Care Home: Berwick Bridges

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What the care home does well What has improved since the last inspection? The home`s staff recruitment practices have been improved to make sure that only people who have been thoroughly checked are employed at the home. This is an important step in keeping residents safe.The home`s quality assurance policy is being put into action. This will build on the existing ways in which residents; their families, friends and relevant people in the local community are asked about the quality of care provided at the home and how it should be developed. Unannounced monitoring visits are now carried out at the home at least every month. The home`s policy on protecting the people who live there from abuse have been updated to reflect current good practice. What the care home could do better: Information about how staff are helping residents to meet their needs is good, but is spread over many different recording systems. These should be drawn together in the care plan/goal plan. CARE HOME ADULTS 18-65 Berwick Bridges 4a Roberts Lodge Tweedmouth Berwick Upon Tweed Northumberland TD15 2YN Lead Inspector Alan Baxter Key Unannounced Inspection 19th March 2008 10:00 Berwick Bridges DS0000000617.V360795.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 Berwick Bridges DS0000000617.V360795.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. Berwick Bridges DS0000000617.V360795.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Berwick Bridges Address 4a Roberts Lodge Tweedmouth Berwick Upon Tweed Northumberland TD15 2YN 01289 303173 01289 303173 bbt.berwick@btinternet.com 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) Berwick Bridges Limited Mrs J A Murray Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Berwick Bridges DS0000000617.V360795.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Of whom 2 may have an additional physical disability Date of last inspection 28th February 2007 Brief Description of the Service: Berwick Bridges, at 4a Roberts Lodge, provides care and support for up to six individuals with a learning disability. The Home is a purpose built bungalow and is situated in a small residential estate in Tweedmouth, on the outskirts of Berwick upon Tweed. Community facilities are within walking distance and Berwick is only a short drive or bus ride away. The Home has an adapted people carrier and the area is well served by public transport. The accommodation includes six single bedrooms, plus a staff ‘sleep-in’ room, an open plan lounge, dining and kitchen area and a separate utility room. Adequate toilets and bathing/showering facilities are provided. The Home is domestic in character and decorated and furnished to a good standard. There is an enclosed garden/patio area to the side of the building as well as a small car park. The Service is operated by Berwick Bridges Ltd. a voluntary organisation that was set up to provide a service for people with learning disabilities from the local area. Copies of the Home’s Statement of Purpose and this Commission’s inspection reports were available in the Home. The current scale of charges is £587.30 per week. Berwick Bridges DS0000000617.V360795.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 star. This means that people using this service experience good quality outcomes. How the inspection was carried out Before the visit: We looked at: • Information we have received since the last visit on 28th February 2007. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on 19th March 2008. During the visit we: • • • • • • Talked with people who use the service, the staff and the manager. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept, Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, Looked around the building/parts of the building to make sure it was clean, safe & comfortable, Checked what improvements had been made since the last visit. We told the manager what we found. What the service does well: Relatives spoke very highly of the home and its staff. Comments included: “The home provides excellent care”; “Residents are obviously very happy, very well cared for, and are encouraged to live as normal a life as possible … most importantly of all they are obviously loved by all the staff”; “The staff have turned [my brother’s] life around – they are fantastic people”. Berwick Bridges DS0000000617.V360795.R01.S.doc Version 5.2 Page 6 “No improvements needed”. The home carefully assesses the people wishing to come and live in the home, to make sure that it can meet all their needs. It then draws up detailed plans of how staff will help them to meet their needs. This means that staff have the information they needed to support each person and keep them safe. Staff make sure that people’s health needs are properly looked after. Residents are supported by staff to make decisions about their daily lives. And each person is supported to take risks as part of the home’s plans to promote as much independence as possible. There are good opportunities for people to take part in a range of activities, which take account of their choices and needs. Residents are also well supported to regularly keep contact with their families. The relationships between staff and the people who live there are good and personal support is provided in a way that promotes and protects their privacy and dignity. The meals provide by the Home were satisfactory and gave residents a varied, nutritious diet. Good systems are in place to deal with complaints and protecting people from risk of harm. Residents feel they can share any worries with the staff and feel that their views are listened to. The standard of the accommodation, décor and furniture and fittings is good and provides a clean and comfortable place to live in. There is a stable and competent staff team who have been given a good training programme that includes training that covers the specific conditions of the people who live there. The manager is suitably qualified and experienced. She and her staff show a commitment to provide good quality care and support for the people living at the home. This is important so that the home is well run in the best interests of people using the service. The health and safety of the people who live in the home is taken seriously, and the proper checks and tests of safety equipment take place. What has improved since the last inspection? The home’s staff recruitment practices have been improved to make sure that only people who have been thoroughly checked are employed at the home. This is an important step in keeping residents safe. Berwick Bridges DS0000000617.V360795.R01.S.doc Version 5.2 Page 7 The home’s quality assurance policy is being put into action. This will build on the existing ways in which residents; their families, friends and relevant people in the local community are asked about the quality of care provided at the home and how it should be developed. Unannounced monitoring visits are now carried out at the home at least every month. The home’s policy on protecting the people who live there from abuse have been updated to reflect current good practice. 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. Berwick Bridges DS0000000617.V360795.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 Berwick Bridges DS0000000617.V360795.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): 2. People who use the service experience good quality in this area. The needs and wishes of people who use this service are properly assessed before they are admitted to the home. We have made this judgement using available evidence including a visit to this service. EVIDENCE: The home receives a range of assessments from the referring agency, including Northumberland Care Management forms CM2a and CM10, and an NHS Care Assessment. In addition, the home carries out its own assessment, to confirm that it can meet all the person’s assessed needs. Service users and their families are involved in their own assessment process. There was also evidence of regular re-assessment of service user needs. Berwick Bridges DS0000000617.V360795.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 and 9. People who use the service experience good quality in this area. Care and support is well planned and documented in clear detail in consultation with people using the service around choice and risk taking. This ensures that people’s needs are met and they can be properly supported to have control and gain independence. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Each person’s assessed needs are met in an appropriate range of systems. Most have clear care plans (or ‘goal plans’). Other assessed needs are met using information recorded in various places, files and systems. For example, the nutritional needs of individuals are kept in one file; their monthly weight recorded in another; and their health and behavioural needs in third file. Berwick Bridges DS0000000617.V360795.R01.S.doc Version 5.2 Page 11 Although it is recommended that the various elements could usefully be brought together in one place, taken overall, it is clear that each person has a plan of care that is thorough, sensitive, flexible and individually orientated. It was also apparent that care/goal plans are looked at closely in regular monthly reviews, and they are updated as necessary. In the case of one person, there was evidence of a progressive plan to become self-medicating. People sign their agreement to their own plans; any refusal is recorded, with explanation. It was noted that, due to the long-term sickness of a care manager, no external input has been made into some care plans. Of the five staff who returned surveys, four said that they are always given up to date information about the residents and their needs; one said “usually”. All five relatives who returned surveys said that they and their relatives are given enough information to help them make decisions. Of the five residents who returned surveys (completed with help from their key workers), three said that they make decisions about what they do each day; two said “sometimes”. Four said that they can do what they want to do during the day; they all said that they can do what they want to do during the evenings and weekends. In discussion with staff, it became apparent that people living in the home have a wide range of opportunities for choice. These include meals and cooking, activities, trips out, what to wear, and toiletries. Holidays are negotiated individually with each person, and they can choose where to go, when, and who with (which other residents and which staff). Each person has a full ‘one-to-one’ day with his or her keyworker every week, and can choose how to spend their day. Examples include shopping, rambling and ‘pamper’ days. The interactions between staff and the people who live in the home were seen to be based on mutual respect and affection, and it was apparent that choice is a real and central part of the community. Initial risk assessments are carried out by both the referring agency and the home before admission. Assessments seen were comprehensive and appropriately detailed. They are reviewed regularly and updated as necessary. The home’s policy is to accept that risk is part of the normal experience of daily living, and is to be properly managed, not eradicated. Several good examples of considered and proportionate risk taking, based on personal development, were discussed. These included the gradual progress of one person towards safely taking responsibility for taking medicines, and a plan to Berwick Bridges DS0000000617.V360795.R01.S.doc Version 5.2 Page 12 build up another person’s ability to go to the local post box and post mail independently. Berwick Bridges DS0000000617.V360795.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 and 17. People who use the service experience good quality in this area. People’s chosen lifestyles are respected and supported by staff. This enables them to keep a positive community prescence, make friendships and take part in activities which reflect their age, culturual influences and individual choice. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Five of the people who live in the home attend the North Star Centre, an adult training centre. Two are also accessing Northumberland College’s ‘Food Hygiene’ course, an essential qualification as they work part time in a local café. Berwick Bridges DS0000000617.V360795.R01.S.doc Version 5.2 Page 14 One person does voluntary work with a local charity, delivering fresh vegetables three days a week to the local community. Although none are in paid employment, all are as fully and gainfully occupied as they wish to be. Each resident has one day a week where they received individual staff support to develop and maintain their self-care and daily living skills. Each person has an individual timetable of activities, tailored to their likes and interests. They are supported to take part in a range of activities in a variety of settings. Outings and activities are organised at weekends, such as trips out to a deer sanctuary, to historic houses and gardens such as the Hirsel grounds. There are meals out, visits to cafes, shops, pubs, a bowling club, trips to a local theatres, sponsored charity walks etc. The staff take large numbers of photographs of all such trips and activities, filling several photograph albums, all usefully dated, to evidence the wide variety of activities the people enjoy. All the people who live in the home have involvement with their families. The degree of contact is decided by the wishes of each individual, and it can be in person or by phone. Some choose to visit their family members outside the home; others, to be visited at home. Friendships are encouraged and supported, and people can bring their friends home for tea. They can use their bedrooms to entertain guests. Both staff and the people living in the home have attended a workshop on personal and physical relationships. Staff were seen to respect and safeguard people’s right to privacy, and asked two of the people if they minded showing the inspector their bedrooms. They kindly allowed this and took an obvious pride in how well they had personalised their rooms. Residents confirmed that staff respected their privacy. The people living in the home have unrestricted access to all areas of the Home other than the office and each other’s bedrooms. They all helped with household tasks such as clearing up after the lunch meal and cleaning the utility room. Throughout the inspection staff were observed talking to and engaging appropriately with the residents. The daily routines in the home were seen to support the independence of the people who live in the home, rather than restrict them. Negotiation and consultation appeared to be the normal methods of communication. Disputes are resolved in a similar manner. An example given was that of over-loud music from one person’s bedroom disturbing other people’s rest: the issue was discussed with all concerned and a compromise acceptable to all was reached. Other issues discussed and resolved recently concerned the timing of meals and what constitutes acceptable behaviour at the meal table. Berwick Bridges DS0000000617.V360795.R01.S.doc Version 5.2 Page 15 Each person has agreed a goal plan regarding his or her responsibility for housework. Each person has his or her own bedroom door key, and bathrooms and toilets are lockable (staff can over-ride, in an emergency, only). They receive their mail unopened. They are addressed by their preferred name. People living in the home are fully consulted as to the weekly menu, and have a genuine input. Staff provide guidance and parameters with regard nutrition, where this is deemed necessary for the ongoing health of the residents. People’s food likes and dislikes are known and are recorded, but staff will also actively try to extend the options available and expose residents to new culinary experiences (recently, this has included trying oysters and lobster). If, however, an individual does not want the agreed meal, then alternatives are offered. A cooked breakfast is available on request. Staff promote healthy eating and aim to provide the advised five portions of fruit and/or vegetables every day. Fresh fruit is available at all times, and is popular. All staff have received basic food hygiene training. Special diets are currently limited to one person who suffers from Diabetes. Proper guidance regarding this is available to staff and a care plan is being drawn up. Berwick Bridges DS0000000617.V360795.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 and 20. People who use the service experience good quality in this area. Healthcare needs are well met and people using the service are given sensitive personal support by staff, who promote each individual’s independence, dignity, privacy and choice. We have made this judgement using all available evidence including a visit to the home. EVIDENCE: People using the service are given sensitive personal support by the staff, who promote each individual’s independence, dignity, privacy and choice. Each person has an individual assessment of his or her personal needs, and has a care/goal plan in place to meet those needs. Plans are person-centred, sensitive and thoughtful. They stress the strengths of the individual, and are positive in terms of seeking to develop the skills and abilities of the person. Privacy is given a high priority. Plans are reviewed every month, and amended as necessary, to reflect the progress made by the individual. Berwick Bridges DS0000000617.V360795.R01.S.doc Version 5.2 Page 17 All five relatives who returned surveys said that the home always meets the different needs of the individual residents; and always gives the care and support expected and agreed. One relative said of the staff “They could not do more.” Another said, “I think the staff do a wonderful job”. Each person has his or her own ‘Personal Health Information’ file. This contains professional health assessments, correspondence, records of contacts with health professionals, and permission form the G.P. about non-prescription medicines. It demonstrated that all aspects of a person’s physical and mental health are taken seriously and are properly met. A six monthly health assessment document is being introduced. A new medication system (the Boots ‘MAR’ system) has recently been introduced. With this system, medicines are ordered monthly, and these are delivered in blister packs. This is said to be working well, and to minimise any risk of a medication error. The Medication Administration Records (MAR) was checked. This was found to completed to a professional standard, with no gaps, and the codes used properly. Any errors would be recorded in full on the rear of the MAR. Senior staff do a weekly audit of the prescribed and non-prescribed (‘homely’ medicines) medications. A detailed audit is also completed weekly on the equipment that one person uses for Diabetes testing. One person living in the home is working through a programme of empowerment that should lead to the person eventually being able to take personal responsibility for storage and self-administration of prescribed medicines. This is good practice. The person is currently self-medicating with daily checks by staff. Medicines are safely stored. All staff have had training on how to use the new Boots medication system. They have also had external ‘Safe Handling of Medicines’ training. Berwick Bridges DS0000000617.V360795.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 and 23. People who use the service experience good quality in this area. Clear and accessible complaints and protection procedures are in place to ensure that that complaints are dealt with effectively and to the satisfaction of the complainant. This ensures that people who live in the home are confident that staff will take seriously any worries they may express, and will act upon them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear complaints procedure. It is also available in a version that uses pictograms to help the people living there understand the system. Four of the five relatives who returned surveys said that they knew how to make a complaint if they or their relative was unhappy; the fifth relative said, “I’ve never needed to complain, but would find out if required to”. All five said that they felt that the home would respond positively to any concerns raised. All five staff who returned surveys said that they knew what to do if anyone has any concerns about the care in the home. All five residents who retuned surveys said they know who to speak to if they are not happy, and all five said they know how to make a complaint. No formal complaints have been received by the home in the past nine years. Following discussion, it was agreed that the introduction of a ‘comments, Berwick Bridges DS0000000617.V360795.R01.S.doc Version 5.2 Page 19 compliments and complaints’ system will be considered. This would help pick up on minor matters that, whilst not formal complaints, nevertheless would provide useful feedback about the service, as these are not currently being recorded. The home has a policy on the protection of its service users from abuse. This policy is currently in the process of being revised with the aim of removing the inappropriate references to internal investigation of allegations of abuse, replacing this with a reference to reporting any such allegation to the local Social Services Department. The issue of consent of the service user being necessary to report such allegations is also being reviewed. All staff have had Adult Safeguarding/Protection of Vulnerable Adults training. All five residents who returned surveys said that the staff always treat them well. They also said that the staff listen and act on what they say. Berwick Bridges DS0000000617.V360795.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 and 30. People who use the service experience good quality in this area. The standard of the accommodation, the décor, furniture and fittings was good and provided the people who live there with a clean and comfortable place to live. The home is kept in a clean, tidy and well maintained state. We have made this judgement using available evidence including a visit to this service. EVIDENCE: The Home is clean, tidy and homely in appearance. The premises are accessible to all of the residents. The Home is situated close to local amenities and public transport within a small housing estate of similar housing in Tweedmouth. The furniture and fittings are of a good standard, with comfortable leather sofas. Maintenance and redecoration is carried out at regular intervals. Berwick Bridges DS0000000617.V360795.R01.S.doc Version 5.2 Page 21 Cleaning materials and other potentially hazardous substances are safely stored. Policies and procedures are in place relating to the Control of Hazardous Substances and Infection Control and other Health and Safety matters. Staff receive regular Health and Safety training including Food Hygiene. Staff demonstrated an awareness of infection control procedures and an appropriate hand washing facility is available in the kitchen. The people who live in the home voluntarily help with the daily chores. There is a roster for hovering, laundry, emptying of bins, loading and unloading the dishwasher, and doing the weekly food shopping. All five residents who returned surveys said that the home is always clean and fresh. Berwick Bridges DS0000000617.V360795.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): 32, 33, 34, and 35. People using this service experience good outcomes in this area. Staff have good access to training to ensure they are competent, up to date and provide the right type of support to people using the service. This is supported by clear and well executed recruitment practices which are rigorous in protecting the people who live in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Six of the seven care staff hold National Vocational Qualification (NVQ) level 2 in health and social care. Two of these staff members also hold NVQ level 3 in ‘promoting independence’. All five of the relatives who returned surveys said that the staff have the right skills and experience for the work. Comments included, “The staff are always friendly and helpful” and, “I think the staff do a wonderful job.” Of the five staff who returned surveys, two said that there is always enough Berwick Bridges DS0000000617.V360795.R01.S.doc Version 5.2 Page 23 staff to meet the residents’ needs; two said there usually is; and one said “sometimes”. One commented, “Staffing not usually a problem. However, better use of sole bank staff and additional bank staff would be beneficial”. Two other staff members also said that there is a need for more bank staff. At the time of this inspection, there were no bank staff available to the home. Advertisements had been placed to find bank staff. The normal staffing ratio in the home is 2 carers to 6 , between 8am and 10pm, with one staff member ‘sleeping in’, overnight. It was a requirement of the last inspection report that the Registered Person must ensure that the information and documents specified in Schedule 2 of the Care Homes Regulations 2001 is in place for each person working at the Home and available for inspection. This has been carried out. Proof of identity, including current photograph, is now required; as is documentary evidence of qualifications; two written work references; a declaration of physical fitness; and a Criminal Record Bureau (CRB) clearance. It was a recommendation of the last inspection report that, in order to more effectively identify gaps in employment histories, the home’s job application form should be amended to state that applicants must provide the month as well as the year in which their periods of employment commenced and ended. This is in the process of being carried out. It was a further recommendation of the last inspection report that, to help ensure that the required checks are carried out on new staff before they commence employment, that a recruitment and vetting checklist is prepared and used as part of the recruitment and selection process. This has been carried out. All five staff who returned surveys said that they are given training that is relevant to their roles; helps them understand and meet the individual residents’ needs; and keeps them up to date with new ways of working. Three staff said that their induction prepared them very well for their roles; two indicated their induction was many years ago, so not really relevant. Recent staff appraisals have identified staff training needs, and there was documentary evidence that appropriate training courses are being arranged Berwick Bridges DS0000000617.V360795.R01.S.doc Version 5.2 Page 24 to meet these needs. These include training in team building; dealing with ‘challenging aspects of mental health’; the use of ‘de-escalation’ techniques; working with Dementia; conflict management; a motivation workshop; ‘reminiscence and life work’; and working with people with poor vision. All staff are up to date with all the aspects required as mandatory training. Refresher courses are being booked, as required. Berwick Bridges DS0000000617.V360795.R01.S.doc Version 5.2 Page 25 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 and 42. People who live in the home experience good quality outcomes in this area. The manager has an open style and is clearly present in the home to give direction and support to staff and listening to the views of people using the service. She has done much to develop the culture within the home to ensure that the service is led by the needs and wishes of residents. We have made this judgement using available evidence including a visit to this service. EVIDENCE: The home’s manager is an Enrolled Nurse (General) and also holds the Registered Manager Award (RMA) and the Diploma in Management. She has appropriate managerial experience with the client group. Berwick Bridges DS0000000617.V360795.R01.S.doc Version 5.2 Page 26 All five relatives who returned surveys said that the staff keep in touch with them and keep them up to date with what happens in the home. It was a requirement of the last inspection report that the Registered Provider must ensure that the visits specified under paragraph 2(b) of Regulation 26 of the Care Homes Regulations 2003, are carried out at least once a month and are unannounced. Ensure that people only carry out these monitoring visits after the completion of a satisfactory Criminal Records Bureau check that includes both POVA and POCA list checks. This has been carried out. There are now monthly visits carried out by the two Directors of the service, both of whom have now been checked and cleared via the Criminal Record Bureau (CRB) checks. It was a requirement of the last inspection report that the Registered Person must establish and maintain a system for reviewing at appropriate intervals, and improving, the quality of care provided at the Home. Also, that the registered person shall supply to the Commission a report in respect of any review of the quality of care provided at the Home and make a copy available to service users. Also, that the system for reviewing the quality of care provided at the Home must provide for consultation with service users and their representatives. These requirements are in the process of being carried out. An annual survey of the views of the people who live in the home has been carried out, and the results are currently being collated with a view to publishing the findings in April 2008. Separate surveys are also being sent out to care managers and to families, to include and respond to their views. Meetings with the people who live in the home take place every six weeks. The minutes of these meetings show that the staff genuinely seek out and listen to their views. Issues such as table manners, respecting each other’s privacy, and noise are discussed in a non-judgemental manner, and consensual agreements reached. The meetings also discuss choices of, for example, menus, trips out and holiday destinations. Staff meetings take place regularly. These are also focussed on the needs of the people living there, with each person’s progress being discussed in detail. There was clear evidence of staff responding to the needs of the people using the service. A ‘comments, compliments and feedback’ book is being introduced, to collect all aspects of feedback from the people living in the home. Berwick Bridges DS0000000617.V360795.R01.S.doc Version 5.2 Page 27 Appropriate policies and procedures are in place for safeguarding the health and safety of both the people who live in the home and the staff who support and care for them. All staff have had a full range of health and safety training. This has included Control of Substances Hazardous to Health (COSHH); first aid at work; moving and handling; and health and safety at work. Appropriate contracts, maintenance and service agreements are in place to ensure the proper working of fire equipment, electrical equipment, etc. There is a named health and safety representative on the staff team. Fire logbooks show that all the required checks and tests of fire safety equipment and staff fire training are in place. The home’s accident book is fully completed, with ‘follow-up’ entries that track the progress of accidents. Berwick Bridges DS0000000617.V360795.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 3 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 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 Berwick Bridges DS0000000617.V360795.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations All the elements of the care/goal plans to meet the assessed needs of the people who live in the home should be recorded centrally (with, if necessary, cross-references to where the detail of the plan is held or recorded). Berwick Bridges DS0000000617.V360795.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Berwick Bridges DS0000000617.V360795.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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