Inspection on 03/03/06 for The Elms [Stapleton]

This inspection was carried out on 3rd March 2006.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

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] 17/08/05

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 Announced Inspection 09:30 31 January, 7 February & 3 March 2006 st th rd The Elms DS0000026632.V268481.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 The Elms DS0000026632.V268481.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. The Elms DS0000026632.V268481.R01.S.doc Version 5.0 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 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) The Brandon Trust Mrs Tanya Abbott Care Home 14 Category(ies) of Learning disability (12), Learning disability over registration, with number 65 years of age (2) of places The Elms DS0000026632.V268481.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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. 2. Date of last inspection 12th August 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 DS0000026632.V268481.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was conducted over one full day with a second inspector and two half days. Two monitoring visits were conducted to discuss Regulation 37 reports received. This inspection was based on assessing key standards, with residents at the home and staff on duty. Other sources used to assess the outcomes for residents included a tour of the premises and examination of the records. . What the service does well: What has improved since the last inspection? Since the last inspection the team of senior staff has been established, this will maintain the intended aims and objectives of the home. Repairs and refurbishments have been undertaken, which respects residents and creates a homelier atmosphere. The Elms DS0000026632.V268481.R01.S.doc Version 5.0 Page 6 It is evident that the focus for care is shifting to a person centred approach to meeting needs 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 DS0000026632.V268481.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 The Elms DS0000026632.V268481.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): These standards were not discussed at this inspection. EVIDENCE: The Elms DS0000026632.V268481.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 & 9 Planning for life files incorporate person centred plans which places the individual at the centre of their care. The approach must be further developed to ensure the a consistent standards of care. . In terms of outcomes, reports of significant events must be linked to the individuals action plans. Outstanding are the action plans that include triggers of a deteriorating mental health. Risk assessments are in place for activities that may involve an element of risk, which must be dated and reviewed regularly by the staff. For restrictions imposed, risk assessments must be clear about the manner in which decisions were reached. EVIDENCE: Planning for Life files were introduced for each person and it is evident that keyworkers, residents and senior staff have taken significant steps have been taken to develop person centred plans. Daily routines were developed which reflects the person’s lifestyle, communication, choices and preference. Core assessments were completed specifying the individuals needs, with action plans on meeting needs. While the key principles of rights, choice, inclusion and independence are incorporated, a system must be introduced for The Elms DS0000026632.V268481.R01.S.doc Version 5.0 Page 10 monitoring plans to ensure the depth of information. In line with the values of person centred care, the individual must sign their care plan to evidence agreement with the action plan. Keyworkers and residents are developing recreational and leisure goals. Residents likes, dislikes, strengths and needs are discussed and recorded to further the development of a person centred approach to meeting needs. For individuals with mental health care needs, antecedents and triggers are being developed and in future training cascaded from senior staff will be used to prepare plans of care. Reports of significant events describe the individuals routines for the days, outcomes of visits and activities with observations of behaviours exhibited. There must be a link between the reports of significance and the care plans, in terms of the progress being made. Some residents have restrictions imposed on smoking and access to information and assessments that evidence appropriate actions are in place. The risks involved, options available and action plans are described. For the individual that has restrictions imposed on access to information, the risk assessments must be further developed to assist the decision making process. Restrictions based on Health and Safety are imposed for using the kitchen and kitchen utensils whenever there is no staff presence. There are reactive strategies for dealing with any challenging behaviour as well as useful contributor factors and actions to defuse aggressiveness. Action plans are in place for residents that at times may self harm and harm others. Staff must ensure that these are dated and reviewed regularly. Person Centred Plans describe the person’s preferences and their desired approach. The manner in which residents make decisions must be included in their plans. The Elms DS0000026632.V268481.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 & 14 For residents to increase their potential for independence, staffing levels must provide opportunities for residents’ personal development. For residents to benefit from leisure activities a programme of recreational pursuits will be developed from questionnaires. EVIDENCE: Weekly activities are in place for each person and generally community-based activities are undertaken, indicating a commitment towards social inclusion. During the day residents participate in employment and attend day care centres. It was understood that from the recreation and leisure questionnaires completed by the resident with support from the key worker that a schedule of activities will be developed for the person and the group. While there is structured activities for the residents, there is little flexibility for residents to have support from the staff to use the skills learnt. It is evident that staffing levels are having an impact on resident’s abilities to become independent. Particularly during periods when residents with mental health care needs The Elms DS0000026632.V268481.R01.S.doc Version 5.0 Page 12 require higher levels of support from then staff on duty. Seven residents completed questionnaires about the standards of care and five indicated that the home provides suitable levels of activities. The Elms DS0000026632.V268481.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): 16 & 20 Service users physical needs are met and assessed regularly. Service users are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: The staff assesses health care needs promptly. Files viewed showed that service users access health care professionals such as the primary health care team, opticians, Psychiatrists and dentists. There was also evidence of monitoring of weight and annual GP checks. One service user suffers from Diabetes and has regular checks of their blood sugar levels. Staff knew the parameters of what blood sugar levels are acceptable for that person. Also present, were the actions needed to be taken if that reading was not within those limits. Medication systems were checked. The home uses a Monitored Dosage system. A separate record is kept of medication given as required. There were some instances where this had not been used for sometime and should be returned to the supplier. The Elms DS0000026632.V268481.R01.S.doc Version 5.0 Page 14 Medication administration charts showed consistent recording and appropriate coding used for when this couldn’t be given. However, the following cautions need to be taken. One change to a dose had been handwritten. This needs to be recorded clearly from the supplier. Any changes to medication resulting from a consultant’s appointment should be confirmed by a copy of that change. An agreed homely remedies policy is used so that staff have the flexibility to give medication such as Paracetamol. 6 support workers have already been assessed as being competent to administer medication. All staff are currently working completing a workbook by Lloyd’s pharmacy called Managed Care Training Package. This will ensure that all staff are competent and skilled at giving medication and understanding the effects. At the moment some night staff have yet to be trained so there is a difficulty in them not being able to administer as required medication. This was discussed with the manager who agreed that should be resolved as soon as possible. The support worker who is responsible for dealing with medication assisted the inspector and was very knowledgeable about each service users medication and when that had been reviewed. The Elms DS0000026632.V268481.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 Service users can be sure that their views are listened to and acted upon. EVIDENCE: The complaints book was viewed. This showed a clear and prompt to concerns raised. These were well recorded including the actions taken with the outcomes. The home has a complaints policy. The inspector was told that all service users are asked at every house meeting if they have anything they are unhappy about. Minutes confirmed this. An example was given of a situation where a service user had identified something they were unhappy about. This was discussed with the staff team and relative, the service user’s confirmed their unhappiness with the situation as it was and how pleased they were with the new arrangements. One service user has no verbal communication so staff are of the need to observe for sings of distress form other means such as body language and using the keyworker as their advocate. The Elms DS0000026632.V268481.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): These standards were not assessed at this inspection. EVIDENCE: The requirements arising from the last inspection was discussed with the manager. The timescales for the residents kitchen to be refurbished is between January and March 2006, a sluice will be installed in April 2006 and the upstairs corridor will be made good. There are no plans to clean the exterior stone of the property, and repairs were undertaken. The Elms DS0000026632.V268481.R01.S.doc Version 5.0 Page 17 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): 33, 35, 36 There are steps in place to organise the staffing levels to ensure that there is an effective staff team with complementary skills on duty at all times. An assessment of the staffing levels that recognises continuity and stability for the residents must be conducted. The joint and individual training needs of the staff team are assessed during supervision and once relevant training is cascaded awareness will be raised on the residents category of needs. Residents benefit from the systems that ensure consistency of care at the home. EVIDENCE: Individual timetables were completed to assess the gaps in opportunities. For this reason Women’s Education Association (WEA) was used to access art groups, employment, independent skills training and gardening to meet group needs. Other activities identified will trigger additional staffing to enable residents to pursue interests. It was understood from the manager that staffing levels can be increased whenever residents exhibit challenging behaviour and have higher levels of mental health care needs. From a recent staffing assessment one full time member of staff will be employed in The Elms DS0000026632.V268481.R01.S.doc Version 5.0 Page 18 2006/2007. These systems are positive in terms of enabling residents to undertake structured activities. They offer little consistency of care and opportunities for staff to maintain a stable environment. To confirm the staffing levels, which meet the changing needs of the residents with opportunities for personal development, an assessment of the staffing levels must be conducted. Assessments must provide evidence of uninterrupted time with residents, non-contact work for staff to undertake administrative tasks and allocated time for residents that do not present with behaviours that challenge. Within the assessment, there must be recognition of quieter residents and a commitment that where possible quieter individuals will not be left unsupervised for more vocal residents. Since the last inspection, one member of staff has transferred within the Trust. There are no short absence sickness issues at the home and five staff are being monitored for long term sickness. Outside professionals with input into the care of the residents accommodated include the CLDTeam, dietician and occupational health. A student nurse is currently on placement at the home, this individual has no responsibilities for providing personal care to residents. Staff meetings generally take place monthly, which staff recognise as essential and therefore are well attended. Records of the meetings demonstrate that house issues, staffing and residents are discussed. Form the meetings action plans are developed. Members of staff confirmed that staff meetings occur and described how this forum has changed. It was reported that staff meetings are more constructive and open for staff to raise issues. One resident is non-verbal and Essential Life Plans (ELP) contains communication needs. For example, when behaviours are exhibited, staff must take the following actions. At present the needs of the residents accommodated are being reviewed by the Trust to set the future of the home. Training needs and personal development is discussed during supervision. Senior staff are attending specific training for people with a dual diagnosis of mental health and learning disabilities. Two staff are on NVQ level 2 and two are on NVQ level 3. The cook is on NVQ 2 for cooking and the one senior staff is undertaking the RMA. The training programme for the home is specific to the roles performed at the home. For senior staff with management responsibilities, introduction to management, process management, PCP facilitator, supervision training is accessible. All staff undertake POVA and statutory training, with the manager undertaking additional training. The Elms DS0000026632.V268481.R01.S.doc Version 5.0 Page 19 Senior staff are undertaking training for people with a dual diagnosis of mental health and learning disabilities. The information will then be cascade to support workers, with further opportunities to access similar training from this source. Other proven strategies and networking within the Trust will used to raise insight into the needs of the residents accommodated. One person was appointed as a senior since the last inspection and has completed NVQ level3, completed the Trust induction programme and updated statutory training. Supervision is shared between senior staff and the manager. Generally senior staff supervise support workers 6-8 weekly and the manager undertakes individual supervision with senior staff. Reports of individual supervision follow the issues brought forward from the last meeting, residents reviews, personnel and training. The external manager visits the home monthly for supervision with the manger. A report on the monthly visits to the home is prepared and copied to the home and CSCI. The Elms DS0000026632.V268481.R01.S.doc Version 5.0 Page 20 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): 38 The focus of care is changing to a culture where residents have greater opportunities. EVIDENCE: Members of staff on duty agreed to feedback on the style of management. Comments made by support workers indicated that positive changes in the management of the home had occurred. Systems that ensured consistency of care were established and steps to raise awareness through training are being taken. Additional comments were made regarding greater opportunities for residents to have more meaningful activities. The Elms DS0000026632.V268481.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 x x x x x Standard No 22 23 Score 3 x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 x 2 x Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x LIFESTYLES Standard No Score 11 2 12 x 13 x 14 2 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x x 2 x 2 3 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Elms Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score x 3 x x x x x DS0000026632.V268481.R01.S.doc Version 5.0 Page 22 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 3 Standard YA20 YA20 YA6 Regulation 13(2) 13(2) 12(3) Timescale for action All staff, including the night staff, 28/02/06 must be competent to administer medication. Changes to medication must be clearly recorded. 28/02/06 a) Residents signatures must 30/06/06 be included in their action plans. b) The individual’s decisionmaking process must be included into their person centred plans (pcp). c) Individual pcp must be developed for the residents accommodated. d) a system for monitoring the quality and content of pcp must be developed. a) Risk assessments must be 30/06/06 dated and reviewed along with pcp. b) For restrictions imposed, risk assessments must be clear about the manner in which the decisions were reached. a) Staffing levels must be 30/05/06 organised to provide continuity and stability. b) a detailed assessments of DS0000026632.V268481.R01.S.doc Version 5.0 Page 23 Requirement 4 YA9 13(4) 5 YA33 18(a) The Elms 6 YA35 18 (c) (1) the staffing levels must be undertaken. Appropriate training for staff to meet the needs of residents with a dual diagnosis must be provided. 30/06/06 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 YA20 Good Practice Recommendations PRN Medication which as not been used for some time should be properly reviewed and returned to the Pharmacy. The Elms DS0000026632.V268481.R01.S.doc Version 5.0 Page 24 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. 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