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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 35 Cranbrook Road 35 Cranbrook Road Redland Bristol BS6 7BP     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: Melanie Edwards     Date: 0 6 0 4 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 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (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 27 Information about the care home Name of care home: Address: 35 Cranbrook Road 35 Cranbrook Road Redland Bristol BS6 7BP 01179442021 01179709301 cartermob@yahoo.co.uk 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) : Aspects and Milestones Trust care home 5 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 5 May accommodate up to 5 persons aged 40 years and over. Date of last inspection Brief description of the care home 35 Cranbrook Road is operated by Aspects and Milestones and is registered to provide personal care and accommodation for up to five people with mental health needs who are 40 years and over. At present there are four men in residence who have lived at the home for a number of years. It is a large residential house, which blends in with the local surroundings. It is built on three floors. It is close to local facilities and amenities, including shops and public houses. It is also close to a main bus route. Fees are around five hundred and eighty pounds a week. Care Homes for Adults (18-65 years) Page 4 of 27 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: We met the four residents staying at the home. We met the registered manager, Mr Carter and one of the support workers. We talked with them about roles, responsibilities, training needs and how they assist residents. We saw the staff talking and supporting residents. We looked at a selection of records relating to the running and management of the home. These included the service users guide, one care plan, one assessment record, training records, staff duty records, staff employment files, quality assurance information, accident records, fire records and menus. Care Homes for Adults (18-65 years) Page 5 of 27 We saw most of the environment except for two residents rooms at their own request. The home was operating within the required conditions of registration set down by us. The conditions of registration detail the type of care and the needs of residents and the numbers of residents who may stay at the home. 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 –03000 616161. Care Homes for Adults (18-65 years) Page 7 of 27 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 8 of 27 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. An assessement is carried out of all residents needs and they are met. People are able to get hold of up to date information to help them to understand the service provided. Evidence: We read a copy of the service users guide to see what information is given to people to find out about the home and the service. We found that the guide contains the information for service users to make a decision about the home and if it is a place they may want to live in. Mr Carter showed us copies of the documents that are kept for residents to read in their rooms. Aspects and Milestones Trust have their own website and there is information on it about the home. To find out how well and how effectively residents needs are assessed we read one persons assessment record. In the assessment we read information about the likes and dislikes of the person and their choice of social and therapeutic activities. We saw Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: some written evidence that residents assessments record are regularly evaluated and updated. This shows us residents needs are monitored and reviewed. On the day of our inspection one prospective resident was coming to the home for a visit to see if they like it. Care Homes for Adults (18-65 years) Page 10 of 27 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. Residents care plans show how their needs are being met and how to support them to stay safe. Good efforts are made to support residents to make decisions and to take risks in their daily lives. Evidence: In the AQAA document it says the home do the following to ensure the views of people who use their service are incorporated into what they do:We try to consult our residents on what they want to make their lives as normal as possible. Menus, choices of outings holidays. Residents go out as individuals for example with their key workers not as a group. Suggestions about furnishings. Colour scheme for example all are listened too. We checked and read the contents of one residents care plan so that we could see how Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: residents are supported to meet their mental health needs. We found that the care plan contained a satisfactory level of information about the persons different needs and what to do to help them meet those needs. We saw information in the care plan about the life history of the person and what matters to them including their family and friends. The care plan had been reviewed and updated. This shows residents needs are monitored and kept under review. Reviewing care plans regularly also demonstrates residents needs can still be met. In the AQAA document it explains how the home meets residents needs:We provide a relaxed and friendly home for our residents, with a key worker system. Residents are treated as individuals .We have had a fixed group of residents until recently. Three residents have left us one to live independently, the other to move back with parents. Residents are encouraged to take holidays and or days out or outings with their key workers where the residents wish it. We saw residents go out to the shops and for a walk. These are good examples of residents doing what they want to do and being able to take risks in their daily lives. We saw some information written in the care plan we read about risks the person may face and any risks from particular activities that they take part in. The care plan set out what to do to safely support the person and was helpful and informative. We saw information in residents daily records that confirmed that staff will try to help support them to maintain their independence in their daily living. Residents told us they get up when they want to during the morning. We also saw people getting up at different times. This helps to demonstrate how their choices and different preferences are respected. Care Homes for Adults (18-65 years) Page 12 of 27 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. Residents are supported to be part of the local community and do leisure activities if they wish to. Residents rights are respected and privacy and respect is promoted. Residents are involved in the choices of menus and they are provided with a healthy diet. Evidence: We saw in the residents care records information about residents regularly going to different community activities. There are local facilities for residents to use in the area Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: near the home. Residents go on their own on a regular basis. Residents go out for coffee as well as to nearby pubs and other social venues. This helps to ensure residents live a varied and fulfilling life. We read information in the care plan about the different risks the person may face and any risks from particular activities that they do. The care plan showed what approaches staff should take and was informative. We saw residents go out to the shops and for a walk. This is good evidence of how residents are well supported to take risks in their daily lives. In our discussion with Mr Carter he conveyed that one of the main aims of the home is to actively promote the rights of residents and to encourage them to develop some independence in their lives as much as possible. The residents we met told us that staff are polite to them We saw staff knock on a bedroom doors before being invited in. Residents can have their own key to their bedroom if they want to give them more privacy. We were told by the residents the food in the home is really nice. Residents said they can make choices of what meals they would like. Residents usually have a snack for lunch chosen by the residents. There is a cooked dinner prepared for the evening. We saw in the residents menus a healthy choices of meals each day. Care Homes for Adults (18-65 years) Page 14 of 27 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. Residents physical and emotional needs are met. Residents medication is handling administered and disposed of safely. Evidence: We read information written in residents care records about the daily routine of the residents and particular likes and dislikes in their daily lives. This information is a way for staff to be able to meet residents needs in the way that is preferred by them. To support residents with their health needs they can use local GP practices. There is also specialist support provided from other external professionals including the psychiatrists and if needed the community mental health nurses. We saw extra information in the residents daily records that showed us staff closely monitor residents and observe their overall health. Staff call the doctor if they are concerned about the persons health. We checked the procedures in place for giving, storing and getting rid of medication to Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: see if residents medication is handled properly. We read in detail the medication administration charts of three residents. The medication administration charts were easy to read, up to date and contained the signature of the member of staff who had given out the medications. This helps demonstrates medication is given to residents safely. The staff who administer medication do regular training to enable them to do this safely. The stock of medication we saw was satisfactorily organised. Medication is stored safely in a secure cupboard in the staff office. Care Homes for Adults (18-65 years) Page 16 of 27 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. Residents are helped to make complaints about the service. There are good ways set up to help to protect residents from abuse. Evidence: We checked the complaints records to see how complaints are dealt with by the home. There had been no complaints made since before the last inspection. In our discussions with Mr Carter he demonstrated an understanding of the importance of supporting residents to make their views known if they are unhappy about any aspect of life in the home. All of the residents who we met said they could talk to the staff if they need to. We saw a copy of the homes complaints procedure, this has our contact information as well the contact details for Aspects and Milestones Trust if people need to get in touch with us, or them. We saw procedures and guidance information on the topic of keeping vulnerable people safe from abuse. This helps to protect vulnerable adults who live at the home. We were told by Mr Carter that staff have done date training on the subject of the safeguarding vulnerable adults. We saw some information in the staff training records that also confirmed this. Care Homes for Adults (18-65 years) Page 17 of 27 Care Homes for Adults (18-65 years) Page 18 of 27 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. Residents live in a home that is clean, safe and satisfactorily maintained. The environment is suitable for the needs of residents. Evidence: 35 Cranbrook Road is in a residential area of the city of Bristol. The home is a short distance from a main shopping area. The home is also situated near to bus stops, a train station, local shops, coffee shops, pubs and a church. This means residents can be part of the community if they want to be. The home is a three storey building and residents use all parts of it. We noticed that there is no lift, so the home would not be suitable for someone with reduced mobility. We found the home looked adequately clean. We also saw that the environment looked satisfactorily maintained. The bedrooms we saw looked adequately clean and adequately maintained. All bedrooms are for single use. We saw that rooms had been decorated in different colours and we were told residents had chosen their own colours for their rooms. Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: Residents had their personal possessions in their rooms. One resident kindly showed us their room. They have displayed in their room a number of their works of art and the results look very impressive. We saw residents sitting in the dining room and in the lounge talking together.We noticed that residents looked comfortable in their environment. We saw there are two bathrooms and three toilets near to communal areas and bedrooms. We saw that the bathrooms and toilets were reasonably clean. There were towels and soap to help minimise risk from cross infection. Care Homes for Adults (18-65 years) Page 20 of 27 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. Residents needs are met by enough competent staff. However residents would benefit if staff kept up to date on mental health matters. Evidence: We asked to see two care staff employment files. We were told by Mr Carter that the references taken up for all new staff are held in the Trusts head office. All staff do a criminal records bureau check before starting employment. These checks aim to make sure the home employees only suitable people to work with residents. We do regular checks on the staff files held at the head office to make sure that recruitment practices are safe. We checked the number of staff on duty for four weeks of March of this year. We saw that there are one or two support staff on duty for a day shift. There is one member of staff who works a sleeping in shift at night and is available for support if needed. Mr Carter works thirty seven hours a week. He is also available on call outside of these times for support and advice if needed. Based on the evidence from the inspection the number of staff on duty at any time meet residents needs. Mr Carter told us all of the staff have done national vocational qualification in care Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: training. We saw this confirmed in the staff training files we saw. However we did not see any evidence that staff had done training or updating in relevant mental health subjects since before the last inspection in 2007. We discussed this with Mr Carter and we recommended that staff keep up to date in current mental health matters, so residents are cared for based on current best practice. Care Homes for Adults (18-65 years) Page 22 of 27 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. Residents benefit from a home run well. Mr Carter tries hard to make sure and residents views are listened to and represented. Residents and staff health and safety is mostly protected. However there needs to be a tightening up on fire testing to make sure that the residents and staff are safe Evidence: Mr Peter Carter has been the manager of the home for over ten years. He has a significant number of years experience caring for people with a range of mental health needs. He has been registered with us as the manager of the home and is a registered mental health nurse. This demonstrates he is fit and competent to be the manager. One resident said to us that Peter is, very fair another resident said he was, helpful. This show us residents feel supported by him. The Trust have a really good system for monitoring the quality of the care and the service that residents are given. The use their service user representative to carry out Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: a review in their care homes. We saw the information that had been obtained from a recent quality monitoring exercise. We saw that residents are well consulted about a varied range of matters to do with the service. All of the staff do regular training in food safety. This is a really good way for staff to help residents to prepare and cook food in a safe way.The staff also do training in health and safety matters including first aid, infection control and fire safety. This should help protect residents if staff are knowledgeable and well trained in health and safety principles and practices. The fire logbook record was checked and showed weekly and monthly tests of the fire alarms and the fire fighting equipment are done. However we saw three gaps of time when the fire tests had not been done on a weekly basis. These tests are neccessary to make sure the alarms work in the event of a fire. We saw records that showed staff check the temperatures of all high-risk cooked food before it is served to people to make sure it is hot enough and safe to eat. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 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 1 42 23 Fire alarms must be regularly 08/04/2009 tested. Health and safety. 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 35 Staff should keep up to date on their knowledge of relevant Mental Health subjects. Care Homes for Adults (18-65 years) Page 26 of 27 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. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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