Care Home: Bradbury Manor

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What the care home does well The home gathers a great deal of information about new service users before they decide if they can offer them support. Much of the information about new service users coming for respite is gathered from the community care assessment which accompanies a referral, but this is added to by staff in the home. The assessment includes such information as mobility, specific health needs and family circumstances. Details of any medication support needed is written down and agreed with the service user or a relative. All the assessment information gathered helps to formulate a detailed support plan for service users. We spent time watching staff and listening to them as they worked with service users. All staff were seen to be patient and good humoured, taking time to talk with residents and encourage them to express their thoughts and opinions. When we asked what the home does well, one relative said: "Caring is always its priority, and making sure the client is happy". Another family member said: "It provides a safe haven for my relative. It appears to be well run, from the manager to the caretaker". Other comments from relatives include: "Bradbury Manor staff go beyond just what they have to do. They often phone and ask how my relative is if they`ve been poorly"; "The staff make the home. To get as good a range of staff members as are at Bradbury Manor is rare as well as fortunate"; "Whoever has the fortunate access to the care offered by the staff at Bradbury Manor will be looked after and cared for to an extremely high standard, no matter their race and ethnicity, age, disability, gender, faith and sexual orientation". What has improved since the last inspection? This is the first inspection of Bradbury Manor. CARE HOME ADULTS 18-65 Bradbury Manor Bradbury Manor Nursted Road Devizes Wiltshire SN10 3AF Lead Inspector Alyson Fairweather Unannounced Inspection 14th August 2008 10:00 Bradbury Manor DS0000071503.V364977.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 Manor DS0000071503.V364977.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 Manor DS0000071503.V364977.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bradbury Manor Address Bradbury Manor Nursted Road Devizes Wiltshire SN10 3AF 01380 732620 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) Wiltshire County Council Mrs Karen Joyce Taylor Care Home 10 Category(ies) of Learning disability (10), Physical disability (4) registration, with number of places Bradbury Manor DS0000071503.V364977.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The following 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 categories: Learning Disability(Code LD) 2. 3. Physical Disability (Code PD) - maximum of 4 places. The maximum of service users who may be accommodated is 8 Until further notice rooms 4 and 12 cannot be used. Date of last inspection This is the first inspection. Brief Description of the Service: Bradbury Manor is a purpose built home which provides short breaks for adults with learning disability, four of whom may also have a physical disability. It has ten bedrooms, most of which are en-suite, and four high dependency bedrooms with hoisting facilities, several assisted baths and toilets. Equipment has been added for people with a sensory impairment. It is situated in Devizes and is conveniently located for shops and public transport. There are several lounges for communal use, a large dining room and kitchen and ample storage facilities. There is a training kitchen which will be used by service users hoping to increase their independence. It is a comfortably furnished home, and the rooms have been newly decorated. Service users’ bedrooms are homely and individual personal items can be taken in when staying there. There is a large garden with a patio, and the garden is fenced which makes it safe for people to be alone in if they wish. There are plants and vegetables growing in the garden, as well as seating and lawns, and it can be accessed from all the main rooms in the house. People pay a top-up fee to stay at Bradbury Manor. These fees range from £102.90 per week if aged 60 or over, £65.20 per week for people aged 25-59 and £52.65 per week for those aged under the age of 25. Bradbury Manor DS0000071503.V364977.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 the people who use this service experience good quality outcomes. We recently asked the home’s manager to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how well they were performing and it gave us information about their future plans. We also sent out surveys to the service users, to family members and to staff, so that we could get their views about the home. One service user replied, with help from their family, three family members wrote to us, as well as one member of staff. We reviewed the information that we had received about the home and we made a visit in August 2008. We met some of the service users who have short breaks at Bradbury Manor and met some of the staff and the manager. We looked around the home and saw a number of records, including care plans, risk assessments, health and safety procedures, staff files and medication records. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visit. What the service does well: The home gathers a great deal of information about new service users before they decide if they can offer them support. Much of the information about new service users coming for respite is gathered from the community care assessment which accompanies a referral, but this is added to by staff in the home. The assessment includes such information as mobility, specific health needs and family circumstances. Details of any medication support needed is written down and agreed with the service user or a relative. All the assessment information gathered helps to formulate a detailed support plan for service users. We spent time watching staff and listening to them as they worked with service users. All staff were seen to be patient and good humoured, taking time to talk with residents and encourage them to express their thoughts and opinions. When we asked what the home does well, one relative said: “Caring is always its priority, and making sure the client is happy”. Another family member said: “It provides a safe haven for my relative. It appears to be well run, from the manager to the caretaker”. Other comments from relatives include: “Bradbury Manor staff go beyond just what they have to do. They often phone and ask how my relative is if they’ve been poorly”; “The staff make the home. To get as good a range of staff members as are at Bradbury Bradbury Manor DS0000071503.V364977.R01.S.doc Version 5.2 Page 6 Manor is rare as well as fortunate”; “Whoever has the fortunate access to the care offered by the staff at Bradbury Manor will be looked after and cared for to an extremely high standard, no matter their race and ethnicity, age, disability, gender, faith and sexual orientation”. 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 Manor DS0000071503.V364977.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 Manor DS0000071503.V364977.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 and 2 Prospective clients and families are given information leaflets so that they can choose whether or not they wish to use the service. Most residents have their individual needs assessed before they arrive, so that staff know how best to support them, although not all had these on file. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home has a Statement of Purpose and Service User Guide, which give an overview of the service which will be provided. This is given to every resident and or their family, and also gives details of the organisation’s complaints procedure. This is still being developed, and should be amended to make reference to the newly appointed Responsible Individual nominated by Wiltshire County Council. The service user who wrote to us said that they were asked if they wanted to go to Bradbury Manor and that they got lots of information about the house before they went there. Of the three families who wrote to us, two people felt they always got enough information from staff and one person said: “Usually”. One person said: “They are always willing to answer questions”, and another said: “The communication levels are extremely high. I have no problems in obtaining any help or information”. Bradbury Manor DS0000071503.V364977.R01.S.doc Version 5.2 Page 9 Referrals come from the prospective service users’ Care Manager who will provide the service with a recently completed Community Care Assessment and any other relevant information, in order to initially identify whether the service is appropriate for and able to meet the needs of the individual. Following this, if it initially appears that they are able to offer a service, a visit will be arranged for the person, along with their Care Manager and/or any other appropriate carer, family member, friend or advocate. If successful, another visit will be arranged in order that the individual can join existing service users for a meal and to spend time socialising and interacting with current service users and members of the staff team. The next stage would be for the new service user to have an overnight stay then gradually build up to longer periods of respite care. This process is very flexible and can be tailored to meet the needs of the individual. Bradbury Manor DS0000071503.V364977.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 Care plans reflect the needs and personal goals of service users, although some were not completed. Service users are assisted to make decisions about their own lives. They are supported to take risks where appropriate, and encouraged to be as independent as possible, although not all risk assessments were up to date. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Service users’ support plans include details of any personal care needs, medical and physical health, mental health needs, mobility and communication skills. They also highlight people’s likes and dislikes, and what activities they like to take part in. Some care plans had been written with service users, and some with the help of their families. Staff record residents’ activities well as their general wellbeing on a daily basis. Manual handling assessments and behavioural guidelines were in place for those service users who need them. Some people had daily routines recorded, although others had little or none. Bradbury Manor DS0000071503.V364977.R01.S.doc Version 5.2 Page 11 The manager has been asked to make sure that all care plans contain up to date information about the people who use the service. There were numerous pieces of information gathered in people’s support plans, although some of the pages were completely blank, and others said “Not applicable”. Some of the information headings bore no relation to people’s lives; for example people were asked how they managed their garden and their home. As most of the service users who have a short break at Bradbury Manor have multiple disabilities, and live with their family, this is not always relevant information. It is recommended that support plans should be more tailored to the individual service user, and be more person-centred. One person had no recent community care review on file. It is recommended that the home obtains a copy of service users’ most recent, up to date community care reviews. This will make sure that staff are aware of any changes in the people’s needs and how to care for them. Service users’ families usually help them to manage their money. Money brought in differs with each service user, depending on what day services or activities they wish to pursue. Receipts are kept when any purchase is made with or for a service user. Where there are restrictions are in place, for example to limit self harm or harm to others, this is clearly recorded and guidelines are drawn up for staff to follow. There have been no service user meetings, as Bradbury Manor has only recently opened, but the manager told us in our Annual Quality Assurance Audit (AQAA) that she plans to have these regularly. One service user said that they could “usually” make their own decisions about what they want to do. Risk assessments had been done for some service users and these included areas such as mobility, use of bed rails and travelling. Ways of minimising risks were identified. Staff place great emphasis on encouraging service users to be as independent as possible, while trying to minimise any risk to their safety. One service user had a risk assessment for bathing which had been done for another service which they used to attend. As the bathing facilities at Bradbury Manor are very different to this, it was no longer appropriate. Another service user, who used to attend a service which has now closed down, had a risk assessment in place about the use of bed rails. Once again this is no longer appropriate, and must be specific to the bed conditions at Bradbury Manor. The manager has been asked to make sure that all risk assessments are reviewed and updated as necessary. The home is using different formats for service user risk assessments, including the generic ones meant for the premises. Some of them also contain the name of another service which people used to attend. It is recommended that all risk assessments should consistently use the same format. Bradbury Manor DS0000071503.V364977.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 and 17 Social and leisure activities are varied and tailored to individual need, and use facilities offered by the local community. Service users can have as much or as little contact with family and friends as they wish, and are supported to do so by staff. They are offered a healthy diet, with their preferences taken into account. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: As Bradbury Manor caters for respite service users, many people already have outside activities which they enjoy, and they are supported to continue with these. Activities are usually recorded in a person’s care plan. All four service users who were staying that day had been out at their different day services or had been out in the afternoon with staff. Two people were planning a trip to Longleat Safari Park the next day. Bradbury Manor DS0000071503.V364977.R01.S.doc Version 5.2 Page 13 One service user likes to horse riding and motorbike riding, and another likes to go to car boot sales on Sundays. Notices of local events were also seen to be placed on staff notice board. Some of the activities people like to do indoors are puzzles, board games, watching DVDs and TV and listening to music. The manager told us in their Annual Quality Assurance Audit (AQAA) that they plan to ensure a staff team member is identified to carry out the role of Activities Co-ordinator. This would seem to complement what one family told us. They said: “My relative looks forward to her visits. She loves her room and the fact that she has different areas to go to and play her music, play electronic games and sit down and watch television. When she returns home she is always full of beans and very happy”. However, the same person said: “I would like to see them get out and about with a carer a bit more often”. Friendships both inside and outside the home are encouraged, and staff support links between service users and their family and friends, although the frequency of contact varies depending on the individual circumstances. Because Bradbury Manor offers respite care to families, some do not choose to visit at that time. Service users are free to visit friends outside the house at any time, and can entertain and choose to see who they like either in the privacy of their own bedrooms, outside in the garden or in the communal areas available. Service users can choose when to be alone or in company, and when not to join in an activity. Daily routines are flexible, although several people attend structured day services. People choose what they want to do when they return home; one service user was hoping to go to a disco later that week. The menu supplied in the home is varied and nutritious, and is centred round the likes of the people staying in the home on a daily basis. Breakfast usually consists of cereal and toast, and lunch can be a cooked meal for those who are at home, or a packed lunch for those who go out during the day. The main meal of the day is at supper time, and is cooked by the home’s chef. He was aware of health and hygiene issues, and each day asks which service users are staying so he can plan the menu. The dining room has a menu board so that people can see in advance what is being cooked. The menu on the day of our visit said that pork, onion and mushroom Stroganoff was for tea. One person who did not like pork was offered shepherd’s pie for tea. Chocolate brownies had also been freshly made. There was a good supply of fresh fruit and vegetables in the home, and juices and yoghurts are also available. Staff have records of the food likes and dislikes of all service users, and of any feeding support necessary. The dining room is large, with good lighting and has paintings on the wall, making it a comfortable, pleasant environment for service users to eat in. Two service users we spoke to said that the food was always good at Bradbury Manor, and one person who wrote to us said their relative “Loves the food, which is freshly cooked”. Bradbury Manor DS0000071503.V364977.R01.S.doc Version 5.2 Page 14 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 Service users’ personal support needs are recorded in care plans so that they can receive this support in the way they wish, and their physical and emotional health needs are met. Service users’ are protected by the home’s medication policies, procedures and practices, although advice on capacity issues and covert administration of medication is needed, as is training for some staff. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: All service users have support plans for any personal care required. The information contained in them is gathered from the initial community care assessment and is updated regularly. There is a keyworker system in place, and the manager reported that there is generally a same sex policy when giving personal care support, and two staff double up at this time. People have guidelines in place which say how they like to be helped to get washed and dressed, assisted with food and helped to and from bed. If the families live locally, the person’s own general practitioner (GP) is used, and the home’s local GPs are used for those who live further afield. Medical Bradbury Manor DS0000071503.V364977.R01.S.doc Version 5.2 Page 15 professionals are seen as and when required. This varies according to the needs of individuals and the situations arising while having respite care. The home has good links with the local learning disability teams, which enables them to get help in any crisis periods that may arise. Bradbury Manor has various adaptations and pieces of equipment in place to help with service users’ physical needs, including hoists and slings. Those service users who have epilepsy had clear guidelines about how staff should manage their condition. Behavioural guidelines were also in place for those service users who needed them, as well as details of how to manage any challenging behaviours. The storage and recording of medicines in Bradbury Manor is good. Medication is kept in a designated room and is kept in a locked cupboard in this room. Medication support is recorded on a Medication Administration Record (MAR) and when checked this was seen to be accurate. Records of medicines received, administered and disposed of, including those sent out with service users to day centres were examined, and seen to be in order. They have a controlled drugs book, and this was correctly signed and dated as and when drugs were given out. A check of the stock in the medication cupboard showed all was in order. Few service users are able to look after their own medication, and staff take responsibility for administering it. One service user has their medication on a spoon, and then has a piece of food to help swallow it. Another person has their medication disguised in their food, and their family has given permission for this. ‘Covert’ is the term used when medicines are administered in a disguised format without the knowledge or consent of the person receiving them, for example, in food or in a drink. Covert medication is sometimes necessary and justified, but should never be given to people who are capable of deciding about their medical treatment. The Royal Pharmaceutical Society says: “Giving medication by deception is potentially an assault. The covert administration of medicines should only take place within the context of existing legal and best practice frameworks to protect the person receiving the medicines and the care workers involved in giving the medicines”. A clear distinction should always be made between those service users who have the capacity to refuse medication and whose refusal should be respected, and those who lack this capacity. The manager has agreed to ensure that the full multidisciplinary team involved with the service user are consulted to ensure that this is the preferred method of administration. The findings of the meeting must be documented and kept on file. The manager should also seek advice about mental capacity issues. Most staff had done medication administration training, although a few new staff had not, and the manager has been asked to make sure that this is done. Bradbury Manor DS0000071503.V364977.R01.S.doc Version 5.2 Page 16 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 Service users feel their views are listened to and acted on, although there was no record kept of any complaint. The policies and procedures the home has in place try to ensure that residents are safeguarded from abuse and harm, although training for staff in the protection of vulnerable adults would enable them to be more aware of abuse issues. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home has a complaints procedure in place, and this is given to service users and their families along with the service user guide. When they returned our AQAA, the home told us that they had received one complaint, which had which had been dealt with immediately, and within their stated timescales. None of the details of any complaint were on file in the complaints folder. This was said to be because a more senior manager had dealt with the matter. The manager was, however, fully aware of how complaints were dealt with, and when she needed to seek advice or support. The manager has agreed that she will keep a log of all complaints made to the service. The service user who wrote to us said they knew who to speak to if they were not happy, and that they knew how to make a complaint if they had to. Two service users we spoke to during our visit said they would be quick to tell the manager if they had any concerns. One relative said: “I know I can go to the manager or her staff if she is not there”. Another said: “I’ve had no reason to complain so far”. Bradbury Manor DS0000071503.V364977.R01.S.doc Version 5.2 Page 17 The home has copies of the “No Secrets” document, as well as the organisational policy and procedure on responding to allegations of abuse. All staff members are encouraged to report any incidences of poor practice, and a “Whistle Blowing” procedure is available. There are guidelines in place for the management of challenging behaviour. Although the manager and most of the staff team have had training in safeguarding adults, some staff have not. The manager has been asked to make sure that all staff receive this training. Bradbury Manor DS0000071503.V364977.R01.S.doc Version 5.2 Page 18 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 Service users live in a homely, comfortable and safe environment which is clean and hygienic. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Bradbury Manor is a purpose built home which provides short breaks for adults with learning disability, four of whom may also have a physical disability. It has ten bedrooms, most of which are en-suite, and four high dependency bedrooms with hoisting facilities, several assisted baths and toilets. Equipment has been added for people with a sensory impairment. It is situated in Devizes and is conveniently located for shops and public transport. There are several lounges for communal use, a large dining room and kitchen and ample storage facilities. There is a training kitchen which will be used by service users hoping to increase their independence. It is a comfortably furnished home, and the rooms have been newly decorated. Service users’ bedrooms were homely and each contained individual personal items. There is Bradbury Manor DS0000071503.V364977.R01.S.doc Version 5.2 Page 19 a large garden with a patio, and the garden is fenced which makes it safe for people to be alone in if they wish. There are plants and vegetables growing in the garden, as well as seating and lawns, and it can be accessed from all the main rooms in the house. One family told us that their relative: “Loves” their room, which is “spotless”. They told us that their relative also “loves” the smell of their clothes which have been washed on the premises. We met with the housekeeper, who described her cleaning routine and said that she only had to ask for any minor repair to be done and it was immediately dealt with. During our visit we noticed that there had been a slight leak behind one of the washing machines, and the housekeeper immediately recorded this in the maintenance book so it could be looked at. One staff member has responsibility for the infection control measures in the home, and ensures that the rest of the staff team are aware of any new policies which are introduced. However, some staff had not had infection control training, and the manager has been asked to ensure that this is done. Arrangements are being made by Wiltshire County Council to further increase the number of bathrooms in the house, but until this is done, two bedrooms cannot be used. One person who wrote to us said: “It’s a real shame that the high dependency rooms are not fully open, as families who really need respite are not getting it”. Bradbury Manor DS0000071503.V364977.R01.S.doc Version 5.2 Page 20 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 and 36 Service users are supported by competent and qualified staff, although some training is needed. They are protected by the home’s recruitment policies, although there was some confusion about storage of information, and some files did not contain appropriate information. Service users do not benefit from well supervised staff. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. EVIDENCE: All new staff receive induction training, and several are using the Learning Disability Qualification (LDQ) to assist their training, which means that the needs of service users with learning disabilities will be more fully understood. Currently fourteen staff members have achieved their NVQ Level 2 or above. We watched and listened as staff members spoke to the service users who were at home. They treated them politely and listened to them when they spoke. They asked service users for their opinion about everyday matters, and spent time preparing them for an outing later that day. When asked by us if staff treated them well, the one service user who wrote to us said they Bradbury Manor DS0000071503.V364977.R01.S.doc Version 5.2 Page 21 “always” did. One relative who wrote to us said: “Bradbury Manor staff go beyond just what they have to do. They often phone and ask how my relative is if they’ve been poorly”. Another said: “Whoever has the fortunate access to the care offered by the staff at Bradbury Manor will be looked after and cared for to an extremely high standard, no matter their race and ethnicity, age, disability, gender, faith and sexual orientation”. Staff training during the last year has included manual handling, first aid, medication, fire instruction, food hygiene and health and safety. However this was not the case for all staff. Some people had not had training in manual handling, or medication administration, or safeguarding adults or infection control, or use of the hoist. The manager has been asked to make sure that all staff have training in the above areas. There has been some specialist input for staff, and some of them have done training in disability awareness, Makaton, how to care for a gastrostomy, suction training, autism and tissue viability. Staff have told us that they are offered regular training, and the one staff member who wrote to us said they were being given training which is relevant to their role, helps them understand the needs of service users, and keeps them up to date with new ways of working. Bradbury Manor is supported in its recruitment by the provider organisation, Wiltshire County Council. Employment checks should include Criminal Records Bureau (CRB) and checks against the Protection of Vulnerable Adults (POVA) register, two written references and a medical declaration. All potential staff should complete an application form, and this should be kept on the individual staff member’s file. Some time ago, CSCI and Wiltshire County Council entered into an agreement that they could keep some records in County Hall and we would inspect them there. However, they agreed to keep a record in the home of the fact that a CRB check had been done, as well as the fact that satisfactory references had been taken up, etc. This was not in place, and the manager had not been issued with any evidence of satisfactory checks. Two staff files we looked at did not have the relevant information, and were missing their photographic ID. Advice and information has been given to several senior Wiltshire County Council managers and has been sent to their HR department, about what CSCI have agreed will be sufficient evidence of recruitment checks. This has also been the subject of requirements at other Wiltshire County Council services. The manager has been asked to ensure that in future all staff files contain the appropriate information, including evidence of an enhaced level CRB check and photographic ID. The “details” form on staff files said that references, CRB checks, passport and driving licence should be available. It is no longer a legal requirement that Bradbury Manor DS0000071503.V364977.R01.S.doc Version 5.2 Page 22 passport and driving licence details are kept. It is also no longer the case that references and application forms will be kept on the home’s files. In order to avoid confusion, it is recommended that Wiltshire County Council management should issue the home’s manager with a list of personnel information which she is to keep in the home. There were some records of staff supervision on file, although staff reported that these meetings had not been happening regularly. The manager explained that staff sickness had impacted on the frequency of supervision sessions, although staff meetings continued to take place. The manager has been asked to ensure that formal, recorded supervision sessions take place regularly. Bradbury Manor DS0000071503.V364977.R01.S.doc Version 5.2 Page 23 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): Service users benefit from a well run home where their views underpin the monitoring and review of care practice. The health, safety and welfare of service users is mostly promoted and protected, although there was no obvious record of fire drills, and some staff had not had manual handling training. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The day to day management of Bradbury Manor is carried out by Karen Taylor. Ms. Taylor was previously a registered manager at one of Wiltshire County Council’s other respite care homes, and has many years experience of working with older people and people with a learning disability. She has achieved an NVQ Level 4 in Management, and an NVQ Level 4 in Care. Bradbury Manor DS0000071503.V364977.R01.S.doc Version 5.2 Page 24 When asked what the home did well, one relative who wrote to us said: “It appears to be well run, from the manager to the caretaker”. Another said: “The staff make the home. To get as good a range of staff members as are at Bradbury Manor is rare as well as fortunate”. Wiltshire County Council conducts regular quality assurance audits internally, and a senior manager visits the home every month to meet with service users and check on various records. The manager completed the Annual Quality Assurance Audit (AQAA) for us, so we could look at what they said they were good at and what they said they wanted to get better. They told us they have established a parents’ support group, “The Friends of Bradbury Manor”, and that they plan for all staff to attend equality & diversity training. The manager has met with an advocacy representative who is going to facilitate service user meetings in the near future. These meetings will be at another site to provide service users with the opportunity to feel more able to express their feelings. This was a recommendation form the facilitator as this type of situation has worked well with other service user groups. A quality assurance questionnaire has been devised by the home for service users and their families. They are asked if they enjoyed their stay and what might be improved on. It is planned to extend this more fully so that all service users and their families have a chance to give their opinions on the home. The service user who wrote to us said that care staff “always” listened to them and acted on what they said. There were some good health & safety records in place. The fridge and freezer temperatures are recorded daily and there are various weekly, monthly and annual checks done to make sure the home is safe. The home’s hoists, tracking systems and fire equipment are serviced on a regular contractual basis. A recent health and safety audit was done by Wiltshire County Council. The home’s fire risk assessment was up to date, and the fire training book showed that all staff had fire training. However, the log where fire safety matters were recorded had no clear evidence of fire drills having been done, although the manager said they had. The manager has been asked to make sure that drills are held and the details recorded. It is recommended that fire drill records should contain information about the time taken to evacuate the building as well as initials of the staff and service user who take part. Although most staff had done manual handling training, some staff had not. As several service users need support with hoists and slings, and the service is specifically designed to work with service users with high needs, this means that some service users are potentially at risk of accidents. The manager has been asked to make sure that all staff receive this training. Bradbury Manor DS0000071503.V364977.R01.S.doc Version 5.2 Page 25 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 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 3 X X 2 X Bradbury Manor DS0000071503.V364977.R01.S.doc Version 5.2 Page 26 N/A 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 2 3 Standard YA6 YA9 YA20 Regulation 15 (2) (b) 13 (4) (c) 13 (2) Requirement All care plans must contain accurate, up to date information. All risk assessments must be reviewed and updated as necessary. A full multidisciplinary review of medication for the service user who has medication disguised in food must be held. The results of the review must be documented and kept on file. All staff must have evidence on file of medication administration training. A log of all complaints made to the service must be kept. All staff must have training in Safeguarding Adults All staff must have evidence on file of infection control training. All staff files must contain the appropriate information, including evidence of an enhaced level CRB check and photographic ID. All staff must receive supervision on a regular basis. All staff must have manual handling training DS0000071503.V364977.R01.S.doc Timescale for action 14/10/08 14/10/08 14/10/08 4 5 6 7 8 YA20 YA22 YA23 YA30 YA34 18 (1) (c) (i) 17 Schedule 4 (11) 13 (6) 13 (3) 18 (1) (c) (i) 17 Schedule 2 18 (2) (a) 18 (1) (c) (i) 14/11/08 14/10/08 14/11/08 14/11/08 14/10/08 9 10 YA36 YA42 14/11/08 14/11/08 Bradbury Manor Version 5.2 Page 27 11 YA42 23 (4) (e) There must be clear evidence of fire drills taking place. 14/10/08 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 3 Refer to Standard YA1 YA6 YA6 Good Practice Recommendations The Statement of Purpose should be amended to include details of the newly appointed Responsible Individual nominated by Wiltshire County Council. Service users support plans should be more tailored to the individual service user, and be more person-centred. The home should obtain a copy of service users’ most recent, up-to-date community care reviews. This will make sure that staff are aware of any changes in the people’s needs and how to care for them. Risk assessments should clearly state the name of Bradbury Manor respite care service not any other service. They should also have one format used consistently. Advice should be sought in relation to capacity issues when administering medication in a covert way. The home’s manager should be issued with a list of personnel information which should be kept in the home. Records of any fire drill should contain information about the time taken to evacuate the building as well as initials of the staff and service user who take part. 4 5 6 7 YA9 YA20 YA34 YA42 Bradbury Manor DS0000071503.V364977.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 Bradbury Manor DS0000071503.V364977.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. Re-publishing this information is in breach of the terms of use of that website. 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