Random inspection report
Care homes for adults (18-65 years)
Name: Address: Prospect Place 19 Prospect Place Cirencester Gloucestershire GL7 1EZ one star adequate service 29/06/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Odette Coveney Date: 1 5 0 6 2 0 1 0 Information about the care home
Name of care home: Address: Prospect Place 19 Prospect Place Cirencester Gloucestershire GL7 1EZ 01285640520 01285640520 claire.mcgovern@brandontrust.org www.brandontrust.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Michael Wayne Thomas Steed Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Brandon Trust care home 5 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Conditions of registration: 5 5 The maximum number of service users who can be accommodated is 5. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability (Code LD) Physical disability (Code PD) Date of last inspection Brief description of the care home Prospect Place is a home for five people with profound learning disabilities and physical disabilities. The home is situated in Cirencester in a quiet location and is close to local amenities. Each person has a single room which they can furnish and decorate as they
Care Homes for Adults (18-65 years) Page 2 of 14 2 9 0 6 2 0 0 9 Brief description of the care home wish and there are bath, shower and toilet facilities. There is a lounge/dining area which is comfortable and spacious, a conservatory and a kitchen which is domestic in style. There is a separate laundry room. The grounds are well managed and are accessible to people who live in the home. A variety of garden furniture is provided as well as a summerhouse. Information about the home is available in a statement of purpose and service user guide. Information about the fees can also be obtained from the home. Inspection reports are available from the home and our website, www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 3 of 14 What we found:
This unannounced random inspection took place over five hours and was completed in one day. The manager was present during the inspection and participated in the process. Evidence was gained from a whole range of different sources, including:- Information provided by the manager in the Annual Quality Assurance Assessment questionnaire (AQAA), completed prior to our visiting the service, directly speaking with people work at the home, a review of individuals care records, a tour of the home, an examination of some of the homes records and observation of staff practices and interaction with the people who live at Prospect Place. The purpose of the visit was to establish if the home is meeting the National Minimum Standards and the requirements of the Care Standards Act 2000 and to review the quality of the care provision for the individuals living in the home. We also spoke with the manager about the new Health and Social Care Act 2008 and the responsibilities of the service. The organisation have applied to us in order be registered under the new legislation, we spoke to the manager Mr Steed about this, he was able to demonstrate to us a sound understanding of the Essential Standards of Quality and Safety and the accompanying Judgement Framework document. A requirement was made by us during our last key visit to the service, in June 2009 that the homes statement of purpose must include the name, address, qualifications and experience of any registered manager. So that people are clear who is responsible for managing the home. We reviewed this document at this visit and found this requirement to have been met. The document contained all of the information as required and was sufficiently detailed in order that those who live at the home and any prospective people into the home have accurate information about the manager, staff, faciltities and services provided at Prospect Place. The assessment procedure for the home is clear and a thorough assessment of prospective residents needs is carried out. The pre-admission assessments were not viewed by us at this visit, there have been no previous concerns over pre-admission assessments. There have been no new admissions into the home for sometime. It is our understanding that a detailed assessment of the residents care needs are established over the initial few days and weeks of the placement and are regularly reviewed. Those who live at Prospect Place have terms and conditions in place, these contracts outline the terms and conditions of the placement. Those seen by us contained appropriate information. Care plans detail residents care, emotional and physical care needs. Peoples wishes and chooses are also recorded. The care plans in place are well written and give clear directions to staff . The staff provide appropriate personal care to maintain residents health, well being and dignity. The care plans, known as My personal plan were informative and detailed how to meet
Care Homes for Adults (18-65 years) Page 4 of 14 the care and other associated needs of the person. The plans included information that is important to the individual such as; about the people in my life, things I like to say about myself and also what I want to do in the future and who will support me. The care plans stated what actions staff must follow to assist the individual, and included information showing how to support the person in aspects of their health in the form of health action plans. The staff are familiar with the content of the care plans and know what actions they must take to meet residents needs. Care plans had been reviewed and updated regularly. This demonstrates residents needs are being monitored and kept under review. A requirement was made by us during our last key visit to the service. This was that the care plans in place for people who live at the home must be regularly reviewed and revised when needs change. This was so that there is up to date information for staff and they can support people properly. This was not an area of concern for us at this visit and we found this requirement had been met. The manager has developed an audit process and care plans, along with associated documents, are reviewed and updated on a minimum of a monthly basis. This is over and above the required minimum standards. Risks are well recorded within the home and these assessments are completed in such a way as to keep people safe without limiting their independence or choices. These are monitored, adapted and changed as and when needed in line with the care plan. People living in the home are registered with a local doctors practice. People are supported with their primary healthcare needs such as the dentist, chiropody and optician, these had all been record in individuals health action plans, care plans and daily records. We saw that the home contacts individuals GP or any other health service as required promptly. Specialist services are also arranged as and when required and we saw that in the past this has included community mental health support and local authority care managers. We saw detailed information in the residents daily records that showed us staff observe residents and their overall health. Staff will call the doctor if they are concerned about the person. During our last visit to the service in June 2009 a requirement was set by us that the registered person must make sure that people have access to activities, including hydrotherapy where this is an identified need, to promote their fitness. This requirement was made to ensure that the people who require hydrotherapy remain fit and healthy and are able to access the services they require. A review of both healthcare and daily records evidenced to us that people are participating in both health and social activitys as recorded in their care plan and as per their choice. This requirement has been met. A requirement was also set by us at our last visit that the registered person must make sure that where exercises are recommended by health care professionals these therapies are carried out. This was in order to make sure that people remain healthy. As reported no concerns were noted or expressed to us and we believe this requirement to have been met. Whilst we were at the home we reviewed residents medication charts. We saw a photo of the person with each record to ensure medication is given correctly to the person named on the chart. All staff administering medication have completed training to make sure
Care Homes for Adults (18-65 years) Page 5 of 14 they can do this safely. We saw guidelines in place to advise staff of the preferred way that residents like to take their medication. This will guide staff and ensure medication is given to them in the way residents prefer. The stock of medication held in the home was satisfactorily organised. Medication that was no longer required was being returned to the pharmacist. The medication administration charts we read were up to date, we saw the signature of the member of staff who had given out the medication. This shows us residents medication is given out safely. The reasons for any omissions had also been written on the charts. Residents family and friends are encouraged to keep regular contact with their relatives at the Home and staff support people to maintain relationships with those people who are important to them. The home operates an open door policy for visitors. Those who live at the home are able to see visitors in the privacy of their rooms if they wish. The lounge/dining room was light, relatively spacious. The menu offers traditional meals and those with a choice available. Meals are often provided to residents based on known likes and dislikes. The menus are designed with consideration given to colour, presentation, taste and texture for the benefit of the residents. A requirement was made by us during our last key visit to the home. This was that the registered person must make sure that a record of food provided for people is made in sufficient detail to tell whether a nutritious diet is being served. This was to ensure that people are receiving recommended nutrients including five portions of fruit and vegetables each day. Records of individuals food (and where required, drink) intake were well recorded. People are able to choose what they want to eat, balancing individual choice and health needs. We saw that the menus incorporate fresh fruit and vegetables and people are encouraged to maintain a healthy diet, however, peoples choices and preferences are also important. We are aware that when needed people have been supported in this aspect of their life and staff have sought and acted upon the advice of experts such as the dietitian. Staff were seen to be assisting residents to eat in an unhurried and respectful manner. For the main meal lose times are set and staff can access beverages and snacks 24 hrs a day for those who would like them. A copy of the complaints procedure is available at the home and information about how to raise issues of concern are also recorded with the homes Statement of Purpose and the homes guide for service users. All of these documents includes the name of the Care Quality Commission for anyone who wishes to contact us and make a complaint. The contact details of the responsible individual are included in the service users guide and within residents contracts, if residents or representatives wish to contact the responsible individuals in order to directly to make a complaint. Staff have received training on safe guarding vulnerable adults. The Local Authority adult protection procedure document is available. In addition to this the Home has its own policy and procedure in relation to the safeguarding of vulnerable adults. This is kept in the office so that all staff are aware of it and what they need to do to protect people from harm and abuse. This policy is in need of review, please see details below. A number of staff have completed the National Vocational Qualification in care award, and a component of the award addresses issues around the topic of the protection of vulnerable adults from abuse. Prospect Place is located within the residential area of Cirencester and is close to local
Care Homes for Adults (18-65 years) Page 6 of 14 amenities. The accommodation is built over two floors, and those who live on the first floor need to be fairly ambulant as there is no passenger lift. Specialist equipment and adaptations are in place throughout the Home, to assist residents and visitors who may have reduced mobility. Bedrooms have been personalised to reflect the tastes of residents with photographs, sensory equipment, mementos and small items of furniture. The standard of furniture and fittings is good and no areas of concern were noted by us. There are bathrooms and toilets located within close proximity to rooms. All of the bedrooms and all the communal areas were viewed. All of the bedrooms are for single occupancy.Rooms were satisfactorily decorated and maintained. The environment was clean and free from unpleasant odours. There is a dining room and a lounge area. Residents were observed sitting in communal areas looking very relaxed and comfortable in the surroundings. We are pleased to report that since the last inspection there have been a number of significant improvements to the environment, there are a number of areas that have been redecorated and the home looks bright and fresh. Specialist equipment and adaptations are in place throughout the Home, to assist residents and visitors who may have reduced mobility. We also found that during our visit specialist assitive technology had been obtained for people in order to maintain and improve their independence and communication. At our last key visit to the home in June 2009 three requirements were made by us in respect of the environment. These were as follows: Areas in the corridors, living rooms and bedrooms which are worn must be redecorated.This was so that people live in a pleasant environment. These areas have been redecorated, this requirement had been met. Another requirement was that the registered person must make sure that the physical design and layout of the building meets peoples needs.That attention must be given to making the corridors and bedrooms more easily accessible. This was so that people can move about the home independently in wheelchairs. Whilst we acknowledge that this is essential it is also important to record that the physical design and layout of the building would not allow this. Since our last visit to the home ramps are now in place which lead from peoples rooms in order to allow them easy access to the gardens, people were seen moving freely about the home. Another requirement in respect of the environment was that the registered person must make sure that there are alternative bathing facilities for the person who does not like a bath. This was so that this person can keep clean and comfortable. The manager informed us that planning and funding had been agreed to install a shower facility within the home in order that an alternative facility is available to people. We will review progress in this area when we next visit the home. Some people who live at Prospect Place were observed walking around the Home and sitting in the enclosed garden. People looked relaxed and settled in their environment, and seemed to particularly enjoy sitting and spending time with staff in the garden . Staff were relaxed and spoke to people in a calm and reassuring manner.
Care Homes for Adults (18-65 years) Page 7 of 14 The recruitment process and staff records were reviewed by The Commission when we visited the headquarters for the Brandon Trust in 2009. Our visit showed that the organisation follows correct recruitment procedure and policies. Records seen by us at that time contained application forms, references, and a Criminal Records Bureau (CRB) disclosure. The staff we spoke were were very motivated and told us that they were happy working at the home, comments made included; It is much better working here now, Our manager is very supportive, he listens to us and supports us. At our last key visit to the service in June 2009 a requirement was set by us that the registered person must make an application to the Commission to register a manager so that they can be approved as a fit person to run the home. This was so that people can be assured that the home is being managed by someone who is fit to do so. Mr Steed was interviewed by us in June 2010 and was deemed to have the necessary, skills, knowledge and experience to manage this service. Mr Steed is also the registered manager of another service 3 & 4 The Rise, also managed by the organisation The Brandon Trust. Throughout the inspection Mr Steed was open to the process and engaged with us. He was extremely knowledgeable about the needs, wishes and aspirations of the people who live at the home. He was aware of his role and responsibilities in respect to his role as the registered manager. The staff reported that staff meetings are held regularly, records were looked at on the inspection and these evidence that appropriate subjects were covered and clear direction and guidence is provided to staff in these forums. Staff said that they felt able to express their views to the manager and to the owner. A requirement was set by us at our last visit to the service that the registered person must make sure that information provided in the Annual Quality Assurance Assessment (AQAA) is up to date and accurate. This was so that the Commission and people who live in the home can be assured that the quality of the service is being maintained. We recieved this document from the manager in March 2010. We found this document to be extremely well written and sufficiently detailed with clear information and evidence provided to demonstrate how the National Minimum standards are met at the home, thus ensuring positive outcomes for those who live at Prospect place. Within the AQAA there is a section in which the service can tell us what they believe they do well. Within their completed AQAA some of the areas we were informed about were: All new service users are admitted with a full care assessment and the home completes its own assessment tool with service user and family/advocate to ensure that the service is needs led. A communication profile is completed. All service users have a named key worker and allocated time to work with them or another named staff member once a week.All service users have a Plan for life which incorporates health concern, access to services and facilities within the home and the wider community, reflects changing needs and sets goals for the future with an action plan.The Plan for life is developed with support from service users friends/family where possible and other professionals and is reviewed every six months. The home works closely with a Befriend organisation to support service users interests and hobbies.All survive users are offered opportunities to participate in day to day
Care Homes for Adults (18-65 years) Page 8 of 14 running of the home through house meetings, complaints procedure and Plan for life reviews. All service users have daily routines, care plans,risk assessments that promote independence, freedom of movement and choice. All service users can participate in valued and fulfilling activities, e.g voluntary work, attending mainstream college, recycling projects, day centre, hydrotherapy, sailing, sports and leisure centre and are supported to access their local community through walking, bus service, taxi or home vehicle. Community participation includes going to local church, using local shops,,hairdressers, medical centre, library, theatres,music halls, pubs and supporting local fund raising projects. The staff rota reflects service user needs so they can be supported to carry out individual and group activities. The staff team at the home are well motivated, committed and well trained in all areas of care. This includes, moving and handling,food hygiene,first aid , fire safety, medication, clinical tasks, communication, positive response, diversity of service users, sensory work,feeding and personal care.Staff training and development fulfills the aims and objectives of the home and reflects the changing needs of the home.All staff receive regular supervision and are trained in NVQ 2/3 in Health and Social care or are working towards gaining it. The organisation have a number of quality-monitoring audits of the Home and the overall service. These include health and safety audits, monitoring visits completed on behlaf of the responsible individual, financial audits, an organisational business plan in which the home develops their own action plan. Other methods include care plan reviews, person centred planning workshops, team meetings and staff development and appraisal of their performance. These variety of methods are a good way to check on the quality of care and satisfaction for those who live at the home, the overall service, and the general standards and quality outcome measures in the Home. Policies are in place to direct and guide practice. There are a number of these that have not been reviewed for over three years, such as bullying, communicable diseases and infection control and dealing with violence and aggression. Policies are in place to direct and guide practice. There are other policies that have not been reviewed for accuracy for ten years. It is recommended that these are reviewed and updated if needed to ensure they provide information that is in line with current good practice. We found the records pertaining to people who live at the home were satisfactorily maintained and in order. The records relating to the management of the home were also up to date and in order. The records are kept secure in the home and are available to staff when needed. We have referred to other records in other sections in the report. At our last visit to the service a requirement was made by us that the registered person must make sure that there are, at all times, enough qualified, competent and experienced members of staff on duty to maintain the health and welfare of people who live in the home. This is so that people receive consistent support and their needs are met. We spoke to the manager and staff about staffing levels as the home and these appear to have improved since our last visit. The numbers of staff on each day have increased and new staff have been appointed. There remains a high dependency from the home on the use of agency staff. We were assured that this is being monitored and that the same staff are used to ensure continuity for those who live at the home. We will
Care Homes for Adults (18-65 years) Page 9 of 14 review this when we next visit the home. Staff are provided with regular training in health and safety matters including fire safety, food hygiene training and moving and handling practices. This should help protect residents health and safety if staff are knowledgeable and well trained in these health and safety principles and practices. What the care home does well:
The manager and staff team at Prospect Place have a strong commitment and drive in wishing to provide a good service at the home. The home has a number of methods to ensure that peoples needs and wishes are known, recorded and responded to in a person centred way. This is undertaken through such methods an an open and engaging management style, one to one support and time spent with those who live at the home talking with them about their care, staff supervision, training and meetings to ensure that all are consulted. There are clear lines of accountability within the home. There is a clear process to ensure that the service is able to meet the assessed care needs of prospective people moving to the home. There is an admission procedure, which is included in the statement of purpose and full assessments of needs are undertaken. The manager ensures that no individual is admitted into the home unless there has been a full assessment of their needs and that the home are confident that they are able to support them to maintain their skills and lead a fulfilling life The home has a good care planning system, which is holistic, and this specifies how identified needs are to be met. Care plans are regularly reviewed and there is an ongoing assessment and monitoring of individuals needs and the service is tailored accordingly. Proper arrangements are in place for residents to access primary health care services. The staff properly store, administer and record medication on behalf of those who live at the home. There are good arrangements in place for staff training and awareness of Protection Of Vulnerable Adults matters. The home is comfortable, homely and well maintained. Prospect Place is also well furnished and those living at the home have personalised their rooms. The home provides a safe and well maintained environment for the those who live there. The bedrooms and communal rooms and facilities are suitable and well presented for their purpose and meet the needs of people who live there. Specialist equipment is in place for the people who live at the home in order to ensure their safety and well being. The standard of cleanliness is good. The recruitment procedures and records are in good order to protect residents. The home is well staffed with appropriately trained and experienced staff for the number of residents. Care Homes for Adults (18-65 years) Page 10 of 14 Staff at the home are well supported by the manager through supervision, appraisals and team meetings. Staff are well trained and undertake training in order to equip them to perform their duties. People who live at Prospect Place live in a home that is well run and run in their best interests. There are creative and effective ways being used to monitor the quality of care and service in the home. The health and safety of those who live and work at the home are well protected. Staff have developed sound relationships with those who live at the home and have a clear understanding of the individual needs, wishes and aspirations of those who live at the home. 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 set out on page 2. Care Homes for Adults (18-65 years) Page 11 of 14 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 12 of 14 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, 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 1 40 Policies are in place to direct and guide practice. There are a number of these that have not been reviewed for over three years, with others that have not been reviewed for accuracy for ten years. It is reccommended that these are reviewed and updated if needed to ensure they provide information that is in line with current good practice. Care Homes for Adults (18-65 years) Page 13 of 14 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 14 of 14 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
