Care Home: South Bristol Rehabilitation Centre

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What the care home does well People are given information when they come into the centre that helps them understand the nature of the service and what their rights and responsibilities are. Improvements are in the process of being made to make sure how people with different needs or from different backgrounds get the information they need. The intermediate care service helps to maximise peoples’ independence so that they can return to their homes safely. People who use services are looked after well in respect of their healthcare and are treated with dignity and respect. People using the service benefit from a comfortable, clean, and safe accommodation. The centre is well decorated and maintained, physically accessible and meets peoples’ needs. Comments received from people included: “The home does everything well.” “They make sure I have what I want and that’s as well as can be expected.” South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 “I don`t think there is anything that they can do better. They have done everything I`ve expected from them to get better.” What has improved since the last inspection? There were no requirements from the last inspection. Three recommendations were made and the following action has been taken: The manager told us Bristol City Council is in the process of setting up systems to collect specific information about different equalities groups. This will then be included in the Statement of Purpose to show how equalities issues are being monitored. The manager has requested from Bristol City Council for information about complaints to be made accessible to people that are blind or sight impaired. When both audio and Braille copies are received the Statement of purpose will be updated. The recommendation for all care plans to be in a form that is clear and easy to recognise and include all care needs, not just rehabilitation ones, has not been fully met. This will make sure that clearly identifiable care plans show that peoples` physical, emotional and social needs will be picked up as well as their rehabilitation ones. What the care home could do better: No requirements have been made. Two good practice recommendations have been made. The new procedures about how people are supported with their medication need to be included in the Statement of Purpose and Service user guide. A previous recommendation is carried forward for all care plans, not just rehabilitation ones to include full information about how people using the service should be supported with their individual needs. Key inspection report CARE HOMES FOR OLDER PEOPLE South Bristol Rehabilitation Centre 30 Inns Court Green Knowle Bristol BS4 1TF Lead Inspector Sarah Webb Key Unannounced Inspection 1st July 2009 09:00 DS0000037003.V376251.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 2 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 South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service South Bristol Rehabilitation Centre Address 30 Inns Court Green Knowle Bristol BS4 1TF 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 9038392 0117 9038395 cathryn.west@bristol.gov.uk Bristol City Council Catherine West Mrs Sarah Leah Stone Care Home 20 Category(ies) of Physical disability (20) registration, with number of places South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. 3. Physical disability, not falling within any other category - Code PD The maximum number of service users who can be accommodated is 20. May accommodate service users aged 45 years and over on admission. 26th June 2007 Date of last inspection Brief Description of the Service: Bristol City Council Health and Social Care run the service in partnership with Bristol Community Health. It’s based in the residential area of Knowle West. The aim of the service is to: “provide help and support to people over the age of 45 who wish to remain in their own home but who are experiencing considerable short term difficulties in doing so because of illness or injury. The Centre provides a programme where staff will work with people to enable them to regain the skills and confidence to return home. Staff also assess for future needs.” Of the twenty beds registered, three are used as safe haven beds. These enable care to be given to people who may be acutely ill but don’t need hospital admission. The arrangements for these beds are made so that service users getting 24-hour personal care can recover quickly and return home. The average length of stay is 3-5 days but can be longer depending on recovery times. Seventeen other beds are for people who are medically fit to be discharged from hospital, but cannot return home immediately as they require further rehabilitation for up to a period of six weeks to maximise their independence before returning home. Two of these beds have also been used by the Early Stroke Discharge team since January 2009 as a pilot. The centre uses the first and second floors of a former older peoples care home. It’s accessible for disabled people and has a number of aids and adaptations. The staff team includes a nurse, occupational therapist and physiotherapist, together with rehabilitation workers, health and social care South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 5 assistants, administrator, cooks, domestic staff and a handyperson. No fee is payable for the first eight weeks of the service. Thereafter fees of £377.72 per week (for rehabilitation) are charged. 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 South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection that took place over one and half days. The pre inspection planning involved reviewing the report from the last key inspection completed in June 2007 and the Annual Service Review carried out in June 2008. We also looked at the service’s Annual Quality Assurance Assessment (known as the AQAA). This is a self assessment that focuses on how well outcomes are being met for the people using the service. Three people using the service were spoken with during the inspection and five people were asked for their views before the visit so that we could find out what people thought of the service. The manager was helpful in giving lots of information about progress since the last inspection. Two staff were spoken with and a range of records were looked at. These included assessments and care records, together with complaints, training records, quality assurance, fire and health and safety records. What the service does well: People are given information when they come into the centre that helps them understand the nature of the service and what their rights and responsibilities are. Improvements are in the process of being made to make sure how people with different needs or from different backgrounds get the information they need. The intermediate care service helps to maximise peoples’ independence so that they can return to their homes safely. People who use services are looked after well in respect of their healthcare and are treated with dignity and respect. People using the service benefit from a comfortable, clean, and safe accommodation. The centre is well decorated and maintained, physically accessible and meets peoples’ needs. Comments received from people included: “The home does everything well.” “They make sure I have what I want and that’s as well as can be expected.” South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 7 “I dont think there is anything that they can do better. They have done everything Ive expected from them to get better.” What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 8 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 South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 & 6 People using the 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 given information when they come into the centre that helps them understand the nature of the service and what their rights and responsibilities are. Improvements are in the process of being made to make sure how people with different needs or from different backgrounds get the information they need. However, recent procedures about how people may be supported with their medication must be included in the information people are given. Information about fees helps people using the service to be clear about what they may have to pay. Clear assessments show peoples’ referral for intermediate care. These cover needs to be met and all aspects of care for each person. Specialist needs are identified and met as far as possible. South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 10 People wishing to use the centre have the opportunity to visit to help them make an informed decision about staying there. The intermediate care service helps to maximise peoples’ independence so that they can return to their homes safely. EVIDENCE: The centre’s Statement of Purpose has been updated recently. We looked at this and found it to contain all the relevant information for people to be able to make a choice about using the service. The aims and objectives were clearly set out. The service users guide had also been recently updated. A copy of this is kept in each person’s room for them to read. The guide includes: a summary of the Statement of Purpose, details of fees and payments and how these are calculated, how people are asked about their views of the service and a copy of the complaints procedure that includes our new address and telephone number. Since the last inspection, Bristol City Council is in the process of setting up systems to collect specific information about different equalities groups. The manager said this will then be included in the Statement of Purpose to show how equalities issues are being monitored. The manager also told us that the assessment process plans to include any specific needs people may have in relation to different equalities groups so their needs can be met and not be discriminated against. We were told this information will then help to further monitor the promotion of equality and diversity. The AQAA told us there will be a two year programme in assessing “service provision and outcome”. This will be followed up at the next inspection. Since the last inspection, team meetings now have equalities as a standing agenda item. This was seen through records of minutes of team meetings. The manager explained recent changes in how people are being supported with their medication. (This is recorded in more detail in Standard 9). This information must also be included in both the Statement of Purpose and Service User guide so that people are kept informed. Information provided through the AQAA told us that some people had made comments in their service users exit questionnaires about not knowing enough about the centre before being admitted. The manager showed us a leaflet that was developed over a year ago with information just about the rehabilitation centre. We were told this has to go through processes within the local council and the manager is waiting for the outcome before it can be distributed to various locations so that more people will be given information. South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 11 However, three people spoken with told us they had been fully informed about their stay before they were admitted to the centre. We saw a record of when an individual came to visit the centre before they were admitted, so that they could decide if they wanted to stay. The manager said two other people had also visited before receiving a service. We did not see any record to show this and advised the manager to keep a record to show that people are given opportunities to visit. People are not admitted to the centre until an initial assessment of their needs is done. Assessments are carried out by a nurse and those seen were detailed and included all information needed to make sure needs could be met. These included dietary needs and peoples’ preferences. People spoken with told us why they had been admitted and their written assessment showed the same information. Individual assessments included information about age, disability, gender, ethnicity, culture and religion. Equalities and diversity issues such as sexuality are in the process of being picked up through new monitoring systems within the council. Training records showed that staff receive equalities training through the local council. After the assessment process, a rehabilitation programme is developed to help people in maintaining their independence so that they can return to their homes. People are supported by care staff, rehabilitation workers and physiotherapists through an intensive programme to help them regain their skills. Rehabilitation workers are trained to a higher level than care staff and also do training in rehabilitation competencies such as physiotherapy. Care records clearly showed how people were being helped by this intensive work and people spoken with confirmed this. People are assessed by an occupational therapist before they can return home to help ensure the right equipment is at their home and they are safe to return. We were shown a record of a ‘reflective practice meeting’. This showed how an individual was discharged and an assessment of what went well and what could have gone better. We were shown a discharge checklist that helps to ensure people return to their homes safely and that the right arrangements are in place to help keep them safe. South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10 People using the 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 majority of care planning makes sure each person’s needs are picked up and met. However some care plans need to include further information other than the focus on rehabilitation. People who use services are looked after well in respect of their healthcare and medication needs. Being treated with dignity and respect makes people using the service feel valued as individuals. EVIDENCE: Staff are informed about peoples’ needs through care plans, and general information about people was found to be accessible for staff. Peoples’ needs are also recorded sensitively in their rooms through a colour coding system. South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 13 This helps to ensure peoples’ privacy and dignity is respected whilst staff are also given up to date and current information about any changing needs. Care plans were seen for both those people currently using the service in the rehabilitation centre and for those who had received a service using ‘safe haven’ beds. The majority of care plans seen were person centred and had been signed by people showing their involvement in their care planning. They included help with daily living tasks, wound evaluation assessments and pressure area care, religious and cultural needs if applicable and nutritional screening e.g. for people on special diets. Exercise programmes showed physiotherapists involvement. A recommendation made at the last inspection has not been fully met for all care plans to include all care needs, not just rehabilitation ones. Some of the care plans for those people who had used a ‘safe haven’ bed did not contain enough detail for care workers to follow consistently. However, daily written records showed clearly how people were being supported with their needs. Care workers spoken with told us if they were unsure of how to support an individual then they would ask what to do. People using the service gave varied answers to the question “How often is your care plan discussed with you? Can you make changes to it or comment on how its written?” Some comments were “I was given it to read and it was made clear to me that I could alter or ask any questions about any of it”, “My care plan has never been discussed with me as such but I have looked at it”, and “I havent had anything to do with my care plan yet”. This information was fed back to the manager. A dependency scoring tool shows how much care people need on a daily basis and to decide the numbers of staff needed. Dependency is worked out on admission by means of a detailed questionnaire filled in by staff and discussed with the manager who decides the initial score. A daily checklist is then used. These included all self help areas such as washing and dressing, taking medication, and mobility needs. Also, to what level people may need support with their general emotional needs. People using the service benefit from having their healthcare needs met by a team of staff. The team includes a nurse, physiotherapists, and occupational therapists, a pharmacist and rapid response team from the intermediate care team. Individual healthcare records and detailed nursing care plans seen showed the teams involvement. We were told by an individual “The physio I am getting here is really good.” Peoples’ medical needs are reviewed weekly and the nurse and rapid response team liaise with General Practitioners (GPs) who visit when needed. South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 14 The AQAA told us a ‘falls prevention’ group is now held weekly to help people in reducing falls. We saw two people joining this group and they told us it had helped them. The intermediate care medication policy clearly sets out the responsibilities for medication giving, assisting and prompting and in what circumstances. The intermediate care service pharmacist and managers have developed the policy and the Commission’s own pharmacy inspector had been consulted on it. However, since the last inspection there has been a change in the procedures for the administration of some medication during the night. The manager told us a difference in staffing grades and job descriptions is in the process of being dealt with. Due to this some staff at the centre are now unable to assist with medication. The centre has responded by putting procedures in place to ensure staff are on duty to give pain relief medication to people if required, who are using the intermediate care beds, between the hours of 10pm to 8am. Before people are admitted to intermediate care, a record of their medication is sent to the centre and a risk assessment is completed to show whether their medication needs can be met. The manager told us the rapid response team, or senior staff in the intermediate care team, are contacted and administer pain relief medication. This was seen on the staff rotas. All medication is kept locked in peoples’ rooms with records kept of medication received, administered, self medicating and leaving the centre. This was seen in an individual’s room. People are encouraged to be independent in taking their own medication. Self medication assessment tools and risk assessments were seen to help to show whether people can do this. The centre has appropriate locked medications cupboard for controlled drugs that are kept on each floor of the centre. These are kept locked and temperatures are recorded daily with a minimum/maximum thermometer. People spoken with confirmed that their privacy and dignity is respected. Comments made by people included “I am treated well and always with respect” “Yes I feel very much treated with respect”. “Im treated brilliantly by the staff and respectfully.” “Yes Im treated very well”. “If I press my buzzer they come quite quickly and the night staff always say to me not to be frightened to use my buzzer during the night” Staff receive training in respecting peoples’ dignity when using equipment such as the hoist. South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, & 15 People using the 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 offered adequate opportunities for social activity and access to the local community. People are offered meal choices helping to meet their dietary preferences and needs. EVIDENCE: As part of peoples’ initial assessment they are asked about their preferences in their daily living. We saw assessments that included information about peoples’ social, cultural and religious interests. The aims of the centre are different to that of a care home and are there to support people with their rehabilitation needs and to return people home as soon as is safely possible. It is not the centre’s priority to provide social opportunities for people. However one person spoken with told us they had continued to go to their local church. The manager told us those people who did not need support went to a local community facility nearby, but there were limited opportunities for those who needed support as there may not be enough staff on duty. One person felt they wanted to “do a bit more socially”. South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 16 The centre provides DVD’s, magazines and books. Since the last inspection all bedrooms have been provided with flat screen digital televisions with in built radios. People can have visitors and they were seen visiting people privately in their rooms. Although the centre has visiting hours between 10 am and 8 pm, the AQAA stated visitors are welcome outside these hours as long as this does not affect the other people staying at the centre. People can either use the centre’s payphone or bring in their own mobiles to keep in contact with their families and friends during their stay. People responded positively when asked the question “How are your choices respected? Can you go to bed when you want and get up when you want?” Comments made included “I can do what I want when I want”, “I go to bed when I want to go to bed”, and “I can do what I want and go to bed and get up as and when I want”. People’s dietary needs are discussed during their assessment so that the centre is able to provide them with their individual preferences and choices. The AQAA told us that people are offered a hot main meal at lunchtime. We joined two people for this meal and both said they enjoyed the food. They had chosen a hot meal of shepherd’s pie, with gateaux for their dessert. We chose a tuna jacket potato with salad. The meal was pleasantly served by staff and after the meal people were asked what choices they wanted for their tea and supper. People are also encouraged , as part of their rehabilitation programme to prepare their own breakfast and tea time meal and some people cook their main meal at their preferred time with ingredients, equipment, initial support and supervision provided if required. Hot and cold drinks and snacks are available at all times. South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Satisfactory complaints management and recording ensures people using the service can feel confident in raising concerns about any aspect of their care. Good arrangements for protecting people who use services make sure that they are protected from risk or harm as far as possible. EVIDENCE: The centre follows Bristol City Council’s complaints procedure. The Statement of Purpose includes these details and leaflets about it were seen in an individual’s room. Details about being able to contact us were included in the Statement of Purpose. A recommendation for information regarding complaints to be made accessible to people that are blind or sight impaired so that they have the same rights as others and for this to be included in the Statement of Purpose is in the process of being met. The manager showed us how she has requested information about complaints in Braille and audio format to help those who are blind or sight impaired. She said as soon as they are received, then both the service users’ guide and Statement of Purpose will be updated. South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 18 Records showed complaints are responded to appropriately. Since the last inspection, there has been one recorded complaint showing the nature of the complaint, action taken and the outcome. People spoken with told us they had no complaints and that they felt well supported. Both the manager and staff were approachable and practiced an ‘open door’ policy to help encourage people to air their views and concerns. Two staff spoken with said they had attended safeguarding adults from abuse training. They were clear about their responsibilities in making sure people using the service are kept safe from abuse or risk of it happening to them. Records showed training dates for individual staff who had attended training in this area since the last inspection. Some staff had updates booked, but there were still staff who would benefit from this. The manager and two assistant managers have attended training in Mental Capacity Act and deprivation of liberty safeguards. The AQAA told us the centre’s training action plan had identified staff still to undertake this training. However due to the demand in training course across Bristol, spaces are often limited to each unit. South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the 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 using the service benefit from living in a comfortable, clean, and safe accommodation. The centre is well decorated and maintained, physically accessible and meets peoples’ needs. EVIDENCE: Since the last inspection the centre has continued with a programme of routine maintenance, including both redecoration and refurbishment of the following areas: • Lounges have been redecorated with new flooring and curtains. • The sluice on the second floor has been updated and a new shower facility is now available. South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 20 • Twelve bedrooms now have new armchairs, which have a more appropriate covering so that they can be kept clean. The further eight bedroom armchairs will be replaced within the next few months. All bedrooms now have non-slip flooring. The AQQA told us consideration is being given to providing an outdoor seating area. An up to date fire risk assessment was seen. The manager has reviewed fire protocols and procedures for both centre and office staff. These are in the process of being verified by Bristol City Council’s Health and Safety department. There is always a fire duty manager and dedicated fire wardens on duty. Fire safety training recorded showed thirteen staff completed training in April 2009. New staff and agency staff are given fire safety induction and this is recorded. Records were seen of fire alarm and equipment tests. The last fire safety officer visited in January 2009 and made two recommendations. We saw that these had not been actioned and the manager said she will chase these up. The standard of hygiene and cleanliness of all areas of the centre was exceptionally high at this visit. Toilets and bathrooms were clean and hygienic. The whole centre smelled fresh and presented as a pleasant environment. The centre follows an infection control policy to help control the spread of infection. South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, & 30 People using the 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 using the service benefit from sufficient numbers of care staff employed to make sure peoples’ needs are met. Proper staffing checks make sure people who use services are kept safe from risk of harm or abuse. A well trained and qualified staff group support people in meeting their needs. EVIDENCE: There are currently five staff vacancies with interviews in the process of being organised. However permanent vacancies for the management team, care and domestic staff are now in place. This has helped to provide a consistency of care. Shifts needing to be covered are initially offered to the permanent staff team and then to agency staff. As previously recorded the use of the dependency tool identifies how many staff should be on duty to support people with their needs. During the first day of the visit there were just four people using the service. This number increased the following day. The rota showed on average there are four staff available during the morning, three during the afternoon, and South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 22 depending on peoples’ needs there will be three or four during the evening. There are two staff available at night. Rotas also showed when agency staff are asked to cover a shift. Staff spoken with told us that weekly meetings took place. These included the physiotherapy and occupupational therapists, and pharmacist. The AQAA told told us that funding for a senior occupational therapist and physiotherapist had helped to meet peoples needs and support the care team. Staff told us that communication had improved between the team and that both verbal and written handovers were practiced. There are ten staff who have a National Vocational Qualification (NVQ) in Care Level 2 or above and with six who are currently undertaking an NVQ. The manager told us she is planning for staff in the team to take on the role of NVQ assessors as currently there are not enough assessors available to ensure continuity in both starting and completing NVQ’s. The centre follows Bristol City Council’s Fair Selection & Recruitment Policy. Staff recruitment records are held both in the council’s central office and in the centre. A record of when staff have undergone a Criminal Records Bureau (CRB) is kept. All staff undergo a Protection of Vulnerable Adults (POVA) check before they start working at the centre. If staff are employed before a CRB is received a risk assessment is completed. CRB’s checks are carried out three yearly. Two staffs’ personal files were seen and these held appropriate information relating to their recruitment, induction and training. Staff attend training courses through Bristol City Council. The two assistant managers showed us the staff training records. Since the last inspection staff have attended appropriate training to their role. This has included training in first Aid, basic food hygiene, and safe moving and handling. Five staff had completed training in risk assessment and four staff health and safety awareness and personal safety. Two staff have completed a fuller four day first aid course. Staff spoken to told us they had attended training in managing strokes. The manager told us some waiting lists to access specific training were lengthy and that sometimes training was cancelled if there was not a good uptake. South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 23 South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, & 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is trained, experienced and competent to run the centre. The centre is run in the best interests of the people using the centre with suitable ways of making sure people can comment about their stay and know this will be acted upon. The health and safety of people using the service is promoted by clear policies and procedures that keep them safe. South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager has been registered since 2006 and is qualified with a NVQ Level 4 in Management. She is in the process of completing NVQ 4 in Leadership and Management of Care Services. She has continued to update her training in other areas such safeguarding adults for managers, Mental Capacity Act, deprivation of liberty safeguards. There are two trained and experienced assisitant managers, who support the manager including supervision of staff. Staff gave positive comments about the manager, that she was approachable and that they felt valued staff members. Peoples’ views are asked for when they are discharged from the centre through exit questionnaires. These were seen in peoples’ files and as previously recorded in standard 1, action has been taken in response to comments made. The manager collates information from these to see if there are any similar trends. Since the last inspection face to face questionnaires have been completed with staff. The overall findings were good with positive comments and the manager has acted on comments made. The centre has arrangements to ensure peoples’ health and safety is protected. Staff follow the Council’s Health and Safety policies and procedures and have been trained appropriately to support people using the service in a safe way. Both generic and individual risk assessments were seen. Rehabilitation workers carry out risk assessments and these had been reviewed and updated. Records of accidents and incidents were seen. These are a regular item on the agenda of monthly meetings. South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 26 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 2 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X X X 3 South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations All care plans should be in a form that is clear and easy to recognise and should include all care needs, not just rehabilitation ones. This will make sure that clearly identifiable care plans show that peoples physical, emotional and social needs will be picked up as well as their rehabilitation ones. Update the Statement of Purpose and service user guide with the current procedures regarding the administration of pain relief medication. 2. OP1 South Bristol Rehabilitation Centre DS0000037003.V376251.R01.S.doc Version 5.2 Page 28 Care Quality Commission South West Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: 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. 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