Care Home: Bradbury Lodge

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What the care home does well Bradbury Lodge has a staff team who continue to be committed to supporting the people who live at the home to lead full and active lives as far as they are able. People who live at Bradbury lodge have opportunities to access community resources and support profiles and risk assessments are detailed enabling staff to offer consistent support. The home continues to review behaviours and incidents and using information gathered to make recommendations for better approaches to supporting people. This process is considered by the inspector to be a strength of the organisation and along with other data gathering methods forms an effective assessment process that has led to design briefs being drawn up for people to `move on` from the home. What has improved since the last inspection? Since the time of the last key inspection of the home there have been a number of changes to the management arrangements for Bradbury Lodge. A new manager has been appointed who is familiar with the home and who has identified areas where support and review are needed. He is committed to continually reviewing staffing levels and the organisation is already negotiating additional staffing for the home. The manager has led a review of the recording and investigating of complaints and is aware of appropriate procedures for sharing information in relation to incidents and allegations. Records are being appropriately kept. What the care home could do better: The manager has identified areas such as staffing levels and staff training to keep under continual review and is supporting the team to look at menus and meal preparation as an area where improvement could be made. No requirements were made as a result of this inspection. One recommendation for improvement was to ensure that the home could justify decisions to appoint staff following review of CRB disclosures. CARE HOME ADULTS 18-65 Bradbury Lodge Claypit Road Whitchurch Shropshire SY13 1NT Lead Inspector Sue Woods Key Unannounced Inspection 24th January 2008 09:30a Bradbury Lodge DS0000063738.V355166.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 Bradbury Lodge DS0000063738.V355166.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. Bradbury Lodge DS0000063738.V355166.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bradbury Lodge Address Claypit Road Whitchurch Shropshire SY13 1NT 01948 666916 01948 667011 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) Perthyn Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Bradbury Lodge DS0000063738.V355166.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th June 2007 Brief Description of the Service: Bradbury Lodge is a ‘short term’ assessment unit for adults with ‘or have a history of’ (taken from the statement of purpose) challenging behaviours. It has been identified that the people who moved in originally are people whose needs previously could not be met in the County and thus alternative placements further a field had been made. The home is managed by Perthyn and registered to support a maximum of six people with learning disabilities. The manager of the home is Mr John Poulter, who is in the process of applying for registration with CSCI. The Responsible Individual is Ms Bethan Evans. Information is shared with people living at the home in the service user guide and during individual care reviews. A Quality of Life Questionnaire is carried out with all people who live at Bradbury Lodge and outcomes are recorded in support plans and used to identify future goals. Fees are paid by the local authority on a block contract basis and individually range from £110,319 to £114,580 annually (figure correct at the time of the last key inspection of the home in June 2007). Bradbury Lodge DS0000063738.V355166.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 who use this service experience good quality outcomes. The unannounced inspection of Bradbury Lodge took place on 24th January 2008 between 09.30 am and 02.30 pm. The inspection reviewed all 22 key standards and information to produce this report was gathered from the findings on the day and also by review of information received by CSCI prior to the inspection date. A quality rating based on each outcome area for service users has been identified. These ratings are described as excellent/good/adequate or poor based on findings of the inspection activity. As part of the fieldwork activity the inspector spoke with one man who lives at the home and with staff on duty at the time of the inspection. In preparation for the inspection surveys were sent to people receiving a service and to the staff team. A total of ten were completed and returned. During the inspection the inspector looked at two care plans and other records that are mentioned within the report. The manager of the home was available throughout the day to support the process. What the service does well: Bradbury Lodge has a staff team who continue to be committed to supporting the people who live at the home to lead full and active lives as far as they are able. People who live at Bradbury lodge have opportunities to access community resources and support profiles and risk assessments are detailed enabling staff to offer consistent support. The home continues to review behaviours and incidents and using information gathered to make recommendations for better approaches to supporting people. This process is considered by the inspector to be a strength of the organisation and along with other data gathering methods forms an effective assessment process that has led to design briefs being drawn up for people to ‘move on’ from the home. Bradbury Lodge DS0000063738.V355166.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. Bradbury Lodge DS0000063738.V355166.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 Bradbury Lodge DS0000063738.V355166.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): Standard 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who stay at Bradbury Lodge are supported by appropriate procedures that have enabled their successful admission to the home. EVIDENCE: Since the time of the last inspection of Bradbury Lodge one person has been admitted as part of a planned move. His file was reviewed and contained detailed assessments of need from a number of health and social care professionals. These assessments have formed the basis of his care and support plan. The inspector also spoke recently to someone who has moved from Bradbury Lodge and he said that the team supported his move and provided good information to his new care providers. Bradbury Lodge DS0000063738.V355166.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 6, 7, and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Care-planning systems are in place to provide staff with the information they need to meet the assessed needs of people who live at the home. People are appropriately supported with decision-making processes and enabled to take responsible risks. EVIDENCE: The care file for the person who most recently moved in to Bradbury Lodge was seen by the inspector as well as extracts from those who have lived there for longer. Care and support plans are very detailed and professionally maintained. There is evidence that all plans are regularly reviewed and updated. Staff said that they felt that the care plan for the latest person to move in to the home was useful and gave good information to enable them to meet his needs. Bradbury Lodge DS0000063738.V355166.R01.S.doc Version 5.2 Page 10 Risk assessments are very thorough and provide clear guidance to staff in order to support them to reduce risks especially while out in the community. Risk assessments are also reviewed regularly. Limitations within the home are now recorded in information documents and there is evidence that one restriction that was being implemented at the time of the last inspection has been reviewed and removed for all but the person it originally relates to. Throughout the inspection staff offered one man choices and opportunities, involving him in all decisions made. One person said in his survey that he could not make choices as he would like and this was discussed with the manager. Bradbury Lodge DS0000063738.V355166.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live at Bradbury Lodge enjoy a variety of leisure opportunities that reflect individual choice. Family links are supported and maintained and the staff team promote healthy eating alongside peoples preferred choices. EVIDENCE: The majority of people who completed a survey said that they are regularly able to do what they choose each day. Care plans identify activities and planners enable activities to be structured into the daily routine. At the time of the inspection one person was seen to change his mind twice as to what he would like to do while out with a member of staff. It was apparent that the staff member was flexible enough to accommodate whatever decision he made. Bradbury Lodge DS0000063738.V355166.R01.S.doc Version 5.2 Page 12 People are supported and encouraged to maintain family contacts and friendships. One person told the inspector of his recent birthday party when he celebrated with family and friends. On the day of the inspection two people were out for the day and two people went out for lunch. Care and support plans are very detailed enabling staff to know how to support people and what to do if things don’t go according to plan. Recent support from a dietician has enabled staff to start and put together a healthy choice of meals however it was said that some of the options were not very popular. Daily records show that people still enjoy chips, burgers and lasagne (for example) but that healthy options are being introduced as well. The manager stated that he and the team plan to involve people living at the home more in mealtime preparation and cooking. Bradbury Lodge DS0000063738.V355166.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 18, 19 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The personal and health care needs of the people who live at Bradbury Lodge are generally well met enabling them to have a good quality of life. People are safeguarded by the home’s system for handling, storing and administering medication EVIDENCE: As part of a general discussion with the inspector, the manager was able to detail how the home supports one person who has different religious beliefs than others living at the home. Care and support plans are very detailed and clearly show how people prefer their needs to be met. Health action plans are in place and the plan of the latest person to move in to the home was seen by the inspector. The manager also shared a new format, soon to be implemented, that will make the process more user friendly. Bradbury Lodge DS0000063738.V355166.R01.S.doc Version 5.2 Page 14 Medication processes were reviewed and guidelines required following the last key inspection of the home had been developed and implemented to support the administration of medicines as and when required. The arrangements for the recording and storage of Controlled medication were seen to be good. Everyone living at Bradbury Lodge now attend a well man clinic locally. All information relating to peoples health care needs is well recorded and identified behaviours and incidents are monitored and reviewed by the clinical team. Bradbury Lodge DS0000063738.V355166.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People living at Bradbury Lodge are now safeguarded by effective procedures in place to record and investigate complaints and allegations. EVIDENCE: Since the time of the last inspection when this outcome group was judged as ‘poor’ the manager has reviewed all processes to ensure that all complaints are now acted upon appropriately. The complaints recording system identifies basic information and then detailed investigation notes are stored separately and confidentially. The complaints policy was put together in 2004 and did not reflect current safe practice. The manager stated however that all policies and procedures were being reviewed by the organisation and would ensure that this one would be prioritised. The Protection Of Vulnerable Adults Policy had been reviewed and the manager was fully aware of his role in relation to reporting allegations to the appropriate outside agency. Bradbury Lodge DS0000063738.V355166.R01.S.doc Version 5.2 Page 16 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): Standard 24 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live at Bradbury Lodge are provided with a clean and wellmaintained place to live. EVIDENCE: These standards were not reviewed in detail at the time of this inspection as the home was in the middle of being redecorated. Colours had been chosen by the people who live at the home. It was noted that the broken door identified at the time of the last inspection had been repaired. The kitchen was seen to be clean and food was being stored appropriately. Bradbury Lodge DS0000063738.V355166.R01.S.doc Version 5.2 Page 17 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): Standard 32, 34 and 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The people who live at Bradbury Lodge benefit from being supported by a knowledgeable staff team, committed to meet individual care and support needs. EVIDENCE: Current staffing levels are enabling people to access the community and receive appropriate levels of support while at home. This situation reflects that there are only currently five people living at the home. The manager is aware of the need to ensure staffing levels remain at a level that enables activities to take place and is currently undertaking a recruitment drive in local areas to attract more staff, especially male staff. Staff who completed a survey said that the home ‘usually’ had enough staff and one person commented that ‘things are getting better’. The manager committed to continue to review staffing levels. All staff who completed a survey felt that they had ‘good training and support’. On the day of the inspection staff were seen to be well organised and able to effectively communicate with the people they were supporting. Bradbury Lodge DS0000063738.V355166.R01.S.doc Version 5.2 Page 18 Staff files were available for review and were well organised. The majority of required information was available on each file and the manager was given advise about the storing of Criminal Records Bureau (CRB) Disclosures. It was also recommended that a written risk assessment support any decision to appoint staff when disclosures are identified. Bradbury Lodge DS0000063738.V355166.R01.S.doc Version 5.2 Page 19 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): Standards 37, 39 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Bradbury Lodge has an effective manager who uses the recourses of the organization’s clinical staff team to meet the needs of the people who live at the home and protect their best interests. Health and safety is promoted within the home protecting the people who live there. EVIDENCE: Since the time of the last key inspection, Perthyn has appointed a new manager to the home. The manager is currently in the process of registering with CSCI and has good ideas of how he will develop the service provided at Bradbury Lodge. He is working closely with the clinical team and is offering good support and direction to the staff team who speak highly of him. Bradbury Lodge DS0000063738.V355166.R01.S.doc Version 5.2 Page 20 Senior staff changes have also impacted positively on the home and visits carried out by representatives from the organisation are focussing on identified national minimum standards in order to monitor the home’s performance. The organisation is currently liaising with the local authority in relation to issues that relate to the homes statement of purpose. The manager confirmed that he is keeping routine health and safety checks up to date. Bradbury Lodge DS0000063738.V355166.R01.S.doc Version 5.2 Page 21 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 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 4 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 Bradbury Lodge DS0000063738.V355166.R01.S.doc Version 5.2 Page 22 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA34 Good Practice Recommendations It is recommended that a written risk assessment support any decision to appoint staff when CRB disclosures are identified. This is to demonstrate that the person making the decision has done so after considering all evidence and reviewed any potential risks to the people living at the home. Bradbury Lodge DS0000063738.V355166.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Bradbury Lodge DS0000063738.V355166.R01.S.doc Version 5.2 Page 24 - 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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