CARE HOME ADULTS 18-65
The Old Vicarage 8 All Hallows Road Easton Bristol BS5 0HH Lead Inspector
Melanie Edwards Unannounced Inspection 29 January 2006 09:30 The Old Vicarage DS0000020336.V271674.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 Old Vicarage DS0000020336.V271674.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 Old Vicarage DS0000020336.V271674.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Old Vicarage Address 8 All Hallows Road Easton Bristol BS5 0HH 0117 9399910 0117 9399910 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 Susanne Burch Care Home 9 Category(ies) of Learning disability (9), Learning disability over registration, with number 65 years of age (1) of places The Old Vicarage DS0000020336.V271674.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 9 Adults with Learning Difficulties aged 18 - 64 years Staffing Notice dated 01/06/1999 applies Manager must be a RN on parts 5 or 14 of the NMC register May accommodate one named person over 65 years old. Will revert when named person leaves. 28th February 2003 Date of last inspection Brief Description of the Service: The Old Vicarage is a large building converted to house 9 residents with learning difficulties. There are two large communal areas and 9 single bedrooms in the home. The home is surrounded by garden, has its own off road parking and situated in a quiet road near to a cyclepath. The home is situated towards the centre of Bristol and near to local amenities. There are recreational amenities, shops and services near to the home. The home has a social focus and has its own minibus. The Old Vicarage DS0000020336.V271674.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day. The inspector met four residents. The registered manager, one registered nurse and four care assistants were also interviewed about their roles and responsibilities, their training needs, and how they assist and support residents. Residents were observed talking with staff and being helped with their needs. The inspector ate lunch in the company of a group of residents and staff at their invitation. A range of records relating to the day-to-day running and the management of the Home were inspected. A selection of resident’s care records and care plans were also reviewed. The whole of the environment was viewed. Specific maintenance and repair work that must be carried out was discussed in detail with the registered manager. What the service does well: What has improved since the last inspection?
The smoking policy has been reviewed to support the majority of residents who do not smoke, and to ensure that residents who do are able to exercise their rights while not putting other residents at risk. The bedroom window sash that was broken in has been repaired. Also a new boiler has been installed to ensure there is hot water when needed. The Old Vicarage DS0000020336.V271674.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Old Vicarage DS0000020336.V271674.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 Old Vicarage DS0000020336.V271674.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): 2 Residents’ individual needs are partly assessed. EVIDENCE: To find out how residents’ psychological, physical and social needs are assessed, two assessment records were reviewed. Residents’ assessments are based on the idea of ‘person centred planning’, meaning the views and wishes of residents are at the centre of all care provided. There was a range of detailed assessment information recorded about residents care needs. However the assessments had not been reviewed or updated regularly, which is required to help demonstrate that staff monitor residents’ changing needs. As referred to in the introduction of the report, the needs of one resident must be reassessed as matter of priority, as the persons needs have changed significantly since October 2005.The person has become physically abusive to residents and staff on a regular basis. The Home must be able to demonstrate how residents are protected and safeguarded from the risk of physical abuse. The change in the person’s behaviour is also clearly having a significant impact on the safety and well being of other residents. Examples of comments made by residents included, `it’s very noisy here with all the banging’, and, `I stay in my room’. The Old Vicarage DS0000020336.V271674.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): 6,9 Residents’ basic needs are met; however residents’ risk assessments do not support residents to maintain their safety. EVIDENCE: To find out if residents’ needs are met and reflected in their plans of care, two residents’ care plans were inspected. Care plans had been written from the perspective of `person centred planning’ meaning residents help to identify what they feel their needs are, and how best they think staff can help them. This can help ensure that care is individualised and based on the involvement and participation of residents. The Old Vicarage DS0000020336.V271674.R01.S.doc Version 5.0 Page 10 The care plans contained some information demonstrating how to support residents to meet their health care needs. Care plans also addressed psychological needs of residents, and detailed how to respond to the person if distressed or agitated. Based on detailed discussion with all the staff on duty, it was evident that despite staff being skilled and competent, the level of physical aggression that one resident is regularly exhibiting (referred to previously in the report), makes it very hard to maintain the safety of residents. The inspector witnessed staff respond calmly to a situation where residents had recently become extremely angry. The risk assessments for the resident were insufficiently detailed, not up to date, and did not reflect current behaviours of the resident. Both resident’s risk assessments that were inspected were not being reviewed and updated regularly. The Old Vicarage DS0000020336.V271674.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): 11,17 Residents are provided with a healthy, well balanced diet and staff work hard to support them to live as part of the community. EVIDENCE: During the inspection one resident went out for a walk to the shops in the local community. Staff work hard supporting residents to go out for coffee, and to nearby pubs and social venues. This is an essential role of staff to support residents to live a varied and fulfilling life. There was information written in daily records showing residents access community activities such as shops, the pub and day care services. The Old Vicarage DS0000020336.V271674.R01.S.doc Version 5.0 Page 12 The residents’ menu was reviewed to see what meal choices are offered. The choices were nutritionally well balanced and varied, and helped demonstrate residents are provided with a nutritious diet. For lunch residents were offered roast lamb, roast potatoes, three freshly cooked vegetables, stuffing and gravy. The inspector took the opportunity to sample lunch in the company of residents and staff. The meal was tasty and well presented. All the residents looked as if they were enjoying their meal. Two residents said the meal was `nice’. The Old Vicarage DS0000020336.V271674.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): 19,20 Residents are supported to meet their needs by competent staff, and resident’s medication is handled, administered, stored and disposed of in an only partly safe way. EVIDENCE: The procedures for the administration, storage, and disposal of residents’ medication were inspected with the assistance of a registered nurse, to monitor systems in place for residents’ medication. Three residents’ medication administration charts were inspected in detail. There was a photograph of the resident maintained with each record to ensure medication is dispensed to the correct person. The medication administration charts were legible, up to date, and contained the signature of the dispensing registered nurse, demonstrating residents’ medication is administered safely; the reasons for any omissions had also been written on the charts. The Old Vicarage DS0000020336.V271674.R01.S.doc Version 5.0 Page 14 Up to date records were kept of medication received into the Home, and medication returned to the issuing pharmacy, showing there are partly safe systems in place to monitor medication. However there is currently no up to date protocol for the administration of one resident’s additional medication. This medication is administered if the person is very angry and agitated. A protocol is necessary to support staff to make decisions about giving such medication to the resident based on objective clinical judgments, and clearly identified `triggers’ that lead to physical aggression. Staff were observed assisting residents with their needs in a calm and sensitive manner, even when residents became extremely angry and agitated. As has been previously referred to in the report, resident’s care plans included information, stating how residents wish to be supported to meet their physical, mental, social and spiritual needs. The Old Vicarage DS0000020336.V271674.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): 22,23 There are procedures in place to ensure complaints are investigated promptly; however residents are not fully protected from risk of harm or abuse. EVIDENCE: There is a copy of the complaints policy on display; a policy written in plain language is contained in the service users guide, and a copy has been given to each resident. All the staff the inspector met demonstrated a good understanding of their responsibilities around the principle of the protection of vulnerable adults from abuse. Staff also explained in detail how the changing needs of residents in the Home have a significant impact on the needs and safety of other residents. This was also confirmed when reviewing the residents and staff incidents accident records for the previous three months. There were a significantly high number of incidents when residents had been physically assaulted or nearly assaulted in the Home. Staff also explained that on a very regular basis they have to use a form of restraint they are trained in, to de-escalate situations. This restraint technique should have to be used only as a last resort when residents are extremely physically angry and other residents are at risk. Residents who are at risk need to be referred under ‘vulnerable adults’ Social Service guidance policy to the local adult protection co-ordinators. This was discussed with the registered manager who said that the majority of residents were at risk of physical abuse from the actions of one resident at this time. The Old Vicarage DS0000020336.V271674.R01.S.doc Version 5.0 Page 16 A number of staff have attended training courses on the issue of `protection of vulnerable adults from abuse’, to help them better understand the principal of protection of vulnerable adults. The Home also has a `protection of vulnerable adults’ procedure and a range of guidance information, which is needed to help staff understand their responsibilities to protect vulnerable adults in their care. However a number of residents were still clearly at risk. The Old Vicarage DS0000020336.V271674.R01.S.doc Version 5.0 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24-30 Residents live in a Home that is only adequately suitable for meeting their needs. EVIDENCE: The inspector toured the building and viewed the majority of the environment. Since the last inspection the window sash that was broken in one bedroom has been repaired. Also a new boiler has been installed to ensure that there is hot water when needed. However there is a range of redecoration and maintenance work that needs to be carried out. The registered manager was made aware of the areas that require attention. A member of staff, who oversees the health and safety in the environment, toured the building with the inspector and they were also made aware of work that needs to be carried out. A programme of maintenance, redecoration and repair must be carried out as a matter of high priority. There were three fire doors along corridors that did not appear to shut properly. It was advised that a fire safety officer should inspect the premises to assess the safety of fire doors, and the premises as a whole. The Old Vicarage DS0000020336.V271674.R01.S.doc Version 5.0 Page 18 The Home is a converted older property, built over two floors, which can be accessed by stairs only. The majority of bedrooms and all the communal areas were viewed. Bedrooms are all for single occupancy, and were mostly adequately decorated and maintained. Bedrooms do not have en suite facilities; however there are bathrooms and toilets located within close proximity, and a washbasin in each bedroom. There is a spacious and ‘light’ dining room situated on the ground floor. At the last inspection it was noted that there was one resident who chooses to smoke. This resident smokes in the lounge and this was the designated smoking area. This was having an impact on the other residents who do not smoke. Therefore it was required that the smoking policy be reviewed to take into account the wishes and needs of the whole resident group. This requirement has now been carried out and the resident concerned was seen smoking in areas away from other residents. Residents were observed sitting in communal areas looking comfortable in the environment. There are adequate toileting and bathing facilities available to residents and where necessary the appropriate equipment has been supplied. Facilities were adequately clean and tidy when viewed. The Old Vicarage DS0000020336.V271674.R01.S.doc Version 5.0 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,35 Residents are supported by a skilled and well-supervised staff team. EVIDENCE: The duty record for the previous four weeks was inspected, to find out if sufficient staff were on duty to meet residents’ needs. There is a minimum of four staff recorded as being on duty in the morning, with three care staff in the afternoon. At night there are one registered nurse and two care assistants on duty. The manager works ‘nine to five’ management hours, and some shifts and days each week. In discussion with all of the staff who were on duty, it is evident that they had a good knowledge and understanding of their roles and responsibilities, and how to meet residents needs. It was reported by staff that there is a structured, regular system of staff supervision in place for all staff. Records were seen demonstrating that regular one to one supervision sessions take place for all staff. Supervision of staff is necessary to help support staff to develop in their work and in meeting residents’ needs. The Old Vicarage DS0000020336.V271674.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): 42 Residents and staff health and safety is only partly protected. EVIDENCE: There are health and safety procedures in place for staff and residents to follow to promote health and safety in the Home. To protect residents and ensure food is stored and prepared safely, there were up to date checks of the kitchen fridges maintained, to ensure it operates within food safety guidance levels. Staff also monitor the temperature of `high risk’ foods before serving to ensure the food has reached above the minimum required temperature. Staff were also wearing suitable protective covering when they are preparing and cooking food. The Old Vicarage DS0000020336.V271674.R01.S.doc Version 5.0 Page 21 The fire logbook record showed that the range of required fire safety checks were being carried out and were up to date, helping to ensure the safety of people inside the building is maintained. The majority of staff had attended recent fire safety update training. However one member of staff had not attended fire safety update training for over twelve months. The inspector toured the whole of the building accompanied by a member of staff, and with a copy of the home’s maintenance records. There is a range of redecoration and maintenance that needs to be carried out. This was discussed in detail with the registered manager. As referred to previously in the report it is also advised to better protect residents, by contacting a fire safety officer as a priority. This is because there are fire doors that do not completely shut, and their advice should be obtained. Necessary action should then be carried out based on their advice, to minimise fire safety risks to residents and staff. The Old Vicarage DS0000020336.V271674.R01.S.doc Version 5.0 Page 22 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 2 X X X Standard No 22 23 Score 3 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score 1 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 3 X 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Old Vicarage Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score X X X X X 2 X DS0000020336.V271674.R01.S.doc Version 5.0 Page 23 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 YA3 YA42 YA24 Regulation 14 23(4),(d) 23.(2),(b) Requirement The identified resident needs to be reassessed to demonstrate how their needs are to be met. The member of staff who has not attended fire safety training must do so. A programme of maintenance, redecoration and repair of the inside of the Home must be carried out. The residents identified must be referred under `vulnerable adults’ Social Service guidance to local adult protection co coordinators. All residents risk assessments must be reviewed and updated on a regular basis. Medication protocols must be devised for the administration of the identified residents medication. The fire safety officer must be contacted their advice sought, and necessary action taken about the three fire doors identified. Timescale for action 08/02/06 28/02/06 29/04/06 4 YA23 13.(6) 30/01/06 5 6 YA2 YA20 13.(6) 13.(2) 08/02/06 08/02/06 7 YA42 23(4)C(i) 08/02/06 The Old Vicarage DS0000020336.V271674.R01.S.doc Version 5.0 Page 24 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 Old Vicarage DS0000020336.V271674.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Old Vicarage DS0000020336.V271674.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
