Inspection on 09/07/08 for 22 North Paddock Court

This inspection was carried out on 9th July 2008.

CSCI 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.

Other inspections for this house

22 North Paddock Court 25/07/06

22 North Paddock Court 01/12/05

22 North Paddock Court 13/09/05

22 North Paddock Court 01/02/05

22 North Paddock Court 12/11/04

22 North Paddock Court 12/01/04

Similar services:

Egerton Lodge Care Home

Alfred Minto House Care Home

St Matthews Unit

Trevayler Residential Care Home

Thornham Grove

Thistle Hill Hall

Conifer Lodge

Westwood Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 22 North Paddock Court Lings Northampton NN3 8LG Lead Inspector Ms Rajshree Mistry Unannounced Inspection 9th July 2008 10:00 22 North Paddock Court DS0000012873.V368046.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 22 North Paddock Court DS0000012873.V368046.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. 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 22 North Paddock Court Address Lings Northampton NN3 8LG 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) 01604 412501 F/P 01604 412501 The Brain Injury Rehabilitation Trust Mrs Gillian Taylor Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th July 2006 Brief Description of the Service: North Paddock Court provides care and support for up three residents between the ages of 18 and 65 years who have a mental disorder, arising out of an acquired brain injury. The service is part of the Brain Injury Rehabilitation Trust. The Trust works in partnership with a number of other external Health Care Professionals to provide specialist rehabilitation programmes within a residential care home setting. North Paddock Court is situated in a residential area on the eastern outskirts of Northampton; the premises blend in with other houses in the road. The Home is close to local amenities and public transport can be easily accessed to get to the centre of Northampton. The premises consist of a semi-detached house on the end of a terrace. Single bedrooms are provided for up to three people. Communal facilities include a homely lounge area, an open plan dining room and kitchen and bathing and toilet facilities. A staff office/sleeping in room is provided. People living at the Home have the use of a pleasant rear garden area. The charges are assessed according to people’s needs and currently range between £1173 and £1402. People living at the Home are responsible for the purchase of their own toiletries, clothing and services such as Chiropody. People living at the Home are also responsible for paying for their own holidays although the Trust pays for any staff needed to accompany them. 22 North Paddock Court DS0000012873.V368046.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 3 star. This means the people who use this service experience excellent quality outcomes. ‘We’ as it appears throughout the Inspection Report refers to ‘The Commission for Social Care Inspection.’ The inspection process consisted of pre-planning the inspection, which included reviewing the Annual Quality Assurance Assessment (AQAA), which is a selfassessment tool, completed by the Registered Manager; the last inspection report of the Home dated 25th July 2006; the Annual Service Review dated 14th March 2008, which was based on the information we had about the service and review of the significant events the affects the people living at the Home. We carried out an unannounced site visit to the Home, on 9th July 2008, and took place between the hours of 10:00 and 17:00hrs. The Registered Manager assisted us during the site visit to the service. The main method of inspection we used was ‘case tracking’. This means looking at the care given to people in different ways. This was done by: • Selecting people who receive a range of care and support from the agency; people that have diverse needs; are new to Home and those that have been receiving care for some time. • Talking with the people we identified for case tracking; • Reading the care files which contained information about the individual people and their choice of lifestyle and support required; • Talking to staff and the Registered Manager; • Reading the written records relating to people living at the Home, staff records, the policies and procedures and records that demonstrate the effective day-to-day management of the service. We sent ‘Have Your Say About 22 North Paddock Court’ surveys to three people who use the service of which one was returned. The comments we received were showed people living at the Home were happy with the level of support they received and showed they were able to live the lifestyle of their choosing. We sent out four surveys to staff of which three were returned. We gave relatives’ surveys to the people living at the Home, who may wish their relatives to comment on the Home, of which none have been returned. We also received comments directly from the people living at the Home who were present at the time of the visit, the staff and the Registered Manager. The comments have been included in the relevant sections throughout this report. What the service does well: 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 6 People living at 22 North Paddock Court live in a comfortable environment that promotes a homely atmosphere and personal responsibility ‘for keeping the home tidy’. The care planning system used is person centred, specifically focused to support people that has suffered an injury or an illness that affects the brain. People are supported to learn daily living skills, build confidence and achieve personal goals and aspirations through good care planning systems and staff having specialist training. People are valued and treated as individuals having rights and choices. The care and support people receive is individually tailored, which involves them and key health care professionals and staff at the Home. People living at the Home benefit from having good record keeping that is up to date and reflects the current needs and aspirations. People receive good support from health care professionals and work closely with the Home’s staff at monthly reviews that promotes people’s independence and wellbeing. Staff have clear roles and responsibilities, having received training to work with people with brain injury. All staff working at the Home are required to have attained National Vocational Qualification level 3 in care. Staff treat the people living at the Home with respect and value their views, support them to achieve individual personal goals such as managing their own personal care, finance or gaining employment. Good policies and procedures of the Home underpin the day-to-day running of the Home and promotes’ the wellbeing and independence of the people living there. Comments we received from the people living at the Home and staff included: “The service supports clients with acquired brain injury by promoting a quality of life enabling them as individuals to achieve a valued role in the community. Supporting and enhancing their competence, individuality and daily living skills” “Had only praise for the Home, the staff and the manager”. “This Home was the best thing that happened to me” “I love it here”; “I knew if I wanted to get on with my life I had to give this place a go, get help to help myself” “I had a few visits here prior to moving in, very happy to do so” “It’s different type of support we offer the people” “It’s really good to see how people improve and achieve things” 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 7 “We treat our clients confidentiality with greatest of respect and keep all details filed away”. “I love it here, this is my home” “The staff are great, there are around to help but we all get on well here” “The service supports clients with acquired brain injury by promoting a quality of life enabling them as individuals to achieve a valued role in the community. Supporting and enhancing their competence, individuality and daily living skills” “We have group meetings before we decide what to do” “I’ve been to see my mother, when she wasn’t well” “I’ve been on holiday with my parents, . . .. we had a lovely time” “This is a lovely home” “It’s the best thing that’s happened to me, I’m more confident and I’ve changed into a better person” “The staff are wonderful” “Enjoy Greek dishes but all our meals are healthy”. “Staff treated them well and saw them as friends”. “We work together as a very good team and log all information and medical notes in the appropriate files and handover books; we always make sure that the staff to come on duty understands clearly” “Always’ feel I have the right support, knowledge and experience to meet different needs of people” ‘tell the staff and the manager about any concerns they may have and were confident it would be addressed’ “Anything that you’re worried about, you tell your key worker or the staff on duty” “Listens to clients, keep good paperwork. House staff are very supportive to clients and each other” “Have some privacy and sense of personal responsibility”. “We have risk assessments for everything, just to make sure we are safe”. 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 8 “People living in the residential area do not know this is a care home and we like to keep it that way” “We know how to diffuse a situation the best way when two of the clients have a disagreement at Home” “You have to be alert when you’re out and about, today as we were coming down the escalator several youths shouting and running around attracted unnecessary attention and I made sure the two people were not distracted by the youths”. “I am very happy with regular supervisions with manager. If I have any concerns, my manager will always make time for me to discuss the problem” “Induction much more formal now” “We a new client arrives at the house or a clients circumstances changes, staff can always ask for further training if required in any unknown area’s” “It’s good to see the manager working here with us, she understands us, what staff do and it gives me a chance to tell her things”. “We like the staff working here, they are kind, friendly, respect and support all of us” “Meets the clients needs very good rapport between staff and manager. Well organised home to work in” What has improved since the last inspection? Since the last inspection of the service, we received information from the registered manager before the site visit found out how the service has improved during our visit to the Home. The new care planning programme used is known as ‘Certificate of Accreditation of Rehabilitation Facilities’, (CARF) specifically for rehabilitation work. This care planning programme involved the person, staff at the Home and health and social care professionals, which looks at all aspects of the individual person’s life from the assessment of needs to goals and aspirations for the future. Staff complete Brain Injury Rehabilitation Training (BIRT), having levels specific to staff roles and responsibility. The BIRT training educates staff to understand the causes and behaviours as a result of people having suffered an injury or an illness that affects the brain and how they can be best supported. 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 9 Improvements have been made to the environment with the new walk-in shower room, decoration and new carpets and new furniture in the lounge and some bedroom furniture. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 10 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 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 11 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. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People have good information about the service, are involved in the assessment process with professionals and have a planned move to that ensures their needs can be met. EVIDENCE: We saw the home’s statement of purpose, which was displayed at the entrance of the Home. This gives information about the Home and the type of support people can expect to receive if they choose to live at the Home and the support they can expect to receive from the trained staff. We also saw the service user guide, which is information that is given to people who want to come and live in the home. This is written in plain English and set out in a helpful way for people to understand. People living at the Home introduced themselves and told us about how they came to living at the Home. We case tracked all three people, who were living at the Home, as they wanted to tell us about their life. The newest person living at the Home told us they visited the home on a number of occasions spending significant time and effort to make sure the Home would be a positive move for them. 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 12 The manager told us the Home uses a care-planning programme known as CARF, which standards for ‘Certificate of Accreditation of Rehabilitation Facilities’. We read the individual care files containing the assessment of needs, which were comprehensively detailed about the whole person. There was good information about the person before they became unwell because of a form of brain injury, the incident leading to the injury and treatment they received and the health care professionals and family involved in their lives, what their care and support needs were at the time of moving to the home and their goals and aspiration. The assessment looked at promoting people’s independence and outcomes from choosing to live at the Home, which ranged from learning daily living skills, having a fuller life and understanding and making choices that would give them greater independence as far as practicable. We spoke with staff and made observations of how staff engaged with the people living at the Home. We saw staff were treated as friends that were around to help the people living at the Home when needed. Staff told us they receive excellent information about any new person that may be moving into the Home and have the opportunity to meet with them during their initial visits so that they can get to know them. We observed people living at the home were treated with respect by the staff and the manager. This showed people were valued and respected. This supported the statement of purpose that stated people’s are treated as individuals, respecting their rights, dignity and lifestyle choices. People we spoke with all “had only praise for the Home, the staff and the manager”. We received comments directly from the people living at the Home and from surveys. These included: “This Home was the best thing that happened to me” “I love it here”; “I knew if I wanted to get on with my life I had to give this place a go, get help to help myself” “I had a few visits here prior to moving in, very happy to do so” All the care files contained a contract agreement for the stay at the Home, which were supported with the terms and conditions. People living at the Home recalled signing a contract to be able to live at the Home, so that when professionals visited them, they were ‘confident that no one could ask them to leave the Home’. 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 13 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, 8, 9 and 10. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People are involved in making decisions about their life, through excellent care planning systems and well-trained staff that promote independence and personal achievements. EVIDENCE: The Home has introduced a new innovative care planning programme that involves the individual person, key people that help them such as consultants, family members (where appropriate), home’s primary support worker at the Home and health care professionals. The care plan programme used is known as CARF, mentioned earlier, for people that have had an illness or injury affecting the brain. CARF is a comprehensive care programme, focused on the individual and involves them, the Home’s staff and health care professionals. People we tracked told us they are involved in all aspects of planning their care, looking at how their daily living skills, goals and aspirations can be 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 14 achieved. We looked at the care folders with the people living at the Home individually. We saw that people were involved and knew about what information was held about them, as they pointed out key information about them. The care plans were person centred, which means looking at all living aspects of the individual people, based on the information from the assessment. The care plans recognises the strengths, personal preferences, how the goals, interests and aspirations will be achieved. All care plans we read were different showed decisions made by the individuals, evidence of respecting individual lifestyle choices ranging from their care and support needs, relationships, employment and acknowledged of the achievements. The risk assessments were detailed, carried out by health care professionals, consultant and the Home’s manager. Everyone living at the Home knew what risk assessments were and why they are done. Risk assessments were individual looking at safety to self and others. These ranged from what people could do and wanted to do both for them living at the Home and being part of the wider community. This showed risks were focused on the individual’s best interest and how this would affect other people living at the Home. One person described the latest risk assessment done in the kitchen, which resulted in the kettle being moved to prevent people being scalded. We saw the care plans were reviewed monthly with the person, the primary support worker (staff) and health care professionals such as consultants who are known as ‘key workers’. We were told that whilst there was a monthly review of the care plans and assessments, changes and achievements were recognised as they occurred, which might be daily or weekly. One person told us when they moved to the Home, they needed encouragement to shower several times a week and now the person showers daily without being prompted. This showed people were able to achieve their goals with the right support from the staff and the Home environment. This supported the information we received from the registered manager before the site visited. Staff showed they had skills and training to work with people that had suffered from an injury associated with the brain such as an injury or an illness. We saw the training completed by the staff as part of their induction, known in short as BIRT, which stands for Brain Injury Rehabilitation Trust. Staff told us the training helped them understand how the injury affected people and how best to support them to promote their independence. Staff understood their role working at the Home, recognising the different needs of people, how to support them that promotes their independence. This showed the training staff received through BIRT was benefiting the people living at the Home. We received the following comments from staff: “It’s different type of support we offer the people” “It’s really good to see how people improve and achieve things” 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 15 “We treat our clients confidentiality with greatest of respect and keep all details filed away”. Everyone we spoke with felt they have a fulfilling life living at the Home, having the individual support and recognising their own development. People said staff respected them and their personal information. This confirmed confidentiality was kept. Other comments received directly from people living at the Home and through surveys we received: “I love it here, this is my home” “The staff are great, there are around to help but we all get on well here” 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 16 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): 11, 12, 13, 14, 15, 16 and 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People make decisions about their life; are fully supported by staff to develop individual skills, participate in the community from social activities to employment to have a fulfilled lifestyle. EVIDENCE: People told us their what they do on a day-to-day basis, which ranged from doing the laundry, keeping the Home tidy to going visit family, the gym and working. People’s interests and goals were detailed care plan. Everyone we case tracked had personal interests and aspirations. As the individual goals were achieved, new goals and aspirations were identified. People said they recognised how they use to behave and what they have done whilst living at the Home to make themselves into ‘better people’, in control, confident and achieving personal goals. 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 17 We saw the weekly programme for people living at the Home displayed in the office. The programme showed people were involved in the day-to-day running of the Home, from domestic tasks to choosing the décor. We know people had individual weekly activity, as two people were going to the gym with the member of staff when we arrived at the Home. Two people told us they have gained part-time employment whilst the third person is looking at working with animals in the future and plans to live closer to family. We saw that individual goals and aspirations were recorded and the progress monitored through the monthly reviews. This showed people received services that were individual. People said they had their own routines and keep a diary of things they need to do, which helps them to remember and be in control of their lives. We found people had a supported and homely lifestyle. This supported the information we received from the registered manager before the site visit that people are involved in writing making decisions about their life at the Home. People told us they feel safe both in the Home and being out in the community or shopping with staff. People said they know staff would act quickly if they felt unsafe in the community. Staff said people living in the residential area were not aware that this was a care home and confident that there was no unnecessary attention. All the people living at the Home are encouraged and supported to maintain contact with family and friends. One person said they were reunited with a family member, who has visited them since living at the Home. People said they go on holidays with family or have planned day trips arranged by the Home, such as trip to Buckingham Palace. We know people are supported with personal relationships and observed staff encouraging one person to seek specific advice from the nurse at the next appointment with regards to relationship and having a family. This showed staff recognised and respected people’s wishes, personal decisions and promoted their independence. Comments we received directly from people living at the Home including those received in the surveys indicated that people ‘can do what they want’ and comments included: “We have group meetings before we decide what to do” “I’ve been to see my mother, when she wasn’t well” “I’ve been on holiday with my parents, . . .. we had a lovely time” “This is a lovely home” “It’s the best thing that’s happened to me, I’m more confident and I’ve changed into a better person” 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 18 “The staff are wonderful” People said they all enjoyed helping around the Home, planning the food shopping and the menu plan for the week. People said they are totally involved in all aspects of meals, from shopping to preparing meals. There is a list of items in the freezer so people know what they can have and what needs to be bought. Everyone has their own choice of meals that they can buy and prepare at Home. Staff told us they have made a recipe folder with favourite recipes, which people use. People told us they prefer to use the recipe book as it saves them from having to find the recipes. People told us they “enjoy Greek dishes but all our meals are healthy”. From the information we received from the registered manager before the site visit support the discussion with staff and the people living at the Home, making observations and reading records. We found that people have an individual lifestyle supported by the staff that promotes their wellbeing. People said they try to keep fit, eat healthily and have their individual interests, which as they said “makes me happy”. We received copies of the monthly visits carried out by a member of the management team within the Trust, which showed the internal system for measuring the quality of the service was used effectively that checked records, sought the views of people living at the Home and staff. This demonstrated that the Home provides the service as stated in the Home’s information pack, which promotes individual choice of lifestyle. 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 19 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. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People have their individual health and personal care needs met through excellent care planning systems, well-trained staff and health care professionals that promotes their wellbeing. EVIDENCE: People we spoke with told us that about the personal support they have from the staff. People described the support they had when they first moved to the Home and the level of support they need now. One person gave us the example of staff needing to encourage them to have a shower at least several times a week and now shower daily without being reminded. This was consistent with the care plans that showed the changing needs of people as they gained confidence, regained daily living skills and independence. People said they manage their own personal care and proudly showed the newly refurbished walk-in shower room on the ground floor. People said “staff treated them well and saw them as friends”. We observed how people were supported and respected by the staff on duty by the way staff 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 20 spoke with individuals. Staff allowed the person to finish speaking; used techniques to help people recall events, conversation or situations and referred to the diaries with the list of things people wanted to do each day. This showed the support people received promoted their independence and rights. People living at the Home said they have support workers that they can talk with and who are involved in the care arrangements who are known as primary support workers. People said the care plans are developed with them, the primary support worker and key workers who may by the consultant, neurologist or another health care professional from the Primary Care Trust. The CARF (mentioned earlier) care planning system used is comprehensive and specific to people that have suffered an illness or injury to the brain, ranging from emotional needs, physical needs to triggers and prevention techniques. The system of using the CARF care planning is ‘person centred’ and used correctly by staff trained that understand brain injury has benefited people living at the Home. The care people received was reviewed; progress updated and identifying new goals and aspirations. This supported what the Home stated in the statement of purpose and the information we received from the registered manager before the site visit. People we spoke with said they attend appointment with the nurse, General Practitioner or the consultant independently or with support from staff. This was confirmed from the records we looked at such as review meetings and records of the health care appointments. We know people are supported with personal relationships from discussion with the people living at the Home and records viewed. We observed staff encouraging one person to seek specific advice from the nurse at the next appointment with regards to relationship and having a family. Staff demonstrated how the training in brain injury helped them understand the experiences of people recovering from brain injury and how this may be displayed through people’s physical and emotional wellbeing. Staff said they have learned how to promote people’s independence by prompting and supporting as opposed to doing for them. This showed staff practiced and applied the learning from the Brain Injury Rehabilitation Training (BIRT) they received to help people living at the Home. Staff told us the organisation expects staff to have attained National Vocational Qualification level 3 in care to work at the Home. This showed the responsibility of the organisation setting a standard to have trained to a higher standard that work at the service. Comments we received from staff during the visit and through surveys included: “We work together as a very good team and log all information and medical notes in the appropriate files and handover books; we always make sure that the staff to come on duty understands clearly” 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 21 “Always’ feel have the right support, knowledge and experience to meet different needs of people” We looked the arrangement for people to have their medication. All medication is stored securely in the office and given to people by trained staff. People we spoke with said they know what medication they take and get their medication daily from the staff. We looked at the records and medication for the three people we case tracked and all were correct, which showed the system in place was safe and reflected the Home’s policy and procedures for medication. Staff training records showed staff received medication training and regular updates to ensure practice remains in line with best practice. The home does not have controlled medication at present. We spoke with the registered manager about the changes in legislation for storing controlled mediation. We recommended they seek advice from the Pharmacist to ensure the controlled medication storage complies with the new legislation. The monthly visited carried out by a representative of the management team from the Trust measured the quality and consistency of the service. The records we received of the monthly visits showed the service has internal systems in place to ensure the service delivers high standard of individual care to the people living at the Home. 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 22 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are confident to raise concerns with staff and are supported by trained staff, confident in their role to report concerns regarding the welfare of individuals. EVIDENCE: The procedure for people to express concerns or make a complaint is included in the statement of purpose. The complaints procedure is written in plain English and has the contact details of Advocacy Service, Primary Care Trust, Social Serivces and the Commissions. People we spoke with said they were confident to ‘tell the staff and the manager about any concerns they may have and were confident it would be addressed’. Other comments received included; “Anything that you’re worried about, you tell your key worker or the staff on duty”. Responses we received from surveys completed by the people living at the Home indicated they knew who to speak with if they were unhappy or had a complaint. One person said they wrote in the ‘compliments, concerns & complaints’ book that they could do with a new stereo in the Home. This was read by the representative from the management team for the Trust during the monthly visit and money was made available for the person to go with staff to buy a stereo. This showed that concerns that affect the lives of people living at the Home are acted upon. 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 23 We saw the ‘Complaint Book’ and noted that the service had not received any concerns or complaints since the last isnpection of the service. The Commission for Social Care Inspection has not received any concerns or complaints about the service. We observed throughout the day and noted that there was an open and relaxed culture within the Home, in that people did not feel restricted in what they did, providing their was mutual respect. People said they safe at Home with the staff and other people living at there. People said sometimes when people disagree with each other they are encourage to tell the staff to help resolve the issue. People told us they have ‘house meetings’ with the member of staff on duty and have their concerns raised and addressed. People described their individual arrangement to manage their own money with the support from the staff. The individual care plans showed the support level and the agreed arrangement for people to manage their money. This showed people were supported to be in control in all aspects of their life. There are policies and procedures regarding safeguarding, which means promoting the well being of people using the service from abuse are available to staff and give them clear guidance about what action should be taken. People living at the Home knew about their individual vulnerability and were confident staff these. They said staff do make sure they were safe in the Home and when out in the community and confident staff would act quickly. We spoke with the staff on duty to ascertain their knowledge and understanding of safeguarding issues. Staff demonstrated awareness of the types of abuse and vulnerability of the people living at the Home and they ensure people are safe from harm and abuse. Staff gave examples such as “people living in the residential area do not know this is a care home and we like to keep it that way”; “we know how to diffuse a situation the best way when two of the clients have a disagreement at Home” and “you have to be alert when you’re out and about, today as we were coming down the escalator several youths shouting and running around attracted unnecessary attention and I made sure the two people were not distracted by the youths”. All were aware of the policies and procedures and that issues of concerns should be reported to the person in charge and were confident to report poor or bad care practices using the ‘Whistle-Blowing’ policy. Staff recruitment files and the training records viewed showed that all staff underwent recruitment checks in line with the law and all had undertaken training, specific to their role. People living at the Home were aware of the importance of risk assessments and said “we have risk assessments for everything, just to make sure we are safe”. 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 24 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, 27 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a comfortable, clean and safe home environment that meets their needs and promotes independence. EVIDENCE: The Home is domestic in character and blends in with other residential properties in the area. We were shown around the Home and the private bedroom by one of the person living there. There are three bedrooms and a bathroom with a toilet on the first floor. The bedroom was homely, personalised and showed the certificate of achievements and photographs of important people in their lives. One person said they have a key to their bedroom, so they “have some privacy and sense of personal responsibility”. On the ground floor, there is a lounge, dining room with kitchen and the new walk-in shower room. People said “this is our home” and showed pride in the accommodation. People said they were involved in choosing the décor and 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 25 design for the Home, having been decorated with new carpets. This supported the information we received from the registered manager before the site visit. People living at the home are responsible with the support of staff to keep the communal areas clean and tidy. We saw the people living at the Home cleaning the lounge together with the member of staff, as this was on the weekly programme and in their individual diaries. People are responsible for keeping their individual bedrooms tidy. We observed one person sorting out the laundry and told us they “have a system in place although not everyone likes to have their clothes tumble-dried”. People said having daily routines helped them take responsibility and for one person this was a goal to enable them to eventually live independently in their own place. Staff demonstrated good awareness health and safety, infection control, including prevention of infection such MRSA and food hygiene. This was supported with the training records, certificates in the staff files and the completion of the basic ‘BIRT’ training and National Vocational Qualifications level 3 in care. Staff we spoke with told us the general maintenance and repairs are promptly carried out, which showed the Home was safe for the people living there. We read the monthly visit reports completed by the management representative from the Trust and showed the Home environment is checked to ensure safety and maintenance. 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 26 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, 33, 34, 35 and 36. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living at the Home are protected by good recruitment processes; staff trained in caring for people with associated brain injury and supervised that promotes people’s independence. EVIDENCE: We looked at the recruitment and training records for two staff who are employed at the Home. We spoke with the staff member on duty who described the recruitment process, which was consistent with the information held in the staff file: completed application forms, two written references and satisfactory protection of vulnerable adults (pova) and criminal records bureau (CRB) check. Staff told us they completed a programme of induction specifically to work with people who have suffered an illness or injury to the brain. The training programme used is known as Brain Injury Rehabilitation Training (BIRT), and has different levels ranging from the care staff to managers. Staff said the BIRT training helped them understand people’s experiences and enabled them 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 27 to provide the level of support in a manner to suits them, protects them from harm whilst maintaining people’s self respect and dignity. Staff said there is an expectation that staff working at the Home are trained at least to NVQ level 3 in care, as staff are often working alone at the Home although additional emergency support is provided through on-call arrangement. People we spoke with said they were confident that the staff understood them, helped them to overcome some disabilities and learn skills that promoted their independence. People said, “we like the staff working here, they are kind, friendly, respect and support all of us ”. This showed that the training staff received is used to support the people living at the Home to improve their quality of life and individual outcomes. We received surveys from staff before the site visit and comments specifically to improving the service related to having a ‘bank worker’ (staff available to provide cover at short notice) for the Home. Staff we spoke with also felt the Home would benefit from having a bank worker to support the people living there and the staff. We shared the comments received with the registered manager who told us that this was recognised and she was interviewing a potential ‘bank worker’ who would be able to provide this support. This demonstrated the service listens and acts to improve the service provided to the people living at the Home and the staff. Staff said they receive regular supervision and have staff team meetings, where information is shared about changes in the service, development and issues affecting the people that live at the Home. The staff meeting minutes read supported the information we received from the registered manager before the site visit. Comments we received in the staff surveys included: “I am very happy with regular supervisions with manager. If I have any concerns, my manager will always make time for me to discuss the problem” “We a new client arrives at the house or a clients circumstances changes, staff can always ask for further training if required in any unknown area’s” “ . . .when the manager is on A/L (annual leave) we can struggle of a member of staff goes sick” “With my manager I always received the right support” “Induction much more formal now” 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 28 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, 38, 39, 40, 41 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at North Paddock Court, live in a well managed Home and have opportunities to express and contribute their views to influence the service provided and lifestyle. EVIDENCE: We spoke with the registered manager who confirmed she has attained the Registered Managers Award, NVQ level 4 and completed a higher BIRT training level to manage a service specifically for people with a brain injury. The registered manager works as part of the staff team, managing the service and doing shifts at the Home. 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 29 People we spoke with said, “it’s good to see the manager working here with us, she understands us, what staff do and it gives me a chance to tell her things”. Staff said they had good support from the registered manager and understood the needs and issues affecting the people living at the Home. Staff said they had clear roles and responsibilities with regards to work and being the primary support worker to a person living at the Home. The Home has a number of ways measuring the quality of service it provides. The information we received from the registered manager before the site visit stated the people living at the Home complete survey questionnaires about the service they receive. People we spoke with said they have regular ‘house meetings’, usually every two weeks or more often if there’s a problem or “we need to decide on things, such as the décor and to see how the Home could improve”. People said they have monthly review meetings about their care and support with the key worker, who may be a health care professional, the primary support worker at the Home, which is another way of expressing views about the service. This demonstrated people influence the quality of service they receive. A management representative from the Trust carries out the monthly visits. The monthly visit reports we read showed they spoke with the people living at the Home, staff, looked at records including the ‘compliments, concerns and complaints book’ and checked the environment. The different ways views are gathered from the people living at the Home, staff and health care professionals showed the management measure the service quality and looks at how areas for improvement. Information received from the registered manager before the site visit stated the policies and procedures were reviewed in May 2008 and showed us that the most recent checks on equipment and service maintenance was carried in May 2008. Staff we spoke with were aware of the policies and procedures that and demonstrated how they influence their role to support the people living at the Home. This showed staff recognised the importance of the policies and procedures and the brain injury training programme, which promotes the health, safety and wellbeing of people living at the Home. Comments received in the staff surveys included: “The service supports clients with acquired brain injury by promoting a quality of life enabling them as individuals to achieve a valued role in the community. Supporting and enhancing their competence, individuality and daily living skills” 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 30 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 4 3 3 4 3 5 3 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 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 4 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 3 3 3 3 3 3 X 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA20 Good Practice Recommendations To seek advice from the Pharmacy to ensure that the existing storage for controlled medication is appropriate in accordance with the new legislation. 22 North Paddock Court DS0000012873.V368046.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 22 North Paddock Court DS0000012873.V368046.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. 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