Inspection on 20/08/07 for The Rambles

This inspection was carried out on 20th August 2007.

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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Rambles 06/07/09

The Rambles 13/03/07

The Rambles 06/06/06

The Rambles 25/11/05

The Rambles 02/08/05

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 Catherine Hill Key Unannounced Inspection 20th August 2007 09:30 The Rambles DS0000020307.V341489.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 Rambles DS0000020307.V341489.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 Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Rambles Address 90 Farleigh Road Backwell North Somerset BS48 3PD 01275 790072 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) amanda.reading@brandontrust.org www.brandontrust.org The Brandon Trust Mrs Amanda Reading Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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 13th March 2007 Brief Description of the Service: The Rambles is a detached house in a residential area, offering supported living for up to 6 younger adults with learning disabilities. It is in large gardens on a main road, within a short drive of several local towns and approximately half a mile from local shops. Three bedrooms are on the first floor. One bedroom is in an annexe to the rear of the home, with its own lounge. The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was done over the course of one day by one inspector, who spent approximately 7 hours in the home. The inspector spent time with three of the residents individually and spoke with three of the staff on duty at length, as well as with the manager. She also looked at all the rooms, and sampled a number of records, including: • the Statement of Purpose • residents contracts • residents care plans and associated documents • residents health action plans • the minutes of residents meetings • residents activities timetables • the staff rota • staff recruitment, training and supervision • residents finances • health and safety checks. Prior to this inspection, the home submitted a self-assessment form, some aspects of which were tested out during the visit to the home. The inspector also received CSCI surveys from two health professionals connected with the home, and from five relatives. What the service does well: The staff team is highly committed to promoting residents rights and opportunities to have fulfilling lifestyles. Residents comments to the inspector included Im quite happy here, and staff are quite nice - they dont tell me off. The relatives who responded to the CSCI surveys felt that residents lives have greatly benefited from being at The Rambles. They commented that the home “considers each individual resident’s needs, is good at meeting not just big needs but also small preferences, and treats the residents as individuals. One person said that their relative is helped to lead as active and stimulating a life as is possible for him. Another said that their relative’s life at the home has expanded beyond anything I might have expected. [The person] receives not only support and care but stimulation and love. Since coming to live at the home, the resident’s whole life has opened out, and the person has engaged in activities I would not have thought possible. Someone else said that their relative has progressed really well since being at the home and is so happy there. Relatives and healthcare professionals also felt that the home liaises well with them, and keeps them appropriately involved. A relative said that the home “does everything well but is particularly good at relationships. One healthcare The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 6 professional commented that the home is good at advocating for its residents, and the second mentioned how well the home uses person-centred planning. The latter professional added that, that there are deep and important interpersonal relationships between residents and staff team and that staff are sensitive to complex and changing healthcare needs. A relative said, I am never left in the dark about anything - even quite trivial matters are brought to my attention. Another person said the home does such a wonderful job. One relative mentioned that the manager, who has been in post for the past couple of years, has proved to be a good team leader and is always available to talk to us. Staff have access to excellent training opportunities, and this is reflected in the high standard of practice that was evident. What has improved since the last inspection? What they could do better: The Statement of Purpose needs more specific detail in some areas. The situation regarding the inappropriate placement of one person needs to be permanently resolved in the near future. The landing needs to be redecorated. A hand rail should be fitted to the stairs to help residents use these more safely. Residents would benefit from having a separate garden area for the main home and the annexe. The occupant of The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 7 the annexe would benefit from having more indoor space to use when the weather is bad. Hot water temperatures in taps that are accessible to residents need to be kept within safe levels. While the standard of care plans and Health Action Plans is generally very good, care needs to be taken to keep these fully up-to-date and ensure they include all necessary information. The manager should have more time as additional to the basic rotas so that she can plan and monitor service development, which will lead to further good outcomes for the residents. Staff should have periodic fire instruction from someone who is qualified in this area. This will help to promote the safety of everyone using the home. 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 summary of this inspection report can be made available in other formats on request. The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 8 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 Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives get good information about the home, but some aspects of this need more detail. Needs are thoroughly assessed prior to admission to ensure that the service will be able to meet them. EVIDENCE: The homes Statement of Purpose and Service User Guide were reviewed in January this year. More information is needed in some key areas of the Statement of Purpose to ensure that people are clear about what they can expect from the service. For example, the section on the admission procedure simply states that the Trusts admission procedure will be followed, and does not actually say what this procedure consists of. The inspector suggested that the information about age range and who the service is aimed for his revised and expanded to give more detailed information. The Service User Guide is in the format of pictures supported by brief, clear written statements. No new residents have been admitted since the last inspection. The manager confirmed that a placing social workers assessment would be sought prior to The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 10 for any new admissions and that, wherever practicable, she would visit the person to carry out her own assessment. The situation regarding one named service user needs to be more permanently resolved within three months to ensure the long-term wellbeing of this person and other service users at the home. Residents files contained information on board and lodging charges, and each had copies of their contracts. Although residents have been invited to sign these contracts themselves, where possible, they were not written in a service user-friendly format. Brandon Trust has drawn up a service users version of this document, and the home’s manager is waiting for it to be e-mailed to her so that she can add pictures of The Rambles and of individual residents bedrooms. The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents needs are thoroughly documented and well met, and their confidentiality is respected. Their own views are sought as far as possible and strongly influence how the service is provided. EVIDENCE: Each resident has a person-centred care plan, which reflects their personal hopes and wishes. The first section of each care plan begins with information on the resident as a person, and lists their strengths and interests. Some sections of the care plan are entirely devoted the individuals own point of view. All sections are written as much from the persons perspective as practicable. Action plans reflected the persons own goals, and subsequent care records showed that staff are very good at helping people to realize these. One persons file contained information on a goal which was then apparently abandoned but no reason for this was recorded. Staff on duty were able to give further information because this had been a recent decision. It is good The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 12 practice to record clearly where a particular aim has been abandoned, the reasons for this decision, and who took part in making it. Where appropriate, behavioural contracts have been drawn up. Risk assessments clearly identify areas of particular risk and what level of hazard these present. They include a note of any steps taken to reduce the risk, and a clear plan of action. These assessments showed that residents are not unduly restricted but that all reasonable steps to promote their safety are explored. Information in residents files was well organised and easy to find. Records that staff have made about residents were phrased very positively, and indicated that staff use peoples strengths to help address their needs. Records of untoward incidents or antisocial behaviour carefully explored possible reasons for this, and looked at ways of removing possible triggers so that the person is able to behave differently. Any successes are warmly praised. Those residents who were able to discuss their care with the inspector confirmed that they feel well supported and do not feel harshly judged when their behaviour slips from the ideal. Conversations with staff revealed that the team takes a very positive view of the people they support, and rewards and encourages positive behaviour, rather than condemning negative behaviour. Basic information on individual peoples communication style is included in their care plans. The staff team is currently developing more detailed communication profiles. One resident has recently acquired a speaking photo album so that she can tell staff more independently and clearly what she wants. Food and fluid record sheets are being kept on each resident at the moment. The inspector suggested that this depth of detail is only kept if there is a particular issue. The menu records are detailed enough to show that each resident is getting a satisfactory diet. Information about residents is kept securely, and staff took care to hold any discussions discreetly. One of the staff holds a monthly residents meeting with the three people who are able to have discussions in this way. Minutes of these showed that a range of issues is raised for discussion, and that residents are enabled to give their views on the running of the home. Activities records and subsequent minutes of residents meetings showed that their ideas are followed up and put into action where possible. The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents benefit from exceptionally good opportunities to lead full and varied lives, and to do things that they enjoy. Residents are treated as valued and respected individuals. EVIDENCE: Activities records show some sort of activity every day for each resident. Several residents attend social events with their day centres. Two of the men play football for their day centre’s team one night each week. Residents also go out regularly with staff on a one-to-one basis. Some residents go horseriding regularly. One person has been supported to get a job. Residents are able to make good use of community facilities, such as pubs and shops, and there are regular trips out to places of local interest. Some of these trips are done in small groups but many are done on a one-to-one basis so that residents can follow up their own particular interests. The home has The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 14 drawn up an action plan for the year ahead, which is looking at ways off getting more out of local community facilities. An aromatherapist is now visiting the home monthly. Two residents choose to have full body massages while other people are starting by having their feet done. Residents who are able to take on some responsibility for household chores have their names on a rota, alongside a picture of the chore they are doing each day. Each person has a key to their own rooms. Residents Disability Living Allowance goes towards leasing a people carrier for their use. One person has use of his own vehicle. Residents have been supported to create life story books. One person shared her book with the inspector. It contained lots of interesting pictures and information about her life, her family and friends, including a family tree. This person was understandably proud of this book, and it was a useful aid to her being able to describe her life to someone who does not know her well. One person has learned to use a computer at his day centre, and the home has acquired the same computer programme for him to use at home. This person is now able to use this programme to write a regular letter to his relative. Relatives who responded to the CSCI survey said that they felt welcomed and involved. People were highly satisfied with the amount of interesting opportunities offered to residents, and the way individuals have been supported to develop their full potential. The way staff spoke to and about residents was respectful and positive, reinforcing the impression gained from other people and from written records. Routines are highly flexible to ensure that residents individual and varying needs can be met. Menu records showed that residents are offered a varied and well-balanced diet, likely to suit the tastes of a younger group of adults. People who were able to comment on the food said that staff cook it well. The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents health care needs are well documented, although some aspects should be recorded more clearly. The home liaises closely with external carers to ensure that residents health care needs are well met. EVIDENCE: Each resident has a Health Action Plan. These have been filled in very thoroughly and in general gave a clear picture of each persons health care support needs, and how these should be met. However, some areas could be expanded to give more detailed information. For example, seen regularly by dentist could be more usefully phrased as seen by the dentist every six months. Some information on these plans was not up to date. For example, according to the Health Action Plan, and essential routine health check had apparently not been carried out for the past four years. But further exploration of this residents file turned up letters and other documents which showed further checks had in fact been done. A relative mentioned that regular health care checks are arranged for residents, and those files the inspector checked supported this. Relatives and The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 16 healthcare professionals who responded to the CSCI survey commented on the high standard of care. The manager confirmed that medications practice remains as it was at the last inspection, when it was judged satisfactory. The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents concerns are taken seriously, and their wellbeing is well protected. EVIDENCE: No complaints have been received by CSCI or the home since the last inspection. The home has a complaints procedure that is up to date, very clearly written, and is easy to understand. Those residents who were able to speak with the inspector said that they feel comfortable talking to staff if they have any worries or are unhappy about anything, and that staff will always listen. Staff the inspector spoke with demonstrated a good understanding of residents rights and of how abusive practices can arise. Staff were familiar with the whistleblowing procedure and the written guidance on protecting residents from abuse. Staff get regular training on safeguarding adults. There was evidently a high level of commitment among the team to promote residents rights and well-being. Any concerns have been promptly reported under PoVA (Protection of Vulnerable Adults) guidelines. Relatives and healthcare professionals comments indicated that they have a high level of confidence in the staff teams ability to protect residents. The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is well suited to the needs of a mobile group of younger adults. The way the environment is now being used - creating a separate service of main home and annexe - is allowing all residents needs to be met much more satisfactorily and individually. EVIDENCE: The home is on two floors, with four bedrooms on the ground floor and a further three on the first floor. The home is only registered for six people, and is currently considering creating an extra office from an unused bedroom. One of the bedrooms is in an annexe area at the rear of the home. This area is separated from the rest of the home by a corridor. There is a lounge, toilet and bathroom in the same area, creating the possibility for a separate flat. The front garden is mainly used for car parking but there are extensive grounds at the back of the home. There is potential for these gardens to be separated so that the user of the annexe could have a separate garden from The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 19 the rest of the home. The inspector recommended that this is done before next spring, so that all occupants of the home can safely use an outdoor area. Residents bedrooms were each very different, and reflected individual tastes and interests. Both the person who has moved into the annexe and the rest of the resident group seemed to be greatly benefiting from this change. The atmosphere in the entire home is calmer and happier. Residents are consulted about decor, and each person chooses how they would like their own room. Residents told the inspector how happy they are with their own rooms, but they are also evidently pleased to be able to use the rest of the home now without feeling at risk of aggression from another service user. New patio doors are being fitted in the lounge soon. The main lounge is spacious and has an outlook to the front and back of the home. The layout of furniture in this room has been changed to look more homely since one person has moved into the annexe, and a number of ornaments have been added to this room. Protective covering for the television has now been removed as it is no longer necessary, as have door bolts and Perspex protective covers elsewhere around the home. The inspector recommended that the Trust considers adding a conservatory area onto the annexe lounge to increase the available space for the occupant of this area when he is confined indoors by bad weather. There is a pleasant dining room connecting the entrance area and the kitchen. At present, this has fixed furniture which looks rather institutional and is not easy to use. This was necessary when the person who now lives in the annexe was accommodated in the main home, but new furniture has been ordered and is being delivered in the next few weeks. This room will be re-floored when the old furniture is removed. Since one resident has moved into the annexe, staff are no longer able to use the lounge in that area for meetings. Any meetings that need to be held in the home are now at times when most residents are out. The ceiling and walls of the upstairs landing are badly marked, and this area needs to be redecorated. The bathroom in this area is due for redecoration in the next six months. The inspector recommended that a hand rail is fitted to the wall side of the stairs as they are very steep and narrow. Doors in the area near the front door are looking very shabby and would benefit from redecoration. In general, all areas of the home looked clean and well maintained. Some areas of the home have a slight residual smell of urine, despite carpets being shampooed on a fortnightly basis. It is likely that some carpeting will need to be replaced, and the flooring underneath may need to be treated. The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 20 The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents benefit from good staff levels, safe staff recruitment practice, and exceptionally well-trained, well supported staff. EVIDENCE: Three care staff are on duty throughout the waking day. Two waking staff are on night duty, supported by one person on sleeping-in duty. One member of staff is with the person living in the annexe at all times, and an extra member of staff is available at a moment’s notice to give assistance. The manager is usually part of the basic rota. In addition to a managers normal duties - such as one-to-one supervision of staff, mentoring staff through NVQs, and planning service development - this manager is a marker for LDAF (Learning Disabilities Award Framework) papers, is a nurse assessor, and will soon be undertaking disciplinary work for the Brandon Trust. It is vital that managers have time to reflect on how the service is working, to stand back from daily routines and observe the homes functioning from a less involved point of view, and to plan service development accordingly. The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 22 Bank holidays, nights and sleeping-in cover are shared equally between the staff so that no one is disadvantaged. The rota is drawn up at least six weeks in advance so that staff have plenty of time to plan their off duty. Recent rotas showed extremely low sickness levels. All senior staff are qualified RMNs. Two support workers hold both NVQ 2 and NVQ 3. Four support workers are starting NVQ in September this year, and all have LDAF (Learning Disabilities Award Framework) training. The manager visits Brandon Trust headquarters periodically and checks their records of staff recruitment. She keeps her own record of these checks securely in the home, and was able to confirm that recent recruitment practice has met the required standard. The staff training file shows that people are getting excellent training opportunities, far in excess of the minimum amounts required. In addition to the statutory training, relevant courses such as advocacy, counselling, positive response and LDAF (Learning Disabilities Award Framework) are laid on. Several months ago, there were very few people among the staff team who were qualified to drive the homes transport, but there are now eight people able to do this. A master record is kept of staff supervision, which helps the manager to monitor that each person is getting the level of support they need. The manager gives one-to-one supervision to the qualified staff, who in turn supervise two support workers each. The supervision list shows that staff usually get formal supervision every month, which exceeds National Minimum Standards. The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42, 43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a particularly well-managed service. The home has an open culture and a consultative, accountable management style. Good attention is generally paid to health and safety issues but staff responsible for carrying out checks need to ensure that they report and act on anything untoward. EVIDENCE: The manager has been a fully qualified RMN for the past 17 years, and has been working in care services for people with learning disabilities for more than 20 years. She is currently doing a course in mentoring for new managers, and will act as mentor for people who are newly in management roles when her course is completed. The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 24 Staff described a very open culture in which their views are actively sought. They felt encouraged to work in partnership with the residents and their other advocates, and to aim for the highest possible standards of care. Staff also felt well supported in their roles, and felt they have good opportunities to develop their skills. Staff told the inspector that they get high levels of job satisfaction. Some routine management tasks are being partly delegated to other staff to ensure that all seniors have a good working knowledge of the running of the home. These tasks include managing petty cash, checking that the training file is kept up-to-date, and ensuring that safety information on the chemicals in use in the home is current. Seniors sign a list every month to show that they have checked the areas of their responsibility. Staff, relatives and healthcare professionals felt that communication is effective. There are a number of systems in use, and the records the inspector checked showed that these are being used effectively. Staff the inspector spoke with were able to give examples of how residents have been able to influence service provision within the home. Some residents attend Brandon Trusts service user forum, which has been set up to enable service users to give their views directly to senior managers and to influence the running of the organization. Policies and procedures are kept under regular review and provide good guidance to staff. The staff team is successfully translating the spirit of these policies into its day-to-day practice. There are effective systems in place for monitoring quality assurance. Any cash handed to staff to spend on a residents behalf is signed in and out of the resident’s account. The amounts of cash held on behalf of each resident are checked against the record at each shift handover. There is a detailed Fire Risk Assessment, which was reviewed in June this year. Fire precautions are being tested regularly, and the home regularly holds a fire drill. New staff have all had fire instruction, and fire safety is also discussed every couple of months in staff meetings. However, for more than a year, staff have not had formal fire training from someone qualified in this area. The manager had booked training for the whole staff team in June this year, and rebooked in July when the first session was cancelled. However, the second session was also cancelled and Brandon Trust has been unable to offer a further session until November this year. Maintenance records show that repairs are usually done promptly. The manager confirmed that the gaps in the record are simply due to staff not filling in the date of repair. However, a hot water blender was requested for one persons bedroom in June this year but has not yet been fitted. This The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 25 persons care plan says that they need a reminder to check water temperature, which indicates they are at particular risk. Hot water testing records show that water temperatures in various areas of the home can be significantly higher than the recommended 43°C (water in the downstairs bar has been recorded at 52°C). The manager said that she would follow this matter up and will remind staff testing water temperatures to act on anything untoward. The specialist bath and hoist are both regularly checked by an external contractor, and staff checked the hoist themselves every month. PAT testing was done in April this year. A representative from the Brandon Trust visits the home unannounced on a monthly basis to review the quality of service provision. The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 26 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 2 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 4 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 4 12 4 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 4 X X 2 3 The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 27 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)(c) Requirement The Statement of Purpose needs to give more detail in some key areas so that prospective service users and their representatives are clear about what they can expect. The situation regarding one named service user needs to be more permanently resolved to ensure the long-term wellbeing of this person and other service users at the home. The ceiling and walls of the upstairs landing need to be redecorated. Suitable adaptations are necessary to meet service users needs. This is with particular regard to the need to regulate hot water temperatures at all hot water outlets to which residents have access. Timescale for action 20/10/07 2. YA3 12.(1)(a) 20/11/07 3. 4. YA24 YA42 23.(2)(d) 23.(2)(n) 20/09/07 20/09/07 The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 28 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. 2. 3. Refer to Standard YA6 YA19 YA24 Good Practice Recommendations A record should be kept of the reasons for abandoning any care plan aims, and of who took part in making this decision. Health Action Plans should contain specific and up-to-date information. Recommendations were made concerning the premises: • Separate garden areas should be created for the occupant of the annexe and occupants of the main home before next spring, so that all occupants of the home can safely use an outdoor area. • The Trust should consider adding a conservatory area onto the annexe lounge to increase the available space for the occupant of this area when he is confined indoors by bad weather. • A hand rail should be fitted to the wall side of the stairs as they are very steep and narrow. The manager should have more time working as additional to basic rotas. This will allow more time for monitoring and planning service development, which will lead to further good outcomes for residents. Staff should have periodic fire instruction from someone qualified in this area of expertise. 4. YA31 5. YA42 The Rambles DS0000020307.V341489.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Regional Office 4th Floor, Colsoton 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: 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 © 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 DS0000020307.V341489.R01.S.doc Version 5.2 Page 30 - 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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