Care Home: Bradley House

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What the care home does well We have noted that despite the unhappiness of the manager and staff regarding the actions we have taken in response to concerns registered with us they have acted too address the improvements we required to improve practices in the home. As a consequencce the home has policies and procedures in place which help in protecting the health and welfare of those that live and work in the home. What has improved since the last inspection? We made a number of requirements at our last inspection and these have all been addressed and improvements made: Night time care plans have been completed which identify care needs of individuals. These will be subject to review and help in making a judgment regarding the continued practice of not having waking night staff in the home. Reviews have been held of all individuals, other then two, so that a clear decision is made as to the needs of individuals continuing to be met through living at Bradley House. There are risk assessments in place regarding individuals access to their rooms particularly where this may present risks associated with use of stairs where no lift is available. The manager has undertaken training to update her skills and knowledge specifically Mental Capacity Act, Deprivation of Liberty, Safeguarding and is due to complete Moving and Handling in January 2010. All staff have completed Safegarding and first aid training with senior staff undertaking Enhanced First Aid. This has raised the awareness of staff in Safeguarding and provided them with the knowledge required when identifying or responding to any concerns they may have where there is possible abuse. The first aid training is crucial in that there are occasions when only one member of staff is on duty. Staffing arrangements have been reviewed and are now subject to monthly review so that there is clear evidence relating to the dependency needs of those living in the home that there are adquate staff on duty at all times. The home has reviewed its practice around responding to individuals when they have had a fall. There is now a specific Falls policy and procedure in place which importantly safeguards individuals from potential harm and enables staff to respond in the manner which is in the best interests of the individual. The use of moving and handling equipment where individuals are on the fall is no longer practiced in the home therby protecting individuals and staff from further harm or injury. A Standing Up Procedure (as part of Fall procedure) is now in place which negates and forbids the use of equipment and used in circumstances where a judgement has been made by a staff member that it is safe to do so. There is now written evidence that the required Fire Alarm tests are taking place. What the care home could do better: This inspection has noted the improvement in practice however the Night Time care plans need to identify any potential support or monitoring needs of individuals during the period when night staff are a sleep. This will further help in making a judgment that the practice of having sleep in staff remains safe and in the best interests of those living in the home. We also identified the need to undertake environmental risk assessments specifically individuals accommodation so that any risks can be alleviated by actions as stated in the risk assessment. We discussed with the manager an individual who has history of leaving their room during the nightime period and has experienced a fall in the early hours of the morning. We discussed how it may at some stage be necessary to look at measures which alert staff and therby alleviate the risk of falls. Any such actions must be taken with regard to restraint policy and possible Deprivation of Liberty safeguarding. Key inspection report Care homes for older people Name: Address: Bradley House High Street Shirehampton Bristol BS11 0DE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: John Clarke     Date: 0 2 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 22 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 22 Information about the care home Name of care home: Address: Bradley House High Street Shirehampton Bristol BS11 0DE 01179235641 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: elisabethlaycock@yahoo.co.uk Mrs Elisabeth Laycock care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: May accommodate up to 10 persons aged 65 years and over requiring personal care. Date of last inspection Brief description of the care home Bradley House is a listed Edwardian building which provides accommodation and personal care for 10 elderly people. The property is arranged over three floors with lift access to one floor and four rooms which are only accessible by stairs. The home has domestic style facilities such as a large kitchen, a large lounge and an extended conservatory which provides additional space which looks out at the large gargen. There is a large dining area, sufficient toilet facilities and bedrooms for single occupancy. The homes aims and objectives are to provide care and to listen to residents concerns and protect them from abuse. The property can be found in the residential area of Shirehampton, in Bristol. The area has a number of amenities on offer such as shops close by, a church and the local bus Care Homes for Older People Page 4 of 22 Over 65 10 0 1 9 0 1 2 0 0 9 Brief description of the care home route which has access into Clifton and the town centre. The home provides twenty four hour staff cover however there is sleep in staff member at night. People can be admitted for emergency admissions. Fees payable and range from £382-£459.23 per week for the total care package; this information was collected during the inspection. People who are funded through the Local Authority have a financial assessment. The home is privately owned and managed by Mrs Elisabeth Laycock. Care Homes for Older People Page 5 of 22 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit to the home as part of our inspection. The focus of this inspection was to look at the requirements made from our previous inspection in August 2009. As a result of that inspection the home was quality rated as Poor through this inspection we were able to make a judgement as to whether the home had met the requirements and review the quality rating. Care Homes for Older People Page 6 of 22 What the care home does well: What has improved since the last inspection? We made a number of requirements at our last inspection and these have all been addressed and improvements made: Night time care plans have been completed which identify care needs of individuals. These will be subject to review and help in making a judgment regarding the continued practice of not having waking night staff in the home. Reviews have been held of all individuals, other then two, so that a clear decision is made as to the needs of individuals continuing to be met through living at Bradley House. There are risk assessments in place regarding individuals access to their rooms particularly where this may present risks associated with use of stairs where no lift is available. The manager has undertaken training to update her skills and knowledge specifically Mental Capacity Act, Deprivation of Liberty, Safeguarding and is due to complete Moving and Handling in January 2010. All staff have completed Safegarding and first aid training with senior staff undertaking Enhanced First Aid. This has raised the awareness of staff in Safeguarding and provided them with the knowledge required when identifying or responding to any concerns they may have where there is possible abuse. The first aid training is crucial in that there are occasions when only one member of staff is on duty. Staffing arrangements have been reviewed and are now subject to monthly review so that there is clear evidence relating to the dependency needs of those living in the home that there are adquate staff on duty at all times. The home has reviewed its practice around responding to individuals when they have had a fall. There is now a specific Falls policy and procedure in place which importantly safeguards individuals from potential harm and enables staff to respond in the manner which is in the best interests of the individual. The use of moving and handling equipment where individuals are on the fall is no longer practiced in the home therby protecting individuals and staff from further harm or injury. A Standing Up Procedure (as part of Fall procedure) is now in place which negates and forbids the use of equipment and used in circumstances where a judgement has been made by a staff member that it is safe to do so. There is now written evidence that the required Fire Alarm tests are taking place. Care Homes for Older People Page 7 of 22 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 22 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 22 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Our inspection of January 2009 found that the home undertakes the necessary preadmission assessment so that they can make an informed judgement as to the capacity of the home to meet the individuals health and social care needs. Evidence: We did not examine this standard on this inspection. However this area of the homes practice was looked at at our previous inspection in January 2009 and found to be satisfactory. Care Homes for Older People Page 10 of 22 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care Planning and arrangements for meeting health needs of indidividuals living in the home are good and identify specifially the needs of individuals at night and potential areas of risk. The arrrangements for the managing of medication include weekly audit of medication given to individuals and management of stock so that individuals medication needs are met and their health protected. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. Evidence: We looked at a number of care plans specifically in relation to requirements made at our last inspection. Night Time care plan had been completed showing needs of individual in relation to specific tasks, signed by individual: Getting Prepared for bed, use of Commode, Medication, Going to sleep. Personal risk assessment completed with review noting potential risks associated with individuals finances. Resident Bedroom Access assessment in relation to location of room in house completed. Risk assessments completed regarding mobility and falls. Care Plans had all been reviewed regularly. Care Homes for Older People Page 11 of 22 Evidence: We looked at records which showed that weekly audit and check of stock with regard too medication had taken place. Care Homes for Older People Page 12 of 22 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides good opportunities for individuals who live in the home to undertake activities and provide an environment where there is flexibility so that individuals are enabled to make choices about their daily lifes. The meals provided in the home meet the dietary needs of those living in the home. Evidence: We did not look at this area of the homes practice on this inspection. However the inspection of January 2009 was satisfied that the home provides the necessary level of service in relation to Daily life and social activities standards. At the time of our visit however individuals were making personal christmas greeting cards with the assistance of the activities co-ordinator. Care Homes for Older People Page 13 of 22 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has policies and procedures in place which help in protecting individuals from harm and staff have completed Safeguarding training. There are policies and procedure in place to enable individuals who live in the home to make a complaint if they so wish. Evidence: We looked at staff training records and found that all had completed Safeguarding training. The manager has completed Safeguarding, Mental Capacity Act and Deprivation of Liberty training. An assessment has been completed regarding the locking of the homes front door. This is now kept open during the day with alarm which sounds when the door is opened whilst at night the door is locked. We looked at the revised Moving and Handling Fall policy which clearly states the actions staff must take to protect individuals from harm in the event of a fall. Identifying actions where possible injury has occurred and care staff to make assessment for need to contact paramedics. Since our last inspection staff have responding in this manner. We spoke with a Senior Care Assistant and they were able to state correctly the home policy. All staff have been issued with this policy and procedure regarding Falls and Standing Up Procedure. This was discussed at residents meeting and demonstrated to those present all of whom accepted the procedure. Care Homes for Older People Page 14 of 22 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe and hygenic environment and facilities are available so that the health and social care needs of individuals can be met in a safe and efficient manner. Evidence: We did not look at the environment on this inspection our previous inspection in January 2009 was satisfied with the environment of the home. It is noted however that in discussion with the manager she advised that work is being undertaken to raise the height of stair bannisters where they may pose a risk to individuals. At our previous inspection we noted the use of moving and handling equipment namely hoist where individuals have had a fall. The home now uses no such equipment in these circumstances. Care Homes for Older People Page 15 of 22 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing arrangements of the home are satisfactory and meet the needs of those living in the home and are subject to review taking into account the changing needs of individuals. Training of staff helps to make sure they have the necessary skills and knowledge to perform their duties in an efficient and competent manner. Evidence: Since our last inspection staffing levels have been reviewed using dependency and guidance issued by CQC. This established adequate staffing is available currently 8 of 9 individuals have low needs and 1 has medium level care needs. Staffing levels are reviewed monthly. Training records we looked at showed that staff have completed Safeguarding training, First Aid with senior staff to complete Enhanced First Aid training. It is noted that a number of staff have recently completed NVQ professional qualification this is to be commended. The manager of the home will be undertaking Moving and Handling training for manager in January 2010 and senior staff will complete Mental Capacity Act training. We did not look at recruitment and selection however our inspection of January 2009 was satisfied that there the required procedures in place. Care Homes for Older People Page 16 of 22 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has acted to address the shortfalls in practices of the home so that the health and welfare of individuals is as far as possible protected. However the undertaking of environmental risk assessments specifically individuals accommodation would help in identifying potential risks and assist in alleviating risks to individuals welfare. Evidence: The manager as required completed our Improvement plan in response the requirements made at our last inspection. She has acted in a professional manner in addressing the concerns and previous poor practice which we identified. Revised procedures are now in place specifically responding to Falls and incidents, DOLLS assessment where this is required, identifying of night time care needs, improved risk assessments. The manager has undertaken the training we identified too update her practice. We looked at records relating to tests of fire equipment and found that fire alarms Care Homes for Older People Page 17 of 22 Evidence: tests are carried out weekly, staff have completed fire drills and associated training. In discussion with the manager she advised that individual room risk assessments had not been completed. Care Homes for Older People Page 18 of 22 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 19 of 22 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 13 The manager to make sure 31/12/2009 that all parts of the home to which individuals have access to are so far as reasonably practicable free from avoidable risks and unnecessary risks to the health and safety of individuals are identified and so far as possible alleviated. This relates to the need to undertake risk assessments of individuals accommodation particularly where this may present risks or there is history of potential harm to that individual as a consequence of the environment. Care Homes for Older People Page 20 of 22 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 38 To keep under review the need to have in place equipment or actions to reduce the level of risks to individuals where they may be at risk of falls or harm. Such actions to be taken with full agreement and consent of those affected, within Mental Capacity Act, DOLLS guidence and good practice, taking into account restaint concerns and following good practice in this regard. Care Homes for Older People Page 21 of 22 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 22 of 22 - 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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