Care Home: 33a Hampstead Road

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What the care home does well 33 Hampstead Rd provides a homely environment for people to live in. Surveys from relatives and professionals stated that the service provided is of a good quality. The home has effective recording systems to ensure peoples` health and welfare is monitored. The home has coped well with the changes to registration that and have taken peoples needs into consideration during this change. What has improved since the last inspection? The receipt, administration and disposal of Controlled Drugs (CD`s) are now recorded in an appropriate register. What the care home could do better: Staff need to record training they have attended to evidence better that they are well trained and can support peoples assessed needs. CARE HOME ADULTS 18-65 33a Hampstead Road Brislington Bristol BS4 3HL Lead Inspector Sarah Webb Unannounced Inspection 9 & 15 November 2007 09:00 th th 33a Hampstead Road DS0000020228.V351600.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 33a Hampstead Road DS0000020228.V351600.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. 33a Hampstead Road DS0000020228.V351600.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 33a Hampstead Road Address Brislington Bristol BS4 3HL 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) 0117 9077219 max@aspectsandmilestones.org.uk admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Mrs Hilary Frances Edwards Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9) of places 33a Hampstead Road DS0000020228.V351600.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: 2. Mental disorder, excluding learning disability or dementia (Code MD) The maximum number of service users who can be accommodated is 9. Date of last inspection 5th October 2006 Brief Description of the Service: The home is operated by Milestones a branch of the Aspects and Milestones Trust, a publicly funded charity. The home is now registered to provide personal care for 9 adults with continuing mental health needs. This is a change from the previous registration to provide nursing care. The home is located a short walk from local shops and a main bus route to Bristol town centre. The aim of the home is to create a person centred home, which is relaxed and homely as well as maintaining peoples’ life skills and encouraging a ‘more independent lifestyle in the community’. The home also provides therapeutic support when needed. 33a Hampstead Road DS0000020228.V351600.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a Key Unannounced Inspection that took place over two separate half days. People using the service and several of the care team were met during the visit. The Manager helped with the inspection that included viewing records in relation to peoples’ care and support, risk management, the administration of medication, and staffing. Information was also provided through the homes Annual Quality Assurance Assessment (AQAA) that was received before the inspection. A tour of the home was undertaken and interaction between staff and people was observed during the two days. Surveys received by 3 relatives, and two from health care professionals were generally very positive in the care and support offered to people. Surveys also received by 4 people stated that they were satisfied with the service offered. As a result of this inspection one recommendation has been made. What the service does well: What has improved since the last inspection? What they could do better: Staff need to record training they have attended to evidence better that they are well trained and can support peoples assessed needs. 33a Hampstead Road DS0000020228.V351600.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 33a Hampstead Road DS0000020228.V351600.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 33a Hampstead Road DS0000020228.V351600.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. Satisfactory arrangements for people coming into the home make sure their needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection, a change in the registration category of the home has been agreed by us following the submission of relevant information showing that people no longer need nursing staff to meet their health care needs. This included assessments of people carried out by the placing authorities. The manager knows the appropriate procedures to follow if peoples needs change significantly and the home is unable to support them; 1 person has moved since the last inspection due to this and a review of another person’s needs by their placing authority has also been asked for. The home has a local admission criteria and process. There are 2 vacancies and referrals from people are in the process of being looked at. The manager said she meets and assesses people before they come to the home so that she can be sure a service can be offered. A survey from a healthcare professional stated that the home meets the assessed levels of residential support. 33a Hampstead Road DS0000020228.V351600.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 9 Quality in this outcome area is good. People are involved in making decisions about their lives and in the planning of their care. Risk assessments help people to take risks more safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Five care files seen contained a contract, assessment of needs, and care plan showing how people should be supported. Care files also included peoples’ personal history, essential and important things, preferences and daily routines. Individuals’ plans also described agreed personal restrictions on choice in helping to keep people safe. Care plans set out goals to be met and how these are to be met; they had been reviewed showing any changes to peoples care needs. Six monthly multidisciplinary reviews also take place. The manager said that if individuals care needs changed then she would notify the placing authority and request a review. This was evidenced through documentation seen for an individual. 33a Hampstead Road DS0000020228.V351600.R01.S.doc Version 5.2 Page 10 The manager said people are involved with the writing of their care plans and some had been signed by people. The home follows a risk management process in that individualised risk assessments are written to support people to help them take risks safely; these included areas such as mobility, bathing, smoking, use of alcohol health related issues and medication compliance. The AQAA stated that people are now encouraged more in voicing their opinions and that people have taken on ‘a sense of real ownership of their home’. House meetings are now chaired by people themselves where discussion can involve the routines of the home, food choices and holidays. The manager said that the main difference now for people is freedom of choice but that this has to be managed slowly so that people can make informed decisions and feel safe. People were seen talking to staff about differing issues; staff treated people respectfully and listened to what they had to say. Surveys received by 1 person stated that they sometimes make decisions about what to do each day. Another survey said ‘ I can do what I want to do during day and staff support me well’. 33a Hampstead Road DS0000020228.V351600.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. People who use the service are encouraged to make choices about their lifestyle, and supported to develop their life skills. People benefit from community services and facilities. People benefit from meals that offer a nutritious and varied choice and encourage healthy eating options. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The ethos of the home has changed in engaging people more in differing activities and responsibilities in the home with two senior staff planning these. An activity room has been set up for people to use for art and craft. The AQAA stated that although people are being encouraged to participate more in the running of the home there have been some areas that this has been unsuccessful with. However the manager is aware that it has been necessary to keep certain routines as it was necessary for people to feel safe. 33a Hampstead Road DS0000020228.V351600.R01.S.doc Version 5.2 Page 12 People are responsible for the cleaning of their bedrooms and they are supported with this and other tasks such as doing their laundry. Two people were also seen being supported to cook a midday meal in the kitchen. People are supported in going to the local community, including going to college, social drop -ins and the local churches. People use public transport; taxis, trains and buses. Coach travel is also used for day trips. Two people have been on a successful holiday to Berlin. The holiday was planned thoroughly making sure people were involved in making arrangements. The majority of people have contact with their families and staff encourage this if wanted. A survey received from a healthcare professional said that the home ‘Works well with community mental health team and wider social support exploring how to fully involve people individually with stimulating interests’ and ‘enables people to take on life skills and engaging people within the local community’. The manager said that the home has a more flexible approach to meals and not such set times as previously. Records are kept of food offered and these evidenced that the home takes into consideration the health needs of individuals as well as preferences. 33a Hampstead Road DS0000020228.V351600.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, & 20 Quality in this outcome area is good. People are treated with respect and are safeguarded by the home’s medication practices. People living at the home are looked after well in respect of health and personal care needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Personal care routines showed how people wanted to be supported. The manager said that routines are important in peoples lives and it was evident that people are treated in a respectful way. Health records showed the home is advised by specialist services in dealing with behaviours. Two people are supported with specific health care needs with community nurses involved in their care. A referral has been made for a district nurse to advise staff on the prevention of pressure sores. 33a Hampstead Road DS0000020228.V351600.R01.S.doc Version 5.2 Page 14 A comment card received from a General Practitioner stated that they were satisfied with the overall care provided to people. A survey returned from a health care professional said that the home’ Works well with people in supporting them when they are distressed ‘and that people are supported in taking responsibility for their physical health. The procedures and systems for administration, storage and disposal of medication were checked to monitor if the systems are safe. The home has a medicines administration policy. The medication administration charts were clearly written and contained signatures of the staff administering the medication. Medication profiles showed photographs of people 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 medication should be used for and the possible side effects. There is one person who has been assessed as being safe to self medicate. This is monitored by staff. A recommendation has been met for the receipt, administration and disposal of Controlled Drugs (CD’s) to be recorded in a CD register. Stock balances are checked at staff handovers twice daily. Medication that was no longer required was being returned to the pharmacist. Staff are trained through the completion of a national vocational qualification in the administration of medication. All staff including bank staff are signed off when they are assessed as competent. The home had recorded an incident when medication had been disposed of inappropriately. 33a Hampstead Road DS0000020228.V351600.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. People know who to go to if they are unhappy and want to make a complaint. Arrangements for protecting people living at the home help to keep them safe from risk or harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are times when there is personal friction within the dynamics of the people living at the home. The manager said that on these occasions staff approach these issues with diplomacy and any concerns from people are dealt with quickly so that they do not escalate into a major complaint. The AQAA received stated that although the home still needs to continue to ‘involve and engage people in the running of the home by acting on complaints promptly’, there have been no recorded complaints since the last inspection One survey received from a family stated that they do not know how to make a complaint but that the home ‘Always responds appropriately to concerns’. The remainder of surveys from families said that they knew how to make a complaint. All but one of the surveys received from the people living at the home said they knew how to make a complaint; everyone responding to the surveys said they knew who to go to if unhappy and if they had any concerns. The Trust has policies and procedures for the protection of vulnerable adults and in supporting staff through ‘whistleblowing’. Staff have also completed training in the protection of vulnerable adults. 33a Hampstead Road DS0000020228.V351600.R01.S.doc Version 5.2 Page 16 The home has appropriate systems for looking after individuals money to help protect people from financial abuse. Two peoples financial files were seen including balance sheets. These were consistent with monies held. Receipts are kept and financial checks are made at each shift. The majority of people have support in managing their bank account and ongoing finances. Those people able to are encouraged to manage their personal allowance. One person looks after their finances on their own. The trust monitors the homes financial practices through both internal and external audits. 33a Hampstead Road DS0000020228.V351600.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, & 30 Quality in this outcome area is good. People live in a homely, safe and clean environment; the bedrooms, communal rooms and facilities are suitable for their purpose and meet peoples’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is located within a short walk from local shops and a main bus route to Broadmead and is in keeping with the local community. A tour of the home was undertaken. People have single bedrooms that are lockable. It was evident that they are involved in making choices about their rooms as those seen had been personalised by individuals. Risk assessments seen showed protocols to follow if people are unsafe to smoke in their bedroom. 33a Hampstead Road DS0000020228.V351600.R01.S.doc Version 5.2 Page 18 Communal areas were seen being used by people including the kitchen, lounge, and smoking room. There is also a dining area and activity room. There are suitable bathrooms and toilets to meet the needs of people, including two bathrooms on the ground and first floor. There is also a shower facility in the first floor bathroom. A communal toilet on the top floor is provided for the two upper bedrooms. The managers said there is no maintenance programme but the property is inspected annually to see areas that will need to be decorated in the coming year. However the staff team have been involved in much of the redecorating recently. Routine maintenance is requested when necessary and logged. Improvements made to the environment include replacing the stair carpet and refurbishment of the laundry room. The lounge furniture has also been re upholstered. The office has been relocated to the first floor to provide an activity room for people on the ground floor. A housekeeper is employed who is responsible for the cleaning of the communal areas of the home. The home has arrangements for the disposal of clinical waste. There is a garden area to the side of the property and the home is planning to make a wildlife pond in the garden as this is of special interest to an individual. 33a Hampstead Road DS0000020228.V351600.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, & 35 Quality in this outcome area is good. Staff in the home are skilled, trained and in sufficient numbers to support people. People benefit from appropriate recruitment processes to help keep people safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: With the change in the homes registration, four staff have left the home. New staff have been recruited and this has taken time for staff to undergo their induction and probationary period. It is evident that with this change people need time to understand the staff teams differing roles and responsibilities. Since the change in the homes registration support workers now have greater responsibility. Previously nursing staff would take all responsibility but there is now more of a sharing role The manager said shifts have changed to a more flexible rota so that people are better supported in going out into the community. 33a Hampstead Road DS0000020228.V351600.R01.S.doc Version 5.2 Page 20 There is a minimum of two staff on duty with a third person sometimes supporting during the week; at weekends there are 2 staff on duty. There are 2 waking staff on duty at night. Staffing records included relevant recruitment documentation such as application, written references, Criminal Records Bureau checks, induction, supervision and training attended. People are involved in choosing new staff in that they will give their opinions of prospective staff visiting the home. New staff attend a 5 day corporate induction including a values day. Statutory training such as manual handling, fire prevention, food hygiene, and first aid is followed up. The Trusts training department checks when staff need to either attend or update training. The manager said that the last 6 months the home has concentrated on in house training, as a priority, around staff role and training in mental health. From discussion with the manager it was evident that staffing records seen were not up to date with current training attended. Two staff have been registered to complete a National Vocational Qualification whilst one staff member is a National Vocational Qualification assessor. Two other staff are also working towards this award. A survey returned from a health care professional said ‘Staff have a wide ranging skills mix and valuable experience but specifically mental health.’ 33a Hampstead Road DS0000020228.V351600.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, & 42 Quality in this outcome area is good. People benefit from living in a home that’s run by a registered, trained and experienced manager. People have been consulted and listened to during the change in the homes registration. Peoples health and safety is promoted by clear policies and procedures that keep them safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager and existing staff are experienced in the care of people with mental health needs. 33a Hampstead Road DS0000020228.V351600.R01.S.doc Version 5.2 Page 22 The manager has previously compleated an Open University “Managing Health and Social care “ course. The AQAA stated that the change from nursing to residential status has been successful and that people were consulted and listened to during the process. The manager confirmed that the ethos of the home will continue to evolve slowly as the rehabilitation of people will increase. A new quality audit tool has been introduced using a peer review process. However this has not been done yet due to the changes in the home and the need for stability. The Trust has procedures for the monitoring of the service through quality assurance. Monthly unannounced visits to the home are carried out by the organisation, with copies of visits sent to us. A fire risk assessment was not seen on the day of the visit but has been sent since showing any hazards and controls put in place to help keep people safe. Staff leading the shift are responsible for testing fire equipment; these had taken place and all staff had undertaken fire drills and training. The home has an annual health and safety check and records showed safety audits take place at regular intervals. The home keeps an inventory of peoples personal belongings. 33a Hampstead Road DS0000020228.V351600.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 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 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x 33a Hampstead Road DS0000020228.V351600.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. Standard Regulation Requirement Timescale for action 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 YA35 Good Practice Recommendations Keep a record of staff training 33a Hampstead Road DS0000020228.V351600.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 33a Hampstead Road DS0000020228.V351600.R01.S.doc Version 5.2 Page 26 - 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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