Inspection on 11/08/08 for Brook Street (101)

This is the latest available inspection report for this service, carried out on 11th August 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brook Street (101) 20/10/05

Brook Street (101) 05/05/05

Brook Street (101) 11/11/04

Brook Street (101) 08/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

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Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 Brook Street (101) 101 Brook Street Northumberland Heath Erith Kent DA8 1JJ Lead Inspector James O`Hara Unannounced Inspection 11 and 14 of August 2008 09:30 th th Brook Street (101) DS0000038200.V369102.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 Brook Street (101) DS0000038200.V369102.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. Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brook Street (101) Address 101 Brook Street Northumberland Heath Erith Kent DA8 1JJ 01322 332840 01322 332840 k.hazell@mcch.co.uk www.mcch.co.uk MCCH Society Ltd 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) Mr Kenneth Hazell Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 6 26th June 2006 Date of last inspection Brief Description of the Service: Brook Street is a purpose built detached two-storey property. It offers shortterm respite care to 6 adults with learning disabilities, referring to its service users as guests. Brook Street currently offers a respite service to seventyseven guests. The property has six single bedrooms (four with en-suite facilities), four bathrooms and two WCs. Two of the bedrooms are on the ground floor. There is a lift between floors and hoists in the bathrooms. There are two lounges, a dining room, kitchen, utility room with laundry facilities and an office. There is a small area for off street parking at the front of the property, with an enclosed garden to the rear. Brook Street is owned by Bexley Council and operated by MCCH Society Ltd. The home is situated in a residential area and has ready access to public transport, shops, a park and other local amenities. Bexley Council pays the fees for resident care. Guests pay a nominal fee per night and pay for any personal expenditure while they are in the home. Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We spent ten hours over two days at the home and talked with three guests, two relatives, the registered manager, the area manager, three members of staff a visiting care manager and day service manager. Records and documents examined during the inspection included the Statement of Purpose, Service Users Guide, care plans, risk assessments, medication, staffing training and health and safety records. Information was taken from a number of surveys returned to the Commission from people who use the service and staff. The home completed an Annual Quality Assurance Assessment (AQAA) to tell us about the service provided, how it makes sure of good outcomes for the people using it and any planned developments. Some information from the AQAA has been included in this report. What the service does well: Good information is available to people about the home. The needs of any new guests would be fully assessed to make sure that the service is suitable. Guests have good care plans that give good information about their support needs. Risk assessments are completed to help people live as independently as they can. Guests are able to take part in activities and be part of the local community. Medication is well managed by the home. A care manager told us “I am very pleased with the service, the registered manager works well with the guests and their families and communication with the home is really good”. A member of staff told us “We ask guests what they would like to do when they arrive and we try to make it happen, we like to try and get people out for the day or down to the coast. Some guests like to go for walks in the park or out for lunch and some guests like to help around the home”. Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 6 Some staff completed surveys and returned them to the Commission. One member of staff told us “Brook Street means a lot to a lot of families and all staff do their utmost to make the service users stay is a happy and enjoyable one. As there can be a quick turnover of guests it can be very busy, the staff deal with this very well”. A guest told us “its alright here, the food is good, I like it here some days, I like coming here”. Another guest told us “I’ve just been to the day service, I like staying at the home and I like the staff”. Relatives of one guest told us “the home is lovely, we have faith in the staff, this is just like a normal home, our son is very happy when he gets here. The staff are true carers and they try to put as much into peoples lives in the short time that they stay. I know my son is safe and well cared for”. A manager from a day service told us “this is an excellent service, staff communicate well with us and attend all of the guests review meetings, there is always a nice atmosphere here and I am always welcomed, I sometimes sit on the interview panel and parents tell me that they are very happy with the service”. The home is well run. Good Quality Assurance systems are in place. What has improved since the last inspection? What they could do better: A requirement that the registered person supply guests with a written contract/statement of terms and conditions has been outstanding for a number Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 7 of years. This requirement has been set again. The Commission has served a statutory enforcement notice to the registered providers in relation to this requirement. Failure to comply with this notice could lead to the Commission taking further legal action against the registered providers. All members of staff should attend training or refresher training (if needed) on safe guarding adults. The home should assess the locks on all of the doors in the home to make sure that guest’s privacy is respected. The latch fitted to the downstairs toilet door should be replaced with a more suitable mechanism that can be opened from the outside in the event of an emergency. The home should keep and up to date and accurate record of training attended by all staff. The home should make sure that the homes fire alarm system is checked on a regular weekly basis, that full fire evacuations are carried out and records of these are kept in the home for inspection. The manager could contact the Nurse Practitioner from MCCH to carry out a medication audit and for advice on the management and storage of medicines. The home could reconsider the practice of guests sharing bath towels and face cloths and develop a system where guests have access to their own personal items for bathing and washing. The home could obtain a copy of the Department of Health’s guide “Essential Steps” to assess their current infection control management. Staff could receive supervision at least six times a year and these sessions could be formally recorded. We would like to thank the guests, the visiting relatives, the registered manager, the area manager, the staff team, the visiting care manager and day service manager for their comments and support during the inspection process. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 8 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 Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. People using this service experience good quality outcomes in this area This judgement has been made using available evidence including a visit to this service. People planning to use the service have good information about the home and they can be sure that the service can meet their needs because their needs are fully assessed before they use the service. EVIDENCE: The home has a Statement of Purpose a Service Users Guide and a Brochure that give good information about the home. The Statement of Purpose was reviewed and updated in April 2008 however the Service Users Guide was last reviewed and updated in 2006. It is recommended that the Service Users Guide is reviewed and updated. The home has an admissions procedure. New guests are assessed by the home and care managers from the local authority learning disability team to see if the home can meet their needs before they are offered a service. Potential guests are offered an opportunity to visit the home and have overnight stays prior to making a decision to move in. Information packs are completed for new guests involving the guest, their relatives or carers and their allocated care manager. The registered manager showed us an assessment that was being carried out by a care manager of a potential guest. The assessment was Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 10 detailed and included area’s such as mobility, health care needs, likes and dislikes and the number of days respite care required each year. The registered manager told us that when the home opened ten years ago some guests used the home like a hotel; their care plans reflected their needs at the time. Although these guests did not have an assessment carried out by the local authority their care plans have been kept under regular review, the registered manager told us that if their needs changed then a referral would be made to the local authority learning disability team. Most new referrals have come through from children’s services. One care manager visiting the home to carry out an assessment told us that she had carried out a number of transition assessments when children/young adults became eighteen and needed adult respite services. The care manager told us “I am very pleased with the service, the registered manager works well with the guests and their families and communication with the home is really good” and “after initial apprehension about their children/young adults moving to adult services, parents have expressed to me that they were very happy with what the home offers”. A requirement was set at the last key inspection that the registered person must confirm in writing to residents that based on assessment the home can meet their needs. The registered manager produced a copy of a letter that is sent to the residents and their carers confirming that based on assessment the home can meet their needs. A requirement was set at the last key inspection that the and at every inspection for the home since 2002 that the registered person must supply each service user with a written contract/statement of terms and conditions between the home and the service user. The registered manager produced a recently developed draft contract including a statement of terms and conditions between the home and the service user however none of the current guests have a contract. The Commission has served a statutory enforcement notice to the registered providers in relation to this long outstanding requirement. Failure to comply with this notice could lead to the Commission taking further legal actions against the registered providers. The registered provider must ensure that all service users are provided with a standard form of contract for the provision of services and facilities by the registered provider. Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People using this service experience good quality outcomes in this area This judgement has been made using available evidence including a visit to this service. Guests can be sure that they are properly supported because care plans give good information about their support needs and how the service can meet these needs. Risk plans are completed so that people can live as independently as possible. EVIDENCE: We examined a number of guests care plan folders. All care plan folders included a photograph of the guest, a personal profile, health issues, medication information, personal care needs, support guidelines, dietary needs, communication methods, blank incident reporting forms, a body map for recording any marks or bruising, a record of the guest’s belongings on arrival at the home, daily diary notes, night time routines, daytime activities and risk assessments. Some guest’s care plans included speech and language Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 12 assessments, food and drink care plans, nighttime support guidelines, and support guidelines for diabetes, epilepsy and challenging behaviours. As required at the last key inspection guests care plans have been kept under regular review and the care plans have been signed and dated by staff. The registered manager told us that none of the guests have person centred plans kept at the home however many of the guests use other services within the local authority and he attends person centred planning meetings on behalf of the respite service to offer feedback and support to the guest. The registered manager told us in the Annual Quality Assurance Assessment (AQAA) that all of the guest’s files had been updated and re-devised and risk assessments had been updated. The registered manager has ensured appropriate risk assessments are completed for all of the guests with their involvement or their relatives/care managers. Risk assessments examined indicated the risk, hazard, actions and further actions to be taken by the guests and staff to minimise or eliminate the risk. Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. People using this service experience excellent quality outcomes in this area This judgement has been made using available evidence including a visit to the service. Guests can be sure that their social and leisure needs are met because their regular daytime activities are continued and they are offered additional activities that reflect their individual interests. Appropriate arrangements are made so that people can have regular contact with their friends and families. EVIDENCE: The registered manager told us in the AQAA that guests have the choice to attend work, colleges, employment, and daycentres whilst receiving respite care. This information is obtained prior to respite care and documented on care plan or information sent in by family/carer. Staff supports guests to activities and with their finances. Staff support guests in the community i.e. pubs, cinema, shops, leisure centres, GP appointments, place of worship, the coast, Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 14 restaurants, theatre trips, to have good relationships with the neighbours, local fund raising events with local pub, once a year guests go to London to lay a reef at the seaman’s memorial with a local fundraiser [ex-seaman], guests attend a church service prior to going to London. Guests invite their friends or family members to visit whilst at Brook Street. Guests attend a nightclub for clients with learning disabilities where some of the guests are able to make new friends. Guests are given the choice of bedroom and given a key to their bedroom if requested. Guests are given choice of menu and staff involves guests to complete a menu. The service can meet the needs of different guest’s diet [diabetes, cultural needs, special needs eating/drinking guidelines will be in place. Dietary requirements are documented on care plans. Some guests are involved in preparing meals, setting the table etc. Staff supports guests in eating and drinking if required and may need special equipment/aids. 101 Brook Street is a busy service that currently offers a respite service to seventy-seven guests. The service operates a booking system so that guests can choose a time to stay at the home. The registered manager told us in the AQAA that in January 2008 the home changed its booking format from January to December entitling each person to have an allowance of 28 days per year 14 high season period and 14 low season period. This was thought to be a fairer system for everyone. Where there were some concerns from carers who needed to have a higher package due to health needs this was assessed and agreed by the learning disability team/local authority. The registered manager told us that when booking guests in he is mindful of the guests needs and he tries to ensure that there are some people with high needs and low needs staying at the same time so that the staff team can easily cater for everyone. Most people use other services within the local authority such as day services and clubs. Whilst staying at Brook Street guests are supported to continue with their normal daytime and nighttime routines. In addition guests are offered the opportunity to access the local community. Some guests go the local pub, noodle bar, cinema, shopping at Bluewater and McDonalds. Some guests go to Jumping Jacks disco, the Beautiful Octopus Club, trips in the minibus to Hastings and the shows at the theatre. A member of staff told us “We ask guests what they would like to do when they arrive and we try to make it happen, we like to try and get people out for the day or down to the coast. Some guests like to go for walks in the park, out for lunch and some guests like to help around the home”. In view of the type of service provided staff work closely with relatives to build good working relationships for the benefit of the guests. Guests are supported to maintain contact with their families while staying at the service. Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 15 A guest told us “its alright here, the food is good, I like it here some days, I like coming here”. Another guest told us “I’ve just been to the day service, I like staying at the home and I like the staff”. Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to the service. Guests can be sure that their health care needs are met because medication is well managed by the home and they have good access to appropriate healthcare professionals. EVIDENCE: The registered manager told us in the AQAA that personal care/support is documented in each guest’s care plan and follow MCCH policy and procedures. Moving and handling guidelines are in place. Night time routines are in each of the guests care plans. When a guest is unwell we seek medical advice from NHS Direct or the guests General Practitioner or our own registered General Practitioners service. We monitor health issues and document this in the guest’s files and care plans. Risk Assessments are completed relating to health issues. Staff support guests when they are unwell. We liaise with the Learning Disability Team [Nursing] if we require support and advice. Staff follows the homes medication policy/procedure. Records are kept of medication being brought in the home and on discharge. The home completes a medication sheet for each guest. Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 17 Guests care plans examined included information on their health care needs, medication, personal care needs and support guidelines and dietary needs. Some care plans included speech and language assessments, food and drink care plans and there are guidelines for staff to follow in order to support people with diabetes, epilepsy and challenging behaviours. It was evident that the guest’s health care needs are fully assessed and risk assessments are carried out to ensure that their needs are met while staying at the service. Guests have a choice to stay registered with their own General Practitioner while they reside at the home if the General Practitioner is in agreement. If this is not possible then guests are registered temporarily with a local General Practitioner. As this is a respite service routine health care needs such as dental, optical or chiropody care are accessed for guests only in an emergency. If guests have a healthcare appointment to keep during their stay in the home staff support them to keep the appointment. The organisation has a policy on medication. Only staff that have been trained and assessed as competent on the administration of medication can administer medication to guests. Training records indicated that most of the staff team has had training and been assessed as competent to administer medication. Guests bring their own medication with them to the home. Medication brought in is checked and counted and recorded appropriately on medication administration records. Medicines are stored securely in the office and a medicine fridge is provided. The registered manager told us that a new medication cupboard had been installed in the home since the last inspection. Medication administration records examined were up to date and accurate on the day of the inspection. The registered manager told us that he carries out regular checks and balances of all medication kept at the home. Medication administration records also included a photograph of the guest and any allergies that they may have. As required at the last key inspection staff records the temperature of the medicine fridge daily and staff ensures that information recorded on medication administration records is the same as that on the pharmacy label. The registered manager told us that the local General Practitioners offers advice on the guests medication however does not offer advice on the management and storage of medicines in the home. The registered manager told us that a Nurse Practitioner from MCCH had visited the home some time ago to carry out a medication audit. It is recommended that the registered manager contact the Nurse Practitioner from MCCH to carry out a medication audit and for advice on the management and storage of medicines in the home. Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. 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. Guests can be sure that their complaints and concerns are listened to because the service has a clear complaints procedure that that they can understand. Guests can be sure that they are protected from harm and abuse because the service has policies in place for safeguarding adults and staff has completed training on adult protection. EVIDENCE: The registered manager told us in the AQAA that the home deals with complaints and respond to complaints within the 28 days. The manager and staff listen to concerns and complaints that are made. We support guests to resolve any issues if we can prior to making a compliant. We follow the homes policy on adult protection, whistle blowing and any incidents/accidents are documented and body maps are completed whilst in respite care. All guests’ monies and valuables can be locked in their bedrooms or in the office safe. Any issues are concerns from guests and parent/carers are listened to and resolved and auctioned monitored and reviewed. The registered manager told us that guests and their representatives are supplied with a copy of the homes complaints procedure at the point of guests taking up the service. However he told us that the procedure had been Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 19 updated and would be sent out to guests and their representatives along with the contracts and an updated brochure about the home. The registered manager produced the homes complaints record folder. The folder contained a description of the complaint, who the complaint was made by, what the complaint was about, nature of the complaint and how the complaint was resolved. Three complaints had been made to the home since August 2007; all of these had been resolved within twenty-eight days of the complaint being made. The registered manager produced the organisations policy relating to safeguarding adults; he told us that the organisations policy is used along side Bexley Councils Alerter Guide Manual on safeguarding adults to ensure that guests are protected from abuse. The home also has a Whistle Blowing policy. One guest was recently observed with unexplained bruising, the registered manager contacted the local authority safeguarding team and a strategy meeting was held. It was not possible to determine the cause of the bruising. Actions from that meeting included a referral to a nurse around epilepsy, a referral to the occupational therapy team and review of the guests moving and handling and support guidelines. The registered manager told us that all of the actions from the meeting were being addressed. Records show that most staff has attended training on safeguarding adults, some staff attended in 2005, 2006, 2007 and one member of staff in 2008 however the registered manager could not clarify if two members of staff had attended the training as their training records had been mislaid while transferring to the home. The home also has a member of staff who is employed to carry out domestic duties. The registered manager must make sure that all members of staff including the member of staff who is employed to carry out domestic duties attends training or refresher training (if needed) on safe guarding adults. Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 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. The home is well maintained so that guests can stay in a clean, comfortable, homely and safe environment. EVIDENCE: The registered manager told us in the AQAA that the home is designed to meet the needs of the guests that use respite services and is adaptable for wheelchair users. We have relevant equipment, hoists, up/down beds, mobile hoists, up/down bath, slings, and transfer boards for special needs. The rooms are clean tidy and well furnished, and some of the bedrooms are en suite. We also have a lift that goes up to the first floor. We can offer local community activities and offer an emergency bed if required within Bexley. We currently employ a domestic with a mild learning disability who has worked at Brook Street since it opened 10 years ago. The home is kept clean and tidy. We have Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 21 good laundry facilities the washing machine, tumble dryer and dishwasher are all industrialized machines. The accommodation provided was suited to meeting the needs of the guests. The environment was comfortable and homely and furniture and fittings is satisfactory. A requirement was set at the last key inspection that the registered person must ensure the premises are well maintained and decorated. The flooring in the downstairs bathroom and laundry room must be repaired or replaced. The registered manager told us that the downstairs hallway, the downstairs and upstairs lounges, dining area and four bedrooms had been redecorated since the last inspection. The flooring in the downstairs bathroom and laundry room has also been replaced. The rear garden was neat and tidy however some of garden furniture had been condemned. The registered manager told us that funding was available to purchase new furniture for the garden and he planned to do this soon. Toilets and en-suites were clean and tidy and bathing facilities were suited to meeting the needs of the guests. However the lock on the downstairs toilet door had been removed and replaced with a latch. It was possible to open the toilet door from the inside and outside even when the latch was on. This device does not make sure that guests are able use the toilet in privacy. The registered manager must assess the locks on all of the doors in the home to make sure that guest’s privacy is respected. The latch fitted to the downstairs toilet door needs to be replaced with a more suitable mechanism that can be opened from the outside in the event of an emergency. The home was clean, tidy and well ventilated. Staff had access to protective clothing and liquid soap for hand washing; the registered manager told us that new paper towel dispensers had been installed since the last inspection. It was observed that there were a large number of bath towels and face cloths in the downstairs bathroom; the registered manager told us that guests are offered a choice of bringing their own bath towels and face cloths however some guests prefer to use those supplied by the service when they stay. Even though the home has a washing machine that washes at high temperatures to reduce the risk of infection this practice could leave the guests at risk to the spread of infections. It is recommended as good working practice that the registered manager reconsider the practice of guests sharing bath towels and face cloths and develop a system in the home where guests have access to their own personal items for bathing and washing. The home has a policy for preventing infection and managing infection control and staff has attended training on the topic however it is recommended that Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 22 the registered manager obtain a copy of the Department of Health’s guide “Essential Steps” to assess their current infection control management. Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. 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. Guests can be sure that they are safe because there are enough competent well trained staff on duty at all times. They can have confidence in the staff because checks have been done to make sure that they are suitable to care for them. EVIDENCE: The registered manager told us in the AQAA that staff have had experience and hold a qualification in NVQ 2, 3 and 4. All of the current staff team are qualified in an NVQ. The manager is currently undertaking phase 2 management course 1 year. Staff get to know the clients and develop good relationships with parents/carers. Staff are familiar with the GSCC standards. The staff team have different qualities and skills which to fulfil their working role. When new staff commences employment references and Criminal Record Checks are obtained by the personnel department at MCCH. Guests are part of the interview process. The home has a training development plan, staff attends mandatory training and training that is identified through supervision and Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 24 appraisal. Staff also have undertaken specialist training which is relevant to the guests needs. All new staff completes an induction programme and an inhouse induction is carried out. Relatives of one guest were visiting the home, they told us “the home is lovely, we have faith in the staff, this is just like a normal home, our son is very happy when he gets here. The staff are true carers and they try to put as much into peoples lives in the short time that they stay. I know my son is safe and well cared for”. The staff team comprises the registered manager, four full time day staff, three part time day staff, three part time night staff and one part time domestic staff. The registered manager told us that the home is in the process of recruiting another full time and another part time member of staff. Staff training records were examined, these indicated that most staff had attended training on moving and handling, health and safety, first aid, food hygiene, fire safety, medication, adult protection, epilepsy, diabetes, dementia care, autism, challenging behaviours and enteral peg feed. However records showed that some of the staff had attended training on these topics at their induction in 2004. There was evidence that some staff attended training on British Sign Language and staff is encouraged to learn makaton sign so that they can communicate well with some of the guests. The registered manager told us that he had sought updated training records from the organisations training department so that he could develop a training programme based on the assessed needs of the guests. The registered manager told us that some staff had attended training on fire safety at a team meeting last year however he could not find any evidence of this and some staff had also attended training on food hygiene, he contacted the training department to establish when staff had attended. The training department confirmed that staff had attended training on food hygiene. The registered manager told us that some staff was due to attend moving and handling and fire safety training the day following the first day of this inspection. He told us that further training had been arranged for staff on adult protection, medication, first aid, enteral peg, food hygiene and rectal diazepam. On the second day of the inspection the registered manager confirmed that nine members of staff had attended training on moving and handling and fire safety following the first day of the inspection. Staff training records within the home had not been kept up to date so it was difficult to establish when and what training staff had attended or required. The registered manager must keep and up to date and accurate record of training attended by all staff at the home. All staff has completed or is completing an NVQ course. Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 25 Staff personnel files are not kept in the home. However a member of the MCCH human resources team confirmed over the telephone that information required by regulation including Criminal Records and POVA checks, two written references, proof of identification, health check, professional qualifications and a full employment history had been obtained for all staff at the home. One member of staff has a mild learning disability and supports the home with domestic duties; this member of staff attends all of the training offered at the home. This member of staff told us “Its nice working here, the other staff are nice and kind”. Another member of staff told us “I like working here, I have experience in working in larger care home’s but this is different, the manager is fair and listens to us, the manager gives good support and supervision”. The registered manager told us that he supervises staff on a regular basis but has not always recorded these supervisions. He told us that all staff has an annual appraisal and staff meetings take place on a regular basis and produced the minutes from these meetings. It is recommended that staff receive supervision at least six times a year and these are formally recorded. Some staff completed surveys and returned them to the Commission. One member of staff told us “the home provides an excellent service for people/carers who need some respite for holidays and quality time. They know the family and service users are well cared for and their needs are with competent staff”. Another member of staff told us “I have only been at Brook Street for five weeks but the induction, ongoing training and information has been excellent”. Another member of staff told us “Brook Street means a lot to a lot of families and all staff do their utmost to make the service users stay is a happy and enjoyable one. As there can be a quick turnover of guests it can be very busy, the staff deal with this very well”. Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. 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. Guests can be sure that their needs are met and wishes are taken into consideration because the home is well managed. Guests can be sure that hey are protected from harm because good health and safety arrangements are in place. EVIDENCE: The registered manager told us in the AQAA that he ensures that aims and objectives of the home are met. Policies and procedures are implemented and that staff read and sign them. The manager has good relationships with parents and carers. The manager attends regular reviews and meetings that are relevant to the guests. The manager promotes a good quality service Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 27 within respite care. The manager has a senior who commenced employment in May and objectives are set for the senior to undertake. We have a professional friendly approach to parents/carers/visitors. The manager has devised a service user contract and parent/carer/client questionnaire. The manager ensures safe working practices are in place within the home. The clients at Brook Street benefit from residing in a well managed respite residential home. We are part of a large social care organisation and we have resources such as housing management, HR, finance and training. We have an experienced line manager who has knowledge of respite services. We have extensive policies and procedures that cover all aspects of the guest’s lives. Regulation 26 visits are carried out monthly. The manager has been in post for since the home opened ten years ago; he has completed the Registered Managers Award and NVQ level 4 in Health and Social Care. He told us that he is currently completing a one-year management course with MCCH. It was recorded in the last inspection report that the homes records were generally up to date and well maintained, however a number of entry errors on records had been amended using correction fluid. A requirement was set that the registered person must ensure that corrections made to record entries are made correctly and without the use of correction fluid. The registered manager told us that this practice had been eliminated. It was agreed with the registered manager that the homes administration records in particular the staff’s training records were in need of updating. A requirement was set at the last key inspection that the registered person must ensure a quality assurance system is in place to review and improve the service. Reports prepared based on quality assurance surveys must be sent to the Commission together with any remedial action plans. The registered manager produced regulation 26 visit reports; since the last inspection these had been developed to include a total quality-monitoring audit. The reports/audits included detailed feedback using the National Minimum Standards headings of choice of home, individual needs, lifestyle, personal health care and support, concerns and complaints, environment, staffing and conduct and management of the home. The registered manager also produced a business plan for the home and recently developed guest and relatives questionnaires. The registered manager told us that he was posting the guest and relatives questionnaires out on the first day of this inspection. The homes environmental risk assessment had been reviewed and updated, the registered manager has developed a lone working policy and new shift planners since the last inspection. Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 28 A manager from a day service was visiting the home, she told us “this is an excellent service, staff communicate well with us and attend all of the guests review meetings, there is always a nice atmosphere here and I am always welcomed, I sometimes sit on the interview panel and parents tell me that they are very happy with the service”. Regulation 37 reports are sent to the Commission the area manager and the local authority learning disability team. The registered manager produced evidence that any incidents or accidents suffered by guests are recorded and forwarded to parents, the area manager and the local authority learning disability team if appropriate. The registered manager produced a portable appliance testing certificate 11/09/07, a landlords gas safety certificate 31/01/08, hoists had been serviced on the 29/04/08 and the lift serviced in July 2008. Fire records showed that a fire risk assessment had been carried out at the home in 2002 and had regularly been reviewed. The fire alarm system had been serviced on the 29/04/08. Weekly fire alarm tests had been carried out however there were gaps of seventeen days between 12/04/08 and 29/04/08, a month between the 28/05/08 and the 30/06/08 and two weeks between 22/07/08 and 08/08/08 when checks had not been carried out. The registered manager told us that full fire evacuations had been carried out at the home but could not locate these records. The registered manager must make sure that the homes fire alarm system is checked on a regular weekly basis, that full fire evacuations are carried out and records of these are kept in the home for inspection. Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 29 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 3 2 3 3 3 4 3 5 1 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 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 X 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 30 Yes. 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. 1. Standard YA5 Regulation 5(1)(c) Requirement The registered provider must ensure that all service users are provided with a standard form of contract for the provision of services and facilities by the registered provider. The registered manager must make sure that all members of staff including the member of staff who is employed to carry out domestic duties attends training or refresher training (if needed) on safe guarding adults. The registered manager must assess the locks on all of the doors in the home to make sure that guest’s privacy is respected. The latch fitted to the downstairs toilet door needs to be replaced with a more suitable mechanism that can be opened from the outside in the event of an emergency. The registered manager must keep and up to date and accurate record of training attended by all staff at the home. The registered manager must make sure that the homes fire DS0000038200.V369102.R01.S.doc Timescale for action 30/09/08 2. YA23 13(6) 30/09/08 3. YA24 13(4) 30/09/08 4. YA32 17(2) 30/09/08 5. YA42 23(4)(e) 30/08/08 Brook Street (101) Version 5.2 Page 31 alarm system is checked on a regular weekly basis, that full fire evacuations are carried out and records of these are kept in the home for inspection. 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. 2. Refer to Standard YA1 YA20 Good Practice Recommendations It is recommended that the Service Users Guide is reviewed and updated. It is recommended that the registered manager contact the Nurse Practitioner from MCCH to carry out a medication audit and for advice on the management and storage of medicines in the home. It is recommended as good working practice that the registered manager reconsider the practice of guests sharing bath towels and face cloths and develop a system in the home where guests have access to their own personal items for bathing and washing. It is recommended that the registered manager obtain a copy of the Department of Health’s guide “Essential Steps” to assess their current infection control management. It is recommended that staff receive supervision at least six times a year and these are formally recorded. 3. YA24 4. 5. YA24 YA36 Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brook Street (101) DS0000038200.V369102.R01.S.doc Version 5.2 Page 33 - 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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