Care Home: Gilbert Scott House

What the care home does well The service provides high levels of support to service users with a range of challenging and complex needs. The staff team meet these well and are able to demonstrate how they meet they positively effect service users lives. The service has a flexible and innovative day care support program. What has improved since the last inspection? The Inspector noted clear documentation regarding the use of physical intervention at the home. The Inspector audited a range of policies and flow charts relating to the use of physical intervention. They were clear and well laid out. Issues regarding removing one service user to the garden have been addressed and stopped. What the care home could do better: The inspector would recommend the use of a stable door in the kitchen. This would maintain safety when staff are serving food without completely excluding the service user group from the kitchen. No significant flaws were noted. CARE HOME ADULTS 18-65 Gilbert Scott House 22-23 Old Weston Road Flax Bourton North Somerset BS48 1UL Lead Inspector Paul Grey Unannounced Inspection 16 of November 2006 09:30 th Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gilbert Scott House Address 22-23 Old Weston Road Flax Bourton North Somerset BS48 1UL 01275 464875 0117 9699000 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) www.brandontrust.org The Brandon Trust Mrs Marie Patricia Cox Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate up to 5 adults with Learning difficulties. There will be a minimum of three staff on duty at the home between 7.30 am and 9.30 pm for the three identified residents. Any additional admissions will be subject to a review of staffing levels. Date of last inspection 21st February 2006 Brief Description of the Service: Gilbert Scott House has been commissioned by the Brandon Trust as a specialist home for intensive support for those service users who have learning disabilities but also at times have challenging behaviours. It is situated at Flax Bourton, approximately 4 miles from Bristol and has transport in order that residents can be supported to access all the leisure and community facilities available in Bristol. Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out in the absence of the acting manager over a 4 hour period. During this time, the Inspector spoke with staff, service users and day care staff. Following this service user files were audited and a tour of the premises conducted. The Inspector found a robust, well run service with good staffing levels, comprehensive day care support, and a well developed administrative infra structure. What the service does well: 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. Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 Quality in this outcome area is excellent. Significant time and effort is spent making admission to the home personal and well managed. Prospective residents and their families are treated as individuals and with dignity and respect for the life changing decisions they need to make. EVIDENCE: The Inspector audited 3 care files. The Inspector noted comprehensive assessments of the service user group and the use of the FANCAP assessment tool to identify physical needs. A comprehensive pre admission assessment had been completed for service users audited by the inspector. Where they were able, service users had been involved in drawing up a person centered assessment and plan. This was good practice. Documentation, the Inspectors observations and staff statement evidence demonstrates that the home is able to meet the assessed needs of the service users living within. The Inspector also noted evidence that the home addresses preferences for minority or ethnic service users. The Inspector found no evidence to suggest that the home offers places to service users whose needs it cannot meet. Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7,9 Quality in this outcome area is Excellent. Care files included comprehensive risk assessments. The management of risk takes into account the specialist needs of people using the service and balanced this against their aspirations for independence, choice and normal living. This was good practice. Where there were limitations on choice it was in the service users best interest. EVIDENCE: The Inspector audited 3 care files. Files sampled were detailed and up-todate. The service user plan and planning for life folder reflected the service users needs and a person centred approach to these needs. Given the level of disability of many of the service users, the home had attempted to involve service users to their full ability. Where there were restrictions on service users choice and freedom, these were based around clear risk assessment and care planning. Risk assessments identified reasonable risks and minimised these where possible. Staff respected service users rights to make decisions and supported the service users where safe and reasonable to do so. Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 9 Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, Quality in this outcome area was good. The service has a strong commitment to enabling residents to develop their skills, including social, emotional, communication, and independent living skills. Individuals are supported to identify their goals, and work to achieve them. EVIDENCE: Service users at the home are involved in a range of activities with a dedicated daycare team. The day care team involves service users in a range of courses designed to give service users some learning objectives and qualifications. One service user recently obtained two ASDAN courses for cooking and basic education. Service users at the home are engaged with the day care team for intensive support. Often a support needs to be given on a 2 staff member to one service user basis. Service users are supported to gain life experience outside of the home through the staff care team and the day care project team. Staff were able to give the Inspector examples of how service users had been supported to Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 11 integrate with the community in Bristol. The staff team support service users from different ethnic groups to maintain contact with their relatives and their culture. The Inspector noted evidence in service user care plans that staff supervise and support them to maintain and develop appropriate relationships. This can involve staff supporting service users to maintain boundaries necessary within a normal relationship. For example, the Inspector noted documentation regarding inappropriate touching by one service user. The Inspector noted a positive onus on teaching the service user how to maintain and develop a relationship appropriately. This was good practice. The homes daily routines reflected its emphasis on modern, individualised care. The Inspector noted evidence from observation that service users and staff interacted well. Staff did not interact with each other, excluding the service users. Service users bedrooms are the most part kept locked. This is because of health and safety issues and in the best interests of the service user. Service users have supported access to the home and the grounds. This is not unrestricted due to health and safety. Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19,20 Quality in this outcome area is good. Staff understand the key principles of giving personal support and are responsive to the varied and individual requirements of the residents. It is recognised that the delivery of personal care is highly individual and must be flexible, consistent and reliable. EVIDENCE: Care files demonstrate that great care is taken to provide sensitive personal support. The Inspector noted that the Brandon person centered planning took great account of service users preferences and organised a way for the staff to be aware of them. This manifested itself in the care taken to support service users to choose their own clothing or hairstyle. Service users were encouraged and supported to develop an appearance that reflected their personality. The residents have primary care needs met by the local GP practice, and specialist care needs met by the CLDT. The individual personal files have information on then indicating that the health care needs of individuals is monitored and any action needed is taken. Service users are unable to retain and administer their own medication. This role is taken on by the carers at the home for health and safety reasons Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 13 Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good The service involves service users and values their input. Service users are protected from abuse by the service. EVIDENCE: The home has robust policies and procedures regarding the reporting of suspected abuse. Allegations of abuse would be recorded at the home. During the time of inspection there were no allegations of abuse or neglect. Staff at the home receive training to understand the causes of physical and verbal aggression by service users. Physical intervention training is provided to staff. The Inspector noted that the Brandon trust provides a strong training program and encourages all staff to update regularly. Staff training and guidance enables the staff team to identify practices that could be abusive and prevent them. Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 30 Quality in this outcome area is good. The home provides a physical environment that is appropriate to the specific needs of the residents who live there. The well-maintained environment provides specialist, safe environment to meet the needs of the residents. EVIDENCE: The Inspector conducted a full tour of the premises. The Inspector noted that throughout, the building was safe accessible and well maintained. Although health and safety issues had a considerable impact on furniture and fittings at the premises, these were of reasonable quality and as domestic as possible. The inspector discussed kitchen access with staff. Following risk assessment, service users are required to wait outside of the kitchen whilst hot food is served up. Staff and the inspector discussed the possibility of having a fire compliant “stable” type door, which will allow service users to see staff and the dishing up of food but will not place them at risk. This would also improve the ability of staff to observe general behaviours at this busy time. This was subject to recommendation. Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 16 All service users were provided with their own bedrooms. Once again, there were considerable constraints on what service users could have in their rooms due to health and safety issues. The Inspector reviewed the service users risk assessments, and care plans which indicated that an appropriate level of furniture was present in the service users rooms. The Inspector noted throughout the tour that the home was clean and no foul odours were present. Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 34, 36 Quality in this come area is good. Residents have confidence in the staff that care for them. Rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the residents. EVIDENCE: The Inspector audited the homes internal documentation. The Inspector noted that the home uses the Brandon trust job descriptions. These clearly describe the roles, expectations and duties of staff employed by the trust. The Inspector noted staff had been made familiar, via induction with the homes expectation and professional standards in the area. Staff had signed to confirm they understood these issues. Staff details including CRB, POVA, proof of identity and employment records are stored centrally by the Brandon trust. A recent visit confirmed all was in order with these records The Inspector noted evidence of regular and appropriate staff supervision. Staff spoken with informed the Inspector that they received enough support Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 18 and had sufficient staff to approach should they have issues to work through relating to working at the home. Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 41, 42 Quality in this outcome area is good. The service has sound policies and procedures, which the manager effectively reviews and updates, in line with current thinking and practice. The manager is regarded highly by other professionals. Staff are positive in their approach to translate policy into practice. Efficient systems are in place to monitor staff adherence to policies and procedures during their practice. EVIDENCE: The Inspector audited the homes policies and procedures. The Inspector sampled four policies at random. These were up to date, complied with current good practice and were maintained in good order. Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 20 The Inspector reviewed the homes record-keeping generally and noted the records kept were accurate up-to-date and stored in accordance with the data protection act. Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 4 3 4 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 3 27 x 28 3 29 x 30 3 STAFFING Standard No Score 31 3 32 x 33 x 34 3 35 x 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 x 4 x LIFESTYLES Standard No Score 11 x 12 3 13 4 14 4 15 3 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x x x x x 3 3 x Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 22 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA24 Good Practice Recommendations The Inspector recommends the use of a stable type door for the kitchen. This would prevent service user access whilst hot meals were served, but allow service users to feel involved with the process. The door would have to be compliant with fire regulations. Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 23 Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 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 Gilbert Scott House DS0000020357.V302404.R01.S.doc Version 5.2 Page 25 - 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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