Inspection on 17/01/06 for Tramways

This inspection was carried out on 17th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tramways 16/09/08

Tramways 12/10/07

Tramways 19/04/06

Tramways 03/08/05

Tramways 19/01/05

Tramways 26/05/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Tramways Tramway Road Brislington Bristol BS4 3DS Lead Inspector Sandra Jones Unannounced Inspection 17 &20 January 2006 09:30 th th Tramways DS0000026641.V276237.R01.S.doc Version 5.1 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 Tramways DS0000026641.V276237.R01.S.doc Version 5.1 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. Tramways DS0000026641.V276237.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Tramways Address Tramway Road Brislington Bristol BS4 3DS 0117 3009637 0117 9709301 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) admin@aspectsandmilestones.org.uk Aspects and Milestones Trust To be appointed Care Home 14 Category(ies) of Learning disability (14), Learning disability over registration, with number 65 years of age (14) of places Tramways DS0000026641.V276237.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 14 persons aged 65 years and over with Learning Disabilities for personal care only May accommodate up to 14 persons aged 40 to 65 years with Learning Disabilities for personal care only 3rd August 2005 Date of last inspection Brief Description of the Service: Tramways is registered to accommodate up to fourteen adults with learning disabilities. Aspects and Milestones Trust home operate the care and at present there are two acting managers. The property was purpose built and arranged on one level, designed into two separate units accommodating seven people, linked by a passage, with a shared kitchen. It is situated in an industrial estate close to the Bath Road and within walking distance of shops, amenities and bus routes. Each unit has their own staffing with a manager, senior and home support workers. Tramways DS0000026641.V276237.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted on an unannounced basis over two days in January 2006. Since the last inspection, one additional visit was conducted to follow-up the immediate requirement regarding risk assessment. An Immediate Requirement was issued during this inspection, which focused on; following advice, risk assessment and fire safety checks. Both managers’ maintain regular contact with the CSCI to ensure the home continues to develop practices. The records and interaction between staff and residents were used to confirm the standards of care at the home. The external manager has formally notified the CSCI of the future plans for the home and the residents accommodated. What the service does well: What has improved since the last inspection? Tramways DS0000026641.V276237.R01.S.doc Version 5.1 Page 6 Requirements made at the last inspection were actioned in house 1 and there was clear evidence that systems are being developed to improve consistency at the home. Individual Person Centred Plans (PCP) were developed into a format that guide staff to meet residents needs, in a manner that incorporates likes, dislikes and preferred routines. Residents in both houses experience a variety of meaningful activities. In house 2, skills learnt can be used at the home increasing the individual’s personal development. Residents in both houses visit local shops, amenities and restaurants indicating that staff empower residents social inclusion into the community. 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. Tramways DS0000026641.V276237.R01.S.doc Version 5.1 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 Tramways DS0000026641.V276237.R01.S.doc Version 5.1 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): These standards were not assessed at this inspection. EVIDENCE: Tramways DS0000026641.V276237.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 &9 In house 1, Person Centred Plans (PCP) must be further developed to incorporate key elements of independence, choice, inclusion and rights to fulfil the aim of person centred care. In house 2, the action plans must be more structured and must also contain the key elements of person centred care. To create a framework that enables the person to make choices, express their views and preferences about the way their needs are to be met. Risk assessments and reactive strategies are completed for activities that may involve an element of risk. EVIDENCE: Significant steps have been taken in both houses to develop Person Centred Plans (PCP). In house 1, personal plans clearly describe communication, mobility and continence needs. The manner choices are made, hobbies and daily routines are drawn together within the plans. Key elements of privacy, rights, choice and inclusion must be incorporated into PCP to fulfil the aim of person centred care. In terms of privacy and dignity the information should be more specific. In house 2 the format is pictorial with statements from staff on the identified need. For example, how the person makes choices. While the Tramways DS0000026641.V276237.R01.S.doc Version 5.1 Page 10 information about all aspects of the person is contained, the actions to be taken must be structured to guide staff. This is a requirement outstanding from the previous inspection, which must be actioned to prevent any enforcement action. Global risk assessments are completed for Food Safety, Fire and Health & Safety. Individual risk assessments for medication, mobility and access are in place. The format in current use focuses on the advantages and disadvantages of the actions, with the professionals involved to make proportional decisions. Two residents in house 2 exhibit aggressive and violent behaviour and reactive strategies were developed to direct staff on the actions to be taken. Within the strategies the triggers that may agitate the person, preventative measures and actions to be taken are described. Tramways DS0000026641.V276237.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,15 &17 Appropriate activities are organised for residents in both houses. Visitors to the home are welcome and residents with their visitors can use shared and personal space. Nutritious and varied meals are prepared to meet residents specific dietary needs. EVIDENCE: In house 1, four residents attend the Women’s Education Association (WEA) for social interaction and communication needs. Colleges were used in the past but at present the residents in house 1 are not registered to attend further education. In house 2 there is an activity programme that list daily activities not incorporated into daily routines. Three residents in house 2 attend college courses in communication, self-awareness, drama and cooking. The resident that is taking a college course in cooking can use the skills learnt at the home. Tramways DS0000026641.V276237.R01.S.doc Version 5.1 Page 12 It was understood from the staff at the home that residents are supported to maintain links with family and friends. The home’s vehicle is used by the staff to transport relatives to enable contact with family is maintained. Visits to the home can take plans in bedrooms and shared space. The manager reported that in house 1 additional information regarding intimate relationships will be added to PCP’s. The cook stated that following consultation with staff of each house, menus are prepared. Menus are varied and nutritious and meals provided to individual residents are in their individual diaries. Special diets for one resident with PKU, reducing diets and additional calorie diets are catered for at the home. The cook currently has additional responsibilities for cleaning the catering area and during time off, alternative arrangements are made for catering and cleaning the kitchen. It was understood that training is accessible and recently attended training in nutrition, POVA, Food Hygiene and weight management. As the cook is rostered Monday to Friday meals for Saturday and Sunday are prepared in advance for the support staff to serve at weekends. Tramways DS0000026641.V276237.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 & 20 In house 1, PCP specifies resident’s daily routines for personal care, evidencing that a person centred approach to meeting residents needs is used. Medications records must be signed immediately after administration to ensure safe handling of medications. EVIDENCE: Within residents Personal Care Plans (PCP), residents personal care needs are described. Routines that are essential for bathing and continence are detailed in their PCP’s. In house 1 PCP’s a daily routine format is used for getting-up, lunchtime, teatime and bedtime. Mobility care needs are specified and describe the person’s abilities and their support needs, with likes and dislikes on the preferred techniques for moving and handling. The equipment and aids needed by the residents for access is included within the format. Hi-low baths that assist with getting in and out of the bath and wheelchairs for outside the home are used by less mobile residents. In both houses, residents are ambulant and assisted baths are used for support residents with getting in and out of the bath. Wheelchairs are used outside the home for residents that must have a level surface for walking. Tramways DS0000026641.V276237.R01.S.doc Version 5.1 Page 14 The arrangements for administering medications in house 2 were examined at this inspection. Medications are administered from a monitored dosage system and gaps in the recording of medications were found. Indicating that medications are not signed immediately after administration. Records of administration must be signed immediately after administration. Homely remedies are not kept at the home. The record of medications no longer required is countersigned by the pharmacist to indicate receipt of the medication for disposal. Tramways DS0000026641.V276237.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Family, keyworkers and support staff ensure that residents perceived views are taken seriously and acted upon. To safeguard residents from abuse agreements made during POVA meetings must be actioned. EVIDENCE: There were no complaints received at the home on behalf of the residents since the last inspection. It was understood family, keyworkers and support staff are the people that will advocate on behalf of the residents. Since the last inspection, a Protection of Vulnerable Adults (POVA) strategy meeting was convened regarding two residents. Part of the outcome of the meeting was for professional advise to be sought and risk assessments to the completed. While risk assessments were devised and professional advice sought, there was no evidence that the advice was actioned. Previous requirements were made for the home to follow advice given by outside professionals. Additionally, risk assessments were not completed for one resident that at times behaves inappropriately towards the resident who was involved in the POVA incident. For this reason an Immediate Requirement was issued for the manager to document the actions that are being taken from the advice given and to formulate a risk assessment for a resident that at times exhibits inappropriate behaviour. The manager produced a risk assessment for the resident within the timescale and efforts are being made to contact outside professionals for a review. It has been a criticism of the home that although Tramways DS0000026641.V276237.R01.S.doc Version 5.1 Page 16 professional advice is sought, there is little evidence that advice given is followed. It was of concerns that senior staff were not aware of the actions that the manager was taking increasing the vulnerability of the resident. The manager must evidence that following from POVA strategy meetings, agreements made are taken seriously and acted upon. Tramways DS0000026641.V276237.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: Tramways DS0000026641.V276237.R01.S.doc Version 5.1 Page 18 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): Training that is accessible through the Trust raises the levels of staff competence to meet the residents changing needs. The requirement to develop individual supervision remains outstanding from the last inspection. EVIDENCE: It was understood from the manager for house 1 that through 1:1 with staff, training needs are identified. For new staff, the induction programme is linked to Values and statutory training. It was reported that mentors are assigned to staff undertaking the Trust’s induction programme that must be completed within 6 months. As part of the induction, staff complete a booklet, which is checked and signed by the manager to indicate completion. Members of staff that successfully complete the induction programme are registered to undertake the NVQ level 2. Members of staff undertake statutory training, which consists of POVA, Food Hygiene, First Aid and manual handling. Medication and epilepsy training is also completed by the staff at the home. Additional training is available for personal development and to meet residents changing needs of the residents. From the comments made by the assistant team leader of house 2, the training programme for both houses are similar. However, the records of additional training completed by staff in house 2 are not up to date. Tramways DS0000026641.V276237.R01.S.doc Version 5.1 Page 19 Two staff are currently undertaking the induction programme and one is on secondment to the home. Two staff are undertaking Empowering Practice training, with two staff on NVQ level3. It was reported that the requirement to organise individual supervision remains outstanding. Tramways DS0000026641.V276237.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): For resident to have a safe environment fire checks and practices must be conducted at the stipulated frequencies. EVIDENCE: The records that relate to fire safety policies, checks and practices for both houses were examined. In house 1 the records indicated that checks and practices are conducted at the stipulated frequencies. In house 2, fire checks have not taken place at the correct intervals. While members of staff were aware that the fire alarm checks had not taken place, no action was taken. For this reason an Immediate Requirement was issued to undertake checks and practices at the appropriate frequencies. Tramways DS0000026641.V276237.R01.S.doc Version 5.1 Page 21 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 x 3 x 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 1 ENVIRONMENT Standard No Score 24 x 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 x 33 x 34 x 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 x x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 x 14 x 15 3 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 x 2 x x x x x x 1 x Tramways DS0000026641.V276237.R01.S.doc Version 5.1 Page 22 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 YA6 Regulation 15 Requirement Timescale for action 30/04/06 2. YA19 3. YA36 4 YA6 5 YA42 6 YA42 PCPs must be cleared in terms of the action plans. Their means of communication and decisionmaking abilities must be incorporated which must be signed and dated. (Previously required 3/8/05) 13(b) Documentation must evidence that professional advice sought is followed by the staff. (Previously required 3/8/05) 18(2) Members of staff must have six supervisions sessions per year. (Previously required 3/8/05) 12(4) PCP’s action plans must incorporate rights, choice, inclusions and dignity to evidence a person centred approach to meeting needs 37 The CSCI must be notified of the incident regarding a resident and member of staff in house 2 17(2)Sch.4.14 Fire safety checks must be conducted at the stipulated frequencies. DS0000026641.V276237.R01.S.doc 30/03/06 30/04/06 30/04/06 30/03/06 28/02/06 Tramways Version 5.1 Page 23 7 YA23 12(6) 8 YA20 13(2) Documentation that evidences 28/02/06 the actions taken from the POVA strategy meeting must be provided Medication records must be 28/02/06 signed immediately after administration. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA22 Good Practice Recommendations Consideration to enabling the residents to make complaints Tramways DS0000026641.V276237.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tramways DS0000026641.V276237.R01.S.doc Version 5.1 Page 25 - 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. 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