Inspection on 16/09/08 for 27 Brockleaze

This inspection was carried out on 16th September 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

27 Brockleaze 12/09/07

27 Brockleaze 09/11/06

27 Brockleaze 14/10/05

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 19/12/2008.

CARE HOME ADULTS 18-65 Brockleaze (27) 27 Brockleaze Neston Corsham Wiltshire SN13 9TJ Lead Inspector Malcolm Kippax Unannounced Inspection 16th September 2008 09:45 Brockleaze (27) DS0000028367.V365068.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 Brockleaze (27) DS0000028367.V365068.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. Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brockleaze (27) Address 27 Brockleaze Neston Corsham Wiltshire SN13 9TJ 01225 811902 01249 765530 nwclservicemanager@unitedresponse.org.uk www.unitedresponse.org.uk United Response 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) Vacant Care Home 3 Category(ies) of Learning disability (3), Physical disability (3) registration, with number of places Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th September 2007 Brief Description of the Service: 27 Brockleaze is run by the national organisation, United Response. The home provides care and accommodation to three people with learning disabilities, who are aged between 18 and 65 years. The home is in a rural location in Neston, which is a village near to the towns of Corsham and Chippenham. 27 Brockleaze is a detached bungalow in its own grounds. Each person has their own bedroom. There is a bathroom and a shower room. The communal areas consist of a lounge and a dining room. There is a kitchen and a separate utility room with laundry facilities. The home has a large garden and a parking area for several cars. One staff member sleeps in at night and there is at least one staff member on duty during the day. The range of fees at the time of this inspection was between £1321.23 and £1437.36. Information about the home is available in a ‘Statement of Purpose’. Copies of inspection reports are available from United Response. They are also available through the Commission’s website at: www.csci.org.uk Brockleaze (27) DS0000028367.V365068.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 0 star. This means that people who use this service experience poor quality outcomes. Initially we asked the home to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how they were performing. It also gave us information about what has happened during the last year, and about their plans. We sent out surveys to the home, so that these could be given to the people who live there, to staff, and to other people who know the service. We had surveys back from the three people who live at the home. They had help with completing the surveys. We looked at all the information that we have received about the home since the last inspection. This helped us to decide what we should focus on during an unannounced visit to the home, which took place on 16th September 2008. We met with two of the people who live at the home. We also met with two support workers who were working at the time, and with the United Response area manager. We looked at some records and went around the home. We were not able to complete the inspection on that day, as everybody went out in the afternoon. A second visit was made to the home on 18th September 2008 in order to finish the inspection. We met another staff member during this visit. The home’s manager was on leave at the time of our visits. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. What the service does well: One person who lives at the home was on holiday with a friend when we visited. Staff had assessed the arrangements, so that the person would be safe when doing the things that they wanted. Staff members support people with taking part in other activities that involve a degree of risk, but promote independence. These include, for example using public transport and going out in the local community. When restrictions are in place, the reasons for this are explained in people’s individual records. Information is recorded about people’s likes and dislikes, their relationships, and how they can make choices. This helps to ensure that staff are aware of people’s individual needs and provide support in a consistent way. There is guidance for staff about the support that people need in areas such as money, managing behaviour, and with communication. Staff are aware of people’s health needs. Appointments are made with outside professionals so that people receive support with their specialist needs. Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 6 There is a varied menu, which reflects people’s choices and preferences. People can feel involved with the meal arrangements, by helping with the food shopping and preparation. Staff members help people to keep the accommodation looking homely. The home is mostly clean, tidy and well decorated. There are procedures so that staff know how to protect people in the home. Checks are undertaken on prospective staff members, which helps to ensure that they are suitable to work with the people who they will be supporting. There is a settled staff team, despite the high use of agency carers. The same agency carers have been coming to the home regularly over several months, so people at the home have got to know them well. Staff members receive training, which helps to ensure that they support people well and safely. Checks are being carried out, so that the home is safe for the people who live there. What has improved since the last inspection? What they could do better: Appropriate action has not been taken in response to the requirements from previous inspections. Arrangements need to be made which will ensure that requirements are fully responded to within the timescales agreed. This is so that people in the home can have confidence in how the home is being run, and in how shortcomings are being responded to. The home has not had a registered manager for over a year. This is in spite of us confirming at the last inspection that an application for registration must be made. People living at the home have therefore not had the reassurance of knowing that the person managing the home has been approved and is legally responsible under the Care Standards Act. United Response must ensure that an application is made to register a new manager without further delay. We have also written to the United Response area manager about this. We confirmed at the last inspection that each person must have a statement of their terms and conditions or a contract with the home. This was to ensure Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 7 that they or their representative knew what to expect from the service. When we visited the home we saw that the people who lived there had ‘service user charters’ on their personal files, but these had not been signed by the person or by a representative. People need to receive information about any services and items that are not covered by the fees, so that they know what they will have to pay for out of their own money. We have reported at the last two inspections that people’s individual support plans have not been up to date and have not been reviewed at six monthly intervals. Action needed to be taken, so that people’s changing needs continue to be met. The plans needed to be regularly reviewed, in accordance with the home’s stated intentions, and evidence kept of the review. This is not yet happening for each person at the home. Requirements have also been made at previous inspections about having a quality assurance system in the home. This was to ensure that developments in the service are based on the views of people, their relatives and representatives. It was confirmed in the requirement that a survey of people’s views must be conducted; a report of the findings produced; and a copy of the report sent to the Commission. This requirement has not been met. We reported at the last inspection that action had been taken to improve the home’s medication procedures. However this improvement has not been maintained during the last year. We have identified a further requirement, to ensure that medication is always appropriately administered and recorded in the home, and people are not at risk from medication errors. 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. Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 Quality in this outcome area is adequate overall. People’s rights are being compromised by a lack of agreed terms and conditions. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two people had lived at 27 Brockleaze for several years. A third person had moved in shortly before the last inspection, which took place in September 2007. Standard 2 was met when it was assessed at that inspection, and nobody had moved into the home since then. At the last inspection we saw that the person who had recently moved in had a service user charter, which set out their terms and conditions and fees for their previous home. They had needed to have a charter that set out their terms and conditions and fees for 27 Brockleaze. We had also seen that one of the other people had a service user charter, which had been signed by a representative of United Response, but not by the person or their representative. We made a requirement at the last inspection for people to have a statement of their terms and conditions or contract with the home. This was to ensure that they or their representative would know what to expect from the service. Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 10 We looked at the service user charters again during the visit on 18th September. The person who had moved in most recently had a new charter for 27 Brockleaze, which was dated 1st August 2008. However, this had not been signed by the person or their representative. Another person had a charter, which was kept in their individual file. This had also not been signed by the person or their representative. The third person did not have a service user charter on their file, and the staff member present did not know where it was. The information that we saw about the home did not include a list of items that people at the home would have to pay for out of their own money, because they were not covered by the fees. During the visit on 18th September, the staff member said that people paid for meals that were bought when outside the home, although the home contributed £2 towards the cost of the meal. Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate overall. People’s current needs are not all reflected in their individual support plans. They cannot be confident that the home will review their plans regularly, which could result in people’s needs not being fully met. People are assisted to make decisions and they receive support which reduces the risk of being harmed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was stated in people’s service user charters that their support plans will be reviewed every six months. However, we have reported at the home’s last two inspections that people’s individual plans have not been up to date, and have not been reviewed at six monthly intervals. We have made requirements in connection with this. We have also recommended that each plan is dated, so that staff can tell which information is up to date. We reported at the last inspection that the person who had recently moved in had previously lived in another United Response run home. They had care Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 12 planning information from their previous home and we had confirmed that this needed to be updated and be consistent with other care plans at 27 Brockleaze. We looked at people’s individual plans again during the visits that we made as part of this inspection. The support plans for the person who had moved in most recently were dated to show that they had been reviewed on 8th January 2008. They had not been reviewed since that date. We spoke to a staff member about the contents of the plans, as it appeared that the review in January had taken into account the person’s new surroundings, and the plans had not been updated to reflect this. The format had not changed and the staff member thought it likely that the plans were the same ones that the person had had at their previous home. Another person had a range of support plans, which had different review dates recorded. Some plans had been reviewed in 2007 and 2008; other plans, such as those for personal hygiene and medication, had not been reviewed since 2006. The plans for a third person were up to date, having been reviewed in February 2008 and August 2008. They had a range of individual risk assessments, which covered such activities as travelling on public transport and managing money. Assessments had been undertaken in respect of the other people who live at the home. The person who had moved in most recently had a risk assessment for going on holiday, which had been completed in June 2008. Staff told us that this person had gone on holiday with a friend. The risk assessments focused on promoting independence. They included the benefits for people of participating in activities that may present a risk, and included the action that was to be taken to minimise risks. Information about some limitations and restrictions was included in people’s individual plans. For example, one person did not have a lockable storage facility in their bedroom, or a lock on the door, and the reasons for this were recorded. Other information had been recorded about people’s likes and dislikes, their relationships, and about how they could experience choice. This helped to ensure that staff were aware of people’s individual needs and provided support in a consistent way. There was guidance for staff about the support that people needed in areas such as money, managing behaviour, and communication. People at the home had personal goals and objectives, which had been discussed at individual review meetings. We have recommended at the last two inspections that the goals should be monitored consistently every two months. The home has had forms for recording this. We looked at this again during our visit on 18th September 2008, and were told by a staff member that these forms were no longer being used. Instead, the home had recently started using new ‘Communication files’ for the recording of a range of information on a regular basis. The staff member said that this would show over time how people were progressing with their goals. Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. People receive support that helps them to maintain relationships and to be part of the local community. People have the opportunity to participate in new activities. They benefit from an individual approach to the meal arrangements and to the daily routines. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We heard about people’s weekly activities during our visit on 16th September 2008. One person was away from the home as they had gone on holiday with a friend for two weeks. Two people were at home during the morning, but arrangements had been made for people to go out in the afternoon. These involved one person going to a local resource centre and the other person having a haircut in town. Staff members said that the number of activities that people attended outside the home had increased during the last year. Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 14 One person was going to start a horse riding session in the following week, which was a new interest for them. Other regular activities included attending sessions at Trowbridge College and visiting a hydrotherapy pool in Swindon. We were told that staff did not need to stay for the college sessions, but supported people when they attended other activities. For example two staff accompanied people when they went to the hydrotherapy pool. People also had time during the week when they did not have planned activities. Staff said that decisions were made at the time about the things that people would like to do, such as going to the library or food shopping. The home had its own vehicle that could be used for trips out. Staff said that people also used the local bus and taxi service sometimes. During our visits, people were watching the television and doing puzzles. People spent time in the communal rooms and went outside on occasions. There was a computer in the dining room, which staff said was used by one person in particular. It was hoped to find some new computer programmes that would be suitable for people. People showed us their bedrooms. One person had received good support with decorating their room. This was a large room, and furnished so that they could meet with their visitors. Another person’s bedroom looked more basic and they had fewer personal items. Staff members were aware of this and said that this was how the person chose to have it. Details of people’s family contacts and important relationships were recorded in their individual files. Staff supported people to keep in contact with their family and friends. Information had been recorded to help with this. For example, one person had a Christmas card list, which was kept on their individual file. We heard that one person’s parents visited them most weeks, and other people had less frequent contact with family members. Details were being kept of the meals that people had each day. These were recorded on an individual basis. There was a varied range of meals being prepared, which staff said reflected people’s likes and dislikes. People went out with staff for food shopping and they could help out in the kitchen, under supervision. During our visits we saw that fresh fruit and drinks were available to people. Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 15 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 adequate. People receive the support that they need with their health and personal care. People are not well protected by the way in which their medication is being managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People had individual plans, which included details of the personal support that they needed. The plans covered a range of areas such as bathing, toileting, foot care, dressing, and eating and drinking. As previously reported, there were shortcomings in the home’s review process, which meant that some of people’s needs had not been reviewed for over a year. We saw information on people’s individual files that showed how they wished to be supported. Risk assessments had been undertaken in areas such as shaving, medication, and the use of sun cream, so that support could be provided in ways which people preferred, and reduced the risk of them being harmed. Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 16 Other guidance had been written which helped people to maintain people’s dignity. For example it was recorded that one person needed reminding to shut doors, so that their privacy would not be compromised. People at the home had their own bedrooms where personal care could be provided in private. There was a section in people’s support plans that covered their health needs. Each person was registered with a GP and they had access to other health care professionals. Appointments and health reports were being recorded in people’s individual files. We read on one person’s file that they had a review with a consultant psychiatrist earlier in the year. Staff meetings were being held, when people’s health needs were discussed. Information about people’s medication was included in their support plans and personal records. Two people’s support plans for medication had been reviewed during the last year, although one person’s had not been reviewed since 2006. We reported at the last inspection in September 2007 that improvements had been made in the recording of medication, which would help to ensure that people were protected by the home’s medication practices. However since the last inspection we have received four notifications from the home concerning medication discrepancies and errors. Medication was stored appropriately in a metal cabinet. We looked at the current medication records. A monitored dosage system was used and a record was kept of medication received into the home and of its administration. A record of medication received into the home was made on the administration record sheets. Some notes about medication had been recorded in a house diary / staff communication book. These included reminders for staff when medication had not been signed for at the time that it was administered. We were told that appointments had been made for two people to have their medication reviewed in the following week. Some medication was prescribed for administration on a PRN (‘as required’) basis. A staff member said that new guidelines about its administration had been written, and these were currently being typed up at United Response’s local office. One of the agency carers we met said that they administered medication to people. They had been shown how to do this, but had not received training with United Response. A date for this had been confirmed in October 2008. There were guidelines for the administration of medication in the home. There was also a sheet that staff were expected to sign every six months to confirm that they have read the administration procedure. Not all the staff had signed this within the last six months. In view of the medication errors that have arisen we thought it was particularly important for staff to familiarise themselves with the procedures on a regular basis. Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 17 We have received another notification about medication since we visited the home. It was reported in the notification that two people had not been given their medication in the morning, although the medication had been signed on the records as having been administered. The GP was contacted for advice about this. We were told that the home was taking advice from United Response about how to support staff, so that they would not make any further errors. Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. People are protected by the home’s policies and practices about complaints and protection This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints procedure had been produced, although the contact details for the Commission needed to be updated. People at the home had been given a copy of the procedure, but they would need the support of a representative or advocate to make a complaint. People told us in their surveys that they knew who they could talk to if not happy with something. We received comments from relatives at the time of the last inspection and they confirmed that they knew how to make a complaint. They told us that any concerns they raised had been dealt with without the need to make a formal complaint. They also said that the home had responded appropriately if they had raised concerns. It was reported in the AQAA that the home had received one complaint during the last 12 months. The outcome of the complaint had not yet been confirmed. We talked to a staff member about this complaint when we visited the home. There was a procedure about protecting people from abuse, and information about the local multi-agency safeguarding adults procedure. We were told in the AQAA that two referrals have been made under the safeguarding adults procedure. We have received information about these and other significant events that have arisen since the last inspection. Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 19 The staff members we met confirmed that they had received training about the prevention of abuse and were aware of the home’s procedures. They had been given copies of the ‘No Secrets’ booklet, which summarises the local procedure for safeguarding vulnerable adults. People did not manage their own personal money and they received support with this from the staff team. We looked at examples of the records that were being maintained. Transactions involving people’s money were being recorded and two staff initialled the entries. Receipts were being kept and there was a system of auditing in operation. Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good overall. The accommodation is meeting people’s needs and is mostly kept clean and tidy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 27 Brockleaze is in a rural location, but there are towns within easy travelling distance that people go to for most of their day to day activities. 27 Brockleaze is a bungalow, so all the accommodation was on the ground floor. Each person had their own room. There was a bathroom and a shower room. The communal areas consisted of a lounge and a dining room. There was a kitchen and a separate utility room with laundry facilities. There was a good sized space for cars, and for people who like to spend time outside. The accommodation has been improved through redecoration in recent years, which has given it a more homely appearance. Work has continued in the Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 21 utility room since the last inspection. The room has been plastered, decorated and had a new floor covering. There was a new tumble drier. We saw that cleaning materials were kept in a locked cupboard in the utility room, so that they would not be a hazard to the people who live at the home. The accommodation generally looked clean and tidy. The carpet in one person’s bedroom was stained in places. Staff said that the carpet had been cleaned fairly recently, and would be again. We thought that a new carpet, with a better stain resistance, might be needed if further cleaning does not remove the stain and produce a good appearance. We reported at the last inspection that the bathroom was in need of some attention. We spoke to a staff member about the decorating work that had taken place and were told that the wall tiles had been painted. This only looked like a temporary measure, as the paint was peeling in places and this would probably only get worse. There was a lack of sealant around the bath and we thought that the room would benefit from updating and a more thorough refurbishment. We were told at the last inspection that the needs of the person who had recently moved in were being assessed, and it was intended to seek the advice from an occupational therapist. We discussed this again with a staff member who said that the occupational therapist had been involved and a handrail was subsequently fitted to assist the person. Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 22 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 and 35 Quality in this outcome area is good. People were supported by an effective staff team, who were appropriately trained and competent to meet their needs in most areas. People were protected by the home’s recruitment practices This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a staff rota and we talked to staff about how they were deployed. Two staff were on duty during the day when all three people were at home. This had reduced to one member of staff on occasions at the time of the inspection, as one person was away on holiday. We reported at the last inspection that the staffing had been increased since the third person had moved into the home. The additional hours were being covered by regular agency staff and relief staff to provide consistency. One of the agency staff had recently been recruited as a permanent staff member. We found that the staffing arrangements had not significantly changed during the last year. No new permanent staff members had been employed and the home has continued to use regular staff from an agency. We met two agency Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 23 carers when we visited the home on 16th September 2008. They said that they had worked regularly at the home for several months and felt like members of the staff team. They were shortly to become United Response employees, but were waiting for their recruitment checks to be completed. After our visits to the home we received more information from the United Response area manager about the difficulties that have been experienced with being able to appoint new staff. We were told that there had been delays in receiving Criminal Records Bureau (CRB) disclosures back, which had significantly impaired progress in appointing a full staff team. A staff member said that staff meetings were due to take place monthly, although the last meeting had been on 1st July 2008. After our visits to the home, the United Response area manager told us that a staff meeting had also taken place on 8th August 2008, and that another meeting was held on 29th September 2008. The standard about recruitment was met when it was last assessed at a previous inspection. Applicants had an interview; two written references obtained; and Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks were made before they started work. The agency carers whom we met confirmed that new CRB and POVA checks were being undertaken. They said that they were completing an induction programme and were being booked into some of the training events that were provided for the permanent staff. There was a training plan for the home, and individual staff training records were being maintained. Staff received a range of training, which included first aid, food hygiene, manual handling, health and safety, challenging behaviour, medication, epilepsy, prevention of harm and autism. New staff members were provided with an accredited programme of induction and then had the opportunity to undertake a National Vocational Qualification (NVQ). We met with a permanent member of staff who said that they were undertaking NVQ at level 2. Other staff had already achieved this qualification. Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is poor. The home continues to be without a registered manager. People cannot be confident that shortcomings in the home are being responded to. Their views are not contributing to a report on quality assurance. People’s health and safety are generally being protected, although one item was in need of attention when we visited. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We have made requirements at the two previous inspections that the home’s manager must apply to the Commission to become the registered manager. One manager has since left, but the manager who was present at the time of the last inspection has remained in post. We reported at the last inspection Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 25 that this person was about to apply to become the registered manager for the home. However, an application for their registration has not been received. This means that United Response is not meeting its statutory responsibilities. People who live at the home have not had the reassurance of knowing that the person managing has been approved and is legally responsible under the Care Standards Act. The ‘What we could do better’ section of the AQAA included the statement: ‘Current Service Manager to become registered with CSCI’. Requirements have also been made at previous inspections about having a quality assurance system in the home. This was to ensure that developments in the service are based on the views of people, their relatives and representatives. It was confirmed in the requirement that a survey of people’s views must be conducted; a report of the findings produced; and a copy of the report sent to the Commission. It was reported in the AQAA that a quality assurance system had been introduced during the last year. However, we have not received a report and one was not available when we visited the home as part of this inspection. We did see that three care managers had completed surveys in October 2007. We discussed this with the United Response area manager during our visit. Appropriate action has not been taken in response to requirements that have been identified at previous inspections. This showed a lack of attention to ensuring that the service was being run in people’s best interests. In particular, the requirement in respect of people’s individual care and support plans has not been met. We have identified a further requirement in respect of medication. We reported at the last inspection that action had been taken to improve the home’s medication procedures, although this improvement has not been maintained during the last year. There was a health and safety policy and staff received training about health and safety. A range of health and safety checks was being made and recorded. The checks covered such areas as hot water temperatures, and fridge and freezer temperatures. Portable electrical appliances were checked in July 2008. Staff received instruction in the fire procedures. There was a monthly fire practice, which involved the people who live at the home. The home’s fire precaution systems were being tested regularly. The records showed that a fire door in the lounge had been ‘sticking’, which meant that it was not closing as it should do. This problem had first been identified during a check of the doors in July 2008, when it was recorded that the door needed attention from a carpenter. The record of another check in August showed that action had not yet been taken. We spoke to a staff member about this during our visit on 18 September 2008, as nothing further had happened. We confirmed that the door needed attention and the staff member followed this up at the time. Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 26 (After we sent United Response a copy of our draft inspection report, we received an improvement plan from them, and a copy of a Quality Assurance Action Plan for October 2007 – October 2008). Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 27 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 X 2 N/A 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 1 X 1 X X 2 X Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5 (1) b and c Requirement Each person must have a statement of their terms and conditions or contract with the home. This requirement is outstanding from the last inspection. 2. YA6 15 (2) (a) (b) (c) Care plans must be consistent within the home and be up to date and reviewed at least at six monthly intervals, with evidence kept. This requirement is outstanding from the last three inspections. 3. YA20 13 (2) Arrangements must be made, through staff training and other measures, which will ensure that medication is always appropriately administered and recorded in the home. 31/10/08 30/11/08 Timescale for action 30/11/08 4. YA39 24 There must be a quality 30/11/08 assurance system in use in the home. A report on the findings of the recent survey and the quality of the service in the home must be sent to CSCI. DS0000028367.V365068.R01.S.doc Version 5.2 Page 29 Brockleaze (27) This requirement is outstanding from the last five inspections. 5. YA37 8 (1) The manager must make an application to CSCI to become the registered manager. This requirement is outstanding from the last two inspections. 30/11/08 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 YA6 Good Practice Recommendations Each care plan should be dated so that staff can tell which information is up to date. Recommendation carried forward from previous inspections. 2. YA24 The bathroom should be redecorated and receive attention, so that it is a more pleasant and better maintained area for people to use. Staff meetings should be held in accordance with the home’s planned timescale for their frequency. This is so that there can be regular discussion about issues concerning the people who live at the home, and about other relevant matters. 3. YA33 Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Brockleaze (27) DS0000028367.V365068.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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