Care Home: Bristol North Rehabilitation Centre

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What the care home does well The rehabilitation centre gives people care and support that they need to help them regain health and strength. This in turn helps them return home to live independently. The service is provided in a homely setting and done in peoples` own time. One person we spoke with said that: `it`s very noticeable the interest that staff take in peoples` lives which is commendable`. Another person told us that: `staff here try their best to look after me and give me everything I want and need. I feel I couldn`t get better care`. Yet another person told us: `I find the care excellent and all my needs are met`. Staff also commented on what they feel the service does well: `Promotes independence. Succeeds in rehabilitating those people wanting to return home. Staff are dedicated to service users` goals and to achieve them`, `The centre will try its best to help meet service users` needs and rehabilitation goals so that they can return home`, `Getting people back into their own homes to be as independent as they`re able to be with other outside services` and:` We provide a safe, supportive environment, encourage confidence and build trust. We work as a team to achieve this aim`. What has improved since the last inspection? All seven requirements made at the last visit had been met. They included: - Revision of the Statement of Purpose so that it`s clear about how needs are to be met including Equalities and Diversity. (This means respecting peoples` needs in relation to race, culture, religion, sexuality, disability and age and not discriminating against them in the meeting of those needs), - Clear records of how healthcare issues are managed so that people are kept safe and protected from risk, - Better recording of complaints that makes sure peoples` concerns are taken seriously, - Details of incidents that happen to people are now sent more frequently particularly in difficult situations such as safeguarding adults from abuse. This shows how the service keeps people safe, - Improved frequency of supervision for staff. However records weren`t fully available at this visit although dates of sessions were sent to the Commission later. This will be followed up at the next visit. - All records we needed to look at were properly kept and available. They included training, supervision and safeguarding adults from abuse. This shows that people are properly cared for by trained and experienced staff. What the care home could do better: We had inspected the City Council`s personnel department in June `08. We looked at a sample of staff records from each service including the rehabilitation centre. From this we found that certain procedures were not being properly followed. They included: keeping clear copies of staff proof of identity, getting two clear references and evidence of qualifications gained. The centre must make sure it follows clear recruitment practices so that people using the service are protected. CARE HOMES FOR OLDER PEOPLE Bristol North Rehabilitation Centre 20 Ellsworth Road Henbury Bristol BS10 7EH Lead Inspector Sandra Garrett Unannounced Inspection 20th September 2008 09:00 X10015.doc Version 1.40 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 Bristol North Rehabilitation Centre DS0000037040.V368081.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 Older People. 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. Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bristol North Rehabilitation Centre Address 20 Ellsworth Road Henbury Bristol BS10 7EH 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) 0117 3772430 0117 3772431 Bristol City Council Ms Elizabeth Calway Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (16), Physical disability (4) of places Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate 2 persons over 50 years with a Physical Disability. May accommodate 2 persons over 45 years with a Physical Disability Date of last inspection 20th September 2007 Brief Description of the Service: Bristol City Council Adult Community Care and Bristol North Primary Care Trust run Bristol North Rehabilitation Centre. The centre is registered in the older persons category to give rehabilitation to sixteen people aged over 65 years. An additional condition of registration enables two people over 50 years, and two people over 45 years with physical impairments, to be given short-term care. The centre gives support to older people that because of illness or trauma need a period of rehabilitation. The centre is run in an environment similar to a care home, although it also includes occupational therapy and physiotherapy (with use of its own gym), plus on-site nursing support if needed. The Centre is situated in the residential area of Henbury, Bristol and close to a number of shops and a pub. The service is free for the first eight weeks of a person’s stay. After that a fee of £308 per week (or £44 per day) is payable. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk The most recent inspection report was seen pinned up on a notice board outside the manager’s office together with the certificate of registration and a Public Liability insurance certificate. Copies of inspection reports were also seen in files of information held in each person’s room. Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. Before the visit, all information the Commission for Social Care Inspection (the Commission) has received about the service since the last inspection was looked at. This included notices of incidents that happened to people using the service, the Annual Quality Assurance Assessment (AQAA) filled in by the service in 2007 and records from meetings held to safeguard adults from abuse. A quality assurance survey was being done by an independent organisation just before our visit. This also meant that we were unable to do our own surveys. At the time of writing the quality assurance survey hadn’t been finalised so no comments were available to include in this report. Seven staff surveys were received and comments are included throughout this report. At the visit we looked at a range of records including care, medication, staff training and supervision, complaints and health and safety. We spoke to people using the service who all said they were well satisfied with the service they were getting. What the service does well: The rehabilitation centre gives people care and support that they need to help them regain health and strength. This in turn helps them return home to live independently. The service is provided in a homely setting and done in peoples own time. One person we spoke with said that: ‘it’s very noticeable the interest that staff take in peoples lives which is commendable’. Another person told us that: ‘staff here try their best to look after me and give me everything I want and need. I feel I couldn’t get better care’. Yet another person told us: ‘I find the care excellent and all my needs are met’. Staff also commented on what they feel the service does well: ’Promotes independence. Succeeds in rehabilitating those people wanting to return home. Staff are dedicated to service users’ goals and to achieve them’, ‘The centre will try its best to help meet service users’ needs and rehabilitation goals so that they can return home’, ‘Getting people back into their own homes to be as independent as they’re able to be with other outside services’ and:’ We provide a safe, supportive environment, encourage confidence and build trust. We work as a team to achieve this aim’. Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improved information about the centre gives people a clear understanding of the service they will get and how their needs will be met. Clear and detailed assessments make sure that the centre is the right place for people using the service and that staff are able to meet their needs, including specialist needs. A specially adapted yet homely environment with staff trained and experienced to work with them, helps people regain their independence. EVIDENCE: We followed up a requirement made at the last visit about the Statement of Purpose. The manager had updated it and sent us a copy. The document included information on meeting needs of people from other cultures and minority groups. One person with cultural needs was spoken with at this visit Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 9 and was satisfied that her/his needs were being met. The care plan showed that any cultural needs the person had were clearly recorded. Assessments are done by a range of health or social care professionals linked to the service. These are done by occupational therapists, physiotherapists, assessment co-ordinators or social workers. A number of them were looked at. Peoples needs had been transferred into care plans. Assessments also gave information on special needs including, culture, disability and religion. Rehabilitation centre staff also assess and review needs at weekly review meetings that includes the person concerned and records their comments on progress. The staff team is a mixture of health and social care professionals and rehabilitation workers. All are trained and experienced in meeting peoples specialist rehabilitation needs. Assessments detail any specialist needs including diet, management of allergies, disability access, cultural needs and other social care needs such as benefits advice. The centre is situated in what once used to be a care home. It has been refurbished and adapted to meet peoples needs for rehabilitation and support. However it’s adapted to give a more homely feel rather than a medical one. One person we spoke with said s/he had been surprised at the homeliness of the centre as s/he expected it to be more like a hospital or nursing home. The centre is fitted with domestic kitchens to help people become more independent (either gas or electricity depending on what they have at home) a physiotherapy gym, and specialist aids and equipment to help them with mobility needs. The centre is decorated in a way that resembles a home environment so that people get support in a way that best resembles what they have at home. Rehabilitation centre staff are trained in physiotherapy or occupational therapy ‘competencies’. This means working alongside people once they’ve been assessed by a physiotherapist or occupational therapist and helping them achieve their particular goals. Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Keeping of good and detailed care and health records shows that people using the service are well cared for and are able to benefit from rehabilitation more quickly. Clear management of medication keeps people safe and protected. Being treated with dignity and respect benefits people using the service. EVIDENCE: A clear system is put in place once it’s decided that a person will benefit from rehabilitation. A senior member of the rehabilitation team does a detailed ‘Overview Assessment’. This helps to decide if the centre is the best place for the person and the process will help them get back their independence and daily living skills. When a person is admitted they have a welcome meeting with a rehabilitation centre worker and a forward planning meeting to discuss Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 11 their needs and goals. An action or care plan is then drawn up which is looked at weekly to check progress. Three peoples records were looked at in detail and all were spoken with. Assessment information was matched with goals and action plans. Health issues were picked up. One person was having difficulty swallowing and this had been acted on quickly. The manager was able to tell us about it and we heard a staff member talking to the GP by telephone about it. A requirement made at the last visit about recording of health conditions was met. Care records covered health conditions such as pressure area care, treatment of infections, likelihood of falls and other mobility issues. One person told us s/he feels a lot of progress was being made with mobility as s/he couldn’t walk at all on arrival but was now getting better with it. The person that had difficulty swallowing was unwell and we saw both a food and fluid chart. These showed what s/he was eating or drinking and what was being done to help boost her/his nutrition and diet. The GP had been contacted regularly and was fully aware of the situation. Treatment and management of pressure sores were recorded and medication records showed this. Risk assessments for pressure areas were in place together with moving and handling risk assessments and others e.g. choking, falls etc. Care plans or goals sheets included mobility, medication, personal care and social care matters such as regaining independence by doing domestic tasks. Where people needed further assessment either by the physiotherapist, community mental health nurse or occupational therapist this was clearly recorded. Nurses, rehabilitation centre workers or health and social care assistants had signed care plans. Weekly review sheets were seen that charted progress or gave information about other action needed. Care records are computerised which makes it easier for any staff member to write in a person’s records. Records were written respectfully and gave clear details of actions taken and progress made. The aim is for people to become confident at doing their own medication. However some people, particularly those in ‘safe haven’ beds (this means a bed for people who are acutely ill and need care but don’t need to go into hospital), may need their medicines given by staff. Peoples medication is kept in a locked space in each room together with administration sheets. The space is kept locked until staff are sure people are confident or safe enough to manage their own medication. One person told us s/he is doing her/his own medication although under supervision from staff. Medicines were all signed for as well as administration of creams and inhalers. We checked the medicines cupboard. All medicines were managed properly. We advised the manager to make sure the returns book records the reason for return of any medicines to Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 12 the pharmacist and this was done immediately. The GP that visits the centre had filled in our survey and ticked ‘yes’ to the question ‘is service users’ medication managed properly?’ People told us that staff come quickly when they use their call buzzers. They said that they feel they are treated respectfully and their dignity is maintained. Everyone we spoke with praised the staff and the way they were being looked after. Staff were observed speaking respectfully to people whilst getting on well with them. Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable activities designed to help with rehabilitation also give people opportunities for more social time. Whilst the aim is to regain independence, people benefit from having choice and control over their progress. Proper management of menus and meals gives people choice, daily variation and social contact. EVIDENCE: Because people stay at the centre for up to eight weeks or less then return home, they don’t have the same range or degree of social activities as people in care homes. There are books, videos, games and jigsaw puzzles for them to do and one person was engaged in trying to finish a jigsaw while we were there. People can use the lounges or stay in their own room, all of which have digital TV’s installed. Newspapers can be ordered and people can choose what to do when they want. For people that are progressing with their rehabilitation, Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 14 they can choose when to prepare their own meals and each kitchen has bread, cereals and other food so that people can choose what they want to eat. A group called ‘Keeping Active Staying Steady’ happens regularly. This is a short course which is partly a discussion group about preventing falls at home and partly an exercise group to aid fitness and regain strength. Four sessions were held in September that included: Why keep active and the importance of footwear, Home Safety and eyesight, Drinking and eating healthily and medication and: Coping with falls. We saw a sheet about the course which is held in the lounge and is informal with tea and coffee served afterwards. The manager told us that recently she had bought a Wii for the centre and the physiotherapist talked to us about how this is being used that combines with the above course. The Wii, which is a high tech games console, has a range of activities stored in it that includes golf, bowls and tennis. The physiotherapist told us that people are assessed to use the Wii to make sure it’s safe for them to use. They get opportunities once or twice a week and it helps them get back their confidence as well as having some fun. All the above is commended. A good practice recommendation that was made at the last visit had been adopted. Menus were now in place for people to see and be able to choose from. People were aware of what was for lunch and told us they think the food is very good. One person told us s/he likes fruit salad for breakfast and this is provided. People were complimentary about the meals that are well prepared, tasty and nutritious. One person had a special gluten free diet and food had been provided to make sure the diet could be followed. The cook had been told about the person with swallowing difficulties and a soft diet was made for her/him. One person with cultural dietary needs told us that s/he knows that s/he could have cultural food if s/he wished but was mostly satisfied with what everyone else was having. Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improved complaints management and recording ensures people using the service can be confident in raising concerns about any aspect of their care. Proper management of abuse issues keeps people protected from risk of harm or abuse happening to them. EVIDENCE: A requirement about recording and management of complaints made at the last visit was met. The complaints log was looked at. This showed that eight complaints had been made since the last inspection. Most of these were about ongoing loss of money from peoples rooms, that was being dealt with under safeguarding adults from abuse procedures. The manager was able to show what action had been taken to stop any further losses (some of which are being treated as theft). All complaints were properly written up with clear evidence of investigation and action taken. One issue about transport not turning up had been dealt with as a complaint even though it wasn’t the centre’s fault. The manager sent us details of complaint received just before our visit. This was about various issues including assessment, care practice and finance. The Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 16 complaints record showed a prompt response taken i.e. to meet with the complainant for further discussion and action. One person staying at the centre told us: ‘I don’t worry about anything here as the staff are very clever and there would be no need to make a complaint. The staff would sort it out before it got to that’. The ongoing issue about the missing money had been properly reported to the police and strategy meetings had been held. People no longer keep cash in their rooms and stronger procedures for looking after peoples money have been put in place. Some of the cash had been mislaid and found on investigation. All staff have regular safeguarding adults from abuse training and the manager is experienced in dealing with and reporting issues. We regularly receive notices of incidents affecting people using the service and the accident book showed this. The manager had kept in touch with us each time a further amount of money went missing and regularly contacts the Commission to ask advice and discuss matters affecting the service. Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Use of a homely environment that also meets rehabilitation needs helps people get back to being independent. People benefit from staying in a well-kept, accessible centre that meets their needs and is clean and hygienic. EVIDENCE: As mentioned above the centre is laid out as much like a home as possible. Kitchens are fitted as they would be in peoples homes and the overall décor is homely and not institutional. Ongoing redecoration is happening and the manager told us a bedroom had been recently decorated. One person’s call buzzer wasn’t working and the manager made sure this was repaired as soon as possible. Because of the spate of missing money the manager had looked at ways of making the centre more secure and cameras were now in place. Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 18 Staff photographs are displayed on a board outside the lift that makes it easy for people and their relatives to recognised individual staff. Domestic staff were cleaning rooms while we visited and the whole centre was very clean and smelled fresh. People using the service told us they were impressed with the décor of the centre and their individual rooms. We saw them using the lounges, dining room, gym and practising their walking in corridors or simply relaxing in their rooms. Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28,29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements in staffing levels available helps give people a better, more consistent standard of care. Failure to make sure proper records of staff recruitment are kept doesn’t keep people safe and protected. People living at the home benefit from a properly trained and qualified staff group that are able to meet their needs. EVIDENCE: We followed up a good practice recommendation made at the last visit that was about checking staffing levels. The manager told us of actions to be taken to manage this. They included: Using secondments of staff from the Intermediate Care Service (that’s based downstairs from the centre) to cover long-term sick leave, Changing the agency used to send staff – which had given a better, more consistent service, Following up a proposal to have an extra deputy manager (to bring in line with the South Bristol rehabilitation centre staffing levels) and: To provide resettlement workers across the whole city and to link up with the Homecare team. Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 20 The manager said there are usually four staff on each morning with two or three in the afternoon and evening and two night staff. We looked at rotas. These showed on average three rehabilitation centre workers or health and social care assistants on each morning with cover also given by the manager or deputy. We saw both the manager and deputy working ‘on the floor’ during this visit. On looking at this rota there was clearly stress on numbers as annual leave, sick leave and training reduced them further. People had already told us that they weren’t aware of pressure on staff numbers. One person told us that s/he thinks staff come ‘pretty quickly but can take longer depending on the situation’. S/he went on to say that ‘as far as I know it’s not short-staffed here at all’. From the staff surveys we received before the visit staff commented on whether there are enough to meet the individual needs of people using the service. Comments included: ‘Sometimes the unit is stretched for staff because of holidays and sickness’, ‘Staff struggle to maintain an consistent routine at all times due to annual leave, sickness and peoples changing dependency levels. It’s difficult at these times to undertake additional duties such as computer recording, key worker one to one sessions and NVQ training as we focus on maintaining the rehabilitation programme’ and: ‘If there is any staff sickness agency staff will cover so will the manager and deputy’ (two similar comments). We also asked staff what could the service do better? Comments included: ‘Provide more staff to enable a more planned schedule’, ‘Employ more staff Giving service users more choice of how they are able to spend money for care as they wish’ and: ‘There is always room for improvement within the service’. Progress with National Vocational Qualification in Care training continues. All but one of the staff have already got or are doing the qualification at levels 2, 3 or 4. Rehabilitation centre workers are trained to Level 3 plus do the occupational therapy and physiotherapy competencies. One of the two health and social care assistants already has Level 2 and the other one is doing it. The only staff member not doing it at all is on a temporary contract. Of the eleven staff, five have either Level 2 or 3, four are doing it now and the deputy manager is doing Level 4. We had done an inspection of the City Council’s Human Resources (HR) (or Personnel) department in June ‘08. To do this we looked at a sample of staff recruitment records from each local authority care service that we regulate and inspect. From the inspection we found there were issues about a lack of references sent to the HR department, proof of qualifications and clear proof of identity (some were of such poor quality as to be unrecognisable). Some of the issues we found related to the rehabilitation centre. Therefore a requirement is Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 21 made to make sure such records required under regulation are properly sent to the HR department when a new staff member is taken on. We also looked at proof of identity that must be kept in the centre itself. None of the staff had supplied clear proof of identity, needed to keep people protected. We required that this be done and the manager later emailed us with a list of staff and proof (such as passports, driving licences or birth certificates etc) that they had given. All the above will be followed up at the next inspection. We followed up a requirement about making sure staff get updated training in dementia care. We saw on the rota that a number of staff did dementia training on 17/09/08. We also saw a sheet of all staff training done over the last year (between 2007 – 2008). This included the dementia training but also a wide range of other training. Sessions included essential training such as moving and handling, food hygiene, medication, fire awareness and safety together with other sessions. These included: diet and diabetes, how the lungs work, observations and oxygen, equalities and diversity, malnutrition and diet and mental capacity act training. We also saw a questionnaire called a ‘person-centred feedback form’, for staff to fill in after the dementia training. This included questions on what staff felt they had learned, what could they do differently, what can they do to improve their communication skills and how to apply the principles of person-centred care (this means care that looks at a person’s whole life, history and needs. It recognises and values them as an individual with rights and choices, rather than just focussing on meeting basic physical care tasks). From our survey staff were asked if they felt they have the right support, experience and knowledge to meet peoples different needs. Comments included: ‘Training and experience has given me the knowledge to meet all the different needs of service users. Support in this comes from work colleagues, management and outside factors’, ‘I feel I have had good training and many years of experience to meet peoples needs, also support from my manager’, ‘Working with people with differing cultural needs we can obtain support from the equalities and diversity unit as well as the service users’ families’ and: ‘If unsure about anything I can ask my manager or deputy or one of my coworkers’. Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A trained and experienced manager, that understands peoples needs and the inspection process, makes sure they are well cared for. Suitable ways of making sure people can comment about their experience of rehabilitation, helps the centre continue to make improvements in the way people are cared for. Peoples money is properly managed to make sure they are protected from risk of financial abuse. People get consistent care from a staff team that have opportunities to regularly reflect on their working practices. Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 23 Satisfactory management of health and safety at the centre makes sure people are kept safe. EVIDENCE: To our question in the staff survey: ‘does your manager meet with you to give you support and discuss how you are working?’ staff told us: ‘The manager is very supportive and we meet on a regular basis to discuss any issues within my role’, ‘Manager always listens and helps with problems that may occur’, ‘We have regular supervisions as well as handovers and informal ‘catch-up’ meetings’, ‘Any concerns that I or my manager may have are discussed e.g. training needs. My manager is also supportive in all matters’ and: ‘Manager gives supervision on six monthly basis but is always available and approachable to discuss and support me over any issues or concerns’. The manager of the rehabilitation centre, Mrs Elizabeth Calway has many years experience in working in care homes. She was welcoming and open to the inspection process and regularly keeps in touch with us giving feedback on situations and getting advice on regulations and issues affecting the centre. We witnessed Ms Calway talking to people using the service and found her to be caring and person-centred in her approach. Ms Calway had worked well to meet the requirements and good practice recommendations made at the last visit and none were outstanding. Both she and the deputy manager were open and available to staff during the time we were there. The company that does quality assurance surveys for local authority care services had recently visited the centre to talk to people using the service and had also sent out questionnaires to relatives and other people involved with the centre, including health and social care professionals. Unfortunately the survey was being done at the time we also wished to visit to do our own surveys so we didn’t do them for this inspection. We contacted the person that co-ordinates the surveys who told us the report would be available soon as they were still receiving questionnaires and hadn’t been able to write up the responses. This will be sent to us when finished. We checked peoples money that the centre holds for safekeeping. Amounts are kept in sealed envelopes with the amount on and signed across the seal by two staff members. People have lockable cupboards in their rooms in which to keep money or valuables but had chosen not to use them. This was how money had gone missing from their rooms. The manager said that new people coming into the centre are strongly advised not to keep money in their rooms. Since the new procedure had been put in place no further money had gone missing. Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 24 We followed up a requirement about supervision made at the last visit. We looked at day and night care assistant supervision dates and records. A sheet at the front of the file had dates of sessions throughout the year. Some of these were filled in and matched with individual records seen although others didn’t. One person had dates of seven sessions this year but no records to match the dates were in the file. Most of the day staff averaged three or four sessions. However night staff showed a lot less, with only one or two sessions over the year. We discussed our findings with the manager who said that staff had had more sessions than we’d seen records of but couldn’t account for them not being on file. Following the visit the manager sent us a list of dates for all night staff this year. From these all night staff had averaged four to five sessions up to October ’08. One of these was a yearly performance review of the staff member’s work. The standard will be closely looked at during the next visit to make sure all staff supervision records are in order and the required number of sessions has happened for each. We looked at the centre’s health and safety records. The centre has a new and detailed fire safety risk assessment done in June ’08 that covers all risks to the premises, people using the service and staff. Fire drills happen regularly, the last one involving night staff (triggered by a fault on the alarm) in July ’08. The previous drill had been in March ’08 and the one before that in February ‘08. Records showed discussion of actions taken and the time it took to evacuate the centre. Other fire safety records such as weekly alarm tests and checks of fire fighting equipment were all seen together with medication fridge temperature records and water temperature checks. Fire safety training was seen in the list of staff training we were given. Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 X 3 2 X 3 Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 26 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. 1. Standard OP29 Regulation 19, Schedule 1 Requirement All staff recruitment records required under the Care Homes regulations must be obtained and sent to the provider’s human resources department when new staff start work. This will make sure staff records are available for inspection so that people using the service are protected. Timescale for action 01/09/09 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 OP36 Good Practice Recommendations Each staff member’s supervision records should be kept on file and available for inspection. This will make sure records are available to show that staff are properly supervised in order to keep people protected. Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bristol North Rehabilitation Centre DS0000037040.V368081.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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