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Inspection on 10/08/09 for Brighton Road (47-49)

Also see our care home review for Brighton Road (47-49) for more information

This is the latest available inspection report for this service, carried out on 10th August 2009.

CQC found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service has consulted with people living there and staff regarding the move to a supported living service. Peoples relatives and care managers have also been involved in these consultations. Peoples person centred plans and care plans include detailed information on their needs and personal goals and are kept under regular review. People have individual risk assessments and risk management strategies in place so that they can participate in activities at the service and in the community in a safe manner. Social and leisure opportunities for people to engage in at the service and in the wider community are well managed and age appropriate. Medication is well managed. There is an appropriate complaints procedure and the service has suitable vulnerable adult protection and abuse prevention measures in place. There is a competent and well trained staff team who understand the needs of people who use the service. The service is well organised and managed. One person who uses the service told us that they liked living there and they were very happy about moving to the supported living service. They said that they had talked to the registered manager, the project manager and other people about the supported living service.

What has improved since the last inspection?

There are now guidelines in place for staff to follow in order to support a person with epilepsy. Risk assessments have been carried out and placed on file for those people that self administer their medication. Regulation 26 visits are being carried out and reports are available for inspection. Quality monitoring has improved. Staff training has improved. The mid and top landings have been decorated.

What the care home could do better:

The overall impression when visiting the service is that it is well managed. The management approach creates an open, positive and inclusive atmosphere.There were five requirements and three recommendations set at the key last inspection. Four of the requirements have been met. The outstanding requirement relates to repainting the outside of the house. This will be completed when the house is refurbished. We would like to thank people who use the service, the staff, the deputy manager and the registered manager for their support during this visit.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Brighton Road (47-49) 47-49 Brighton Road Purley Surrey CR8 2LR     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: James OHara     Date: 1 0 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Brighton Road (47-49) 47-49 Brighton Road Purley Surrey CR8 2LR 02086604078 NOFAX thfcare@brightonroad.fsnet.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: THF Care Estates Limited care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home 47/49 Brighton Road is currently registered to provide residential care for up to fifteen adults with moderate learning disabilities. There are currently ten people living at the service. The service will be deregistered and completely refurbished and reopened as a supported living service run by Consensus Support Service. They will support ten adults with moderate learning disabilities. 15 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. We spent two hours at the service and talked with two people living there, two members of staff and the registered manager. Records and documents examined during the inspection included person centred plans, care plans, activities, medication, staffing and training and health and safety records. The registered manager completed an Annual Quality Assurance Assessment to tell us about the service provided, how it makes sure of good outcomes for the people using it and any planned developments. Care Homes for Adults (18-65 years) Page 5 of 27 The service will be deregistered and completely refurbished. The service will be reopened as a supported living service run by the Consensus Support Service. The service will support ten adults with moderate learning disabilities. They had hoped to achieve this in July 2009 however negotiations are still taking place with the placing authorities. The registered manager told us that agreement is expected very soon. Five people have already moved to a service within the Consensus Support Service. What the care home does well: What has improved since the last inspection? What they could do better: The overall impression when visiting the service is that it is well managed. The management approach creates an open, positive and inclusive atmosphere. Care Homes for Adults (18-65 years) Page 7 of 27 There were five requirements and three recommendations set at the key last inspection. Four of the requirements have been met. The outstanding requirement relates to repainting the outside of the house. This will be completed when the house is refurbished. We would like to thank people who use the service, the staff, the deputy manager and the registered manager for their support during this visit. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. They provide people who plan to use the service and their representatives with all the information they need to make an informed decision about whether or not to use the service. This information will be updated when they reopen under the Consensus Support Service. Evidence: No new people have moved in since the last inspection. All of the people living at the service have moved there as a result of care management assessments and referrals. The service is currently registered to support fifteen people with learning disabilities. The registered manager told us that the service will be deregistered and become a supported living service run by the Consensus Support Service. They had hoped to achieve this in July 2009 however negotiations are still taking place with the placing authorities. The registered manager told us that agreement is expected very soon. The intention is to move people into temporary accommodation and completely Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: refurbish 47-49 Brighton Road. Ten people will be readmitted to the supported living service the once the refurbishment is complete. Five people have already moved to a service within the Consensus Support Service. There is a statement of purpose and a service users guide. The statement of purpose is available in a book format and supplemented with photos of the premises, the documents are easy to understand. These documents will be updated when they reopen under the Consensus Support Service. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples person centred plans and care plans include detailed information on their needs and personal goals and are kept under regular review. People have individual risk assessments and risk management strategies in place so that they can participate in activities at the service and in the community in a safe manner. Evidence: We looked at two peoples personal files. Their files were very detailed and included person centred plans, care plans, health action plans and risk assessments. The registered manager told us that the person centred plans had been developed by Consensus and completed by people with the support of their key workers. The plans had been completed using words and pictures and included areas such as activities, community presence and participation, communication skills, daily living skills, relationships, sexual, cultural and spiritual needs, likes and dislikes and a strengths Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: and needs list. All of the person centred plans had been kept under regular review. The files also included individual support plans, health action plans, a grab sheet in case of hospital admittance, individual risk assessments and nutrition and moving and handling risk assessments. Risk assessments had been kept under regular review. All of the people who use the service have had their care plans and placements reviewed by care managers from their placing authorities. The registered manager told us that people had been consulted about the move to the Consensus Support Service at review meetings and with their local authorities. The registered manager also showed us the minutes of a number of residents meetings were a project manager from Consensus attended the meetings to discuss the move to supported living. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social and leisure opportunities for people to engage in at the service and in the wider community are well managed and age appropriate. Evidence: People attend various activities. On the day of the visit some people were leaving to attend regular day time activities at Tandridge Hill Farm. Some people attend day centres at the Peter Sylvester Centre and the Hazeldean Day Centre. One person attends Carshalton College five days a week, another person attends Caterham College once a week and another person attends South Norwood College once a week. One person is employed to work four days a week repairing photocopiers and computers. People make use of local community resources such as shops, pubs, bowling, and a social club run by Mencap. There are two lounge areas that offer a wide range of in Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: house entertainment facilities such as television, videos, DVDs, music system, art and craft activities, jigsaws, computer and board games. We spoke to two people who use the service who had a home day. One person was observed getting ready for the day, they appeared very relaxed and had just made breakfast. When asked they indicated that they were happy at the service and were relaxing that day. The other person told us that they liked living there and they were very happy about moving to the supported living service. They said that they had talked to the registered manager, the project manager and other people about the Consensus Support Service. They told us that they enjoyed a recent shopping trip to Croydon, they had gone to Church the previous day and they were going on a trip to Tower Bridge on Friday. They told us that they knew how to make a complaint if they needed to and said the staff is very nice. The registered manager told us that there are no visiting restrictions although it does ask that visitors telephone before a visit in case people are out. There is a varied choice of meals that represents a range of tastes and cultural and personal preferences. People are asked to choose the meals they want to eat and a pictorial menu is developed for the forthcoming week. People are able to eat at flexible times according to their routines and social lives and are actively encouraged to be involved in the preparation of meals. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The knowledge of experienced staff helps ensure that people receive personal care and support in ways they are familiar and comfortable with. Policies and procedures for handling medicines ensure the people are so far as reasonably practicable protected from harm and or abuse. Evidence: People are supported to access a range of health care providers such as the General Practitioner, dentist, chiropodist and opticians. Some people self medicate and have signed a form indicating that they will administer their own medication. The registered manager told us that people are closely monitored and supported when the need arises. Risk assessments for people that self medicate are in place. Peoples files examined included health action plans, individual support plans and a grab sheet in case of hospital admittance. One person has been diagnosed with epilepsy and there are guidelines in place for staff to follow in the event of them Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: having a seizure. Prescribed medication is supplied in blister packs from a local pharmacy. Medication is stored in a locked cabinet in the office. Administration records were checked and were up to date and accurate. The service receives six monthly audits from the pharmacist to further ensure safe practice. Staff training records showed that staff had undertaken medication training. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an appropriate complaints procedure in place. There are suitable vulnerable adult protection and abuse prevention measures in place to ensure that people are so far as possible protected from abuse, neglect and or harm. Evidence: There is a complaint procedure located in the hallway that people can understand. One person told us that they knew how to make a complaint if they needed to. A complaints policy and procedure is in place and a clear version of this is made available to people and their representatives. A complaints book is available for recording any concerns or complaints. One complaint had been made by a person who uses the service. This had been recorded, responded to, fully investigated and resolved to the persons satisfaction. The registered manager told us that Consensus expect them to record any complaint, even minor complaints, made by people to make sure that people were being listened to and protected from harm or abuse. A safeguarding adults issue was raised in April 2009. The registered manager contacted the local authorities safeguarding team and the issue was fully investigated. Steps have been taken by the Consensus and the registered manager to make sure Care Homes for Adults (18-65 years) Page 18 of 27 Evidence: that people are being protected from harm and abuse. We spoke to two members of staff, both knew what to do if people made a complaint or if they witnessed or suspected abuse. The registered manager told us that all members of staff attended safeguarding training in July 2009. The registered manager told us that all of the people attend the Big Talk on the Road self advocacy group once a month. Care Homes for Adults (18-65 years) Page 19 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is suitable to meet the needs of the people who live there, the service is due to be refurbished. Evidence: Requirements were set at the last inspection that the outside of the house is repainted and maintained on a regular basis and the mid and top landings be decorated. The mid and top landings have been decorated. As previously stated in this report 4749 Brighton Road will be completely refurbished and reopened as a supported living service. During a tour of the premises there were no health and safety issues observed and the premises was clean and hygienic. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a competent and well trained staff team who understand the needs of people who use the service. Evidence: The staff team has remained consistent and largely unchanged since the last inspection. The registered manager told us that one new member of staff had started work and two staff had been redeployed there from another Consensus service. The registered manager showed us Criminal Records Bureau checks for these members of staff. Staff training records indicated that staff had attended training on food hygiene, first aid, fire safety, moving and handling, health and safety, medication, infection control and safeguarding adults. Staff had also attained a learning disability qualification. The registered manager told us in the Annual Quality Assurance Assessment that six of the nine staff hold a National Vocational Qualification at level 2. The deputy manager holds a National Vocational Qualification at level 3. Records showed that all staff receives regular formal supervision at least six times per year. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: Staff meetings are held on a monthly basis and in depth consultations about care practices and peoples needs are routinely discussed. Staff have also discussed the move to supported living and the impact it will have on them with the project manager. We spoke to two members of staff they told us that they had plenty of opportunities to develop because there was a good emphasis on staff training and they received good support from the registered manager and the deputy manager. One of these staff told us that they had started working at the service eight months ago and they had completed an induction course. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The overall impression when visiting the service is that it is well managed. The management approach creates an open, positive and inclusive atmosphere. Evidence: The registered manager has managed the service for fifteen years. They are currently undertaking the Registered Managers Award and told us that they would complete this in September 2009. The registered manager told us that during this period of transition they were overseeing a Consensus Support Service. They were being supported by the Brighton Road deputy manager. Staff and people spoken to indicated that the service is managed in an open and positive way. Two members of staff told us that the service was very well managed. One member of staff told us and the manager was very good and the other member of staff told us the manager was perfect. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: Regulation 26 visit reports were available for inspection. The registered manager also told us that a Consensus care services manager visits the service on a six monthly basis to carry out a very thorough audit. The registered manager produced the audit reports. The reports identified areas were the service needed to improve, an action plan and a timescale for the registered manager to complete. The registered manager showed us questionnaires completed by people who use the service, relatives, day services and other people and professionals with an interest in the service. The registered manager told us that feedback from the questionnaires was used to improve the service. The Commission wrote to the registered manager on the 20th May 2009 requesting that an Annual Quality Assurance Assessment be completed and returned to the Commission by the 17th of June 2009. The registered manager told us that they had not completed the Annual Quality Assurance Assessment because they thought that the service would have been deregistered by that time. The registered manager completed the Annual Quality Assurance Assessment on the day of our visit and forwarded this to the Commission. The fire book indicated that the fire alarm system is being checked on a regular weekly basis by staff, full fire evacuations had been carried out monthly and there was a fire risk assessment for the service that had been reviewed in 2008. All staff attended fire safety training in November 2007. A member of staff has been allocated a role as the health and safety person. They showed us the health and safety folder. The folder was well maintained and contained detailed information about health and safety issues at the service. The registered manager told us in the Annual Quality Assurance Assessment that portable appliances, the premises electrical systems, fire alarm, fire fighting equipment and gas appliances had all been tested in 2009. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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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