Care Home: 42 Barry Road

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What the care home does well 42 Barry Road is a well-run home offering a good standard of care and the manager and staff endeavour to provide a good quality of life for those people who live at the home. The overall impression following the visit was that the individuals living at the home are happy, settled and secure and that the staff have a good rapport with them. A number of staff have known those who live at the home for many years and have an in depth knowledge and understanding of their needs, this contributes to the wellbeing of individuals. The staff team at 42 Barry Road are caring and have developed good relationships with individuals at the home; they have a sound understanding of the needs of those living at the home. There is a low staff turnover and individual`s can be confident that they will receive support from people they know. It was clearly evident that the management and staff team are committed to ensuring that all of the needs of individual`s at the home are met, this is done through consultation and observation and previous knowledge and an understanding of individual`s. What has improved since the last inspection? In order to ensure that those living at Barry Road are fully aware of their rights and responsibilities in respect of their placement at the home it was required during our last visit that all people living at the home must be provided with a copy or their terms and conditions of their placement. That these must include the arrangements for fees. We saw that this requirement had been met, with these documents fully completed and in place for all. In order that people are aware of the procedure to follow should they wish to make a complaint we recommended during our last visit that the manager considers ways of raising the profile of how to make a complaint to both relatives and health/social care professionals. We saw that since our last visit there has been some joint teamwork development training between the staff at Barry Road and health/social care professionals. The impact of this training has benefited both those who live and work at Barry Road. It was required at our last visit that the staffing levels required at night are monitored. This was to ensure that the needs of people during the night are met. Since our last visit this is an area of change. There is now a member of staff on duty at night, who is awake and available to support people should they need assistance. In order to ensure that individuals wishes and choices in the event of their death are respected and adhered to it was recommended during our last visit that the home seek and record individuals wishes in this sensitive area. Of the records reviewed we saw that peoples wishes had been discussed with them and had been recorded within care documentation. We reported following our last visit that in order to demonstrate that staff are competent it was required that records of staff fire training records be better maintained and that emergency lighting is checked as per the Avon Fire Brigade guidelines. This was in order to ensure the safety of those living and working at Barry Road in the event of a fire. Fire records of safety, equipment and staff training checks were reviewed at this visit and we noted no concerns. The requirement had been met. What the care home could do better: We noted that the home has a key pad entry and exit system linked to the front door and discussion took place about individuals restriction to leave, balanced with risk and the providers `duty of care`. The manager was fully aware of his responsibilities in this area. In order to ensure that the home is fully aware of the rights of people living at the home and to demonstrate that individuals movements are not restricted in line with the proposed deprivation of liberties legislation it is recommended that the home review the key pad system which is place for people who are living at the home.In order to ensure that people are being supported fully with their medication it is required that a full audit must be undertaken of stock held medication to ensure that records are accurate and to also ensure that medication which is not required is returned to the pharmacist for disposal. Also medication that is to be given `as and when` required should contain full details of what this means. To ensure that people are fully aware of the risks associated with having a key pad entry/exit system it is recommended that the home review the fire risk assessment which is in place in order that this area is fully covered and those living and working in the home are safe. Individuals risk assessments in this area should also be reviewed. CARE HOME ADULTS 18-65 42 Barry Road Oldland Common South Glos BS30 6QY Lead Inspector Odette Coveney Key Unannounced Inspection 18th September 2008 09:00 42 Barry Road DS0000003392.V368867.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 42 Barry Road DS0000003392.V368867.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. 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 42 Barry Road Address Oldland Common South Glos BS30 6QY 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 9329705 F/P 0117 9329705 admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Mr Martin Rogers Care Home 11 Category(ies) of Learning disability (11), Learning disability over registration, with number 65 years of age (11) of places 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 11 persons aged 18 years and over. May include persons aged 65 years and over 10th November 2006 Date of last inspection Brief Description of the Service: 42 Barry Road is registered to accommodate up to eleven active adults with learning difficulties, which may include people over the age of 65. The home is operated by Aspects and Milestones Trust. The home is on the edge of Oldland Common village within walking distance of shops, which include a post office, public house, chemist and other stores. The property is a Victorian detached house, which has been extended to create a large ground floor purpose-built area. The original building also houses a self-contained first floor flat which has the potential to be independent from the rest of the home for either a single person or a couple. All communal areas are on the ground floor and consist of a modern and spacious lounge with a partial glass roof with ten bedrooms leading off from this area. There is also a more traditional and comfortable front lounge in the older part of the building, a smaller lounge and a dining room and kitchen. The large and well maintained rear garden is fully accessible to service users. There is parking available to the front of the premises. The Home has a ‘mini bus’ to transport residents for necessary appointments and for leisure activities. Fees at this home range from 790 – 900 pounds per week, this is based upon a full assessment of individuals needs. 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience Good quality outcomes. This was an unannounced visit as part of a key inspection process. The purpose of the visit was to review the progress to the requirements and recommendations from the visit in November 2006. In addition to monitoring the quality of the care provided to the eleven individuals living in the home. The inspection methods used included record checks, reviewing the care and associated records for three of the people who live at 42 Barry Road, a review of staff records including training and supervision records, a tour of the home and discussion with the manager, three staff, and people who use the service. The home has been sending information in respect of regulation 37 notices of events affecting the well being of the people who use the service. The visit was conducted over a period of seven hours and ended with structured feedback. What the service does well: What has improved since the last inspection? 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 6 In order to ensure that those living at Barry Road are fully aware of their rights and responsibilities in respect of their placement at the home it was required during our last visit that all people living at the home must be provided with a copy or their terms and conditions of their placement. That these must include the arrangements for fees. We saw that this requirement had been met, with these documents fully completed and in place for all. In order that people are aware of the procedure to follow should they wish to make a complaint we recommended during our last visit that the manager considers ways of raising the profile of how to make a complaint to both relatives and health/social care professionals. We saw that since our last visit there has been some joint teamwork development training between the staff at Barry Road and health/social care professionals. The impact of this training has benefited both those who live and work at Barry Road. It was required at our last visit that the staffing levels required at night are monitored. This was to ensure that the needs of people during the night are met. Since our last visit this is an area of change. There is now a member of staff on duty at night, who is awake and available to support people should they need assistance. In order to ensure that individuals wishes and choices in the event of their death are respected and adhered to it was recommended during our last visit that the home seek and record individuals wishes in this sensitive area. Of the records reviewed we saw that peoples wishes had been discussed with them and had been recorded within care documentation. We reported following our last visit that in order to demonstrate that staff are competent it was required that records of staff fire training records be better maintained and that emergency lighting is checked as per the Avon Fire Brigade guidelines. This was in order to ensure the safety of those living and working at Barry Road in the event of a fire. Fire records of safety, equipment and staff training checks were reviewed at this visit and we noted no concerns. The requirement had been met. What they could do better: We noted that the home has a key pad entry and exit system linked to the front door and discussion took place about individuals restriction to leave, balanced with risk and the providers ‘duty of care’. The manager was fully aware of his responsibilities in this area. In order to ensure that the home is fully aware of the rights of people living at the home and to demonstrate that individuals movements are not restricted in line with the proposed deprivation of liberties legislation it is recommended that the home review the key pad system which is place for people who are living at the home. 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 7 In order to ensure that people are being supported fully with their medication it is required that a full audit must be undertaken of stock held medication to ensure that records are accurate and to also ensure that medication which is not required is returned to the pharmacist for disposal. Also medication that is to be given ‘as and when’ required should contain full details of what this means. To ensure that people are fully aware of the risks associated with having a key pad entry/exit system it is recommended that the home review the fire risk assessment which is in place in order that this area is fully covered and those living and working in the home are safe. Individuals risk assessments in this area should also be reviewed. 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. 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 8 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 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3, 5. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Information is in place about the facilities and services provided at 42 Barry Road. Clear contractual arrangements are in place outlining individuals’ rights and responsibilities EVIDENCE: The information within the Statement of Purpose for the home was comprehensive and contained clear information for individuals and their relatives about the services and facilities provided at the home. The document contained information about the staff arrangements at the home, information about the admissions process into the home and how to raise issues of concern and how these would be responded to. This document is kept under review by the manager of the home and is updated when required. The home is registered to provide personal care and residential services for 11 adults, accommodating individuals over the age of 64. There are currently no vacancies at the home. There are no individuals living at the home who are self funding. New people are only admitted to the home on the basis of a full assessment of their need; 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 10 this would involve the prospective individual. In line with the Trusts admissions policy. All individuals referred through the care management process would have an assessment outlining their needs and would record how these are to be met by the home. There has been one person admitted into the home since our last visit and we fully reviewed the process for this person. We saw that this person had a full assessment of their needs, wishes and aspirations and this had been written in a person centred way. The home had fully ensured that they would be able to support this person with all aspects of their life before admitting them into the home. The person remained at all times central to the discussions about their life and their needs. There is an admission procedure, which is included in the statement of purpose and full assessments of needs were undertaken. The care files reviewed during previous site visits have showed evidence of pre-admission assessments to enable staff to develop personalised care plans of individuals and these record how the needs were to be met. Care plans, which have been developed by the home, were found to be extremely detailed and well written. A requirement was made during the last site visit to the service that terms and conditions (license agreements) between the home and those who live at the home must contain full and clear information. These documents were reviewed during this visit and it was found that the requirement had been met. Each individual had in place a ‘licence agreement’ detailing the terms and conditions of stay at the home and provided clear guidance on the rights and responsibilities of both the resident and the registered provider. Information within this document also includes clearer information about fees and services to be provided During our visit staff were observed interacting with individuals, in familiar, friendly manner. 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 11 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. This judgement has been made using available evidence including a visit to this service. Care plans are well written and enable staff to provide a consistent and individualised care. Those who live at the home are involved with the personal care planning process and the home’s philosophy promotes individual’s personal development, self-direction and empowerment. Individuals are supported to take risks without hindrance or impacting on their safety, one persons risk assessment would benefit from a review. EVIDENCE: We reviewed in detail the care plans and associated health, social and lifestyle records for three of the people who live at the home. The care plans seen at this visit were detailed and explicit and contained all of the required individualised, person centred information. The daily reports contained entries of what, when and how care was provided. Information recorded on care documentation corresponded with information given to us by the manager and 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 12 staff about the individualised levels of support that people living at the home received. We saw that individuals had recorded their preferred routines, these remain flexible and services are tailored to the needs of the individuals on the day. Recorded routines were very detailed and gave clear direction for staff in respect of individual’s preferences and choices to minimise their anxiety and to respect individual’s choices. One person had recorded that they must have a light on at night, that this was important to them. We saw the lamp in this person’s room and the person told us that they have it on every night. Staff told us this assists the person to sleep. One the day of our visit one of the people living at the home took part in a review of their care with the home and an independent care manager. The purpose of the meeting was to ensure that the individuals needs and wishes were recognised and were supported by the home, the meeting went well with all parties in agreement that the placement was meeting the persons identified needs with no issues or concerns identified. People living at the home are supported to take risks as part of a lifestyle to promote independence; information seen within assessments provided clear information on which decisions have been based. Action is taken to minimise risks and hazards and people are provided with appropriate support to minimise identified risks and hazards; assessments seen included aspects of daily living, support with personal care and social and community activities. Records showed that assessments are reviewed and updated. For one person we saw that is had been identified that one person was at risk of walking out of the home and would be unable to find their way back that there was a high risk of this person getting lost and they would be at risk of traffic. We saw that this assessment had been reviewed in July 2008. In order to ensure that all potential risks have been evaluated it is required that the keypad entry/exit system is also included within this evaluation of risk. 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 13 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, 15, 16, 17. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Individuals have opportunities to participate in activities both in the home and the local community. Good contact is maintained with friends and relatives. Individuals have a health and varied diet. EVIDENCE: Staff support those who live at 42 Barry Road to become part of, and participate in, the local community in accordance with assessed needs and individual plans. Staff enable peoples integration into community life through knowledge and support to enable those living at the home to make use of services, facilities and activities in the local community, such as shops, pubs, and places of local interest. Information seen by us, and confirmed by staff and seen on individual’s records showed that those living at the home are offered a variety of social and leisure activities. Individuals are able to participate or not, 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 14 this is dependent on the individual’s choice. Information seen in daily records evidenced that individuals regularly take part in the following activities such as; keep fit, local community social clubs, church, bowling and cinema. We also saw that people are supported to maintain relationships with others and people attend a number of social clubs such as the ‘Nita nata’ club, and a church based group called the Joshua Club as well as visiting social luncheon clubs in Longwell Green and Warmley. Those living at the home appear to be well supported to maintain links within the local community. On the day of our visit one of the people living at the home was supported to visit the local hairdresser, another person went out with a staff member to undertake an activity of their choosing, another person was supported by two staff members to attend a hydrotherapy session. People have also been supported with a holiday and have been fully involved in choosing their destination and how and how they would be supported. The manager told us about one person’s holiday to France and how this had achieved a long-term ambition for the individual and told us of the job satisfaction in supporting this person in achieving their person’s wish. The manager and staff told us of the preparations for a forthcoming garden party which was planned to take place on the weekend. Members of the local community had been invited as well as the family and friends of people who live at the home. We spoke with the Registered Manager Mr Martin Rogers about the rights and choices of people living at 42 Barry Road and he was able to give a number of examples of how this is promoted to ensure the people’s needs are fully examined and met. Mr Rogers demonstrated a sound understanding of the Mental Capacity Act Legislation and told us that he also involved other agencies external to the home, such as independent Mental Capacity Act advocates in order that peoples rights known and upheld. We also saw recorded in individuals care records whether people have the capacity, ability and understanding to make their own decisions with support and care records showed how this took place in practice. We saw that the home have worked in partnership with social and healthcare professionals on a project entitled ‘what matters most”. This involved staff from all agencies looking at how life can be improved for people who live at 42 Barry Road. Nine sessions were held and each one covered specific areas looking at improving quality. These sessions included engagement and communication and involved evaluating the service provided. Action plans were set and allocation of responsibilities was given. The manger and staff told us about the success of this project and we saw that goals set had been achieved demonstrating a positive outcome for people living at the home. 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 15 It was noted that there is a ‘key pad’ system, which is in use to exit and enter the home. Those living at 42 Barry Road have a diagnosis of learning disability and most would not retain the code number needed in order to leave the home. To ensure that the home is fully aware of the rights of people living at the home and to demonstrate that individuals movements are not restricted in line with the proposed deprivation of liberties legislation (April 2009) it is recommended that the home review the ‘key pad’ system which is in place for all people who are living at the home. The staff try to ensure the menus are nutritionally well balanced and varied, so that those living at the home are provided with a balanced diet. We heard staff offering individuals choices of what, when and where to eat. Staff were fully conversant with specialist diets and support needed by people living in the home. Recent Environmental Health Office checks have been satisfactory. The kitchen area appeared well managed. 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 16 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, 21. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Individuals are supported in a manner they prefer with physical, emotional and healthcare needs being met. Medication systems at the home are satisfactory, however improvements in this area would ensure that safe practices are in place for all. EVIDENCE: Information seen in individuals records showed that individuals have been consulted about their preferences in all aspects of their life and have been offered and encouraged to make choices about areas which affect them, this has included; how they wished to be supported with their personal care, what communication methods are best for them and what is important to them in their life. This is regularly reviewed to ensure the information is still accurate. Thorough examination of care documentation evidenced that individuals are well supported with their health care requirements in order to access services. There were records of when individuals have visited the dentist, optician’s district nurses and general practitioners. Records showed that where there had 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 17 been concerns about individual’s health the home had made prompt contact with the GP or other services that have been needed. Within people records we saw that individuals had accessed healthcare services such as physiotherapy, occupational therapy as well as continence and diabetes advice. Records had been completed after each appointment, which provided a good report of the outcome and any action that needed to be taken as a result. Prior to our visit we received two comment cards from general practitioners who visit the home, one of them told us that they have had no significant contact with people at the home for the past six months and therefore felt unable to comment. The other GP told us that the home does communicate and works in partnership with them and that the home demonstrates a clear understanding of the needs of service users. We also saw recorded within the home that a general practitioner who visits people at the home complemented the staff team on how well one of the people living at the home looked and commented on how well the person had been supported following their return from hospital following treatment. During this visit we reviewed systems of medication, including administration, storage and staff training. There are no people living at the home who are able to manage their medication themselves and all are supported with this. Medication was stored securely in a locked cabinet. We saw that there was one item of medicine, which is no longer, required, and one item of stock held medication, which did not tally with the record in place. A full audit must be undertaken of stock held medication to ensure that records are accurate and to also ensure that medication, which is not required, is returned to the pharmacist for disposal. Some people are prescribed medication to be given ‘as and when required’, staff were able to provide full information about when this would be given however records pertaining to this were not always clear. In order to ensure the safety of people living at the home medication that is to be given ‘as and when’ required should contain full details of what this means. Staff confirmed they had received medication competency training and records seen also confirmed this. During our last visit to the home we recommended that the home to seek and record the wishes of individuals in the event of their death. We appreciate that this is a difficult subject matter and is an area, which requires sensitivity. Within the care records we viewed we saw that this information had been obtained and peoples wishes had been recorded. 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 18 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. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure, which is made available to those who live at the home. People living at the service are protected from abuse with the homes policies, procedures and practice. EVIDENCE: The home has a complaints policy and procedure. A copy of the complaints procedure is available upon request. All complaints are investigated and a record is kept. All people spoken to during the visit stated that they would be happy to raise any concerns they had with the home manager. During our last visit to the home we recommended that the home should consider ways of improving the profile of how individuals can make a complaint. We reviewed the complaints logbook held at the home and saw that the last recorded complaint was from a person who lives at the home about another person who also lives at the home. The issue was well managed by the home and by senior management who visited and spoke with all parties concerned. The issue was resolved to the satisfaction of all those involved. 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 19 The home has adult protection and whistle blowing policies and staff have undertaken training in this area. A copy of the joint policy and procedure for safeguarding adults was on prominent display in the main office outlining the roles and responsibilities of the local authority, individual services, the primary healthcare trusts and the police ensuring a consistent and thorough approach. The manager has also arranged to undertake training in respect of the Mental Capacity Act in order to ensure that he is aware of current legislation and the legal rights of those who live at the home this information will be shared with the staff team. We saw that staff have received training in order that they are aware of their role and responsibility in respect of the protection of vulnerable adults who live at the home, there are also staff that have completed National Vocational Qualification (NVQ) in care and this important area would also be covered within that training. 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 20 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. This judgement has been made using available evidence including a visit to this service. 42 Barry Road provides a safe comfortable home in which individuals are able to stay as independent as possible. The home has a good standard of furnishings and fittings, which provide a comfortable pleasing environment for individuals to live in. EVIDENCE: Aspects and Milestones Trust operate the home. The home is on the edge of Oldland Common village within walking distance of shops, which include a post office, public house, chemist and other stores. The property is a Victorian detached house. All of the 11 bedrooms in the home are for single occupancy; two of the rooms have en suite facilities. One of the people who live at the home showed us their room, it was comfortable and ‘homely’, they said ‘I love my room and all 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 21 my things around me’. The rooms were personalised with photographs, plants, books and ‘nick knacks’. There are two lounges in the home, one located at the front of the house with a television, books and comfortable seating there is also a large lounge which has patio doors that lead into the rear garden. There is also a separating dining room, this is located next to the kitchen. We saw that there new dining furniture had been purchased, improving the area for people living at the home. Also since our last visit to the home a fish tank has been provided in the main lounge area, one of the people in the home told us they liked watching the fish. The manager told us that fish tank had brought interest to the people who live at the home. There are people who smoke in this home and a covered area outside is provided for them. The manager is looking to improve this area for people; we will review this during our next visit to the service. There are two bathrooms and a shower in the home for people to use. One of the baths is a ‘parker’ bath, a bath especially for those with mobility difficulties. There are also four separate private toilet facilities; these are all located within close proximately of the lounge and individuals private rooms. During our visit contractors arrived to undertake repairs at the home, they were replacing plasterboard panels in the dining room, lining the lower half of the walls. We noted that the area was left unfinished and the contractor explained that this was due to not having enough boarding and more being required. The manager assured us that the work would be completed and that the area would be repainted. That he would deal with this to ensure work was complete. We also saw that an environmental health officer from South Gloucestershire Council had visited the home in August 2008 and the home was awarded a four star food hygiene award. The gardens are attractive and well maintained. The home was clean and tidy and free from offensive odours on the day of visit. 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 22 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): 31, 32, 34, 35. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff on duty meets individual’s needs. Staff are trained and competent to do their job. The home has recruitment policies and procedures that protect those who live at the home. EVIDENCE: Upon arrival at the home we were met by the Register Manager Mr Martin Rogers, also on duty were five support staff and a cleaner. During our last visit to the home we made a requirement that the home must keep under review/monitor the level of support individuals require at night to ensure staffing levels are reflective of the needs of people living at the home. Mr Rogers confirmed to us that there is now a member of staff on duty at night. This member of staff is awake and supports people should they need it during this time. Records seen by us confirmed this. The organisation has policies on equal opportunities and recruitment processes as seen at a previous inspection. We noted no concerns at this visit. Staff told 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 23 us of the recruitment and selection process, which is accordance with the policies and procedures in place. Morale is good within this home and staff spoke positively about their role and the work they do. Staff were able to give a number of examples of areas within their role which gave them job satisfaction such as one to one time with individuals, supporting individuals in they way they prefer and supporting people with their activities and accessing the community. Staff meetings are held on a regular basis, we saw minutes of the last meeting held in August 2008, areas of discussion included respecting the privacy of those who live at the home, recording information and effective communication. Individuals were given the opportunity to raise and discuss items in full and resolutions were discussed and sought. We reviewed training records and saw that staff have completed training in areas such as medication competency, first aid and fire safety. The manager also confirmed that all staff would be completing training in dementia awareness within the next four months. A training department who have an audit of staff training supports the home and record core and specialist training which staff, has undertaken, this is monitored and training arranged as required. Relationships between staff and those who live at the home were directly and indirectly observed throughout the course of the visit. Staff were seen to respond to people appropriately and work to protect their need for privacy and dignity. Staff demonstrate a friendly, supportive and caring approach when 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 24 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. This judgement has been made using available evidence including a visit to this service. The Home benefits from good leadership and management; its practices have offered protection to the health and safety of those who live at the home. The home is run in the best interests of individuals. The home is well managed ensuring that individual’s interests and rights are promoted and protected by a committed staff team. EVIDENCE: Martin Rogers is the registered manager of the home. Mr Rogers has a wealth of knowledge and experience in working with and supporting the care of older people with learning difficulties and has management experience in developing and supporting a staff team. Mr Rogers registered as a nurse supporting those with a learning disability in 1979 and qualified as a general nurse in 1981. Mr 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 25 Rogers has also completed his Registered Managers award and is also an internal assessor a verifier for the NVQ’S process. During the visit Mr Rogers was able to demonstrate a clear understanding of the aims and objectives of the home and of his role and responsibilities for those who live at the home and the staff team. The home has good systems for monitoring the quality of the care provided to the individuals living at 42 Barry Road these included regular reviews of care plans, review meetings where the individual was involved, supervisions, staff meetings and a quality assurance tool, which encompasses the Care Homes National Minimum Standards. We also saw that the manger has in place a management overview tool where he monitors and reviews progress in areas such as the organisations business plan, the mission statement for the service, as well as incidents and vacancies profiles. This ensures measurement of effective service delivery. The Commission for Social Care Inspection has received regular reports of monitoring visits in respect of regulation 26 conducted by a representative of the responsible individual. These reports cover the arrangements for the support and assistance for those who live at the home, staffing arrangements; the environment, health & safety and finances are checked during these visits, these visits happen on a monthly basis. Prior to the site visit the Commission requested from the Registered Manager a completed an annual quality assurance assessment. The annual quality assurance assessment (AQAA), this is a new process that is being used for all regulated services from April 2007. The AQAA is in two parts: Part one is a self assessment, part two is a dataset. It is a legal requirement for all services to return an AQAA to the Commission. We had not received this AQAA in time for this visit. When received we will use the information to inform the homes annual service review which will take place in 2009. We reviewed accidents and incidents, which have occurred in the past two months at the home and saw that issues had been dealt with appropriately and individuals had been supported well to maintain their personal safety and wellbeing. A review of the fire logbook found that staff are receiving sufficent fire instruction and drills, maintence and equipment checks are undertaken on a regualr basis. All weekly, daily and monthly checks have been recorded. The home have maintained records of fire training, and emergency light is checked on a monthly basis, this is recorded. The home has a well-written risk assessment in place, which covers areas, which are associated with the risks in the event of a fire. In order to ensure that people are fully aware of the risks associated with having a key pad 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 26 entry/exit system it is recommended that the home review the fire risk assessment which is in place in order that this area is fully covered and those living and working in the home are safe. Accidents and injuries that have occurred at the home since the last visit have been properly recorded and dealt with appropriately. During this visit we discussed with the Manager notifications which had been forwarded to us from the home. These included incidents which had affected the wellbeing of those who live at the home. The home have been able to demonstrate that action is taken to support individuals and that each situation is reviewed to reduce, where possible, the likihood of reoccurance. We provided the Manager with a copy of the new Regulation Notification 37 form. This is available from the Commissions website and the new format is easier to complete. 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 27 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 3 2 3 3 3 4 X 5 3 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 3 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 3 X X 3 X 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13 (2) Requirement Timescale for action 18/10/08 2. YA16 13 (1) 4 A full audit must be undertaken of stock held medication to ensure that records are accurate and to also ensure that medication, which is no longer required, is returned to the pharmacist for disposal. Individuals risk assessment to be 18/10/08 reviewed in respect over concerns for them leaving the home. 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. 2. 3. Refer to Standard YA20 YA42 YA16 Good Practice Recommendations Medication that is to be given ‘as and when’ required should contain full details of what this means. The home should review the fire risk assessment, which is in place in order that this area is fully covered and those living and working in the home are safe. Consideration should be given to the use of a ‘key pad’ entry and exit system, which is linked to the front door. 42 Barry Road DS0000003392.V368867.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West 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. 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