Inspection on 02/08/05 for The Rambles

This inspection was carried out on 2nd August 2005.

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 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 Rambles 06/07/09

The Rambles 20/08/07

The Rambles 13/03/07

The Rambles 06/06/06

The Rambles 25/11/05

The Rambles 08/02/05

The Rambles 16/08/04

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 Rambles 90 Farleigh Road Backwell North Somerset BS48 3PD Lead Inspector Paul Grey Announced 2 August 2005 nd The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Rambles D53-D02 S20307 The Rambles V234526 020805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Rambles Address 90 Farleigh Road, Backwell, North Somerset, BS48 3PD Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01275 790072 The Brandon Trust Ms Jo Anne Dixon Care Home with nursing 6 Category(ies) of Learning Disability (6) registration, with number of places The Rambles D53-D02 S20307 The Rambles V234526 020805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate up to 6 persons with Learning Disabilities. Staffing Notice dated 14/04/1999 applies. Manager must be a RN on Part 5 or 14 of the NMC register. Date of last inspection 8th February 2005 Brief Description of the Service: The Rambles is a small community based care home with nursing support for up to six people with a Learning Disability and additional Mental Health support needs. The residents also present challenging behaviour and may have communication difficulties. It is based in Backwell and is close to local amenities and services. The Rambles D53-D02 S20307 The Rambles V234526 020805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Rambles resources and care provision have been severely impacted by the needs of one service user. The inspector recognises that this service users needs at night times have now been met. However the inspector observed the general standard of living of the other service users is profoundly impacted by the needs and actions of the same service user. Staff endeavour to minimise this effect (as has Brandon Trust) but with limited success. Given the general environment of the home and the nature of the service users needs and actions it is the inspectors opinion that the service provision is unable to fully meet both the needs of the service user group individual concerned. The inspector recognises the efforts of the team in dealing with these issues. What the service does well: What has improved since the last inspection? 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 Rambles D53-D02 S20307 The Rambles V234526 020805 Stage 4.doc Version 1.30 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The Rambles D53-D02 S20307 The Rambles V234526 020805 Stage 4.doc Version 1.30 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,4 The Rambles provides service users with sufficient information to make an informed choice about living at the home. The home assesses service users prior to them moving into the home. Prospective service users are invited to visit the home to meet staff and fellow service users. EVIDENCE: There has been no change in service provision. The statement of purpose meets National Minimum Standards. The inspector audited 2 care files. The inspector noted extensive evidence of a clear and comprehensive assessment procedure for service users. There have been no recent admissions but current service users have clear assessments in their care files. Prospective service users are invited to the home prior to a trial period. They would be assessed during this time for suitability. If assessed as suitable service users would be invited to come for a trial period. The Rambles D53-D02 S20307 The Rambles V234526 020805 Stage 4.doc Version 1.30 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9 The manager develops with each service user an individual plan. Staff respect and support service users rights to make decisions. Staff support service users to take responsible risks. EVIDENCE: The inspector audited 3 individual plans. Care plans audited were derived from a clear assessment process and covered all aspects of care. Care plans clearly outlined any potential restrictions on freedom or choice of the service user and tied with appropriate risk assessments. Plans sampled outlined clear policies and procedures in the event of aggressive behaviour by the service user. The inspector noted documentary evidence of ways that service users were helped make informed decisions and life choices by staff. Documentation demonstrated how individual choices were supported in all 3 files sampled. The inspector noted extensive risk assessment in place to identify risks to service users. Highlighted risks were acted upon to ensure the safety of the service user concerned. The Rambles D53-D02 S20307 The Rambles V234526 020805 Stage 4.doc Version 1.30 Page 9 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,15,16 Staff support service users to have opportunities to maintain and develop independent living skills. Staff encourage and support service users to maintain family and friendship links. The homes routine promotes independence and freedom of choice for service users. EVIDENCE: Service users are exposed to a range of learning activities both inside of the home and at external agencies. These experiences may consist of staff support with hygiene or cooking or assertiveness training externally. Service users would be supported to attend church or an appropriate spiritual activity if they choose. Staff support service users maintain family contact in and outside of the home. External friendships are welcomed and supported as they arise. Friends or family are welcome to visit whenever they wish. The Rambles D53-D02 S20307 The Rambles V234526 020805 Stage 4.doc Version 1.30 Page 10 On inspection of the home, staff entered service users bedroom after knocking and used service users preferred form of address. During inspection staff interacted with service users and the inspector and included service users in conversation. The Rambles D53-D02 S20307 The Rambles V234526 020805 Stage 4.doc Version 1.30 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 20 Staff provide sensitive and flexible support to service users. Staff support service users to administer their own medication within a risk assessed frame work. EVIDENCE: Staff provide personal support where needed in private. The inspector noted in 2 plans of care that staff were mindful of the service users dignity and privacy when performing personal care. Service users at the home are encouraged to choose their own clothes and their own hairstyles. Medication was clearly risk assessed for service users. Staff administer service users medication in accordance with a risk assessed framework. The inspector noted medication administration records had no crossings out or omissions. The Rambles D53-D02 S20307 The Rambles V234526 020805 Stage 4.doc Version 1.30 Page 12 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 The home protects service users from abuse. EVIDENCE: The inspector noted the possessed robust procedures for the reporting of any incident of suspected abuse. The Brandon trust provide extensive training in the understanding and management of aggression No staff at the home are on the POVA list. The Rambles D53-D02 S20307 The Rambles V234526 020805 Stage 4.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26, 30 The Rambles offers a homely and comfortable environment for service users. Service users bedrooms have sufficient usable floor space. Service users are provided with a bedroom that is supplied with suitable fixtures and fittings. The premises are clean and hygienic EVIDENCE: The rambles is an extended bungalow which has been modified to meet service users needs. The lay out and furniture and fittings are domestic in design and generally homely. The bedrooms in the home meet spatial requirements Service users are supplied with appropriate fixtures and fittings that are suitable for their bedrooms. Service users are encouraged in making a choice about the décor of or furniture in the rooms. Service users are lockable by service users on a risk assessed individual basis. The Rambles D53-D02 S20307 The Rambles V234526 020805 Stage 4.doc Version 1.30 Page 14 The home was clean and pleasant throughout, the inspector noted no offensive odours. The Rambles D53-D02 S20307 The Rambles V234526 020805 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,34, 36 Staff have clear job descriptions and understand their roles. The inspector is unable to ascertain whether the home protects service users with it recruitment procedure. The home does not store records on the premises contrary to the Care standards Act. Service users benefit from appropriately supervised staff. EVIDENCE: The Brandon trust provide detailed and clear job descriptions for all staff. Training and induction provides staff with a clear understanding of their roles and makes staff aware of limitations in their skill or knowledge. In accordance with the Brandon Trust Policy details of staff references, CRB, and POVA are not stored on the premises. This is contrary to schedule of the act and is subject to requirement. The inspector noted documentary evidence that the manager supervised staff and monitored work with individual service users meeting National Minimum Standards. The Rambles D53-D02 S20307 The Rambles V234526 020805 Stage 4.doc Version 1.30 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 40,41 The homes written policies comply with current legislation and recognised professional standards. The homes written policies and procedures protect service users rights. EVIDENCE: The inspector sampled 2 policies and procedures. Both were present and up to date. Records are securely stored, well maintained and kept up to date. Records are stored in accordance with Data protection. The Rambles D53-D02 S20307 The Rambles V234526 020805 Stage 4.doc Version 1.30 Page 17 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 2 3 x 3 x Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 x x x 3 Standard No 11 12 13 14 15 16 17 3 x x x 3 3 x Standard No 31 32 33 34 35 36 Score 3 x x 3 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Rambles Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score x x x 3 3 x x D53-D02 S20307 The Rambles V234526 020805 Stage 4.doc Version 1.30 Page 18 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 34 Regulation 7,9,19 Requirement The inspector requires that records as defined under schedule of the act are stored on the premises. Timescale for action 30/9/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations The Rambles D53-D02 S20307 The Rambles V234526 020805 Stage 4.doc Version 1.30 Page 19 Commission for Social Care Inspection Riverside Chambers Castle Street Taunton TA1 4AL 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 Rambles D53-D02 S20307 The Rambles V234526 020805 Stage 4.doc Version 1.30 Page 20 - 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. 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