Inspection on 25/11/05 for The Rambles

This inspection was carried out on 25th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 3 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 20/08/07

The Rambles 13/03/07

The Rambles 06/06/06

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 Paul Grey Unannounced Inspection 25th November 2005 09:30 The Rambles DS0000020307.V256549.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 Rambles DS0000020307.V256549.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 Rambles DS0000020307.V256549.R01.S.doc Version 5.0 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) The Brandon Trust Ms Jo Anne Dixon Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Rambles DS0000020307.V256549.R01.S.doc Version 5.0 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 2nd August 2005 Brief Description of the Service: The Rambles is a pleasant detached bungalow offering supported living for 6 service users with learning disabilities. The service is owned and staffed by The Brandon Trust. The Rambles DS0000020307.V256549.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Historically, The Rambles has had a number of issues identified regarding the needs of one specific service user. This theme emerged again on inspection. During the inspection process consistent evidence arose highlighting the service’s inability to meet the needs of the general service user group whilst fulfilling those of the identified service user. In particular, the inspector noted the actions of the service user group to isolate themselves from the identified service user; service user statement service users who stated they are frightened of the service user. Consistent evidence emerged indicating the disproportionate effect the single service user has on the service user community as a whole. Further evidence emerged indicating that the service user group is divided and alienated by their fear of the identified service user. Specific evidence is sited in the body of the report. Given the nature of the evidence, and the service user feedback, the inspector concludes that The Rambles is unable to meet the needs of both the identified service user and the service user group. Furthermore, the inspector is of the opinion that placement at The Rambles is inappropriate and needs to be addressed as a matter of urgency. The inspector does however recognise the efforts made by the staff team to maintain this placement. The inspector made 3 requirements regarding the implementation of the Protection of Vulnerable Adults procedure, documentation of incidents and review of the placement of service users at The Rambles. What the service does well: What has improved since the last inspection? Staffing levels at nights have been increased to a level where they can ensure the safety of both staff and service users. The Rambles DS0000020307.V256549.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 Rambles DS0000020307.V256549.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 Rambles DS0000020307.V256549.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): 1, 2 & 3. Service users considering this service are provided with sufficient information to make an informed choice. No service user moves into the home without having had his/her needs assessed. The home cannot demonstrate to perspective services users that it is able to meet their needs. EVIDENCE: The Rambles has an up to date statement of purpose outlining the aims, objectives, staffing and facilities available at the home. The service’s statement of purpose and service user guide contains detailed descriptions of the service and information about the service to allow a prospective service user to make an informed choice about the service. The Rambles is able to demonstrate a clear assessment of service users needs. Although there have been no recent admissions, the standard of previous assessments, and ongoing assessments are robust. The home cannot provide evidence that it has the capacity to meet service users needs. The inspector noted the services capacity to meet all service The Rambles DS0000020307.V256549.R01.S.doc Version 5.0 Page 9 users needs was frequently dominated by the needs of one service user. The ability of staff to spend additional time with a service users is dependant on the needs that specific service user. The inspector notes that the staff team have sufficient skills and experience to deliver care to the service user group and that the staff group have sufficient training and experience to identify and meet the needs or preferences of ethnic minorities. The home has maintained a placement for a service user who’s needs it can meet, but often to the detriment of the remaining service user group. The Rambles DS0000020307.V256549.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 &10. The home assesses the service user’s changing needs and reflects the service user’s goals and needs in their individual plan. Service users are assisted to make decisions about their lives whilst staying at the home. Service users are supported to take reasonable risks in offer to live and into lifestyle. Service users confidential information is stored appropriately and staff adhere to appropriate procedures for the maintaining sharing of information. EVIDENCE: Care planning and assessment is completed in conjunction with Brandon’s Person Centered planning documents and are generated by assessment of service users needs in conjunction with the PCP documents. The generated care plans were well written and reflected the service users goals and overall assessment. The Rambles DS0000020307.V256549.R01.S.doc Version 5.0 Page 11 The inspector noted a number of specialist assessed needs were identified and appropriately care planned. This often involved complex care needs and was well planned and documented. The inspector noted that procedures for dealing with aggression and seizures were particularly documented. Plans were drawn up where possible with the co-operation of the service user and reviewed appropriately. The Rambles DS0000020307.V256549.R01.S.doc Version 5.0 Page 12 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): 13, 14, 15 & 16. Service users are supported by the home to become part of the local community. Service users are encouraged to engage in a variety of social activities, however this is impacted by the homes inability to consistently meet all the leisure needs of the whole service user group. The home does not meet National Minimum Standards. The Rambles supports service users in establishing and maintaining personal, family and sexual relationships. However the service is unable to fully meet all the service user groups assessed needs. Service users are supported by staff in maintaining Service users rights are respected by the home in the service users daily lives. EVIDENCE: The Rambles DS0000020307.V256549.R01.S.doc Version 5.0 Page 13 The inspector found evidence of extensive day care support for the service user group and efforts on the part of the service to involve the service user group in the community. This is good practice. However the inspector noted this was adversely effected by the needs of one service user. Impromptu trips to local facilities are disproportionately effected by the needs of a single service user. This will often prevent such community activities despite of the best efforts of the staff team. The inspector noted evidence of creative management and use of flexi time by staff to maximise the quality of life and service user benefits. The inspector noted evidence that the home does not have the capacity to consistently meet this standard (13). The inspector noted evidence of increased day care support for one service user. The service user is now receiving 15 hours day care support from a support worker. This enables greater flexibility for the remaining service user group. However the inspector notes that opportunities for interests and hobbies for the majority of the group are adversely effected by the need of staff to co-ordinate the homes activities around a single service user. The staff team encourage and enable service users to maintain and develop friendships in and out of the home. Service users are supported to write to friends and relatives, and maintain contact via phone calls and visits. The daily routine at the home is designed to promote and encourage independence among service users. Staff support service users with a series of chores around the home, which are not unduly onerous. Staff enter the service users bedrooms only after knocking and service users are supplied with a key to their rooms. The inspector spoke with one service user who regularly locked himself in his bedroom in order to avoid an identified service user. A second service user spoken with, used a similar strategy to isolate themselves from the communal areas and avoid an identified service user. Staff indicated another service user another appears to have a similar strategy and generally avoids communal areas occupied by the identified service user. The inspector noted that there appears an organised response on the part of more able service users to avoid communal areas when an identified service user is acting in a manner they find intimidating or aggressive. Documentation would suggest this is relatively frequent. The service user community appears alienated by and frightened of one service user. The Rambles DS0000020307.V256549.R01.S.doc Version 5.0 Page 14 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): 18 & 19. The home helps service users with personal support in the manner, which they prefer. Staff at the home meet service users physical and emotional needs. EVIDENCE: The inspector obtained evidence from documentary sources, staff statement and service user statements. The staff team provide personal care and support to service users requiring support. The inspector noted evidence that personal care is provided with due regard to the service users wishes for privacy, dignity and respect. Service users are encouraged and supported to express their own taste and preference in clothing and personal appearance. Service users can get up or go to bed at flexible times and are not subject to unreasonable restriction. The inspector noted statement and documentary evidence indicating that the home can demonstrate that they meet service users physical and emotional needs. The inspector notes that some service users have complex needs, and The Rambles DS0000020307.V256549.R01.S.doc Version 5.0 Page 15 when the inspector tracked needs assessment and the provision of an appropriate service, the home performed very well. Service users are supported to obtain appropriate health care from NHS providers or local GP’s and staff will support service users with visits etc. The Rambles DS0000020307.V256549.R01.S.doc Version 5.0 Page 16 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. The home listens to service users views and acts upon them. The home cannot meet all service users needs, particularly regarding protecting service users from abuse or harm. EVIDENCE: The inspector noted the home has a clearly laid out and effective complaints procedure. Service users spoken with understood who they should complain to if they are unhappy at the home. In the service users guide, the inspector noted an outline of complaints procedure in a format designed to be understood by the service user. The home will document any complaints, at the time of inspection there were none. A record is kept of any complaints. The home has policies and procedures outlining the actions of staff should they see or suspect abuse. The Trust also provides a good standard of training for care staff and managers regarding potential abuse. The home has appropriate policies and procedures regarding whistleblowing and the inspector noted the Somerset ‘No secrets’ document. The Brandon Trust provide staff with training to understand the causes of physical aggression toward staff. The Trust has a good program of training to cover this eventuality. However, service user statement, statement evidence from staff and underpinning documentary evidence indicates that the staff team are unable to protect the service user group from a consistent level of psychological and physical intimidation by one identified service user. The inspector noted clear documentary evidence of a disproportionate amount of incidents involving an The Rambles DS0000020307.V256549.R01.S.doc Version 5.0 Page 17 identified service user. These incidents have become so frequent that the staff team do not always document these common place incidents. The inspector tracked 57 documented incidents of levels of aggression or intimidation over the period 20.4.05 until 21.8.05. These incidents varied from intimidating other service users, to slapping, pushing, or hitting. These incidents involved both staff and service users. The inspector spoke with the manager regarding the frequency and documentation of these incidents. The manager informed the inspector that these are probably an underestimate as due to their frequency not all such incidents were documented. During the inspection, one service user was hit by the identified service user. The inspector noted no evidence of POVA procedures being implemented and this is now subject to requirement. Evidence arising from this and previous inspections leads the inspector to conclude that despite the best efforts of a committed and well trained staff team, the home is unable to safeguard the service user group. Given the domestic scale of the home and the complex nature of the identified service users needs the inspector believes this placement is inappropriate. The Rambles DS0000020307.V256549.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The inspector did not inspect these standards. EVIDENCE: The Rambles was clean and hygienic on the day of inspection. The inspector did not review the environment. The Rambles DS0000020307.V256549.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): 31, 32, 33 & 36. The staff team have clearly defined roles within the home. Service users are given support by a competent and well trained team. Service users at The Rambles are supported by an effective team. The staff team are appropriately supervised. EVIDENCE: The Brandon Trust have clear well defined roles and job descriptions. Staff understand the aims and values of the home and implement its policies and procedures. The Brandon Trust have a strong training program exceeding the Sector Skills councils strategy targets. Staff receive a wide range of training during their career with the trust and during their induction. Staff are supported to achieve NVQ training. A number of issues have been highlighted earlier in the report regarding protecting service users from low levels of aggression and intimidation. The inspector concludes that there are sufficient numbers of staff on duty and that The Rambles DS0000020307.V256549.R01.S.doc Version 5.0 Page 20 the incidents are not as a result insufficient staff. The home has a sufficient staff to service user ratio. The inspector noted documentary evidence that staff receive sufficient supervision to carry out their roles at the home. The home manager also receives appropriate supervision from their line manager. The Rambles DS0000020307.V256549.R01.S.doc Version 5.0 Page 21 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): 38, 40 & 42. Service users’ benefit from the homes general ethos and management approach. Service users rights and best interests are protected by the homes policies and procedures. The home protects service users health and safety. EVIDENCE: The home fosters an open and inclusive ethos which staff and service users are part of. The process of managing the home is clear and transparent with clear strategies to enable service users input into day to day decisions. The inspector checked 3 written policies at random and they were present and up to date. The Rambles DS0000020307.V256549.R01.S.doc Version 5.0 Page 22 The inspector noted appropriate fire, first aid and positive response training at the home. The Rambles DS0000020307.V256549.R01.S.doc Version 5.0 Page 23 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 3 3 1 x x Standard No 22 23 Score 3 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 3 x 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x LIFESTYLES Standard No Score 11 x 12 x 13 2 14 2 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 X X 3 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Rambles Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score x 3 x x 3 3 x DS0000020307.V256549.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? No 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 YA3 Regulation 14 (2) a 14 (2) b 14 (1) d Requirement The registered person must review their assessment of each service user and confirm in writing to the commission that they are able to meet their needs in respect of their health and welfare. An adult protection referral must be made if it is believed service users are suffering harm; even if this is caused by the behaviour of another service user. Staff must document all untoward occurrences or incidents of violence or aggression in the home. Timescale for action 10/02/06 2 YA22 13 (6) 10/01/06 3 YA22 17 (1) a Schedule 3 10/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Rambles DS0000020307.V256549.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor 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 DS0000020307.V256549.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. 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