Inspection on 14/10/05 for 27 Brockleaze

This inspection was carried out on 14th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

27 Brockleaze 16/09/08

27 Brockleaze 12/09/07

27 Brockleaze 09/11/06

27 Brockleaze 15/04/05

27 Brockleaze 25/11/04

27 Brockleaze 26/05/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Brockleaze (27) 27 Brockleaze Neston Corsham Wiltshire SN13 9TJ Lead Inspector Mrs Jacqui Burvill Unannounced Inspection 14th October 2005 09:03 Brockleaze (27) DS0000028367.V260152.R01.S.doc Version 5.0 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 Brockleaze (27) DS0000028367.V260152.R01.S.doc Version 5.0 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. Brockleaze (27) DS0000028367.V260152.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Brockleaze (27) Address 27 Brockleaze Neston Corsham Wiltshire SN13 9TJ 01225 811902 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) None United Response Vacant Care Home 3 Category(ies) of Learning disability (3), Physical disability (3) registration, with number of places Brockleaze (27) DS0000028367.V260152.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th April 2005 Brief Description of the Service: 27 Brocklease is a detached bungalow in the village of Neston, close to the towns of Chippenham and Corsham. The home is in a rural location. There is a pub fairly close by and a shop a short drive away. This is one of a number of homes run by an organisation called United Response. 27 Brocklease provides care and accommodation for three service users aged between 18 - 65 years who have a learning disability. Each service user has their own single bedroom. There are no hand washbasins and no lockable units in the bedrooms. There are two bathrooms. There is a lounge, a small dining room, a kitchen, a separate utility room and a large garden with parking for several cars. One member of staff sleeps in every night and two staff are on duty each day. Brockleaze (27) DS0000028367.V260152.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over three hours. The inspector met two staff and one service user. The acting manager came to the home during the inspection. Service users are not able to comment directly on the care they receive. Observations were made of the way staff and service users communicate with each other. The acting manager used to be the manager of the home and this has provided some vital continuity through a period of uncertainty in the home. Staff commented on how important this has been for them and that they continued to feel valued as part of a team during this time. The acting manager has ensured that the CSCI has been kept up to date with all of the developments affecting the service. The organisation has received applications for the manager post. Difficulties over the future ownership of the building have meant that renovation works, which should have been completed, have not been done. Although major planned work may not be able to take place, this does not detract from the point that service users have a right to live in a homely environment and one that is well kept. Whilst there was movement on deciding ownership and the future of the property, the CSCI supported the home as these decisions looked like being concluded. Since the last inspection, no issues have been resolved, so some work must now be completed in order to improve the home for the service users who live there and for any new service users that are admitted. United Response believes in a philosophy called collective team management, which means that staff must take day-to-day responsibility for management type tasks in the home. The effectiveness of collective team management has arisen again, as staff do not appear to be taking responsibility as reflected by this policy within this organisation. Regulation 26 visits are taking place and yet a number of the points raised in this inspection such as inconsistent and out of date care plans and some poor medication practices had not been picked up or followed up under these visits, which are made monthly by a representative of the responsible individual. The statement of purpose identifies the home’s philosophy as a ‘life history approach’, ‘social role valorisation’ and a ‘framework for accomplishment’, yet there is little evidence of these philosophies in action. An immediate requirement was issued for 3 staff to receive fire safety training by the 30th of October as they had not received any training in the last quarter. Brockleaze (27) DS0000028367.V260152.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? 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. Brockleaze (27) DS0000028367.V260152.R01.S.doc Version 5.0 Page 7 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 Brockleaze (27) DS0000028367.V260152.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 This standard was not assessed on this occasion, as no new service users have been admitted. EVIDENCE: The assessment for a potential service user was discussed with the acting manager. Brockleaze (27) DS0000028367.V260152.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 The care of service users is being compromised by the use of care plans that are inconsistent with different methods of recording in use. EVIDENCE: Care plans for both service users were seen. There are marked differences between the style and content of the care plans. One has evidence that it has been updated on a regular basis and is signed and dated. The other is not. This was raised at the last inspection. There are sections in the care plan based on the needs of service users. The acting manager spoke about updating the care plans to be in line with care plans from another home within the organisation. Objectives set at the care review had not been forwarded or included into the care plan. It is important to do this when objectives have been set at such meetings. The review report completed by staff, show that the objectives do not really change from year to year and are not measurable, nor do they seem to have any relevance or involvement with the service user. Brockleaze (27) DS0000028367.V260152.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 Evidence about service users’ choices and decisions are not fully recorded. EVIDENCE: Daily notes record the choices and activities service users have made during the day. There are some subjective statements and staff could be clearer about choices offered to service users, where restrictions have been made and how behaviour has been managed. The record is very detailed, with entries made three times a day, but the level of choice offered, or how behaviour has been affected by strategies used by staff is not clear at all times. Staff were observed to support a service user in making choices on the day of inspection. Care was taken to ensure that the service user was happy with the choices on offer, as the staff were aware there had been a recent issue about this for the service user. Staff were observed to speak calmly and clearly at all times to the service user and acted in an understanding and sympathetic manner. Menu plans show that service users have a varied diet, based on choices made by staff, who are aware of service users’ likes and dislikes. Brockleaze (27) DS0000028367.V260152.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Poor medication recording practices are putting service users at risk. EVIDENCE: There is evidence of staff having received medication training, which was not available at the last inspection. Much of this training took place in 2004. The organisation has asked staff to sign to say they read the home’s medication policy and procedure every six months and the last entry shows that this was done in July 2004. The medication administration sheet is being used to record a count of medication received into the home. The medication administration sheet also shows that staff are crossing out medication that is listed and inserting homely remedies, such as Paracetamol to be administered as and when required. This practice could lead to confusion, as it may not be clear what medication is being signed for. Blank medication administration sheets need to be obtained for this purpose. Codes are being used incorrectly, for example the code ‘S’ is being used but this does not match the codes that are listed. In discussion with the manager it appears as though staff are using this code as ‘social leave’, however, the manager stated that on social leave, staff would have been present, so would have administered medication and should therefore have signed to say they administered it. Brockleaze (27) DS0000028367.V260152.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): and 23 Service users are partially protected by complaint and adult protection procedures and staff training. EVIDENCE: There have been no complaints since the last inspection. Service users have family or advocates who would complain on their behalf, as service users would not be able to use the complaints procedure. Staff training records were looked at to see if staff had received adult protection training. One member of staff on duty confirmed that she had received this training. Two staff do not appear to have completed this training according to their training record. Brockleaze (27) DS0000028367.V260152.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 The service users’ quality of life is being affected by parts of the home that are in a poor state of repair. EVIDENCE: After the last inspection, the manager in post showed the inspector plans to redesign part of the building, which would improve the layout and facilities in the home. Since that meeting, there has been no work on any part of the building as the future ownership between the Children’s Society and a Housing Association is in question. There is evidence that surveyors have cancelled visits on several occasions, so no view can be formed as to their intentions. Whilst these discussions were taking place, the inspector took the view that it would be better to have all of the work done, rather than smaller parts. As the ownership is no further forward, decisions must be made now about the current state of parts of the home. The kitchen must be re-furbished and redecorated, as it is in a poor state with patched flooring, some fronts missing from the cupboards and needs decorating. Other parts of the home that are in a poor state of repair need to be listed, so that they can be repaired and identified as part of any surveying process. Brockleaze (27) DS0000028367.V260152.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 34 Service users would benefit from a staff team that took more action and responsibility with actions and records. EVIDENCE: Collective Team Management is a philosophy within the organisation that encourages and supports staff to manage day-to-day aspects of the running of the home. This approach has been discussed with the senior management team at United Response and staff have received training on this in the last year. However, there appears to have been no change to several aspects of the last inspection where issues were identified, nor have staff taken responsibility to complete tasks or follow them through, when other training should have made them aware of the importance of these issues. Examples of this are medication recording and care plans. Staff spoken to said they felt very supported by the acting manager, who had provided some vital consistency at a time of change and uncertainty and yet these issues had not been picked up during visits to the home. One staff member has no First Aid certificate and another’s certificate has expired. Staff have completed training in challenging behaviour and physical intervention, an introduction to autism and collective team management but there is no evidence of staff receiving at least five training days per year. Two staff have NVQ certificates, while a third staff member is doing NVQ level 3. There are only five staff members in the team. Brockleaze (27) DS0000028367.V260152.R01.S.doc Version 5.0 Page 15 No new staff have been recruited since the last inspection. Brockleaze (27) DS0000028367.V260152.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42 The views of service users, their families and advocates as well as stakeholders would benefit the development of the home. Service users’ safety is compromised as not all staff have received fire safety training in the last 4 months. EVIDENCE: The quality assurance system was discussed and the manger stated that the responsible individual will be writing a report based on the Regulation 26 visits. This means that views from stakeholders and families and will not be included. The manager stated that United Response would be looking to hold meetings with families form North Wiltshire and discuss any issues. There would be a questionnaire available for everyone to complete. Fire safety records were the only aspect of standard 42 that was assessed. All fire records were in order except that three staff had not completed fire safety training in the quarter between July and September. An immediate requirement was issued. Brockleaze (27) DS0000028367.V260152.R01.S.doc Version 5.0 Page 17 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 2 17 Standard No 31 32 33 34 35 36 Score X 2 X N/A X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Brockleaze (27) Score X X 2 X Standard No 37 38 39 40 41 42 43 Score X X 2 X X 2 X DS0000028367.V260152.R01.S.doc Version 5.0 Page 18 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 YA6 Regulation 15 (2) (a) (b) (c) Requirement Care plans must be consistent within the home and be up to date and reviewed at least at six monthly intervals, with evidence kept. A new kitchen must be installed. This is to include flooring, wall units and floor units, work surface and re-decoration of the kitchen. The manager must make a record identifying all areas of the home that need work and when this is to be completed. This includes the kitchen and external doorframe leading from bedroom corridor. (Carried forward from previous inspection 25/11/04). The internal redecoration of the premises continues in order to enhance the current standard of the accommodation. (Carried forward from inspection dated 19th March 2003, 1st July 2004 and 25th November 2005) All staff must receive first aid training. There must be a quality assurance system in use in the home. A report on an DS0000028367.V260152.R01.S.doc Timescale for action 30/12/05 2 YA24 23 (2) (b) 31/03/06 3. YA24 23(2) (b) 30/11/05 4. YA24 23(2) (b) 31/03/06 5. 6. YA32 YA39 13(4) (c) 24 30/12/05 30/12/05 Brockleaze (27) Version 5.0 Page 19 assessment of quality in the home must be sent to CSCI by the date shown. (Carried forward from previous inspection 25/11/04) Due to be met by 30th October 2005 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 YA6 YA6 Good Practice Recommendations Goals or objectives set at review meetings should be included in the care plan. Staff reviewing care plans should ensure that they record the actual date of the review of the care plan and date any changes in the interim. (Carried forward from the last inspection 15th April 2005) New medication administration sheets should be used so that staff can record medication that is to be given ‘as and when required’ in a blank box on the sheet. When medication is handwritten onto a medication administration sheet, two staff should sign to say they have witnessed this. Dates should be recorded on creams or other topical medication when they are opened and used, as the shelf life is only three months from opening. The reasons why there are no hand washbasins or lockable units in the service users bedrooms should be described in the service users guide and the individual plan. (Carried forward from previous inspection 25/11/04) All staff should receive five paid training days per year. 3. 4. 5. 6. YA20 YA20 YA20 YA26 7. 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