Inspection on 04/03/09 for The Old Rectory

This inspection was carried out on 4th March 2009.

CSCI found this care home to be providing an Good service.

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 Old Rectory 05/03/08

The Old Rectory 29/11/06

The Old Rectory 22/11/05

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Old Rectory Chewton Hill Chewton Mendip Near Bath Somerset BA3 4NQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Justine Button     Date: 0 4 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: The Old Rectory Chewton Hill Chewton Mendip Near Bath Somerset BA3 4NQ 01761241620 01761241497 michelle@bradburyhouse.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Neil Bradbury t/a Bradbury House care home 10 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Service users who have concurrent mental health needs may be admitted. Date of last inspection Brief description of the care home The Old Rectory is registered to provide a service for ten younger adults who have a learning disability. The service aims to support people who have relatively high needs including those who have Autistic Spectrum Disorders. The service is located in a large substantial house in the rural village of Chewton Mendip. The cathedral city of Wells is approximately 6 miles away and the city centres of Bath and Bristol are within travelling distance. There is a village shop across the main road. The home provides accommodation on three floors. The ground floor provides a lounge, dining room and activities/games room. There are two kitchens. The first is the house kitchen, which provides meals for the home. The second kitchen is accessible, with staff supervision, Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 10 Brief description of the care home to the people living at the service. This kitchen is used to develop life skills. In addition to the living accommodation there are a range of staff areas including meeting room, administration office and staff office on the lower floor. The bedrooms are located on the upper floors. All the bedrooms are large and have en-suite facilities. There are three bathrooms, one of which has a spa bath. There is a staff area predominantly used by staff for night supervision. Additionally there is separate selfcontained staff accommodation. The service would not be suitable for people with a physical disability who could not access the stairs, as there is no lift to the upper floors. There is an accessible garden to the front of the house and a courtyard area to the rear. Bradbury Homes Ltd owns the home. There is a manager in post but they are not yet registered with the Commission for Social Care Inspection. Fees at the home are assessed on an individual basis but are currently around 2000 pounds per week. Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The focus of this inspection visit was to inspect relevant key standards under the Commissions Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are excellent, good, adequate and poor. This inspection was carried out over a one day period. During this time we were able to meet with people living and working at the home, observe care practices, tour the building and view records. We were given unrestricted access to all areas of the home and all records requested were made available. Prior to the inspection the manager completed an Annual Quality Assurance Care Homes for Adults (18-65 years) Page 6 of 26 Assessment. (AQAA) This gave details of the homes achievements and plans for the coming year. It also supplied some numerical information. Surveys were sent to the home although none were returned to us prior to the inspection. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides appropriate information to people thinking of moving into the home. This based on the needs of the individual. This can include a visit to the home and a trial period. Staff at the home lisase with other healthcare professionals to ensure that they have all required information and to ensure that the home can meet the needs of the individual Evidence: It should be noted that all the people who live at home have done so for a number of years. There are currently one vacancies at the home. The staff described how any new people thinking of moving into the home would be given information according to their individual needs. Staff stated that this would include a visit to the home (on more than one occasion if this was required). This may include a meal or staying over night if this is required. Everyone living at the home has details of what is included in the fee and items that Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: individuals will need to purchase for themselves. The manager and staff gave evidence that they monitor the needs of individuals and take appropriate action if they feel the home may no longer be meeting someones needs. Care Homes for Adults (18-65 years) Page 11 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans give clear guidance to enable staff to assist people in their preferred manner. Various communication methods need to be developed to ensure that people are able to make choices and have an input into their care and the running of the home. The management need to ensure that the locking of doors does not impact on the lives of people living at the home Evidence: Everyone living at the home has a care plan. We looked at the documentation relating to two people. Both contained an up to date support plans. These plans were very personal to the individual and contained information about likes and dislikes as well as needs. Staff have attended training in person centred planning and those spoken to demonstrated an excellent knowledge of individuals and their personalities. Care plans Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: gave clear guidance for staff to follow to ensure that people received care in their preferred way. The plans viewed were very person centred and gave staff guidance on behaviural triggers and diffusion tenchinques. As some people at the home are not able to fully express themselves verbally staff could use various forms of communication to ensure that their views are taken account of. There is currently limited use of varied communication methods. This could include such things as photographs, symbols or pictures. These would support or enable people to make choices about their day-to-day lives and the running of the home. We did not see that photographs or other visual materials were used to ensure that everyone is able to participate in service user meetings nor were photographs, symbols or pictures incorporated into the minutes. People are assisted with personal financial matters the manager audits all records, in relation to finances. A recent audit showed that records were well maintained and no discrepancies were noted. Some areas of the home were seen to be locked during the inspection with staff holding the keys. These areas included both kitchens, some bathrooms (although not en-suites so toilet facilities were not restricted) and the craft room. This may restrict access to people living at the home and thus also restrict choices.This gives the home a rather institutional feel. The staff stated that doors were locked to protect people from risk of harm from such things as kettles and hot water. The management need to ensure that the locking of doors is absolutely necessary and that risk assessment are kept and updated to ensure that the locked doors do not restrict the free movement of people in what is their home. Care Homes for Adults (18-65 years) Page 13 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to learn and develop independent living skills but the building itself does not always promote this. Staff support people living at the home to undertake a range of social, recreational and learning opportunities. Evidence: People living at the home are encouraged to learn and develop independent living skills in line with their abilities and interests. Everybody has one day that they spend with their keyworker carrying out tasks that are personal to them such as cleaning and tidying their rooms. The home has a small kitchen which when not locked can be accessed by people living at the home to prepare breakfast, drinks and meals at the weekend when the cook is Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: not on duty. The home is surrounded by garden. The garden is secure and well maintained People at the home attend a range of social and recreational opportunities these include atmospherics, gateway club, college and the companies farm where people have the opportunity to grow vegetables and raise livestock. The home has its own transport, to ensure that people are able to access community facilities. Trips to local pubs and shops are a regular events. The staff and management are currently organizing a group Holiday to a centre which provides adventure activities. People spoken to during the inspection stated that they were able to choose what they did during the day, in the evenings and at weekends. People are able to have visitors at any time and many staff commented that families visited regularly and appeared comfortable in the home. It was evident at this inspection that routines are flexible and people are able to choose how and where they spend their time (outside of such things as regular college courses) . During the inspection people were able to spend time in the communal areas or in the privacy of their rooms. Privacy is respected. Staff were seen interacting with people in a friendly and respectful manner. There is no set menu in the home but menus are drawn up in line with individual wishes. People at the home create their own weekly menu with support from staff. People are involved in the household shopping so that they are able to make choices about the food coming into the home. This could be further developed if communication aids were available as previously discussed. Care Homes for Adults (18-65 years) Page 15 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have access to healthcare professionals in line with their individual needs. Staff assist people with personal care in their preferred manner. Evidence: As previously mentioned care plans give clear guidance for staff to ensure people living at the home receive care in their chosen manner. All the bedrooms have en suite facilities. There are additional bathrooms on the ground floor and first floors. Records show that people have access to a variety of healthcare professionals including GPs, psychologists, psychiatrists and speech and language therapists. Staff spoken to were able to demonstrate a good knowledge of individuals, including their mental and physical healthcare needs. It was apparent that advice is sought to ensure that people receive appropriate care and treatment. A food and fluid chart is maintained for one person. Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: Medication is well managed. Care Homes for Adults (18-65 years) Page 17 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure is accessible to people living at, or visiting, the home who wish to make a formal complaint. There is evidence in the home that recruitment practices and procedures minimise the risk of abuse to the people who live there. People living at the home know who to talk to if they are unhappy with any aspect of their care. Evidence: The home has policies on making a complaint and whistle blowing. The complaints policy is available and this has been used to assist someone to make a complaint in the past. People living at the home said they knew who to talk to if they were unhappy about any aspect of their care. The complaints procedure is displayed in the home . Care Homes for Adults (18-65 years) Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable and enabling environment in all areas for the people who live there. The home is well maintained. People are able to independently access outside space. Evidence: Bedrooms have been personalised to reflect the personalities and wishes of their occupants. One person living at the home has their own small flat and an additional person has a sitting room attached to their bedroom. There is a small laundry, which is adequate to meet the needs of the home. This has been updated since the last inspection. Hand washing facilities are available throughout the home. There are a range of communal areas throughout the home including a lounge dinning room and arts and crafts room. In addition there is a small kitchen used by people living at the home to prepare breakfast and meals at the weekends. As previously discussed some of these areas were locked on the day of the inspection. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good opportunities for training leading to a well-qualified and competent staff team. Staffing levels are adequate Evidence: All staff spoken to said that they were happy with the training opportunities available. Training records show that people are undertaking training in the majority of health and safety issues and other subjects relevant to the care of the people who live at the home. A number of staff stated that they had been supported to undertake an NVQ. The home follows accepted recruitment procedure, which includes obtaining written references and carrying out a Criminal Records Bureau check before the person begins work. Records of references and checks were available in the home for the most recently appointed person. The checklist with the recruitment file had been completed to give evidence of when checks and references had been received. Staff spoken to were extremely well motivated and committed to providing a high standard of care. Everyone said that, except in unforeseeable circumstances, the home was adequately staff. All staff spoken to said that there was good teamwork and Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: communication. Given the needs of the people living at the home the staffing levels need to kept under review. Staff were observed to interact well with the people living at the home. All staff receive regular formal supervision. Records of supervisions seen showed that a wide variety of subjects are discussed including training needs. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is effectively managed. Policies and procedures protect the people living at the home. confidentiality is respected with care records being held securely. Health and safety is on the whole well managed. Evidence: The manager of the home is Madele Steyl. Ms Steyl has worked at the home for some years and has been the manager for the last year. Ms Steyl has recently submitted an application to become registered with us.This is required to ensure that managers have the skills and competence to manage a care home. Ms Style is hoping to undertake a Managers qualification in the near future. Staff described the manager as very approachable and were very happy with the level of support and guidance that they received. We observed that people living and Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: working at the home appeared very comfortable with the manager and she demonstrated a good knowledge of individuals. All records requested were made available, all were well maintained and up to date. Confidentiality may be at risk as the care records are not kept securely The regional manager and manager carry out a monthly audit of facilities and care as part of the homes quality assurance. There is a fire risk assessment in place. The home is fitted with a fire detection system and records seen show that the alarms and emergency lighting is regularly tested. Staff said that they received adequate instruction on fire safety. Training records show that fire safety training is carried out on a regular basis. Portable electrical appliances have been completed. Health and safety is maintained Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 It is required that the home develop communication methods such as Photographs, symbols or pictures. This will to enable people living at the home to make choices, decisions and to contribute to the day to day running of the home. The management of the home need to ensure that the locking of doors does not impact on the freedom of movement of people living at the home. 2 7 Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 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. 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