Inspection on 06/06/06 for The Rambles

This inspection was carried out on 6th June 2006.

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 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 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 Paul Grey Unannounced Inspection 6th June 2006 09:30 The Rambles DS0000020307.V297196.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.V297196.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.V297196.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 The Brandon Trust Mrs Amanda Reading Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Rambles DS0000020307.V297196.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 25th November 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. Provision of care at the service costs in the region of £1372 per week. The Rambles DS0000020307.V297196.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspector visited the service, spoke with 2 members of staff, one service user, audited two care files and conducted a tour of the premises. The Inspector also met with a service user at Scotch Horn leisure Centre to discuss their experience of care at the home. The inspector noted the actions of the service user group to isolate themselves from one identified service user continues. Service users previously stated they are frightened of one service user. The Inspector understands that this service user will shortly be assessed for more appropriate placement. Given the consistent nature of service user feedback, the inspector concludes that The Rambles is unable to meet the needs of both one 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. At the time of inspection the home manager was responsible for 2 Brandon trust homes. One in Clevedon and The Rambles. The Inspector was informed by the Brandon trust that the manager was available and responsible for both homes. However, on inspection the Inspector observed that the manager was rostered onto shifts at The Rambles as the nurse in charge. This had compromised the manager’s ability to meet the needs both care homes. This was contrary to the Inspectors understanding of the situation. What the service does well: What has improved since the last inspection? What they could do better: The Rambles DS0000020307.V297196.R01.S.doc Version 5.2 Page 6 The rambles provides a good service that is adversely affected by the complex and extensive needs of one inappropriately placed service user. This service users needs still impacted negatively on the entire service user group within the home. Efforts have been made to reduce this negative impact but it is still a significant life experience for the service user group. 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.V297196.R01.S.doc Version 5.2 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.V297196.R01.S.doc Version 5.2 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, 3 Quality in this outcome area is poor. Prospective service users needs are assessed. The service is unable to meet the needs and aspirations of the service users. EVIDENCE: During inspection the Inspector reviewed 2 care files. The Inspector noted evidence of continued comprehensive assessment processes, to assess the needs of the service user group. The homes assessments were based on a person centered approach and were of a good standard. The Inspector was able to track service users assessed needs through to care planning and implementation of care. This was good practice. The Inspector audited care files, spoke with staff, and spoke with a service user at Scotch Horn leisure Centre. The Inspector noted that the home obtains specialist input from external agencies such as the community learning disability team, audiology, or physiotherapy where necessary. The Inspector noted clear evidence that the home supported service users with a range of specialist needs. Service users are supported by the staff team who are able to communicate effectively with the service user group. However, on this and previous inspections the Inspector noted that the home is often unable to meet service users basic needs such as freedom from intimidation. The Inspector obtained statement evidence indicating that the The Rambles DS0000020307.V297196.R01.S.doc Version 5.2 Page 9 majority of the service user group are frightened of one service user. One service user speaking with the Inspector informed him that he preferred to remain locked in his room. This continues to impact negatively on the service user group throughout a wide range of day-to-day activities. The Inspector noted that there is an improvement in the service provision as the identified service user is able to access an increased amount of day care activities outside of the home. This appears to offer a degree of respite to the remaining service user group and helps the identified service user fulfil a range of needs outside of the home. However, the Inspector notes that for standard 3 there is insufficient evidence to conclude that the home meets the needs of the majority of the service users in their care. The Rambles DS0000020307.V297196.R01.S.doc Version 5.2 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 Quality in this outcome area is good. Service users no their assessed needs a reflected in their individual plan. Service users make decisions about their lives with assistance as needed. Service users are supported to take risks as part of an independent lifestyle. 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 Inspector reviewed service user care plans and noted that there is no unreasonable restriction on service users rights. Service users are involved, where possible, in drawing up off the plan of care. The Rambles DS0000020307.V297196.R01.S.doc Version 5.2 Page 11 Service users are supported by the staff team to make their own decisions regarding everyday matters in their life. The Inspector noted documentary evidence of the staff team supporting service users to make a wide range of day-to-day decisions. Service users are supported to take reasonable risks as part of living a normal lifestyle. Staff at the home have appropriately risk assessed activities, reviewed them and support service users where necessary to minimise risk. This was good practice. The Rambles DS0000020307.V297196.R01.S.doc Version 5.2 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): 12, 13, 15, 16, 17 Quality in this outcome area is adequate. Service users are able to take part in appropriate activities. Service users are part of the local community. Service users have appropriate personal family and sexual relationships. Service users rights are respected and recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. EVIDENCE: No service users at the rambles are in paid employment. Service users are supported to take part in a wide range of daycare and supported activities, which enable service users to take part in appropriate activities outside of the home. Service users at the home are supported to engage in a range of activities in the local community. This includes visiting places of interest, individual The Rambles DS0000020307.V297196.R01.S.doc Version 5.2 Page 13 timeout to help with shopping, and going to the pub or similar activities, (depending on the service users risk assessment). The Inspector noted an improvement in the service user group being able to access these resources. This is as the result of greater daycare input for one service user. However it is the Inspectors understanding that one service users needs continue to impact negatively on the remaining service user group. Service users receive support from staff to maintain family links and friendship. Service users are supported to maintain contact via letters, cards or phone calls. The Inspector notes as service users age, this process is increasingly difficult because the relatives of the service users age also and it becomes more difficult to maintain an active relationship. The daily routines at the house are flexible and designed to support service users standard of living. the daily routine is designed to promote independence and individual choice for the service user group. However, running consistently through service users experience at the home were consistent issues with freedom of movement resulting from avoiding close proximity with one service user. The Inspector notes this was not constantly the case, but it was a consistent issue for the service users at the home. Subject to risk assessment service users are offered a key to their own rooms. In some cases service users prefer to lock themselves in their rooms to avoid exposure to one particular service user. At the time of inspection service users were addressed by their preferred name and the staff team interacted with the service user group, not exclusively with other staff. Service users have unrestricted access to the home and its garden; however, this is once again impacted by the needs off one service user. Service users can choose whether to be alone or in company at the home. However this is adversely effected by one service users needs. The inspector noted at times the service user group preferred to withdraw from communal areas to their bedrooms inspite of staff efforts. The home has an appealing and varied menu. One service user spoken with from Scotch Horn leisure centre informed the Inspector that the food was nice and he enjoyed meal times generally. Although again this was dependant on the needs of one service user. The inspector noted that there appears to be a continued 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. The Rambles DS0000020307.V297196.R01.S.doc Version 5.2 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 20 Quality in this outcome area is good. Service users receive support in the way they prefer. Service users physical and emotional health needs are met. Service users are protected by the homes policies and procedures for dealing with medication. EVIDENCE: 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 when the inspector tracked needs assessment and the provision of an appropriate service, the home performed very well. The Rambles DS0000020307.V297196.R01.S.doc Version 5.2 Page 15 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 Inspector noted in the files sampled that service users are supported with medication by the staff team. To maintain service user safety, the staff team support service users by administering service users medication. The Inspector reviewed the medication charts and noted no crossings out or omissions on the charts. On reviewing the medication the Inspector noted the stock balanced with medication charts. The Rambles DS0000020307.V297196.R01.S.doc Version 5.2 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 Quality in this outcome area is poor. Service users feel their views are listened to and acted on. Service users are not protected from abuse and self 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. Service users have experienced a reduced amount of physical and psychological aggression from 1 service user as highlighted in previous reports. This appears to be the result of increased day care and timeout for the identified service user. This is an improvement. However, statement evidence from service users indicates that service users are still intimidated by and avoid the named service user. The Rambles DS0000020307.V297196.R01.S.doc Version 5.2 Page 17 Evidence arising from this and previous inspections (see inspection report dated 25/11/05 for more detailed information), 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.V297196.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. Service users live in a homely, comfortable and safe environment. The home is clean and hygienic. EVIDENCE: The Inspector conducted a tour of the premises. The homes premises were accessible, safe and well maintained throughout. The furnishings were of good quality and pleasant and domestic in design. The Inspector noted evidence of continued maintenance in the home. The premises are clean and hygienic throughout. The Inspector noted no offensive odours during inspection. The Rambles DS0000020307.V297196.R01.S.doc Version 5.2 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, 34, 35 Quality in this outcome area is good. Service users are supported by competent and qualified staff. Service users are supported and protected by the homes recruitment policy. Service users needs are met by the staff team. EVIDENCE: During inspection, the Inspector observed the staff team communicating well with one service user. The Inspector noted evidence that service users are supported by a staff team train with specialist skills. Documentation at the home highlighted a wide range of training offered by the Brandon trust for staff members. The Inspector noted in particular the training is given to enable staff to understand the nature of physical and verbal aggression, and how to react when faced with such behaviour. The manager at the home is also a trained positive response instructor. In excess of 50 of the care staff at the home have achieved NVQ to or higher. Staff records are held at the Brandon trust Central office. The Inspector will be assessing staff records after visiting the Brandon trust Central office. The Inspector understands that the home meets national minimum standards but has been unable to find evidence to fully substantiate this. The Rambles DS0000020307.V297196.R01.S.doc Version 5.2 Page 20 Service users are supported by a well trained staff. The Brandon trust provides training facilities and courses in excess of the required by the sector skills Council workforce. The home has a documented training and development plan and access to ample training from the Brandon trust. This is good practice. The Rambles DS0000020307.V297196.R01.S.doc Version 5.2 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): 37, 42 Quality in this outcome area is good. Service users benefit from a well run home. The health, safety and welfare of service users are promoted and protected. EVIDENCE: The homes registered manager is a qualified nurse with in excess of the 2 years required experience in management . The manager was able to demonstrate to the Inspector how the written aims and objectives of the home are being met by the staff team. the Inspector notes, that this ability however is impacted negatively by the inappropriate placement of one service user. The Inspector did not assess standard 39, (quality assurance), on this inspection. The Rambles DS0000020307.V297196.R01.S.doc Version 5.2 Page 22 The Inspector noted staff were up-to-date with moving and handling, fire safety and positive response training. The Rambles DS0000020307.V297196.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 1 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 2 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x x x x 3 x The Rambles DS0000020307.V297196.R01.S.doc Version 5.2 Page 24 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 YA3 Regulation 14 (2a, 2b), 14 (1d) 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. Staff must continue to work with the funding authority to identify an alternative placement for a named service user Timescale for action 10/02/06 2. YA23 12 1 (A/B/C) 13 6 14 1 (C/D) 14 2 (A) 04/07/06 3. YA22 17 (1) aSch.3 Staff must document all untoward occurrences or incidents of violence or aggression in the home. 10/01/06 The Rambles DS0000020307.V297196.R01.S.doc Version 5.2 Page 25 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.V297196.R01.S.doc Version 5.2 Page 26 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. 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