Care Home: Bedrock Mews

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What the care home does well Bedrock Mews provides a homely setting for individuals that could challenge the service. It is located in a good setting that affords people who use the service easy access to the shops and other amenities. People who use the service described a good level of satisfaction from living in the home. In addition professional feedback was very complimentary about the service. People who use the service stated that they felt safe and secure. What has improved since the last inspection? Individuals are protected within a risk assessment framework where they are responsible for their own administration of medication. Individuals have benefited from a more personalised approach in responding to them when they are challenging. Individuals have benefited from staff having more support and guidance through regular supervisions. Individuals can be confident that staff have received training in safeguarding, which will further protect them from abuse. Individuals are now supported by competent staff in respect of first aid and food hygiene. What the care home could do better: Individuals should be assured that care plans and risk assessments clearly describe how they should be supported which will ensure a consistent approach. Broad statements must be expanded to give clear guidance to staff. Individuals must be protected by the home`s recruitment practices, ensuring that all gaps in employment are explored with the prospective member of staff. Staff should be assured that their induction is in accordance with the guidance from Skills for Care. CARE HOME ADULTS 18-65 Bedrock Mews 1 New Road Stoke Gifford Sth Gloucestershire BS34 8QW Lead Inspector Paula Cordell Key Unannounced Inspection 26 September 2008 09:15 th Bedrock Mews DS0000058581.V367934.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 Bedrock Mews DS0000058581.V367934.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. Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bedrock Mews Address 1 New Road Stoke Gifford Sth Gloucestershire BS34 8QW 0117 9694198 01454 772089 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) Mr John Michael Gay T/A Nightingale Care Homes Mrs Beverley Denise Hancock Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Bedrock Mews DS0000058581.V367934.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 category: 2. Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is 6. Date of last inspection 3rd October 2007 Brief Description of the Service: Bedrock Mews is one of three homes operated by Nightingale Care Homes. The home was registered with the CSCI in February 2004 to provide accommodation and personal care to six adults with mental health. The statement of purpose describes the individuals the home can support including the age range, which is up to the age of 64. The home is situated in Stoke Gifford close to the Avon ring road and bus routes. There are retail outlets and shops close to the home. Bristol Parkway railway station is within easy reach of the home. Each bedroom has its own bathroom. People who use the service have full access to a lounge, kitchen and conservatory/dining area. Currently no people who use the service have physical or sensory needs that require adaptations or equipment. There is a well-maintained garden and a summerhouse. Ms Beverley Hancock is the registered manager. The fees for the home are in excess of £685 per week based on the individual’s care needs. Bedrock Mews DS0000058581.V367934.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 announced visit as part of a key inspection process. The reason the visit was announced is that all the individuals and staff go to Bedrock Lodge during the day for day care. The home was visited the previous week and all the individuals were out. The home was given five days notice. The purpose of the visit was to review the progress to the requirements and recommendations from the visit in October 2007. In addition to monitoring the quality of the care provided to the six individuals living in the home. There have been no additional visits since October 2007. The Commission for Social Care Inspection has not received any complaints during this period. The inspection methods used included record checks, case tracking, 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. These were used as a focus for the site visit, along with the annual quality assurance selfassessment completed by the home and comments from people who use the service (3), relatives (0), staff (2) and visiting professionals (2). The visit was conducted over a period of six hours and ended with structured feedback. What the service does well: Bedrock Mews provides a homely setting for individuals that could challenge the service. It is located in a good setting that affords people who use the service easy access to the shops and other amenities. People who use the service described a good level of satisfaction from living in the home. In addition professional feedback was very complimentary about the service. People who use the service stated that they felt safe and secure. Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bedrock Mews DS0000058581.V367934.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 Bedrock Mews DS0000058581.V367934.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): 1,2,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available to individuals living at Bedrock Mews. Individuals can be confident that their needs are assessed prior to the agreement of a placement at the home. EVIDENCE: The home has a statement of purpose and a service user guide. This has been viewed on previous visits to the home where it was assessed as meeting the National Minimum Standards and the Care Home Regulations. The statement of purpose includes the restrictions imposed on people who use the service including the locking of the front door and the kitchen area. The manager stated that this has been discussed with the provider in relation to the locking of the kitchen and the provider stated that this must continue as part of the generic risk assessment for the three homes. Concerns are raised in that none of the individuals living in the home are detained under the mental health act and there was no link in the placing authorities care plans to the need to have restricted access to the kitchen or the locking of the front door. Individuals had been consulted on the locking of the front door and all of the individuals stated that they agree to the front door being locked. One of the individuals has a front door key and one person can request one when they go Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 9 out (as agreed in the person’s plan of care). The other individuals are all supported by staff when they access the community. The home is fully occupied. The statement of purpose clearly describes the process of admission which would include visits being arranged to suit the person, including seeking the views of the people already living at Bedrock Mews. Since the last visit one person has moved into Bedrock Mews. It is evident that a comprehensive assessment of need was undertaken ensuring the person was suitable to live in the home. The person confirmed that they had settled in well and liked living at Bedrock Mews, although they did say it was a temporary arrangement and wanted to live in another part of Bristol. The person said they were in consultation with their social worker on this matter. As seen at the last inspection there was information available to people who use the service and their representative in the form of a contract and a service user guide. People receiving a service contribute towards their transport cost and weekly toiletries. The individual or their representative had signed these. Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 10 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 adequate. This judgement has been made using available evidence including a visit to this service. Individuals can be confident that their care needs are being met. However to ensure a consistent approach goals could benefit from more information to enable staff to follow them. EVIDENCE: Care files seen were well organised and divided into sections including personal details, background, assessments, care plans and risk assessments, medication profile and correspondence. In addition the home maintains a central file containing all current care plans and risk assessments for the six people living in the home. Care plans included a lot of valuable information relating to the individual’s care these have been expanded to include comments from previous visits to the home. Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 11 It was evident from team meeting minutes that there have been concerns about consistency amongst some staff. From reading some of the care plans it was understandable why as some of the care plans made broad statements that could be interpreted differently by each member of staff; for example “to have a healthy diet” & to “take regular exercise”. The documentation did not break these down into measurable clear steps (who, what, how and when). Risk assessments covered a wide spectrum of activities. From conversations with staff it was evident that not all the action taken to minimise the risk was recorded. It was noted during the last visit that one person had been aggressive whilst in the home’s vehicle. The home has now developed a risk assessment. Whilst this acknowledged the risk, the actions that staff should take to minimise the risk were not recorded. From talking with staff it was evident that there is always two staff in the vehicle and the individual sits to the rear. The manager confirmed it was company policy for two staff to be in the vehicle at all times. This should be recorded in the risk assessment. Whilst the home has in part demonstrated compliance by ensuring the safety of the individuals this would be improved and ensure a consistent approach if this was recorded. During the last visit, individuals stated that they were involved in the planning of their care specifically around the activities. This was further evidenced in house meetings and annual individual program meetings completed by the day care co-ordinator who is based at Bedrock Lodge. From reviewing the care documentation it was evident that professionals were involved in the planning of the care, with reviews being completed by Social Workers, Community Psychiatric Nurses and Psychiatrists. One professional stated “the manager and the staff seek help and advice whenever necessary and have worked extremely well with our client to improve his quality of life”. Another professional confirmed they were kept informed of any changes and advice was sought. Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 12 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. People living in Bedrock Mews have available to them a structured day care plan which is varied. Individuals are encouraged to maintain contact with relatives. Individuals have little control over the menu planning. EVIDENCE: Each resident has a structured five-day care plan; the manager stated that this is planned at Bedrock Lodge in consultation with the individual. Activities included swimming, gardening, woodwork, animal care and house keeping skills. Individuals confirmed attendance and said that they all liked going to Bedrock Lodge. Individuals are paid a wage for the work that is undertaken at Bedrock. One person said they had not received this since moving to Bedrock Mews. This was clarified with the provider, the office administrator and the Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 13 manager all said this is paid into the individual’s holiday fund with records maintained. Surveys returned prior to the visit indicated that all individuals are happy with the level of social activities during the day, evening and weekends. One person said “I like going to Tesco” and another said “I like going to Bedrock Lodge”. Individuals spoken with said that there were regular activities during the summer including trips out, skittles, trips to the shops and pub evenings. One person said there was not a lot to do during the evenings and weekends. However from daily records it was evident that the person had been out on trips etc. The manager stated all individuals are asked what they would like to do but some often refuse preferring to watch television. This could be better recorded in the daily records where individuals had made a choice to stay at home. All the individuals spoken with said they had enjoyed their recent holiday and described lots of activities that had been undertaken. It was evident that they were asked prior to the holiday what they would like to do and eat. Evidence was provided that most of the requests had been met. Observations between the staff member and the manager on duty and the individuals indicated that staff know the individuals well and evidenced that there is a good rapport with positive respectful relationships being nurtured. Three of the completed surveys stated that staff treat them with respect and listen to what they want. This was further confirmed in conversations with two of the individuals during the visit. One person said “staff spend time talking with them”. Another said “staff are good”. Evidence was provided via conversations with staff, individuals and in the daily diaries that family contact was maintained. The manager stated that at the weekends individuals are supported to see their relatives or friends. No surveys were received from relatives prior to this visit. However the home has recently completed their own quality audit seeking the views of relatives. Feedback was positive in all aspects of the care provided. Minutes of house meetings demonstrated that the individuals are involved in the running of the home including décor, planning of activities, discussions re the locking of the front door and staffing. Menus were viewed on this occasion. The provider completes the menus in respect of the three homes. Concerns have been raised in that this does not allow the individuals to have input into the planning of the menu. However the provider prefers to have control over this. The menu provided evidence that individuals had available to them a nutritious and healthy diet which was varied. Individuals confirmed that they could have alternatives to the planned menu and the home caters for their likes and dislikes or special dietary Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 14 requirements. Records were maintained supporting this. However, two of the individuals were not happy with what was being provided for lunch. Individuals are sent to Bedrock Lodge with a packed lunch and according to the two people this is more often than not sandwiches. From the conversations it was evident that they would prefer a more substantial lunch especially in the winter. One person said “it would not take too long to make beans on toast for a change”. Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 15 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. This judgement has been made using available evidence including a visit to this service. Individual’s personal and health care needs are being met. Individuals are protected by the home’s medication procedures and practices. EVIDENCE: Each individual has a health action plan that details the support required to ensure that an individual remains healthy and a care plan that details support in relation to personal care. Records demonstrated that individual’s health and personal care needs were being met. Health care plans detailed individuals support needs in relation to their mental health. There has been improvement noted in that the information is more personalised and focuses on the individual in relation to coping strategies and actions plans to address health issues. Care plans clearly documented the personal and health care needs of the individuals. Systems for monitoring an individual’s wellbeing were in place and concerns about health were quickly addressed. Individuals had access to other Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 16 health professionals including a GP, opticians, chiropody, dentist and the community mental health team. The home has been keeping the Commission for Social Care Inspection informed of incidents that affect the wellbeing of the people who receive a care service in respect of regulation 37. Accident records were being maintained and cross-referenced with the diary of events for individuals. Feedback from two visiting professionals was positive in relation to keeping them informed of changes and the home seeking and acting upon advice. Medication was reviewed on this occasion. Robust systems are in place for medication entering and leaving the home and the administration. Policies and procedures were in place including evidence of training for staff who have the responsibility for administering the medication. The home has demonstrated compliance with a requirement to ensure that where a person self medicates that this is clearly documented and risk assessed. Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 17 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. Individuals can be confident that their concerns are listened to and that they are protected from abuse. Individuals do not have full control over their finances. EVIDENCE: The home has a complaint procedure and record. Evidence provided from completed surveys from people who use the service demonstrated that they were aware of how and who to complain to. The home has not received a complaint in the last twelve months as evidenced in the home’s record of complaints and the annual quality assurance assessment. No complaints have been received by the Commission for Social Care Inspection. The home has a policy on safeguarding. This was not revisited on this occasion as it was previously assessed as meeting the standard. In response to a requirement from the visit in October 2008 all staff have now had training in safeguarding. The manager stated this was completed with the local council. The manager stated that generally individuals living in the home rarely exhibit challenging behaviour, which results in violence towards staff or the people living in the home although it was noted that the potential is there. However, individuals can be verbally challenging at times. From reviewing staff training it Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 18 was again noted that 2 staff have not received annual update training on supporting individuals that challenge. This was due in June 2008 and two staff were due the beginning of September 2008. The manager said that the provider has organised this for December 2008, as this was the earliest that the trainer could organise this. This will be explored further during the visit to Bedrock Lodge. The manager said there is no money in the home that belongs to the people who receive a service. This is held at Bedrock Lodge. The manager stated that individuals can have money at all times and this is taken from a petty cash budget and the home is reimbursed by the individual’s funds. Whilst this may be deemed as safe practice by the organisation, this means that individuals have little control over their overall finances and the staff are not fully able to assist them with budgeting, as information relating to their accounts is held at Bedrock Lodge. The manager stated that individuals are free to see this information whilst they are at Bedrock. Two individuals have responsibility for their own finances. One person was concerned that they owed money for cigarettes but felt that they had paid for these. This was discussed with the provider and the administrator who said that due to annual leave taken during the summer this was from a couple of months back and it was only recently the receipts were reconciled. This is not good practice as it is evident that the person was distressed and anxious about the matter which has been heightened when their bike was taken for repair without informing the individual. The individual had linked owing money with the bike being taken. Whilst this was resolved during this visit it highlighted that if the individuals had more control over their expenditure with better communication this may have not happened. . Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 19 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is meeting the current needs of the people living at Bedrock Mews. EVIDENCE: Bedrock Mews is a two-storey semi-detached property of domestic style that is within easy reach of local facilities and public transport routes. The home was clean and there was good evidence that the home responds promptly to repairs. Communal areas were comfortably furnished and were homely. Since the last visit new furniture has been purchased in the lounge and the manager said that new furniture has been requested for the conservatory. Two areas of concern were raised during the visit in respect of the environment. The bathroom on the first floor would benefit from being resealed around the bath as this was black from mould and the other related to grout Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 20 being missing in the Kitchen by the small fridge. The manager has agreed that these should be resolved and would contact the provider. It was noted that the dining area and the conservatory had been painted pink. When the manager was asked whether the individuals had been involved in the colour choice the response was that this was done without the knowledge of the men when they were on holiday. This further evidences the lack of involvement of the people living in the home and decisions being made by the provider. The manager said that the individuals would be supported to choose the colour scheme for their bedrooms. None of the people receiving a care service had specific needs in respect of their mobility that required adaptations to the home or specialist equipment. There are two ground floor bedrooms both have ensuites however the main bathroom is on the first floor accessed by stairs. The home would not be suitable for an individual who required a wheelchair, due to its layout. Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 21 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, 34, 35,36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient and competent staff support the individuals living at Bedrock Mews. However, recruitment processes could be putting individuals at risk. Consideration should be taken to ensure that staff attend regular updates in supporting individuals that may challenge. EVIDENCE: Bedrock Mews is staffed with two staff during the day and one member of staff working at night. Monday to Friday all the individuals and the staff go to Bedrock Lodge. This was confirmed in conversations with the staff and the individuals and further evidenced in the home’s duty rota. An opportunity was taken to review the staff files. These are kept at Bedrock Lodge but the provider brought the files across during the visit. Three staff files were reviewed in relation to the recruitment processes that were undertaken. The files were well organised and contained all relevant documentation including the application, two references and a criminal record disclosure from the CRB. Records of the interview were also available. It was noted that one person had a gap in their employment history and the dates recorded on the Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 22 reference were not consistent with those specified in the application. There was no evidence that this had been explored with the individual during interview demonstrating that the provider had assessed whether the person was suitable to work with vulnerable adults. The manager stated that the provider makes the decisions on whether to employ a person. It was noted that one person had commenced in post prior to a criminal record being returned. From the duty rota it was evident that the person had been working supernumerary as part of their induction. The manager stated that the person had not been involved in any personal care during that time and had been supervised at all times. It was noted that the person’s start date did not correspond to the home’s duty rota and that of the overview record. This could be misleading. Concerns have been raised on previous visits about the lack of training in supporting individuals that challenge, mental health, health and safety first aid and food hygiene with the appropriate updates in place. It is evident that this has been addressed in relation to health and safety, first aid and food hygiene. All staff have now attended this training. As mentioned earlier in this report updates for training to support individuals that challenge have not been completed every twelve months. Two staff’s training had expired in June 2008 and two staff’s training had expired in September 2008. However, training is planned for December 2008. The manager stated that mental health training has been completed for three staff, but this has not been completed for the newly appointed staff. The manager has agreed to chase this up. Staff are inducted using TOPPS. This has now been disbanded and replaced by Skills for Care. It is advisable that the provider ensures that the induction that is covered is current and covers all the appropriate information in accordance with the recommendations from Skills for Care. Surveys from staff confirmed that they felt supported and had sufficient information to fulfil their roles. One Professional survey stated “staff appear highly professional within their roles”. The manager stated that she has a National Vocational Award at level 3 in care and the Registered Managers Award. A further two member of staff have an NVQ 2 in care. A further 2 staff are completing an NVQ 2 in care. It is evident that the home is trying to meet the government target of 50 of the workforce having an NVQ 2 in care. Staff have an opportunity to meet approximately every two to three months. The manager said it has been difficult to get everyone to attend. In addition meetings are held at Bedrock Lodge for all staff working in the organisation. Minutes were kept of the discussions and any actions agreed. Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 23 Supervision records are held at Bedrock Lodge with staff files. The home has demonstrated compliance with a previous requirement to ensure that all staff have regular supervision with a senior member of staff as evidenced in the files that were brought across from Bedrock Lodge on the day of the visit. Staff surveys confirmed that they met regularly for one to one supervision. Two of the individuals living in the home stated “they were happy with the staffing and felt supported. One person said “staff are caring and spend time chatting with them”. Bedrock Mews DS0000058581.V367934.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): 37,49,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed well. Individuals benefit from a safe place to live with good quality assurance measures in place. EVIDENCE: Ms B Hancock is the registered manager. She has in excess of five years management experience and has a National Vocational Award Level 3 in care and the Registered Managers Award. She is also an NVQ assessor. A member of staff in the completed survey stated “my manager is approachable, supportive and someone who is caring both to the service users and the staff. She always has a listening ear”. Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 25 Monthly visits are being completed by the provider and copies are being sent to the Commission for Social Care Inspection in respect of regulation 26. In addition the home measures the quality of the care provision by seeking the views of relatives, people who use the service and health professionals. An opportunity was taken to review the comments from relatives. These were all positive in relation to the care provided, the environment and the welcome that they receive when in the home. Fire records were viewed during the visit. Routine checks were being completed on the equipment and staff were receiving adequate training and participating in fire evacuations. Risk assessments were in place relating to fire, care of substances hazardous to health and tasks completed in the home. In addition there were risk assessments for manual handling. These had been undertaken by the registered manager and a carer in the home. There was no evidence that they had attended training to complete these. In addition the manager assists with manual handling training. It was not clear what level of training had been completed to enable her to fulfil this role. The provider should ensure that she is competent to fulfil this role. A requirement was made at the last visit which the home has not demonstrated compliance with, in that the person completing assessments relating to manual handling must be competent. The manager stated that she has not been on a manual handling course for the past three years. Whilst this does not affect outcomes for individuals as there is no manual handling of people undertaken it could void insurances as staff are not being taught by a competent person in relation to safe lifting practices. The manager stated that training is delivered using a video and questionnaires. These are held at Bedrock Lodge. This will be explored further with the provider at the next visit to Bedrock Lodge. Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 26 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 X 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 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 Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 27 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 (1), 12 (1) (a) 13 (4), 12 (1) (a) Requirement Care plans to be expanded as discussed during the visit so that they are clear and offer guidance to staff. Where there has been a risk identified all the actions that are undertaken to ensure the person’s safety must be clearly documented. Where there are gaps in a person’s employment this must be explored and documented. Timescale for action 23/10/08 2. YA9 23/10/08 3. YA34 19 Schedule 2.6 30/09/08 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. Refer to Standard YA37 YA35 Good Practice Recommendations For the manager to complete a National Vocational Award at level 4 in care. For the provider to ensure the induction is suitable and current based on the recommendations from Skills for Care. Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 28 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. Extracts may not be used or reproduced without the express permission of CSCI Bedrock Mews DS0000058581.V367934.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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