Care Home: Bradmere

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What the care home does well Resident`s needs are thoroughly assessed prior to admission and care plans are developed based on these needs assessments. Residents confirmed that they are fully involved in decisions that affect their day-to-day lives. It was evident that the needs of residents are put first with an emphasis on encouraging individual choice. Records demonstrated that residents had regular access to local health and social care professionals to meet their needs. Staff demonstrated a good awareness of residents` needs and were seen to be supporting people well. The residents in this home are supported and encouraged to contribute on how the home is run, and are able to talk or show their concerns and worries and be able to make choices that affect them. From talking to residents and staff, the service showed that they encourage people to be as involved as possible in areas such as keeping their home and personal space clean and homely. Each resident is supported to keep his room clean. Residents are encouraged to make their own decisions and choices about holidays, social and leisure events. There was good access to medical and health treatment, and residents were supported to keep appointments with healthcare professionals. The home helps residents to maintain their health and wellbeing through supporting them to regularly visit their GP, dentist, optician and specialist health providers. The home has a lot of knowledge and understanding of people`s specific individualhealth needs and works closely with other healthcare services to monitor and respond to any changes. Residents who were spoken to said that they were very happy at Bradmere. One resident said, "People are very friendly here. One resident said he was very happy in the home, "you can talk to them about anything". Residents have had residents` meetings and their views and opinions have been listened to. The meetings have also served the purpose of letting residents know the rules and regulations about living at Bradmere and what they are able to do. Additional meetings are to take place on a regular basis to keep residnets informed for example about planned changes and to empower them to have a say in what happens. What has improved since the last inspection? We were told that all residents, and any new people making enquiries are now provided with up to date information about the service enabling them to make an informed choice about the care and support arrangements. There was evidence of an ongoing rolling programme of refurbishment and decoration throughout the home. This ensures that residents can benefit from and live in a clean and homely environment. We were told that the lounges and dining room has benefited from having new carpets fitted. A new kitchen has been installed and new fridge, dishwasher and flooring has been fitted. Residents were pleased with the kitchen and one resident said, "it`s so modern it`s lovely". What the care home could do better: Care plans need to be reviewed regularly to ensure that any recent identified needs had been added to the plan. This will ensure that no care needs are overlooked when staff are providing support to individuals. Residents should be encouraged to sign their care plans to provide written evidence that they agree to the contents. Risk assessments should be further developed to include information on how risks are to be managed, such as the prevention of falls or when selfadministering some of their medication. The manager needs to keep a record of all complaints or issues raised made by residents, or relatives, friends or stakeholders, and detail any investigations, the action taken and the outcome.Staff need to be provided with formal training in adult protection to ensure they are aware of the differing types of abuse and how to recognise and act of these matters. To safeguard residents and staff the manager needs to provide staff with updates in their mandatory training and training in mental health to further develop their expertise and knowledge CARE HOME ADULTS 18-65 Bradmere 16 Franklin Street Patricroft Eccles Gtr Manchester M30 0QZ Lead Inspector Kath Oldham Unannounced Inspection 13th August 2008 08:15 Bradmere DS0000008343.V369861.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 Bradmere DS0000008343.V369861.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. Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bradmere Address 16 Franklin Street Patricroft Eccles Gtr Manchester M30 0QZ 0161 787 8631 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) Mrs Joan Rawlinson Mr Bradley Rawlinson Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 4 named individuals have a physical disability in addition to a mental disorder. 8th May 2007 Date of last inspection Brief Description of the Service: Bradmere is a care home providing personal care and accommodation for up to 12 adults with enduring mental ill health. The home has good links with the Forensic Psychiatric Service and provides accommodation to some people who have mental health needs. Admission for people with these needs is dependent upon a thorough assessment of risk. The main aim of the home is to provide a rehabilitation service for younger adults who have experienced a period of hospitalisation. Long-term care is provided dependent on the assessed needs and aspirations of the individual resident. Bradmere forms part of the Bradmere and Merrymeet Care Group, which includes a second care home and a domiciliary care agency. The home is situated in the Eccles area of Salford, close to local shops, pubs and public transport routes. The home is a large modern style house with car parking at the front and a garden at the rear. Fees for the home range from £343.64per week to £612.32 per week. There are no additional charges. Bradmere DS0000008343.V369861.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 two stars. This means the people who use this service experience good quality outcomes. This visit was unannounced, which means the manager and staff were not told we would be visiting, and took place on 13th August 2008, commencing at 8:15am until 3:10pm. The inspection of Bradmere included a look at all available information received by the Commission for Social Care Inspection (CSCI) about the service since the last inspection in May 2007. We also sent the manager a form before the visit for him to complete and tell us what they thought they did well, and what they need to improve on. The manager completed this. We considered the responses and information provided and have referred to this in the report. We call this form the Annual Quality Assurance Assessment (AQAA). We undertook an Annual Service Review in May 2008 and as a result of that review because we did not know how people who use the service feel about the support they receive, we changed our inspection plan and decided to do the key inspection earlier than planned. Bradmere was inspected against key standards that cover the support provided, daily routines and lifestyle, choices, complaints, comfort, how staff are employed and trained, and how the service is managed. Comment cards were sent prior to the inspection for distribution to staff and posted to specific residents to obtain their views of the service, the views expressed in returned comment cards and those given directly to the inspector are included in this report. We found our information at the visit by observing care practices, talking with people staying at Bradmere; talking with the manager and staff. A tour of Bradmere was also undertaken and a sample of care, employment and health and safety records seen. The main focus of the inspection was to understand how Bradmere was meeting the needs of residents and how well the staff themselves were supported to make sure that they had the skills, training and supervision needed to meet the needs of residents. The care service provided to two residents was looked at in detail to help form an opinion of the quality of the care provided. Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 6 A brief explanation of the inspection process was provided to staff on arrival at Bradmere. Time was spent at the end of the day to provide verbal feedback to the manager. Since the last inspection CSCI have not received any complaints about Bradmere. During the visit lots of information was gathered about the way Bradmere was run, which included the assessment of records relating to care planning and medication. The inspector spoke to several people living at the home, the manager and the staff team about the day to day care, support and management available at Bradmere. The term preferred by people using the service was ‘residents’. We have therefore referred in this report to the residents at Bradmere. What the service does well: Resident’s needs are thoroughly assessed prior to admission and care plans are developed based on these needs assessments. Residents confirmed that they are fully involved in decisions that affect their day-to-day lives. It was evident that the needs of residents are put first with an emphasis on encouraging individual choice. Records demonstrated that residents had regular access to local health and social care professionals to meet their needs. Staff demonstrated a good awareness of residents’ needs and were seen to be supporting people well. The residents in this home are supported and encouraged to contribute on how the home is run, and are able to talk or show their concerns and worries and be able to make choices that affect them. From talking to residents and staff, the service showed that they encourage people to be as involved as possible in areas such as keeping their home and personal space clean and homely. Each resident is supported to keep his room clean. Residents are encouraged to make their own decisions and choices about holidays, social and leisure events. There was good access to medical and health treatment, and residents were supported to keep appointments with healthcare professionals. The home helps residents to maintain their health and wellbeing through supporting them to regularly visit their GP, dentist, optician and specialist health providers. The home has a lot of knowledge and understanding of people’s specific individual Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 7 health needs and works closely with other healthcare services to monitor and respond to any changes. Residents who were spoken to said that they were very happy at Bradmere. One resident said, “People are very friendly here. One resident said he was very happy in the home, “you can talk to them about anything”. Residents have had residents’ meetings and their views and opinions have been listened to. The meetings have also served the purpose of letting residents know the rules and regulations about living at Bradmere and what they are able to do. Additional meetings are to take place on a regular basis to keep residnets informed for example about planned changes and to empower them to have a say in what happens. What has improved since the last inspection? What they could do better: Care plans need to be reviewed regularly to ensure that any recent identified needs had been added to the plan. This will ensure that no care needs are overlooked when staff are providing support to individuals. Residents should be encouraged to sign their care plans to provide written evidence that they agree to the contents. Risk assessments should be further developed to include information on how risks are to be managed, such as the prevention of falls or when selfadministering some of their medication. The manager needs to keep a record of all complaints or issues raised made by residents, or relatives, friends or stakeholders, and detail any investigations, the action taken and the outcome. Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 8 Staff need to be provided with formal training in adult protection to ensure they are aware of the differing types of abuse and how to recognise and act of these matters. To safeguard residents and staff the manager needs to provide staff with updates in their mandatory training and training in mental health to further develop their expertise and knowledge 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. Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 9 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 Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People coming to the home can be confident their needs will be assessed prior to moving into the home. EVIDENCE: When a person considers moving into Bradmere the manager would visit the proposed resident to carry out a full assessment of their needs, this is to ensure that Bradmere is equipped with the resources to meet the individuals’ needs and wishes. All placements to Bradmere are pre planned with no emergency placements being arranged. We were told that the planning and assessment process can take six months and possibly more to make sure the manager has all the detail relating to the prospective resident. We were told that the manager receives a lot of referrals many of which are not accommodated at the home due to the residents needs, the needs of current residents, staff skills and knowledge and the building. We were told that all these factors are considered before accepting a resident to attend for trail visits. We were told that prior to a person moving into the home they would visit Bradmere and spend time with the residents and staff before they made a decision to move in. The person’s needs would be fully assessed to establish Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 11 their needs, likes, dislikes and aspirations to ensure that Bradmere had the facilities to meet the persons needs. A resident said, “At my introductory interview to Bradmere, I was encouraged to ask as many questions as I could regarding Bradmere and given additional information as well”. A further resident told us, “I personally found out about this residence from acquaintances whom resided here several years ago”. And added, “I visited Bradmere approximately ten occasions (weekly-afternoons) and I also read some information from a ‘brochure’ and the ‘notice board’ as well as learning info from some of the staff, in particular the manager” Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans provided details of residents’ care needs and the interventions required to meet needs. Risk assessments are in place to ensure the safety and well being of residents. EVIDENCE: Individual care plans were available for all residents. The care planning and recording system for recording peoples needs and wishes relating to their care, their long term needs, personal information details and personal history of the resident has been included. A selection of these records were assessed during the visit. Most care plans contained informative information about the resident and their needs. It is essential that all care and support offered and delivered throughout the day is recorded. The care planning format gave staff the opportunity to record information about each individual on a daily basis. Several of these records were read and were informative. A resident, in response to the question do the Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 13 staff treat you well said, “very well”. Another resident said, “always looking after me”. “I feel wonderful here”. Support plans and risk assessments considered the potential for changes in an individual’s capacity to make decisions when experiencing changes to their health and welfare needs. This information was recorded to ensure that staff supporting residents are aware of all aspects of the residents needs. A member of staff said, “We are given very detailed and informative care plans on each resident we also have in depth handovers especially if there is a change of needs for a resident”. It is important that support plans contain detailed up to date information to ensure that people receive the care and support they require. The care plans need to be regularly reviewed and recorded as such so it is clear that the care needs are as identified within the plan. A resident said, “I developed my independence and confidence at Bradmere which helped me in preparing me to live in my own flat”. Individual risk assessments were available on residents care plans. These assessments were reviewed along with other care plan information. Support and risk assessment documentation available in residents’ files was not always dated. All assessments should be dated and signed by the people involved and a new review date set. To protect residents from the risk of fire it was practice for some residents to hand their cigarettes to staff for safekeeping before going to bed at night. This information should be included in residents risk assessments. Risk assessments had been undertaken for the two residents case-tracked. These assessments need to be further developed by including more detail about the management of risk, such as in the prevention of falls. Residents said that they were involved in care planning. If they are encouraged to sign their care plans this would provide written evidence that individuals agree to the support they will receive. A resident said, “I am fortunate that I am classified as high functioning but Bradmere staff provided me with support with any counselling needs that I had during my stay”. Staff were seen supporting residents in a positive and respectful manner. During the visit staff were observed supporting residents to make decisions. Several residents were observed being supported by staff to manage their finances; another resident was observed being supported by staff to contact their care manager and another resident was seen being assisted to contact family by telephone. Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 14 Residents were supported to keep appointments with a range of health care professionals, including hospital appointment, regular contact with community psychiatric nurses, and dental and optical appointments. In response to the question what does the service do well one member of staff said, “Caters well for the physical and mental health of residents”. Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 15 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, 14, 15, 16 &17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to engage in activities and maintain social contacts and benefit from participating in recreational activities EVIDENCE: There was evidence that residents were participating fully in their local community. Information was available for them about local activities and opportunities that they could access. This included advice and support groups provided by specialist organisations and it was evident that residents were accessing such services. A resident said, “My family and friends were welcome to visit me at Bradmere by being invited to meals etc”. “My family were made aware of any changes that affected me”. Support is provided to enable residents to develop and maintain their personal and family relationships. Staff viewed these relationships as a valuable resource and had taken the opportunity to use these resources creatively to promote residents’ wellbeing and personal development. A resident said, Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 16 “Residents can decide what to do or where to go each and every day except when we have to honour appointments with such people as doctors, therapists, consultants, CPNs, social workers etc”. Another resident said, “I am a highly motivated person and developed my living, social and personal skills whilst living at Bradmere”. When asked what do you feel the care home does well one resident said, “Helps the individual to succeed”. Throughout the inspection the atmosphere in the home was very relaxed. The comments in surveys stated that the service supported individuals to live the life they choose. A relative said, “ my relative is an alcoholic and can be very difficult at times but the staff are always there to listen and advise X and are extremely patient”. A resident said, “It is a very welcoming environment”. During this visit, residents were seen coming and going independently. One resident talked about the pleasure they experienced from shopping. Staff were observed engaging in meaningful conversations with residents, asking about their day and what their plans were for the following day. In response to the question how do you think the care home can improve one resident said, “Structured activities for those residents who spend most of their time in the home and organised days out”. Daily routines were flexible and residents could choose when to be alone or in company. Residents are expected to take responsibility for keeping their private space clean and tidy, and to help with household tasks although support is available if needed. Residents should have the opportunity to choose from a varied, appetising, nutritionally balanced menu to ensure their nutrition needs can be met and that they have a choice of meals/food. A menu system is not used, as meal planning was flexible and decided by the people in the home on a daily basis. People helped themselves to breakfast and staff provided support in preparing the midday and evening meals. Residents were observed helping themselves to drinks and snacks during the visit. A member of staffs’ response to the question what does the service do well said, “We also provide a healthy varied diet”. Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have access to flexible routines and the full range of community healthcare services, which has positive outcomes for their health and wellbeing. Policies and procedures are in place to ensure the health and well being of these people EVIDENCE: Staff demonstrated a good awareness of individual resident’s mental and social healthcare needs. Records demonstrated that residents had access to local community mental health services and social workers when required. This included visits to local clinics for the monitoring health and hospital appointments. All residents were registered with a local GP and residents told us that they could request to see their doctor at any time. There was information available to residents to inform and promote the use of independent advocacy and self advocacy groups available locally. These services are promoted to ensure that residents have an awareness of independent services available to them outside of their home. A relative said, “I feel they do an excellent job. Also the home is always nice and clean and they work as a team”. Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 18 Medication was appropriately stored and all medication administered was recorded on Medication Administration Records (MAR). A medication policy was in place. All staff responsible for the administration of medication have received training. There is a need for updates to be received to this training to ensure compliance and to keep up with changes in practice and routines. It is essential that all medication is managed and dispensed appropriately to ensure that all records are maintained to demonstrate that all medication has been administered appropriately and that residents are receiving medication prescribed for them. Overall, the practice of handling medication in the home was carried out in a manner to ensure the safety and well being of residents. Medication was administered using a monitored dosage system. Medication records (MAR), contained sample signatures of those staff responsible for the administration of medication. When we looked at the medication records for the period commencing 23rd July 2008 to the date of this visit. We found that some symbols were used for the omission of medication, which were not explained. The reason why the symbol “O” is used needs to be explained in line with Bradmeres’ procedure. There was handwritten medication on the medication records. To safeguard residents and to make sure staff have copied the detail correctly from the prescription best practice indicates that a second member of staff should also sign the record to verify that the entry is correct. A label was attached to the medication records over printed instructions. We were told that this was because the medication had been changed. When this happens a separate entry should be made on a separate line so the records of medication administration is accurate. It would be best practice if the manager resumes the task of carrying out regular audits of medication and assessment of staff competency levels in carrying out medication administratin. Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and systems are in place to support residents in making a complaint and to ensure they are protected from abuse. EVIDENCE: The home had a complaints procedure. We asked to look at the complaints record, which couldn’t be located as we were told there had been no complaints made since 2003. The manager needs to hold a complaints record and detail within the record the complaints, which have been made to the manager and staff, and how they have been addressed. During this visit, residents were seen approaching staff with issues and concerns. The staff team took time to listen and respond appropriately. A resident said, “I have never found it necessary to process my complaints further than the staff and have found this method to be effective”. “To my knowledge there weren’t any concerns about my care”. A relative said, “I have had no reasons for concerns as I visit Bradmere on a regular basis and can see the high level of care and attention each individual receives”. A further resident said, “I feel that if I had a complaint I could go to staff failing that manager”. Another resident told us, “There are various channels through which to address a viable complaint either to the management or from addresses and or telephone numbers of individuals of organisations”. Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 20 The complaints procedure and records can be used as a development tool and used to see if there are any patterns to the comments and complaints made to staff. The Commission for Social Care Inspection has not received any complaints about this service Training records demonstrated that staff had attended ‘in house’ awareness training on the Protection of Vulnerable Adults. Staff who were spoken to during this visit were able to demonstrate an understanding of issues surrounding abuse. It is recommended that staff receive awareness training on Salford Social Services Safeguarding procedure so that they are aware of what actions to take if they suspect an abusive situation has taken place. The Manager was aware that Social Services took the lead following an allegation of abuse and that Commission had to be informed. There have been no safeguarding matters reported to the Commission. Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 21 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Bradmere is maintained, decorated and cleaned to enable residents to live in a pleasant, hygienic and safe environment. EVIDENCE: During this visit a tour of the building was undertaken. This included communal areas and a selection of residents’ bedrooms. There were several communal areas where residents could spend their time, or they could access their rooms when they chose. There was a designated smoking area. Service users who were spoken to said they liked their accommodation. The home presented as clean and tidy, with no unpleasant odours. Residents and staff and the visitor spoken to, confirmed this as the usual state of the home. We were told that since the last inspection 4 bedrooms had been redecorated and there was a rolling programme of decoration and replacement of furniture and carpets. Some of the carpets were in need of replacement particularly in bedroom 11 and in the hall stairs and landing. The carpets here were very Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 22 dirty. We were told that the replacement of the carpets had been organised and would be fitted in forthcoming months. The lounge and dining room carpets have been replaced in recent months and a new kitchen has been fitted. Residents said they liked the kitchen and it was much better. New white goods had also been purchased for the kitchen. Residents commented on enjoying sitting out in the back garden and the fact that it was quiet and private. One of the residnets kept the back garden tidy and was busy working in the garden on this visit. In response to the question is the home fresh and clean a resident who responded, “always” added, “The day to day cleanliness and freshness of the throughout the building is vested as quite an important issue as it jolly well should be”. Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 23 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff on duty promotes the independence and well being of residents. EVIDENCE: Staff stated in their survey forms that there were usually enough staff on duty to meet the individual needs of the residents. When asked do the care staff have the right skills and experience to look after people properly. One residents said, “I think so, the care staff are friendly and efficient and provide support when needed”. “Each individual at Bradmere is respected for the person they are and not judged in any way”. Discussion took place during the visit regarding other possible training that staff may require to carry out their role. These areas of training included equality and diversity, person centred planning, risk management training and awareness of the Mental Capacity Act to promote person centred care within a social care setting. Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 24 Staff stated that they were being given training that was relevant to their role, that helps them understand and meet individuals’ needs and that keeps them up to date with new ways of working. Staff who were spoken to reported that the manager were very supportive of staff taking up training opportunities. We were told that there had been no new staff appointed at Bradmere since the last inspection in 2007. Two staff files were looked at to find out what training they had undertaken recently. The staff files records contained completed application forms, written references, statement of terms and conditions of the role. A member of staff said, “My induction covered all I needed to know regarding my job. It was very comprehensive induction”. We were also told in the comment cards we received, “Training which is relevant to my job my manager arranges. Our training up to date and relevant to the type of clients we look after”. A further staff said, “Our training is also up to date”. We were told that one of the staff had BTEC in Care Management and two staff had recently enrolled to obtain NVQ 2 qualifications. Homes should have now achieved a ratio of 50 trained care staff. Once these staff have achieved this qualification they will be on the way to having half of the staff team trained to NVQ standards. Staff were not recorded as having taken part in any training in mental health. We were told that informal training sessions had been undertaken over the years. To support the continuing development of the staff team training in this specialism needs to be arranged. Training undertaken was also included in the staff files. Looking at the training it was apparent that updates were needed as some staff hadn’t had mandatory training in excess of the recommended frequency. Residents who completed survey forms stated that the staff always treat them well and that staff listen and act on what they say. A duty roster is in place and details the names of the staff on duty. A copy of the duty roster for the week commencing 11th August 2008 was looked at. This indicated that staffing levels were usually maintained at two carers on duty between 8:00am and 8.00pm each day with a member of staff on sleeping duty. The manager is also indicated on the duty roster predominantly office hours Monday to Friday and provides on call support outside of these hours and at weekends. These numbers presented as being appropriate to meet the needs of residents living at Bradmere. In addition to the care staff, residents benefit from ancillary staff who provide domestic support for two hours each day during the week. Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager presents as qualified and competent to manage the service for the benefit of the residents. Most of the home’s health and safety procedures are implemented for the benefit of residents and staff EVIDENCE: All residents and staff who were spoken to were very positive about the manager’s approach and competency. The manager was reported as having appropriate qualifications for the role, including the Registered Managers Award. Proof of those qualifications was not sought at this inspection. The manager reported that a formal, structured, quality assurance system was still under development. In spite of the absence of a formal quality assurance, residents reported being involved in their care planning, and felt listened to. Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 26 Occasional residents meetings were held. The meetings offer another forum where residents’ views are aired. Residents meetings formed part of the services quality assurance system and a copy of the minutes to the most recent meeting, were available. We were told, “Residents views and problems are usually taken note-of at particular times and there is usually some amendments and or action decided upon”. Staff confirmed that regular checks of fire detection equipment took place. No obvious risks to health and safety were observed during this visit. We looked at the fire safety records these were completed in line with procedures. The record of fire drill practice training did not confirm that staff had taken part in this. Residents were indicated but the names of staff were not. Staff did say that they had completed fire drills routinely. The home had a policy and procedure for supporting people with their personal finances. Financial transactions were recorded and the resident signs the record. The manager needs to resume the task of sending out quality assurance surveys to health and social services professionals, relatives and residents. There were records available of comments made about the service in May 2004 and June 2006 but nothing more recent than this. We were told that the administrator was scheduled to organise this by sending out surveys. Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 27 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 2 36 X 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 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations Care plans need to be regularly reviewed, so that current care needs are added and included in the care plan. This will ensure that care needs are not overlooked and that staff have the correct, up to date information to help them to support residents appropriately. Residents should be encouraged to sign their care plans to provide written evidence that they agree to the contents. Risk assessments should be further developed to include information on how risks are to be managed, such as the prevention of falls. When medication is handwritten on the medication records make sure it is signed by staff and also signed as being accurately copied from the prescription by a second member of staff When symbols, which need defining, are used on the medication records make sure that each occasion is DS0000008343.V369861.R01.S.doc Version 5.2 Page 29 2 3 YA6 YA9 4 YA20 5 YA20 Bradmere 6 YA20 7 YA20 8 9 10 11 YA22 YA23 YA35 YA38 12 YA39 defined for the date the symbol was used. When new or differing medication is prescribed to residents when the medication records have already been printed make sure that labels are not fixed onto medication records. The manager should resume the task of carrying out regular audits of medication and assessment of staff competency levels in carrying out this task, so that residents can be confident that they are supported appropriately to receive their medication safely Keep a record of all complaints or issues raised made by residents, or relatives, friends or stakeholders, details of any investigations, action taken and the outcome. Provide staff with formal training in adult protection ensuring they are aware of the differing types of abuse and how to recognise and act of these matters To safeguard residnets and staff provide staff with updates in their mandatory training and training in mental health to further develop their expertise and knowledge To confirm staffs attendance at fire drill practice training ensure they sign when this is provided. So in an emergency situation the manager is confident that staff will know what to do and their signature will act as confirmation that they have understood the training provided. Reintroduce the quality assurance and quality monitoring procedures based on seeking the views and opinions of residents, relatives and professionals visiting or having contact with Bradmere which can support the manager to measure success in achieving the aims and objectives. Bradmere DS0000008343.V369861.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North West Region Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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. 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