Inspection on 12/07/06 for The Mendips

This inspection was carried out on 12th July 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 no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Mendips 14/07/09

The Mendips 23/07/08

The Mendips 12/07/07

The Mendips 14/02/06

The Mendips 29/09/05

The Mendips 16/02/05

The Mendips 01/07/04

The Mendips 10/03/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME ADULTS 18-65 The Mendips 2-3 Shamrock Road Upper Eastville Bristol BS5 6RL Lead Inspector Sandra Jones Key Unannounced Inspection 12th July 2006 09:30 The Mendips DS0000026568.V303913.R01.S.doc Version 5.2 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 Mendips DS0000026568.V303913.R01.S.doc Version 5.2 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 Mendips DS0000026568.V303913.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Mendips Address 2-3 Shamrock Road Upper Eastville Bristol BS5 6RL 0117 9518548 0117 9518548 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) Mr Mamode Raschid Ghamy Mrs Bibi Ghamy & Mr M R Ghamy Mrs Bibi Ghamy & Mr M R Ghamy Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (9) The Mendips DS0000026568.V303913.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 9 persons with mental disorder aged 30 years and over 14th February 2006 Date of last inspection Brief Description of the Service: The Mendips is operated by Mr and Mrs Ghamy, it is a registered care home for nine adults with mental health care needs, aged 30 years and over. The home is situated close to the Fishponds Road and is within walking distance of shops, library, places of worship and other amenities and bus routes. The property has the appearance of a domestic dwelling and blends well with its local environment. The fees range from £334.00 - £553.54 per week. Items not included in the fee include dry cleaning chiropody, clothing and hairdressing. The Mendips DS0000026568.V303913.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was conducted over one day in July 2006 and focused on the assessment of key standards of care. Records were examined and a tour of the premises took place to make judgements on the standards of care. Residents’ feedback was sought to confirm the standards of care. The service providers and family members were on duty at the time of the inspection. For this reason their feedback on the conduct of the home was not sought. What the service does well: What has improved since the last inspection? The home continues to develop the systems that ensure it operates within National Minimum Standards. Redecoration is to take place and heating systems are being updated. In accepting that change is inevitable, the service providers will be able to introduce the changes that develop the existing standards of care. The service provider is currently undertaking the RMA training. The Mendips DS0000026568.V303913.R01.S.doc Version 5.2 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. The Mendips DS0000026568.V303913.R01.S.doc Version 5.2 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 Mendips DS0000026568.V303913.R01.S.doc Version 5.2 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): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The Statement of Purpose requires further development to enable potential residents, their representatives and placing agencies to make decisions about the home. EVIDENCE: Outstanding requirements that relates to adding information to the Statement of Purpose were checked. The status for accommodation at the home under the Mental Health Act remains outstanding from previous inspections. The Statement of Purpose requires updating in terms of the information included for admission at the home. The Mendips DS0000026568.V303913.R01.S.doc Version 5.2 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The person centred approach must be further developed to include the person’s wishes and personal development needs with key principles of rights, choice and independence incorporated. The terminology must be more respectful and the action plans must be more descriptive. Residents are able to make decisions about their day-to-day life at the home and records must provide evidence that residents are empowered to make decisions. The requirement to develop risk assessments is outstanding from the last inspection. EVIDENCE: Care plans in place are signed and dated by the resident which list the individuals assessed needs and actions to be taken. The responsible person, with additional information about meeting the needs and timescales are incorporated within the care plan. While the service provider has taken steps to develop a person centred approach to meeting needs, the process requires further development. The Mendips DS0000026568.V303913.R01.S.doc Version 5.2 Page 10 The terminology used and the actions plans must be better explained to ensure good practice guidelines in terms of rights are followed. The wishes and personal development of the person must be included within the care planning process along with key principles of rights choice and independence. One resident is subject to section 117 and must comply with the conditions of the after care arrangements. It is evident from the documentation that three residents can become aggressive. Reactive strategies must be developed to ensure that members of staff can manage aggressive situations consistently. It was understood from the service provider that care coordinators will be appointed to convene the care plans reviews. The care plans reviews will replace the previous Individual Care Planning Approach (ICPA) meetings Members of staff record daily events in the home’s diary, which is later transferred by the service provider into individual daily report. Daily reports are based on staff’s observations, outcomes of visits and incidents. Reports must be specific to the person, linked to the care plan, signed and dated by the author. Choices and decisions made by residents are not included in the daily reports and evidence that residents make choices must be included in the daily reports. The residents consulted were not clear about the care planning process but were aware that records are kept about them. The service provider explained that the views of the residents are sought on a daily basis. English is not the first language for one resident and simple words are used to communicate, with family members assisting. The service provider stated that advocacy was used in the past for one resident. The current residents are able to express their wishes and feelings without support from an advocate. The requirement to develop risk assessments for activities that may involve an element of risk has not been actioned by the service provider. The service provider has given his assurances that risk assessments will be developed. The service provider maintains an accident book and no accidents have occurred since the last inspection. It was noted from daily reports that one resident had a number of falls for which there was an admission to hospital. The service provider maintains the Commission informed of incidents and accidents that are reportable under Regulation 37. The Mendips DS0000026568.V303913.R01.S.doc Version 5.2 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): 12,13,15,16, &17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The service provider must consult residents on their goals in terms of education and occupation during reviews and assessments. Where necessary, members of staff support residents to community facilities. Residents’ friends and family are welcome by the staff at the home ensuring that links with family and friends are strengthened. Residents have a varied diet. The arrangements for privacy and dignity at the home must be included within the Statement of Purpose to support that residents’ individuality is respected by the staff. EVIDENCE: A record of activities was previously maintained for one resident about the daily activities undertaken with the home’s staff. The residents consulted confirmed the service providers’ comments that continuous discussions with them take place, about their goals and aspirations. The service provider accepts that residents’ goals and aspirations must be included in residents care plans. The Mendips DS0000026568.V303913.R01.S.doc Version 5.2 Page 12 It was understood from the service provider that four residents attend structured community based activities. One resident canvasses during the day, with members of the congregation as part of his religious beliefs. Four residents can leave the home independently and staff accompany four residents to assist with crossing the road. It was understood from the service provider that the staff accompany residents to visit shops, theatres and restaurants. The residents consulted reported that they were able to leave the property without staff support. Visitors to the home are welcome. Residents confirmed that whenever their friends and family visit, the staff greet their visitors in a positive manner. It was reported that visits can take place in the shared space or in their bedrooms for additional privacy. Regarding the rules and routines of the home, the information about additional costs not included in the fees, visiting and pet policy is included in the Service User Guide. Other information about alcohol, smoking and the use of shared space is provided within the Guide. The arrangements for residents’ privacy and dignity must be appended onto the Statement of Purpose. There is a rota for setting the table and washing-up displayed in the kitchen listing the designated person to complete the tasks. The service provider stated that residents are provided with keys to their bedrooms and to the home. Regarding rights to privacy and dignity, there is an expectation that staff follow the home’s set procedure. The service provider maintains a record of the food provided which indicate that generally residents have a cooked lunch and tea. One example was provided where an alternative was served to one resident. The range of fresh, frozen and dried food, confirms that residents have a varied diet at the home. During consultation with residents, positive comments were made about the food. It was also stated that they have the freedom to prepare refreshments and light snacks at anytime. The Mendips DS0000026568.V303913.R01.S.doc Version 5.2 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Care plans must be detailed about the personal care that is provided to three residents. The staff at the home monitor and recognise residents health care needs and where appropriate referrals through GP’s are requested. Safe practices of administration, ordering and disposal of medications exist at the home. EVIDENCE: The service provider reported that currently three residents require assistance from staff with personal care. The care plans for people with personal care needs, vary in detail to meet the assessed needs. Care plans must be consistent about the needs and the actions plans must contain sufficient detail to best meet the needs. There are three people at the home that are from diverse cultures and the service providers stated that the residents have no specific cultural needs. For one resident, family member’s provide the support to meet religious needs. The Mendips DS0000026568.V303913.R01.S.doc Version 5.2 Page 14 Aids and equipment is not provided at the home and the residents must therefore be mobile to live at the home. There is no specialist input from therapist for the residents currently accommodated. Documentation in place from health care specialists, evidence that the staff follows any advice given. Generally the documentation is written confirmation of the visit sent to the GP and copied to the home by the GP. The service provider reported that the residents have psychiatrists involved in their care. The care coordinators will in future arrange care reviews with the psychiatrists, residents and other agencies involved in the care of the person. Residents access NHS facilities within the local community. The service provider stated that dental and optician appointments are arranged for the residents. One resident has continence difficulties, which are behavioural and not linked to medical issues. Residents consulted during the inspection reported that the service provider accompanies them on GP’s, hospital and specialists visits. Medications are administered from standard packaging by the staff at the home. The records of administration indicate that staff sign the records immediately after administration. Records of medications received and no longer used at the home are maintained. The pharmacist countersigns the records of medication no longer required to indicate receipt of the medication for disposal. The Mendips DS0000026568.V303913.R01.S.doc Version 5.2 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents expressed confidence with the service provider’s abilities to resolve complaints. The homes Abuse policy must follow “No Secrets” guidance. EVIDENCE: There were no complaints received from residents at the home since the last inspection. The staff currently employed at the home have attended external POVA training. The home’s Abuse Guidance policy requires updating, the procedure for making allegation of abuse must be follow the “No Secrets” guidance. The service provider gave assurances that the POVA policies will be updated by the next inspection. Residents giving feedback about the standards of care confirmed that the service providers would be approached with complaints. One resident felt that the service provider’s monitored staff’s attitude, which ensured that they were safeguarded from abuse. The Mendips DS0000026568.V303913.R01.S.doc Version 5.2 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The service provider is taking steps to provide a homely and safe environment for the residents. The vanity units in a number of bedrooms require attention. The home was found clean and free from unpleasant smells. EVIDENCE: Two terraced properties were originally converted to offer accommodation to nine adults with mental health care needs. The property of the service providers adjoins and can be accessed through the care home. It has the appearance of a domestic dwelling, which blends well with its immediate environment. It is within walking distance of shops, library, amenities and bus routes. While there is a gentle gradient into the property, residents must be mobile, as the property does not allow for aids and equipment. The accommodation is arranged over two floors with shared space on the ground floor and bedrooms on both floors. The Mendips DS0000026568.V303913.R01.S.doc Version 5.2 Page 17 Shared space at the home comprises of a lounge, dining room and smoking room. In the lounge and dining room there is sufficient seating for all the residents to sit together as a group. There is a pay phone available in the corridor for residents to make personal calls. All bedrooms are single and lockable, with a combination of the home’s furniture and residents’ personal belongings. The residents consulted reported that their bedrooms were suitable to their lifestyles. There are two bathrooms with toilets on the first floor and a downstairs toilet shared by the residents at the home. It was reported by the service provider that the utility room and downstairs toilet are to be redecorated. The repairs noted from the tour of the premises relate to the vanity cupboards in a number of bedrooms require attention and the drawer fronts in one bedroom require repair. The Mendips DS0000026568.V303913.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 &35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The recruitment process at the home endeavours to employ staff that are suitable to work with vulnerable adults. Members of staff must complete Mental Health Awareness training. EVIDENCE: The service providers are the main carers for the residents. Two members of staff are employed and family member are also rostered to maintain the staffing levels. The steps used to establish the suitability of the person to work with vulnerable adults was examined. For this reason the personnel files of the staff employed at the home were examined. The completed application forms, references and Criminal Records Bureau (CRB) disclosures are held to demonstrate the process followed. CRB disclosures are obtained for family members. One member of staff is a qualified nurse and the other has undertaken NVQ level 2. Before their appointment at the home, one person has undertaken induction training and other courses. Both staff recently attended Food Hygiene training. The service providers are committed to having competent staff at the home, for this reason the two staff at the home will be undertaking Mental Health Care training. The Mendips DS0000026568.V303913.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The service provider is undertaking vocational training to maintain the management of the home within the stated purpose. To provide a safe environment for residents, the service provider must ensure that portable electrical equipment is checked at the stipulated frequencies. EVIDENCE: The service provider stated that to maintain the home operating within its stated purpose, management training is being undertaken. The service provider has registered onto the NVQ level4 and will in future update statutory training. The records that relate to fire safety were examined and the records indicate that checks and practices are conducted at the stipulated frequencies. The service providers ensure compliance with associated legislation by the checks of system and appliances. However, confirmation of the portable appliance testing was not available at the time of the inspection. The Mendips DS0000026568.V303913.R01.S.doc Version 5.2 Page 20 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 Standard No Score 1 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 3 X X X X 2 X The Mendips DS0000026568.V303913.R01.S.doc Version 5.2 Page 21 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 YA1 Regulation 4(1) Sch. 1 Requirement a) The status for accommodation under the Mental Health Act must be listed in the Statement of Purpose. (Previously required 1/7/04, 16/2/05, 29/09/05 & 14/02/06) A person-centered approach to meeting residents’ needs must be incorporated into the care plans. (Previously required 14/02/06) a) Risk assessments must be completed for activities that may involve an element of risk. b) Manual handling assessments must be completed for residents that require assistance outside the home c) Reactive strategies must be developed for residents that may exhibit aggressive and violent behaviour. (Previously required 14/02/06) Testing of electrical equipment must take place to ensure the safety of the residents. Timescale for action 30/10/06 2. YA6 15 30/09/06 3. YA9 13(4)(b) 30/09/06 4 YA42 23(2)(c) 30/11/06 The Mendips DS0000026568.V303913.R01.S.doc Version 5.2 Page 22 5 YA42 23(2)(b) 6 7 YA18 YA12 15 12(1)(b) Repairs and redecoration of the utility are and downstairs toilet must be carried out. The vanity units in a number of bedrooms are in need of repair. Residents care plans must be more detailed about the personal care provided to residents. Residents must be consulted on their goals for education and occupation to develop and action plan to meet these goals. (Previously required 14/02/06) Members of staff must attend Mental Health training. (Previously required 14/02/06) The seal around the hand washbasin in the laundry must be replaced. (Previously required 14/02/06) In-house policies and procedures must follow No Secrets guidelines (Previously required 14/02/06) 30/10/06 30/09/06 30/09/06 8 YA32 18(a) 31/10/06 9 YA30 23(2)(b) 30/10/06 10 YA32 13(6) 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Mendips DS0000026568.V303913.R01.S.doc Version 5.2 Page 23 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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