Latest Inspection
This is the latest available inspection report for this service, carried out on 13th October 2009. CQC found this care home to be providing an Adequate service.
The inspector found no outstanding requirements from the previous inspection report,
but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.
For extracts, read the latest CQC inspection for Brightbow Lodge & Brightbow Court.
What the care home does well The people at the home made positive comments about the standards of care received. We were told that that ICPA meetings, where needs are discussed with them, the staff, health and social care professionals and where appropriate their relative`s present, takes place at least annually. There are opportunities for learning, education and occupation and there is better contact with the community. People said that they knew who to approach with complaints and generally people felt safe at the home. When we asked about the staff, we were told that staff were respectful and knew how to meet their needs. Staff said that training and vocational qualifications is available and encouraged by the service providers. They felt informed about the needs of the people at the home and therefore skilled to meet their needs. What has improved since the last inspection? The re-design of the accommodation into smaller units of 7-13 people, has shown a commitment to a less institutional way of working. The large dining room has been divided into an office, meeting room and activity area creating a space where people can participate in leisure activities ensuring that they are motivated. The health and social care professional said that there is a forward move to promoting independence and that the staff are working cohesively with people that have complex needs. Staff said that there had been a vast improvement with the leadership of the home, which has raised the standards of care. What the care home could do better: There are seven requirements arising from this inspection that mainly hinge on the care planning process. It will ensure that people at the home receive personalise care, empowering them to shape the lives they lead. The Statement of Purpose must include Privacy and Dignity policy, the age ranges, the room sizes and the range of needs that can and cannot be met, with the way the two units function. This will ensure that people wishing to live at the home can make decisions about moving there. Care plans must show that people have a say about the way their care is to be delivered. Their likes, dislikes and preferred routines must form part of the action plans. Risk assessments must include the triggers, signs and symptoms of a deteriorating mental health, with management plans that guide the staff on the actions to be taken to meet the individual`s needs. Where cigarettes are held in safekeeping, risk assessments must show that the actions reduce the level of risk and that the person was involved in the formulation of the risk assessments. The manager must ensure that the recruitment process is robust and the process must confirm that only staff suitable to work with vulnerable adults are employed. Where there are inconsistencies between the information sought and the applications form, a clear process to test the candidate`s integrity must be followed, references must be validated by the referee and where possible, one reference must be from the last employer. Mental health Awareness and Responding to behaviours that challenge training must be provided to the staff, so that they have the insight and the necessary skills to meet the changing needs of the people at the home. Fire risk assessments must be completed to ensure that preventatives measures are put in place to reduce the potential of fire, particularly where people smoke. Key inspection report
Care homes for adults (18-65 years)
Name: Address: Brightbow Lodge & Brightbow Court 11-16 Philip Street Bedminster Bristol BS3 4EA The quality rating for this care home is:
one star adequate 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: Sandra Jones
Date: 2 0 1 0 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 Adults (18-65 years)
Page 2 of 35 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 Adults (18-65 years) 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 Adults (18-65 years) Page 3 of 35 Information about the care home
Name of care home: Address: Brightbow Lodge & Brightbow Court 11-16 Philip Street Bedminster Bristol BS3 4EA 01179636409 F/P01179636409 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Lodge Rest Limited Name of registered manager (if applicable) Mrs Angela Olive Sankey Mrs Ann Wickham Type of registration: Number of places registered: care home 54 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Manager must be a RN on parts 3 or 13 of the NMC Register May accommodate up to 20 persons aged 18 - 64 years with mental disorder requiring personal care excluding persons detained under the Mental Health Act 1983 May accommodate up to 54 people aged 65 years and over with mental disorder requiring nursing and/or personal care within the existing registered numbers, excluding persons detained under the Mental Health Act 1983 May accommodate up to 54 persons aged 18 - 64 years with mental disorder requiring nursing care excluding persons detained under the Mental Health Act 1983 Staffing notice dated 28/4/1994 applies Date of last inspection 54 Over 65 54 Care Homes for Adults (18-65 years) Page 4 of 35 Brief description of the care home Brightbow Lodge and Court are located close to the city centre, within walking distance of local shops and amenities. Main bus routes and bus stops are nearby. The home has two separate premises on the same grounds but the two buildings have different managers and care staff. Brightbow Court has a manager but the ultimate managerial responsibility for the whole site is with the nurse manager based in Brightbow Lodge. The homes offer 24-hour social and nursing care, and are able to meet a range of needs. The people using services in these homes have a diverse range on needs. The diverse needs have been recognised by the service and individuals who were classified as continuing care are now being carefully relocated to services that provide continuing care. Current service users that do not need continuing care are engaging with staff within a re-enablement strategy. The description of a re-enablement strategy and what it means for people using the service should appear in the statement of purpose. The home has an activities organiser who works with individuals to develop individualised, activity programmes. The emphasis is towards social, recreational, educational, or employment skills training. The cost per week to live in Brightbow Lodge or Court for new residents, is #600 and fees are reviewed annually. This weekly fee does not include the cost for items such as hairdressing, chiropody, dental, ophthalmic, or audiology services. Prospective residents can be provided with information about the home by using the Service Users Guide, which details the services and facilities offered by the home. Care Homes for Adults (18-65 years) Page 5 of 35 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home
peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was conducted unannounced over three days in October 2009 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined and feedback was sought from individuals and staff. Prior to the visit some time was spent examining documentation accumulated since the previous inspection. This information was used to plan the inspection visit. There are fifty-two individuals living at the home and six were case tracked during the inspection. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The homes policies and procedures were also Care Homes for Adults (18-65 years)
Page 6 of 35 used to confirm the findings. The views of the people living at the home, social and health care professional, and staff were gathered through face-to-face discussions. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: There are seven requirements arising from this inspection that mainly hinge on the care planning process. It will ensure that people at the home receive personalise care, empowering them to shape the lives they lead. The Statement of Purpose must include Privacy and Dignity policy, the age ranges, the room sizes and the range of needs that can and cannot be met, with the way the two units function. This will ensure that people wishing to live at the home can make decisions about moving there. Care plans must show that people have a say about the way their care is to be delivered. Their likes, dislikes and preferred routines must form part of the action plans. Risk assessments must include the triggers, signs and symptoms of a deteriorating mental health, with management plans that guide the staff on the actions to be taken to meet the individuals needs. Where cigarettes are held in safekeeping, risk assessments must show that the actions reduce the level of risk and that the person was involved in the formulation of the risk assessments. The manager must ensure that the recruitment process is robust and the process must confirm that only staff suitable to work with vulnerable adults are employed. Where there are inconsistencies between the information sought and the applications form, a Care Homes for Adults (18-65 years)
Page 8 of 35 clear process to test the candidates integrity must be followed, references must be validated by the referee and where possible, one reference must be from the last employer. Mental health Awareness and Responding to behaviours that challenge training must be provided to the staff, so that they have the insight and the necessary skills to meet the changing needs of the people at the home. Fire risk assessments must be completed to ensure that preventatives measures are put in place to reduce the potential of fire, particularly where people smoke. 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 Adults (18-65 years) Page 9 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 35 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information provided through the combined Statement of Purpose and Service User Guide is not transparent. It is therefore difficult for people wishing to live at the home to make decisions about the way their needs are to be met at the home. The admission process is not robust and must reassure people wishing to live at the home that their needs can be met by the staffs skills. Evidence: The Statement of Purpose and Service User Guide is combined and says that the aims and objectives are to promote the re-enablement and social integration of people with enduring and profound mental health. The Statement of Purpose and Service User Guide must be reviewed to include information about the way individuals privacy and dignity is respected; the age range in particular the way the diverse range of ages are accommodated at the home; the rules and room sizes. Additional information about the way Brightobow Court and the Lodge operate must be included. This information will ensure transparency and assist people to make decisions about the way their needs will be met at the home.
Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: A Referral/Admission procedure and criteria is included in the Statement of Purpose and confirms that information will be gathered through social workers needs assessments, homes initial assessments and introductory visits. While it is acknowledged that the criteria for admission and range of needs are included within the procedure, the information is vague in places. For example the various needs of people under Sections of the Mental Health Act that can be met at the home and the range of needs that cannot be met at the home must be included. Comments about the admission process were sought from the manager who said that referrals for admission are generally through the Avon and Wiltshier Partnership Mental Health Team (AWP) and from the hospitals. Essential information is gathered from the care coordinator and home staff will then arrange to visit the person to conduct initial assessments with a view of assessing their suitability to move into the home. Initial assessments seek past and present history, personal information, mental health care with personal care and social needs. A summary of needs is then completed to assess that the staff skills can meet the needs of the person wishing to live at the home. The case records of the two most recent admission to the home were examined to determine the admission process followed at the home. Records show that one person was admitted from another home and the other was a transfer within the organisation. Current social workers needs assessments for the home were not provided for the most recent admissions and the manager must ensure that admissions are based on full assessments of needs. For the person transferring within the organisation a care plan dating from 2007 is in place and says the needs are ongoing. It is evident that initial assessments are not carried out for people that are moving from the homes nursing environment into the residential unit and there are inconsistencies between the needs identified and homes care plans. For example, daily reports, documentation from health care professionals and the most recent needs assessments. One person recently accommodated was consulted about the admission process. It was stated that written information about the home was not provided but people were shown around the home by the manager. Care Homes for Adults (18-65 years) Page 12 of 35 Individual needs and choices
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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are not involved in decisions about the way their care is to be delivered. Care plans are not personlised do not show that consistency of care is maintained and the individuals may not be receiving up to date care from the staff. Evidence: Feedback was sought from the manager about the care planning process at the home. We were told that daily living and mental health care needs form part of the care plans which are developed by the nurses. The care plans are then explained to the person and to indicate agreement with the plan the person then signs the care plan. Reviews are monthly during the trial period, then three monthly and annually once permanency of residency is confirmed. There are inconsistencies between the practice and the procedure described within the Statement of Purpose and these must be changed to describe the correct process followed. The care plans examined do not show a personalised approach to meeting needs, the individuals likes, dislikes and preferred routines are not incorporated and do not show
Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: that people have a say about the way their is to be delivered. Care plans in place give raise to concerns about the way consistency of care is maintained at the home. Action plans are not specific and are open to staffs interpretation about the way the care is to be delivered. The triggers of deterioration and the way their mental health presents itself is not part of the care plans. The individuals mental health needs together with triggers and signs of deterioration must form part of the care plans and action plans must guide the staff to meet the individuals mental health care needs. The way care plans are developed is not always respectful and the manager must ensure that when care plans are written in the first person, they represent what the person has said. The needs of the people at the home are reviewed by the Avon and Witlshire Partnership Mental Health team (AWP) and Personal Recovery Plans were developed following multiagency meetings. However, it is evident that homes care plans were not reviewed to incorporate the multiagency agreements. The running reports completed by the staff at the home are physically focussed and generally say that the person rose, they ate and conducted personal hygiene. It was then difficult to establish the outcomes for people that do not participate in activities, have a tendency to self neglect and are aggressive to others. We were told that people are generally able to make day to day decisions. The manager said that where people are unable to make complex decisions, family are approached and best interest decisions are made. People that are on Community Orders generally relate to medication and not on freedom of movement and choice. Assisstive technology to access parts of the building and to enter the property is being considered to ensure that only the people that can enter, have access into the building and parts of the property. This means that people have freedom to enter the property and are safeguarded, this is seen as good practice. Risk assessments are in place for activities that involve an element of risk. However, management plans are not always devised for risks identified, they are inconsistent with the social workers crisis plans and observations reported by the staff. Cigarettes are held in safekeeping for certain individuals and risk assessments must Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: be devised to show the options considered and that the actions reduce the level of risk. People consulted about care planning said that they had Individual Care Programme Approach (ICPA) and attended care reviews convened through their AWP care coordinator. Feedback about keyworkers was sought and one person was aware of their keyworker. It was stated that people have 1:1 time with their keyworkers and are supported with independent living skills and shopping. Support workers consulted said that they have access to care plans and they are responsible for explaining care plans to the person. It was confirmed that support workers act as keyworkers and they have 1:1 with the person, assist with independent living skills and budgeting. Care Homes for Adults (18-65 years) Page 15 of 35 Lifestyle
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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. People are able to make decisions about their future and are supported to develop life skills. Evidence: An Activities Coordinator is employed at the home and feedback about the way people are supported are empowered to shape the life they want was sought. We were told that initially all activities were in house but since the employment of the Activities Coordinator people are participating in more activities away from the home. It was also stated that following consultation with the person during their admission about their hobbies and aspirations during, an overview of the assessment is completed, an activity rota is then formulated and reports on the progress is maintained. Care records were examined and it is evident that people have learning, leisure and occupation opportunities. The City Farm is used for IT courses, art classes, the local
Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: swimming pool, Bristol Vocations that may lead into employment, walking groups and voluntary employment. Each person has an activity plan that is specific to them and people and reports show the progress that is being made with the activities undertaken. At present 36 people participate in structured activities, 8 people do their own thing and 8 are not participating in any form of activities. There is an expectation that keyworkers spend 1:1 time with individuals that do not engage in any form of activities. Comments were sought from people at the home about the way their opportunities for leisure, learning and occupation are organised. One person said that it is their choice to only participate in the outings organised . One person is seeking voluntary employment with assistance from the coordinator, another said that they participate in structured activities and the fourth person said that they stay in their room during the day. A senior member of staff is now delegated the responsibility to provide more intensive recovery to assist 6 people with independence living. Wellness Recovery Action Plans (WRAP)will be developed so that these individuals can move into independent living environments. The Activities Coordinator and manager were consulted about the steps taken to ensure that people are better connected with the local community. The coordinator said that there is an assumption with the locals that all the characters in the area are from the home. The manager said that staff ensure that the people living in the home appear like everyone else in the community, if people are distressed they are supported outside the home. Comments were sought from four people about the opportunities available for leisure, learning and occupations. One person said that it was their choice not to participate in structured activities The manager said that with the exception of 7, the people accommodated can leave the home without staff support. At present four people are banned from entering the local supermarket without staff support. Smoking is only permitted in bedrooms and outside the home. A number of people abuse alcohol and local pubs and shops will contact the home when concerns arise about the behaviours exhibited. The way people are respected as individuals was discussed with the manager. We Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: were told that staffs inductions and vocational training incorporates the Principles of Care and how individuals rights are to be respected. Examples such as the accommodation and handing letters unopened to people were used to show the way privacy and dignity is respected at the home. The manager also said that while people at the home are able to read and write, the way information is interpreted can be a problem. Where there are concerns that people may miss key information, they are advised to take more notice of letters. Catering staff were consulted about the way meals are catered. There is a four week rolling menu that is changed four times each year. The menus seen show that there is a standard Continental style breakfast during the week and at weekends there is a cooked breakfast. At lunch and tea-time there is a choice of meals, with the main cooked meal at teatime. Catering staff explained the way health eating is promoted at the home and the special diets catered for. A good range of fruit and vegetables with tinned foods which are not basic or value products which support the people at the home have a varied diet. Care Homes for Adults (18-65 years) Page 18 of 35 Personal and healthcare support
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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. The health and personal care that people receive is based on their individual need. Medication systems are safe. Evidence: It is evident from care plans and ICPA that people with personal care needs are accommodated at the home. While the needs of the individuals are listed, the action plans do not describe the abilities of the person, the assistance needed and the way the care is to be provided by the staff. It is acknowledged that care plans are monitored, however, the progress made with the care plan is not detailed. Care plans in place confirm that individuals are registered with a GP, they have a care coordinator involved in their care and access NHS facilities which include optician, dentist and chiropodist. The manager said that the home has good links with the surgery and the GP will contact the home about health checks and to review medications. We were also told that people can be accompanied by the staff on health care visits or can visit their GP independently. One person consulted about their health care needs
Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: said that they are registered localy with a GP and are accompanied by the staff. This individual also said that they are under section of the Mental Health Act which relates to taking medication which is injected. Another person said that depending on the nature of the visit, is whether they are accompanied on health care appointments by the staff. The individuals accommodated have an care coordinator appointed who will organise their annual ICPA meetings with health care professionals present, for example, psychiatrists and community nurses. Where individuals need support with their mental health care needs, the care coordinator is contacted so that the person can access health care professionals. The way medical advice is followed at the home was discussed with the manager and we were told that daily reports and verbal communications ensure that advise given is followed. Documentations such as charts are also used to monitor individuas health. It was understood that the GP will contact the home to ensure that advise is followed for those individuals that independently visit their GP. Medications are administered by the staff through a monitored dosage system. The records examined show that staff sign the records after administering the medicines and use codes to record the reasons for not administering the medications. Homely remedies are administered from a stock supply when required by the person and records include the name of the person, the dosage administered and the balance. This shows that safe administrations of homely remedies. Medications profiles must be further developed to include medications leaflets and when required protocols to ensure that medications are administered consistently by the staff. A record of medicaitons no longer required is mainatained and signed by the pharmacist to indicate receipt of the medication for disposal. Care Homes for Adults (18-65 years) Page 20 of 35 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. People at the home can express their concerns and have access to effective complaints procedures. People are protected from abuse Evidence: The homes Complaints procedure is included within the combined Statement of Purpose and Service User Guide and on display in the home. A record of complaints received is maintained and confirms that complaints received at the home are investigated and resolved to the complainanats satisfactions. The log of complaints are audited to monitor that a wider resolution is sought for persistant complaints. Four people were consulted about the way the staff respond to their complaints. Three people named the person that they would approach with complaints and one person said that complaints made are rarely resolved. Two staff on duty were consulted about the way people at the home are supported to make complaints. We were told that complaints would be passed onto senior staff and one member of staff said that they would sit with the person and assit the person to make formal complaints in line with the procedure. The Safeguarding Adults and WhistleBlowing policy in place show the homes
Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: commitment towards safeguarding people from abuse. The Safeguarding Adults procedure in place provides little guidance to staff on the actions to be taken for alledged abuse. The Safeguarding Adults procedure must be updated to guide the staff on the actions to be taken for reporting alledged abuse which must follow No Secrets guidance. While the Whistlblowing policy reassures staff that staff who report poor practice will be protected from reprisals, the implications for staff that do not report poor practice is not stated. The WhistlBlowing policy must inform staff of the implications if they witness poor practice and do not report it. This will ensure that people at the home are safeguarded from abuse. Four people were consulted about protection from abuse and three people said that they felt safe at the home while one person said they felt safeish. Members of staff consulted were aware of the factors of abuse and the expectation that abuse is reported. The manager made one safeguarding adults referral for alledged physical abuse towards one person at the home. This member of staff was dismissed and referred to the POVA (Protection of ulnerabl Adults) list. Care Homes for Adults (18-65 years) Page 22 of 35 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the accommodation would benefit from further refurbishment, there is a clear commitment to providing homely accommodation in a less institutional environment. Evidence: Brightbow Lodge and Court are located in Bedminster, close to the city center, within walking distance of local shops and amenities. They are separate premises on the same grounds, Brightbow Lodge is arranged over three floor with single rooms on each floor, accessible by stairs and passenger lift. Brightbow Court can accommodate up to twenty people and arranged over three floors with communal space on the ground floor and bedrooms on the upper floors. Since the last inspection Brightbow Lodge has been remodelled into three separate units. Each floor has its own communal areas which comprise of a kitchen/dining/lounge area and rightly decorated. The kitchen area has fully functioning kitchen with washing machine and tumble dryer for people to undertake their own laundry and to prepare light snacks and refreshments. Downstairs the large dining room has become an activity area with a meeting room and office. The introduction of separate units and the reorganisation of the large dining area, with the closure of a serving hatch has created a less institutional way of working. However,
Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: corridors,floor covering, bathrooms and bedrooms are in need of redecorating. The service provider had put in place an action plan on the redecoration and refurbishment of the home. This will be monitored to ensure that a homely environment is provided. Brightbow Court was purpose built and has a large lounge and dining area with an office, meeting room and kitchen on the ground floor. Bedrooms are on the upper floors single and lockable, people accommodated at the Court told us that they are able to have personal belonging in their rooms to reflect their taste and lifestyles. It was observed during the inspection that hairdressing was being undertaken in the activities area, which is a public space easily seen by people visiting and individuals using the space. It is acknowledged that the area is not frequently used for the purpose of hairdressing; nevertheless, it raises concerns about where and how individuals are washing their hair. Hairdressing was discussed with the directors and service providers who gave their reassurances that a room specific for this purpose would be provided. A hairdressing room will ensure that people can have a more relaxing and therapeutic experience than they are currently receiving. Care Homes for Adults (18-65 years) Page 24 of 35 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment process is not sufficiently robust to reassure people at the home that staff suitable to work with vulnerable adults are employed. People at the home receive a consistent service from staff that receive statutory and vocational training. Members of staff must receive specific training to ensure that the changing needs of people accommodated are met. Evidence: The Personnel files of the two most recently employed staff were examined to test the recruitment process followed at the home. Completed application forms require full employment history, the name of two referees and declaration of criminal background were in place for both staff. While written references were sought, character references from colleagues and friends were accepted. The manager must ensure that at least one reference is from the last employer. The manager is also advised to ensure that references from the last employer are validated. Criminal Records Bureau (CRB) checks were obtained as part of the recruitment process for the staff, however, the process that followed for inconsistencies between CRB and application form were not evident. The recruitment process must be more robust to ensure only staff that are suitable to work with vulnerable adults are employed. Written references from the last employer must be sought which must be validated and a separate process for candidates that are not honest about criminal history or declare convictions to ensure
Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: they are of good character. Feedback about recruitment, training and supervision was sought from two staff on duty. One member of staff told us that their recruitment process involved completing an application form, the manager requested references and a CRB was obtained. Staff said that were convictions are declared, the manager will discuss the nature of the convictions, the reasons and the lessons learnt. We were told by both staff that training and vocational qualifications are encouraged, Since the last inspection First Aid, Safeguarding Adults and Fire training has taken place along with NVQ level 2. When comments about specific training such as Mental Health awareness training were raised, we were told that specific training has not happened for a while. In terms of supervision were told that this took place and focused on the needs of the people accommodated, work performance and training. A health and social care professional visiting the home was consulted about the way staff meet standards of care at the home. We were told that staff work cohesively with people that have very complex needs, they are providing personalised care and are moving forward in promoting Independence. However, the professional said that staffing levels are sometimes poor. The manager, service provider and directors were consulted about the staffing levels at the home. Since the last inspection Brightbow Lodge has been divided into three separate units and we were told that staffing levels have dictated the environmental changes of the home. Two care assistants are rostered on each unit throughout the day, with a qualified nurse taking overall responsibility; at night there is one waking and one sleeping staff. At Birghtbow Court, the residential unit there are two care assistants at all times. The training programme at the home was discussed with the manager. We were told that an induction package that follows Skills for Care is used and senior carers have the responsibility of inducting new staff. Statutory training encompasses Fire, Infection Control, First Aid, Principles of Manual Handling and Safeguarding Adults. Vocational qualifications is encouraged and currently 80 of the staff team have NVQ level 2 and above. However, mental health awareness and behaviours that challenge training has not been provided. The manager must ensure that training appropriate to the role is provided to the staff employed. Mental health Awareness and Responding to aggressive and violent situations training must be provided to ensure that the staff have the insight and skills to meet the range of the needs that people at the home have. Care Homes for Adults (18-65 years) Page 26 of 35 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 aims and objectives and the needs of the people at the home are met by the ongoing monitoring of standards and effective leaderships style. People at the home live in an environment where safety checks are carried out, however, the quality of the checks must be monitored to ensure the information in accurate and up to date. This will ensure that people work and live in a safe environment. Evidence: Feedback was sought from the manager about the way the aims and objectives and the needs of the people at the home are met. The manager said that following standards ensure that the home offers consistency of care which is achieved through regular meeting with staff and people accommodated, handovers when shift changes occur, good communicating networks and involvement. In terms of leadership, the manager said that having an open door policy, knowing about issues and acting quickly ensures that the home operates effectively. The manager explained that the future plans of the home included the redecoration of bedrooms, the introduction of a No Smoking policy and motivations of staff to
Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: empower people to re-use their life skills when asked about the future development of the home. People at the home were consulted about the staff and the leadership style used at the home. Comments from people at the home included staff are OK, I have problems with some staff and staff know how to care for me and are respectful. One member of staff said that there has been a vast improvement in the leadership and the general appearance of the property. There was more support for staff, more training and on-site maintenance improved the property. A Quality Assurance is operated by the organisation which comprise of audits and feedback sought from staff, people at the home and their relatives or advocates. The manager explained that audits are generally done by the staff at the home and feedback through questionnaires comes directly from the service provider. Questionnaires are then analyzed and the service provider prepares a report that details the action that will be taken as a result of the comments received. The manager said that audits undertaken include medication, complaints, and accidents, violent and aggressive incidents. We understood that there is good support from the directors and the service provider undertakes monthly visits and reports on the conduct of the home. However, the reports completed for each monthly visit were not available for inspection. Facilities for the safekeeping of cash and valuables exist at the home and a sample check was conducted during the inspection. Records checked corresponded with the cash held in safekeeping and receipts further evidenced the purchases made on behalf of the people at the home. The manager ensures that the property is safe for people living and working at the home. A qualified member of staff is employed to undertake checks of equipment and appliances used at the home. Portable Appliance tests, hoist, passenger lifts are checked at the home and external contractors are used to service the gas boiler. Fire Risk assessments were undertaken by an external company and included is the action plans, checks and practices for staff to ensure the potential for fire is reduced. However, the fire risk assessments say that there is No Smoking permitted in the home or in bedrooms. This is incorrect, people were observed smoking in bedrooms and in two occasions observed using plastic bins and carrier bags to extinguish cigarettes. This is of concern and while we are reassured that the No Smoking policy Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: is imminent, fire risk assessments must be reviewed and appropriate measures used to lower the riks of fire particular by people smoking in bedrooms. Care Homes for Adults (18-65 years) Page 29 of 35 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 Adults (18-65 years) Page 30 of 35 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 1 6 The Statement of Purpose and Service User Guide must be kept under review The manager must ensure that the Statement of Purspose contains: a) Privacy and Dignity policy, b) the age ranges, c) room sizes, d) the range of needs that can and cannot be met at the home and e) the way the two units operate. 22/01/2010 2 2 14 The manager must ensure that the needs of the people wishing to live at the home are assessed before their admission to the home. Assessments of needs must be sought from the Local Authority for people funded by them. 22/11/2009 3 6 13 Where activities involve an element of risk, action is taken to reduce the level of risk. 22/03/2010 Care Homes for Adults (18-65 years) Page 31 of 35 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 Risk assessment must be developed for a) Triggers, signs and symptoms of a deteriorating mental health and must include an action plan to meet the needs, b) where cigarettes are held for safekeeping risk assessments must be developed to show that the actions reduce the level of risk. 4 6 12 The manager must ascertain 22/03/2010 the wishes and feelings of the people accommodated for the purpose of providing care. Care plans must show that people have a say about the way their care is to be delivered. Their likes, dislikes and preferred routines must be incorporated into their care plans. 5 34 19 The manager must employ people that are of a) good character, b) one reference must be from the last employer and c)satisfied as to the authenticity of the references and The manager must then ensure that a)where there 02/11/2009 Care Homes for Adults (18-65 years) Page 32 of 35 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 are inconsistencies between the information sought and the application form a clear process is followed to test the candidates integrity, b) references where possible are from the last employer and c) the references are validated by the referee. 6 35 18 Members of staff must receive training to the work they are to perform. Members of staff must receive specific training in Mental Health Awareness and behaviour that challenge to ensure they can meet the range of needs at the home. 7 42 23 The manager must ensure that the Regulatory Reform (Fire Safety) Orders 2005 are complied with in respect of the care home. The manager must ensure that fire risk assessments are up to date and accurate so that preventative measures can be put in place and reduce the potential of fire in the home. 01/11/2009 26/02/2010 Care Homes for Adults (18-65 years) Page 33 of 35 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 20 When required protocols must be reviewed to ensure that staff adminster medicaitons consistently. Care Homes for Adults (18-65 years) Page 34 of 35 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 Adults (18-65 years) Page 35 of 35 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!