifts per week. Date of last inspection 17-Mar-2005 Brief Description of the Service: The ELms is operated by the Brandon Trust and managed by Tanya Abbott. The purpose of the home is to provide accommodation and personal care for up to fourteen adults with learning disabilities. Within the numbers, nine individuals with learning disabilities for whom mental health care needs is the primary focus of care, are accommodated. The property is situated within its own extensive grounds on Stapleton Village close to shops, bus routes and other amenities. It is arranged over two floors with shared space on the ground floor and bedrooms on both floors. The Elms D56_D05_26632_The Elms_241864_120805_Stage2.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted on an unannounced basis over three days with the manager and a visiting professional present, on the second and third day of the inspection. There is a condition of registration that the manager has a minimum of three days supernumerary time. Two monitoring visits took place following the last inspection to check on the arrangements for the manager. Immediate requirements were issued at the last inspection about an assessment of staffing levels and the development of care plans. Individual care plans have been formulated for each person within the given timescale. However, the staffing assessment remains outstanding. The unmet requirements from the previous inspection are of concern and the Trust must take responsibility for their reluctance to action these requirements. Enforcement action will follow for non compliance. This home has experienced a variety of long standing issues that relate to the management and forward planning of the home. While the manager has been in post for a year, changing the culture will take time. The manager has shown clarity on the expectations of registered services to meet NMS and legislation. The residents, relatives, staff and visiting professional were consulted on the standards of care at the home. Evidence was also gained from a tour of the premises and examination of records and other documentation. What the service does well: What has improved since the last inspection? There is more empowerment for residents to make choices and staff show a genuine interest in improving the residents’ skills. There is better consistency of approach. The Elms D56_D05_26632_The Elms_241864_120805_Stage2.doc Version 1.40 Page 6 Visitors to the home during the inspection commented positively on the changes that have occurred in the last year. One resident for the first time agreed to have a holiday with the keyworker and the experience was so successful that the resident has agreed to go again. The manager has taken steps to develop links with the Community Learning Disability team and to establish a consistent system of Care Programme Approach planning for residents with mental health care needs. Residents’ needs are more easily identified - for example, when is eye contact given and a more moderate approach to managing behaviours identified. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Elms D56_D05_26632_The Elms_241864_120805_Stage2.doc Version 1.40 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 The Elms D56_D05_26632_The Elms_241864_120805_Stage2.doc Version 1.40 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 The prepared Statement of Purpose will enable potential residents to make informed decisions about the home. EVIDENCE: The Statement of Purpose was developed in line with guidelines to enable decisions to be made about the home. Information about the services and facilities is included and relevant procedures are appended. The Elms D56_D05_26632_The Elms_241864_120805_Stage2.doc Version 1.40 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 standard(s) 6 & 9 Care plans must be further developed using a person centred approach. Mental health care needs and risk assessments must be incorporated so that residents have meaningful involvement in planning decisions about their lives. EVIDENCE: An action plan to develop the care planning process is in place. Background information is being sought from family members by the staff to provide a better understanding of the person. In terms of residents’ mental health care needs, Care Programme Approach formats are being used to establish the level of approach necessary. Further assistance is anticipated from the local Community Learning Disability team, initially through there being an agenda item on the CPA involvement of the residents at their team meeting. Since the last inspection basic care plans based on identified needs have been developed with. A person-centred approach is to be developed, with action plans on meeting needs and mental health care needs assessments. The Elms D56_D05_26632_The Elms_241864_120805_Stage2.doc Version 1.40 Page 10 Generic risk assessments are in place and based on medication, kitchen equipment, laundry and COSHH. There are also Health & Safety and Food Hygiene assessments which are up to date and lead staff to the appropriate policy and procedure. Disaster plans that focus on the actions to be taken to limit damage and trauma are available at the home. For activities that may involve an element of risk, assessments are completed. Reactive strategies for residents that may exhibit aggressive and violent behaviour must be reviewed. It was understood from the manager that reactive strategies and risk assessments will form part of the care planning process. It will follow residents CPA assessments. The Elms D56_D05_26632_The Elms_241864_120805_Stage2.doc Version 1.40 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 standard(s) 11 & 14 Facilities for residents to use the skills learnt must be provided by renovating the residents’ kitchen. An assessment on the leisure activities provided at the home must be conducted with residents input and based on transport and staffing. EVIDENCE: Thirteen residents are currently accommodated and nine participate in structured community-based activities. Residents attend day care centres, college courses and are in paid employment. Although residents learn practical skills, facilities are not available for residents to use them at the home. Staff are expected to guide residents to be as self-managing as possible. Facilities must be provided for residents to use the practical skills with appropriate staff support. The Elms D56_D05_26632_The Elms_241864_120805_Stage2.doc Version 1.40 Page 12 The positive attitude of the residents is based on the culture of the home. Residents are the primary focus of care, evidenced by the staff’s approachable attitude towards residents. The manager clarified that residents entering the office are given full attention and visitors to the home have to accept this ethos. While measures are in place for handovers, 1:1, and interviews, there must be clarity about boundaries and accountability - for example, the procedure for discussing confidential issues when residents refuse to leave the office. It is the intention that staff follow Person Centred Plans (PCP) for supporting individual to pursue hobbies and interests. In-house and group activities will be available to offer choice through interests - for example, visiting friends and spectator sports. Activities through arts and league of friends will forge new links for residents. Residents currently visit pubs and accompany staff on errands, with the individual making choices about joining ad-hoc group activities. During residents meetings social activities are discussed and on an ad-hoc basis activities are organised. Transport provided by the Trust can take up to seven people. Realistically, only five residents can use the transport, when two staff must accompany residents. Two of the seven people must be agile; otherwise the two seats at the back cannot be used. This has impacted on the number of people that can use the transport to access community activities - for example, two groups of people cannot use the transport to access separate activities in a geographical area. Residents and staff giving feedback on the activities available reported that there were insufficient community activities for residents. The size of the vehicle was raised by the staff and staffing levels by residents. The Elms D56_D05_26632_The Elms_241864_120805_Stage2.doc Version 1.40 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 standard(s) 18 Care plans that incorporate likes, dislikes and preferred routines will ensure residents receive support in their preferred approach. EVIDENCE: Care plans for personal care will be further developed into a person centred approach. Since the last inspection care plans were devised to meet the requirements of previous visits. Staff are to be commended for meeting this requirement. Action plans are specific and require the addition of the person’s likes, dislikes and preferred routines. The staff team have acknowledged that because of the number of male residents, there must be a gender mix in the staffing. With more male staff, where required personal care can be provided by the same gender. The Elms D56_D05_26632_The Elms_241864_120805_Stage2.doc Version 1.40 Page 14 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 Residents were confident that their views are sought and acted upon. EVIDENCE: Since the last inspection, three complaints were received at the home for investigation. From the records of the investigations, satisfactory outcomes were reached and the complainants were satisfied with the actions. Residents comments indicated their confidence with staff taking their complaint seriously and taking action. The Elms D56_D05_26632_The Elms_241864_120805_Stage2.doc Version 1.40 Page 15 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 The property has been neglected and requires attention in terms of repairs and replacement of furniture. Outstanding requirements must be actioned to prevent further non compliance. EVIDENCE: The Elms is a listed building within its own grounds in Stapleton Village close to shops, amenities and bus routes. The property is large and because of its age requires constant upkeep. It is evident from this and previous inspections that the building has been neglected; areas of the building would benefit from redecoration and torn and broken furniture replaced. There is a charming approach to the property that does not stand-up to closer scrutiny. Since the last inspection a number of requirements based on the maintenance of the property remain outstanding. The exterior of the stone is dirty with mud and following the water damage the upstairs corridor requires redecoration. Sluicing facilities are not provided and the residents’ kitchen has not been refurbished. During this inspection it was noted that the lounge curtains require attention, the sofa needs replacing and the floor covering in one bedroom must be replaced. The Elms D56_D05_26632_The Elms_241864_120805_Stage2.doc Version 1.40 Page 16 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 There are a significant number of vacant hours, which are hindering the effectiveness of the support for residents. Appropriate mental health training must be provided to also enable more effective support. EVIDENCE: The rota in place indicates that three members of staff are rostered throughout the day. At night there is one person awake and one person sleeping in the premises. During periods when residents are in “crisis”, additional staff are rostered. From October 2005, there will be 130 vacant hours, which includes one senior staff. Staff meetings take place 4-6 weekly with the manager chairing, minutes of the meetings indicate that house issues, rules and policy changes are discussed. Mental Health training has been provided for the staff. However, the training has little depth. Training that provides staff with the skills and capabilities to meet the needs of the residents must be provided. Appropriate training not only increases staff skills to meet the residents needs, it adjusts staff attitude towards the person and changes the culture. The advice of the CLD team should be sought on the most appropriate training to be provided. The Elms D56_D05_26632_The Elms_241864_120805_Stage2.doc Version 1.40 Page 17 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 Changes in the ethos of the home are taking place. The records of fire safety evidence that residents welfare is promoted. EVIDENCE: Relatives at the home during the inspection reported that the concerns they had have lessened with the changes of management. Their satisfaction with the advancements, made with their family member, was a source of celebration for them. Residents’ comments on the standards of care confirmed that their rights are observed and cultural changes are occurring. For example, they felt there is a more open culture. Two members of staff were asked to comment on the conduct of the home. One person said that more structured activities should take place, the other criticised some staff. It was suggested that there were inconsistencies between staff and advice was not always followed. The Elms D56_D05_26632_The Elms_241864_120805_Stage2.doc Version 1.40 Page 18 A professional visitor to the home stated that from previous experience of the home, there have been changes in the discipline and culture. The records that relate to fire policies, procedures, checks and practices were examined. It is evident from the records that checks and practices are conducted at the stipulated frequencies. The Elms D56_D05_26632_The Elms_241864_120805_Stage2.doc Version 1.40 Page 19 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 x x x x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 x x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x x x x x x Standard No 11 12 13 14 15 16 17 1 x x 2 x x x Standard No 31 32 33 34 35 36 Score x 1 x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Elms Score 3 x x x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 3 x D56_D05_26632_The Elms_241864_120805_Stage2.doc Version 1.40 Page 20 no 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 Standard 6 Regulation Requirement Timescale for action Six residents care plans by 10/1/06 2. Standard 11 3. Standard 24 Regulation a)Care plans must be 15(1)& underpinned by the residents 12(3) likes, dislikes and preferred routines. b) For residents with mental health care needs, their care plans must details signs and symptoms of a deteriorating mental health. c) review reactive strategies for residents that at times may exhibit aggressive and violent behaviour. Regulation An assessment must be 31.12.05 12(1)(b) completed with the residents on the leisure activities. Transport and staffing must be included in the assessmnent. Regulation a)The residents kitchen must be 31.1.06 23 refurbished and sluicing facilities provided. Previously Required on 17/3/05. b)The exterior stone is dirty and needs cleaning.c) upstairs corridor nmust be redecorated following the water damage. d)One bedroom requires the floor covering to be replaced.e)The lounge curtains must be replace. f) The sofas are in the lounge are broken and need replacing The Elms D56_D05_26632_The Elms_241864_120805_Stage2.doc Version 1.40 Page 21 4. Standard 33 5. Standard35 6. Standard 23 Regulation An assessment of the staffing 18 (1)(a) levels to evidence that there are appropriate numbers of duty must be completed and submitted to CSCI. Previously required on 17/3/05 Regulation Appropriate Mental Health 18(1) training must be provided to all staff. Previously required 17/5/05 Regulation The manager must attend the 13 (6) managers investigators course 30.11.05 31.1.06 30.4.06 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. Refer to Standard Good Practice Recommendations The Elms D56_D05_26632_The Elms_241864_120805_Stage2.doc Version 1.40 Page 22 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 The Elms D56_D05_26632_The Elms_241864_120805_Stage2.doc Version 1.40 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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