Care Home: 26 Cheddar Grove

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What the care home does well The staff team is committed to providing a good service for people who live at the home. The home has effective recording systems to ensure peoples` health and welfare is monitored. The home demonstrates good working relationships with other professionals through a multidisciplinary approach. People benefit from differing social opportunities and activities and are able to make their own decisions as to where and what they do. What has improved since the last inspection? The home have developed risk assessments about supporting people who use the service. This will ensure they are safer. What the care home could do better: People would find their contracts easier to understand if they were in a user friendly format. People would be fully assured that they were safe if their risk assessments were always reviewed. People would be assured that the staff are trained to meet their needs if certificates of training were on the staff files. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 26 Cheddar Grove 26 Cheddar Grove Bedminster Bristol BS13 7EN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jacqueline Sullivan     Date: 2 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: 26 Cheddar Grove 26 Cheddar Grove Bedminster Bristol BS13 7EN 01179077214 01179077214 colin.westwood@brandontrust.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Brandon Trust care home 7 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 7 The maximum number of service users who can be accommodated is 7 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home Cheddar Grove is a large house set in a quiet area of Bedminster Down on the outskirts of Bristol. It has good links with local amenities, shops, pubs and a post office, which are all within walking distance. The house has seven bedrooms, four of which are on the ground floor. There is a large back garden overlooking a school field. The home has qualified nurses on duty at all times and provides a service for adults with learning difficulties and mildly challenging behaviour, some of whom are non amublant. The home has mobility aids and all parts of the home are accessible. The aim of the home is to provide total support for the people using the service in all aspects of their lives. People are encouraged to develop self-confidence and life skills. Care Homes for Adults (18-65 years) Page 4 of 28 Brief description of the care home People are taken on various holidays, outings and have links with local colleges and day centres. The fees for the home are 1230 pounds per week. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a Key Unannounced Inspection that took place over one day. People using the service and several of the care team were met during the visit. The Manager was unavailable but discussion was had with two senior staff members who helped with the inspection process. This process included viewing records in relation to admissions, care and support plans, risk management, the administration of medication, and the management of behaviours and interventions. Further information was also provided through the homes Annual Quality Assurance Assessment. Care Homes for Adults (18-65 years) Page 6 of 28 A tour of the home was undertaken and interaction between staff and people was observed during the day. We also spoke with two relatives. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that they can visit the home prior to making a decision to live their. People can be assured that their needs and aspirations will be assessed by the staff team once they have moved into the home . Evidence: We looked at the care files for three people and saw that they contained assessments of peoples needs including copies of those completed by placing authorities. We saw that there were also care plans that identified how staff should support people. The admissions process also includes visits to the home that are arranged prior to people moving according to their needs. We spoke with staff members who were able to describe how people moved into the home. We spoke to a relative who confirmed that they visited the house several times with their family member. One relative said We liked it the moment we saw it. We chose this house because a Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: staff member came to work there and X really liked them. At the last inspection there were concerns that staff were supporting a person to the best of their ability and within the resources they had but it was noted that a more suitable placement was being looked for. At this inspection it was noted that the staff team have worked closely and consistently with this person and this person remains at the home as the staff team can meet their needs. At the last inspection it was recommended that peoples contracts were user friendly. This remains outstanding. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that they can make decisions about the way they wished to be cared for. people will be more assured that they are fully safe once there is a system in place to review risk assessments Evidence: We looked at the care plans and spoke to two senior staff members. Both staff members were able to demonstrate a sound knowledge of each of the residents. We also spoke to a care worker who was able to describe detailed work she had put in place to assist a person who was admitted as an emergency. She said She has transformed since being here. We looked at this persons care file and found that the staff team have worked well to assist this person. We also spoke to a relative who stated that since living at the home her family member has become more outgoing and happy. Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: At the last inspection it was noted that a requirement about developing a persons care plan and producing guidelines for staff dealing with challenging behaviour had been partly met. Staff spoken with said the unpredictability and daily changes of the behaviour was a concern and that there were specific processes that are followed when using the homes vehicle but no risk assessments. At this inspection it was seen that risk assessments were in place about the use of the vehicle. The staff team had attended training on meeting the needs of people with challenging behaviour. This has helped the staff work with this person so that they can remain in the house. The care plans contained the majority of the information to assist staff meet peoples needs . They are being further developed. As noted at the last inspection, care files identified that key workers complete monthly summaries of peoples general care, welfare and activities attended. Three monthly reviews are carried out and this was evidenced through records. The diary contained set dates for future 3 monthly reviews. House meeting records showed that staff encourage people to speak up and voice their opinions and make decisions about various aspects of life in the home. Risk assessments were detailed and and there was system in place for their review but this was inconsistent. Discussions with the staff and evidence in the files confirmed thats the home involves families in their relatives care through the development of person centred planning. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lifestyle, and supported to develop their life skills. People benefit from differing social, educational, and recreational opportunities. People benefit from meals that offer a nutritious and varied choice and encourage healthy eating options. Evidence: Discussion with staff and people it was evident that they have varied and individual lifestyles. We saw activity sheets and photographs of residents activities. Structured timetables of activities are followed, including attendance at day centres, hydrotherapy college and activities with the staff. We saw that people go to concerts in Bristol. People were seen going out in the homes vehicle, listening to music and watching television. Records of activities showed that people go to different places for a variety Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: of activities. People have had a barge holiday and stayed in holiday lodges in Wales and Ireland. The home has lots of BB-Qs and parties and we saw that the staff team make a big effort to ensure people who live their enjoy going out to places they like.One person was also supported by two staff on an individual holiday. A family member told us that The staff really look after x . I know I can visit when ever I want to and I am always made welcome... they are lifeline as sometimes I cant visit but I know X is in safe hands. As noted at the last inspection,menus seen were varied and nutritious. People are involved in making decisions about their choices of food and it was evident that staff have a good understanding of their preferences. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to lead healthy lifestyles with their health care and personal needs being monitored well. People are treated with respect and are safeguarded by the homes medication practises. Evidence: We looked at four care files and saw that records indicated that people are supported through professionals including the dentist, dietician physiotherapist and occupational therapist. We saw health action plans contained information showing that people have an annual health check and that their medication is reviewed regularly. In the health files we saw photographs of people were kept with each record to help ensure medication is administered correctly to the person named on the chart. There were guidelines for giving as and when required medication. These showed what the Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: medication should be used for and the possible side effects. We spoke with the qualified nursing staff responsible for administering medication and have attended training in the monitored dosage system. They demonstrated that they keep up with new information and training. We saw the staff training records showed that some staff have attended training in first aid,, manual handling and epilepsy. However we noted that their was not a training matrix which would easily identify gaps in staff training and not all training records had been updated with current training. We observed that staff treat people who liveat the home with respect and are aware of the choices they make about the way they want personal support. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that their complaints will be acted on by the staff team. However the recording could be improved. People can be assured that they will be protected from abuse. Evidence: We saw that there is a protocol that supports people living in the home and staff if allegations of abuse are made. The protocol includes following safeguarding procedures and who to contact . We saw evidence in the care files that the protocol has been followed.and senior staff spoken with were able to describe it. We saw copies of the complaint procedure were available for people in their bedrooms in an easy to read format. We saw examples of how peoples concerns had been acted on by the staff team. The recording of complaints could be improved to evidence that they are resolved within 28 days to the persons satisfaction. As noted at the last inspection,regular meetings have taken place through safeguarding procedures and minutes of meetings showed a protection plan is in place to help ensure the safety of other people living at the home. There is a rolling programme in place for staff training in safeguarding. A care staff we spoke with was able to demonstrate a good understanding of safeguarding issues. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home enjoy a clean, homely house. Evidence: 26 Cheddar Grove is situated in a residential area to the South of the city of Bristol. The home is in keeping with the local neighbourhood and has good access to public transport. The home is accessible to people who have a physical disability. We were shown peoples bedrooms and we saw that they all have single bedrooms. Those seen had been personalised and staff members help people keep their rooms tidy. There is a stair lift to access the first floor bedrooms. There are also bedrooms on the ground floor. There are two lounges that are homely and decorated to a good standard, and a dining area and kitchen. Both lounges were in use during the visit and people were seen moving around the house freely. We sat in the dining room talking to staff and noted that it was very homely, clean and comfortable. Since the last visit the home has been further improved by a new upstairs bathroom and walk in shower. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: A staff member said We try to make it as homely as possible. A relative told us The house is clean and tidy when I visit. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that they are looked after by a training and experienced staff team. People can be assured that the staff team is well supported to meet their needs. Evidence: The staff rota confirmed that there are are sufficient numbers of staff employed at the home. They are an effective staff team consisting of qualified nurses and support staff. At the time of inspection there was one vacant post. Several of the staff spoken with demonstrated a good understanding of their role and responsibilities. Staff complete the Learning Disability Award Framework before doing a National Vocational Award in care. New staff attend corporate induction which includes attending training including fire, food hygiene and abuse. Copies of these were seen to be well maintained. As noted previously the staff training records did not show all the training that staff had attended. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: The staffing records are not kept on the premises but held at the Brandon Trust Headquarters. It is expected that we will be completing inspection of the personnel department to view staffing records. The manager supervises the qualified nurses, and then they in turn supervise the home support workers. We looked at these records and noted that staff receive appropriate,timely supervision. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can be assured that it is well run and their views will be listened to. Evidence: The manager Mr Westwood is now a locality manager. He was not present at the inspection.He also manages two other home nearby. At the time of inspection there was anxiety about how this would work and whether it would impact on the residents, We spoke with a staff member after the inspection who told us that Its not as bad as we thought. At the time of inspection the home was well manager. The senior staff spoken with had a sound idea of the homes policies and procedures and were open to new ideas. A relative told us that The staff are very helpful to me. I feel very supported. A staff member said of the manager He is absolutely fantastic and well respected. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: There are assistant managers and we were told that another assistant manager may be employed. The way that this new structure works will be a focus of the next inspection. A staff member said that they are worried about the changes as the staff have worked so well together. There was evidence in the care files and from the minutes of residents meetings that people who live in the home views are listened to and acted upon by the staff team. Monthly unannounced visits to the home are carried out by the organisations copies are available at our request. We looked at the fire records and we saw that they are well maintained.Fire records evidenced that the home has completed a fire risk assessment identifying any fire hazards and how to keep the home safe. Fire equipment checks were taking place and all staff also undertook fire drills and training. As noted at the last inspection,other records such as the servicing of the hoists and portable appliance testing showed there are health and safety systems in place helping to ensure people are protected. We saw that the certificate of employers liability was displayed with the registration certificate. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 4 5 9 20 22 The registered person ensures that peoples contracts are user friendly. The registered person ensures that risk assessments are reviewed. The registered person ensures that staff training about peoples health needs is available on their staff files. The registered person should ensure that the recording of complaints is reviewed. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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