Inspection on 18/08/06 for 3 Brae Walk

This inspection was carried out on 18th August 2006.

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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

3 Brae Walk 23/07/07

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 3 Brae Walk 3 Brae Walk The Wheatridge Gloucester Glos GL4 5FA Lead Inspector Mr Richard Leech Key Unannounced Inspection 18th & 21st August 2006 10:00 3 Brae Walk DS0000066771.V308177.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 3 Brae Walk DS0000066771.V308177.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. 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 3 Brae Walk Address 3 Brae Walk The Wheatridge Gloucester Glos GL4 5FA 01452 530119 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) www.brandontrust.org The Brandon Trust Mr Michael-Paul James Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (2), Physical disability (2) of places 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 03/03/06 Brief Description of the Service: 3 Brae Walk is a detached two-storey house in a residential area about two miles from Gloucester city centre. There are two bedrooms on the ground floor for people with mobility difficulties. There are further four bedrooms on the first floor. The home has a lounge, a kitchen-diner and a landscaped garden. Some of the bedrooms have en-suite facilities. There are bathrooms on the ground and first floors which are fitted with aids and adaptations. The home is situated close to a range of local amenities and at the time of the inspection had two vehicles. The home is run by the Brandon Trust, who also run other care homes in Gloucestershire and the South-West. Accurate information about fees was not obtained during the inspection but will be supplied separately by the organisation in due course. Prospective service users are offered the opportunity to visit the home and have access to the Statement of Purpose and Service Users Guide. 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection began on a Friday morning lasting until late afternoon, and continued the following Monday for about the same length of time. A follow up visit was made a couple of days later to give feedback to the manager. During the visits all of the service users were met along with many of the staff team. The manager was present for most of the time. A range of records was checked including selected care plans, risk assessments, healthcare notes, staffing files and training records. The manager agreed to CSCI piloting a new observational tool in the home, as part of a trial taking place at locations around the country. The results were fed back to the manager and will form of part of the overall evaluation of the tool. Feedback was also invited from the manager and team in the home. Since this was a pilot the outcome of the observation does not form part of the judgements made in the report. The inspector would like to thank the manager, staff and service users for their assistance with this and the rest of the inspection. Since there was a change of service provider in April 2006 the requirements and recommendations made in the last report do not strictly apply. However, they were considered and are referred to in the text. What the service does well: Good care plans and risk assessments are in place, although some aspects of reviews and daily records and could be better. Service users are offered choices in their day-to-day lives. People are valued, listened to and treated as individuals. Good support is offered for people to stay in touch with their families. People living in the home have a healthy diet which meets their preferences and needs. They have the support that they require with personal care and healthcare, although improvements could be made to healthcare records. There are good systems for the recruitment of new staff. Care workers have the opportunity to take part in a wide variety of training and more courses are planned which should further develop their knowledge and skills. The home has systems for checking the quality of the service it provides and for making improvements. Steps are taken to safeguard people’s health and safety. Overall there was evidence that the home is well managed. 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 Page 6 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. 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 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 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A good policy and procedure framework helps to reduce the probability of inappropriate admissions being made, benefiting current and prospective service users. EVIDENCE: There had been no new admissions since the last inspection. The Trust has an admissions procedure, a full copy of which has been seen in other settings (the manager was waiting for this to be forwarded). A referral form was viewed along with an admissions flowchart. The manager described his understanding of the admissions procedure and said that an assessment tool was available. He said that he would conduct an assessment with a senior colleague, having not overseen an admission to the home before. The manager said that he was considering contacting other managers with a view to shadowing an admission in order to broaden his experience of this. This would be good practice. The standard is assessed as met in view of the above, though will be revisited in the event of a future admission in order to ensure that the relevant standards and regulations have been met. The manager reported that a joint assessment of care needs was being requested for one person in view of changes to their condition. 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 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, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A good care-planning framework exists in the home, helping to ensure that service users’ needs are identified and steps taken to meet these, although aspects of recording could be improved. Service users are offered choices in day-to-day life, promoting a culture of respect and empowerment. Systems are in place for assessing and managing risk, enhancing service users’ safety. EVIDENCE: Care plans for two service users were checked. These provided clear guidance for staff and covered a wide range of relevant areas. There was accompanying detailed information about communication with the person. A review chart was being completed each month. The manager had also conducted a detailed care plan audit in June 2006 to make sure that they were up to date and 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 Page 10 appropriate, resulting in an action plan being devised. Many care plans had already been updated following this. Some plans were noted as needing further review and update, such as one person’s care plan about nutrition using a specialised technique. It is recognised that care plans are dynamic and that review and update is an ongoing process. Daily notes were numbered to relate to care plans. Whilst this can be an effective system for focussing on whether care plans are being fulfilled or need review, caution also needs to be exercised about the content of the entries. Many were seen to consist of stock phrases which were repeated such as ‘independence encouraged’ or ‘choices respected’. Care should be taken to make the entries meaningful, such as by giving examples of when care plan goals were met (or not met, with explanation), although it is recognised that this is more time consuming. There is also scope for reflective practice and thoughts about how care could improve. Such entries can then form more of a basis for care plan reviews. Care plans and communication guidelines included reference to how people made choices and what their preferences and wishes were. There was also description of some limitations and restrictions, as far as possible in consultation with service users, such as about having a key to their bedroom. This area is being monitored and reviewed through the care plans audits. Service users were seen being offered choices where possible throughout the inspection. Staff spoken with described how they aimed to offer and respect choices as far as possible, though some comments were made about it being difficult to respect some choices at times due to staffing levels. This is discussed later. Selected risk assessments provided evidence of a satisfactory system for assessing and managing risk. New risk assessments were completed around the time of the visit about a specific hazard in one bedroom. As with care plans, a monthly review sheet operates as a check on whether risk assessments remain current or need archive/review. However, one risk assessment confirmed by the manager as obsolete had been reviewed as current. The manager is auditing risk assessments as well as care plans and as part of this will consider the quality of keyworker reviews, including whether people have the confidence and training to review risk assessments. 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 Page 11 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): 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements are needed to aspects of activity provision in order that service users are offered appropriate activities, are part of the community and have a good quality of life. Support is provided for service users to maintain close contact with important people in their lives, promoting their wellbeing. People are offered a varied diet which respects their preferences and needs. EVIDENCE: An activity timetable was on display in the dining room. Service users also had individual activity care plans. The manager and staff reported that it was proving particularly difficult to find appropriate activities for one person. Their planner indicated that their main activity was a drive out on most days of the week. An example of this was 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 Page 12 seen on one day, with a short drive being offered just before lunch. A review of the handover sheet and daily records indicated that for a two-week period in august 2006 the person had left the home just four times (for a drive or shopping). No other activities were recorded besides aromatherapy, interaction with staff and ‘relaxing’ in the home or garden. The manager said that there were plans to try taking the person to a sensory room, though this had been attempted before, and that the person was also being supported to use public transport. Staff spoken with agreed that the person did not have enough activities, putting this down to a combination of difficulty finding things that the person enjoyed, staff not have the time/availability to take the person out as much as they would like (particularly on one-to-one outings) and also some complex interactions with other service users. The person had just returned from a holiday and it was reported that they had enjoyed this and shown signs of wanting to go out as soon as they returned to Brae Walk. During the visit to the home the person was seen to spend most of their time sitting in the lounge or walking around the home accessing the communal areas. The above suggests that the person is lacking stimulation and activities. It may also be that not all activities are being recorded. This needs to be addressed, although it is acknowledged that this presents challenges to the team and that efforts have been ongoing for some time. There was evidence that the issue may relate in part to inadequate staffing levels resulting in insufficient opportunities for one to one time. Another person whose care was looked at had been poorly. Their activity record for the same period in August also indicated relatively few activities although this reflected changes in their condition. A third person’s activities as recorded on handover sheets and daily records indicated that they had been out just four times during the same fortnight in August. Records, discussion with staff and general observation provided evidence that service users were supported to stay in contact with family. Care plans noted people’s preferred routines. Service users were seen moving freely around the home. People were observed to be getting up at different times and choosing what to have for breakfast. Staff were heard addressing service users with terms such as ‘darling’ and ‘sweetheart’ frequently. The term ‘droopy drawers’ was also used. Whilst the tone was warm and friendly some of these terms could be regarded as disrespectful. Use of these terms should be reviewed. The manager explained that in at least one case certain terms were part of their behaviour management plan, although use of the term in question was observed to extend to most service users. A four-week rolling menu was viewed. This indicated that a good range of healthy and interesting food was served. There was reference to service users’ choice on the menu. Some mealtimes were observed. These were relaxed, with 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 Page 13 people having different options. One service user indicated that they liked the food served in the home. Care plans referred to people’s specific needs around diet and nutrition. It was agreed that some service users might appreciate a photo/picture menu (or at least an indication of what was to be served that day). 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 Page 14 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): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive necessary support with personal care, promoting their health and wellbeing. Appropriate support is also provided with healthcare needs, although there is scope to improve recording in order to make the system more robust. Generally satisfactory arrangements are in place for handling medication, although there is potential for improvement to make the systems safer. EVIDENCE: Care plans included reference to the support people needed with personal care. There were some indications of people’s preferences around routine and how care was provided. The manager reported that he was about to review all care plans relating to intimate personal care to include as far as possible more information about the person’s preferences around issues like the gender of the carer. He added that he planned to generally review procedures in this area to introduce greater safeguards for staff and service users. Some examples were seen, having been drawn up over the course of the inspection. 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 Page 15 Staff spoken with described how they provided personal care, respecting the person’s choices and their privacy and dignity as much as possible. During the inspection many of the service users were asked if they wanted to go to the toilet at relatively high volume in front of other residents. The manager explained that this had been explored in the past and it had been established that some service users needed a clear, direct and relatively loud form of verbal communication. However, this was seen to be an approach used for the majority of service users and the team should consider whether there is scope for this to be approached more sensitively and discreetly in some cases. Discussion, observation and records provided evidence that service users were being supported to access a wide range of routine and specialist healthcare services according to their needs. Whilst all of the information appeared to be included in healthcare records the manager agreed that they were a little scrappy and disorganised in their current form. Some entries were all hard to read. It was agreed that introducing health action planning and an appropriate template should be a priority. The manager had already recognised this and two staff had completed relevant training with a view to becoming in-house coordinators. Some time had been set aside in September for them to begin to work on the health action plans. Care plans referred to individual healthcare issues as appropriate. During the inspection some plans were updated/created about specific healthcare needs. These were seen to provide some important information which some staff had previously expressed uncertainty about. One person’s weight had not been taken since May 2006. Some new scales were purchased during the inspection and their weight taken. Medication records appeared to be generally in order. Some gaps were noted. The manager was aware of these and said that he was reminding staff about the importance of ensuring that the chart was fully completed. He added that he investigated gaps to ensure that the medication had actually been given. This will need ongoing monitoring. Handwritten entries were seen to be double signed. Reasons for nonadministration had been recorded where applicable. Individual procedures and protocols were in place as necessary. The manager had recently approached GPs for up to date guidance on homely remedies. The response had been variable and he intended to chase up surgeries where more information was required. The medication cabinet appeared to be in order. External medications were dated when opened and stored separately to internal medicines. During the inspection a particular medication and a sharps bin were moved from a bedroom to more secure storage. This medication needs to be stored in the 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 Page 16 fridge. The manager said that the current arrangement was not ideal as the fridge (a small domestic one without a shelf, located in a lockable cupboard) defrosts resulting in the boxes of medication becoming damp. If the problem persists this should be replaced, ideally with a dedicated, lockable medication fridge. In the meantime they could be stored in a plastic container with a lid to avoid the boxes becoming wet. The medication referred to above is administered by district nurses, who keep their own administration record. During the inspection it was clarified that there should be cross-referencing on the home’s MAR charts to this. The nurses have discussed the possibility of delegation of this clinical task to the staff team. Guidance on the CSCI website about medication administration and training includes some reference to this, including care workers’ right to refuse to do this if they do not feel competent. The manager described the training that staff had undertaken around medication. He said that two staff who had not taken a distance-learning course would be put forward for some training run by the Trust. New guidance from CSCI states that care providers need to establish a formal means to assess whether each care worker is sufficiently competent in medication administration before being allowed to give medicines and that this process must be recorded in the care worker’s training file. The home/organisation should therefore create an appropriate written competency framework for each person. 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 Page 17 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): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A good framework is in place to help service users and other to express dissatisfaction, and planned improvements should further help people to feel valued and listened to. Shortfalls in the handling of service users’ finances need to be addressed so that service users can be confident that their money is being appropriately managed. EVIDENCE: There is a text and symbol version of the complaints procedure. The manager was planning to modify the latter to make it brighter and more accessible before going through it with service users. This is good practice. He also planned to ensure that families knew how to complain. The manager said that there had been no formal complaints in the last 12 months. Staff spoken with demonstrated an awareness of how different service users indicated if they were unhappy. They described how they responded, giving examples. The Trust policy on safeguarding adults was seen and appeared to be comprehensive. There is also a whistle blowing policy. The manager described how he promoted a culture whereby staff felt confident raising concerns. Staff spoken with indicated that they would feel comfortable using the whistle blowing policy if necessary, or raising issues on a more day-to-day level. 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 Page 18 Behaviour management plans included clear guidance on the team’s approach to challenging behaviour. A red/amber/green system for describing behaviour was seen in some care planning files. Samples of service users’ financial records were checked. Whilst a clear system including numbered receipts and regular balance checks was in operation, the following was noted: • Some service users had paid for protective equipment such as gloves, tabards and wipes. Such items would usually be provided by the care home and as such the service users need to be refunded, particularly since no statement could be found indicating an expectation that service users would meet such costs (e.g. in the Service Users Guide). One person paid for bottled water whilst on holiday which was necessary for their nutritional needs (met by a specialised technique), totalling £4.67 on 12/08/06. Again, it would be usual for the service to cover this kind of cost. Four service users had been for a meal out on 15/08/06. Their receipts included staff meals and £2.50 had been deducted from each receipt for this. However, the remainder had been charged to the service users meaning that they were subsidising staff members’ food and drink. The manager said that this was not the policy, and that the difference should be picked up either by the staff member or the home. Refunds need to be made accordingly and service users’ financial records need to be checked as far back as is necessary to establish whether similar errors have occurred. One of the above receipts showed that £2.50 had been taken off but the person had actually been charged the full receipt amount, resulting in an even greater subsidy from the service user. • • • Having spoken with senior staff in the Trust about this, the manager said that the organisation would be producing a clear policy on what is covered by fees and what service users are expected to pay for. Arrangements for the funding of service users’ and staff members’ meals on holiday were discussed. The manager said that the practice included a rotation system whereby service users would take it in turns to cover a bill in a particular establishment (including costs of staff drinks and food), with the service covering some of the bills. Aside from the likelihood that service users will pay different amounts depending on what was consumed when it is their turn to pay the bill, questions could be asked about the practice of service users contributing to the funding of staff meals on holidays. Clarification is required in order that a judgement can be made about whether the arrangements are fair, clear and appropriate. Entries in service users’ financial records were not always double signed. This should be done consistently as an added safeguard. The manager should regularly check these records to ensure that procedures are being followed. 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 Page 19 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A homely, pleasant and clean environment is generally maintained although some parts of the building and décor need attention in order to promote service users’ comfort and wellbeing. Aspects of routine checks also need to be reviewed in order to promote hygiene and safety. EVIDENCE: 3 Brae Walk appeared homely, clean and comfortable throughout. Bedrooms that were checked were pleasant and personalised. The following issues were identified: • The bathroom continues to be unfit for purpose/does not fully meet the needs of the service users. Before the inspection the manager had described plans to CSCI about converting it into a wet room with a walkin shower. He and the staff team expressed confidence that this would meet service users’ needs. The lounge curtains are ripped and stained. These need replacing. The lounge carpet needs cleaning or replacing, as it is very stained and worn. DS0000066771.V308177.R01.S.doc Version 5.2 Page 20 • • 3 Brae Walk • • One person’s bedroom on the first floor has some small cracks/blemishes in the paintwork. Whilst this would not usually warrant a requirement, staff and the manager reported that, related to their condition, the service user was repeatedly distressed by these décor issues. A detached letterbox flap and sharp screws had been left in an accessible position near the front door. The action plan received in response to the draft report stated that this had been removed. Some staff expressed frustration at the length of time that it took the Housing Association to address maintenance and repair issues. In addition the following is highlighted for consideration: • • Staff and the manager reported that the existing milk fridge was too small and should be replaced. The pantry itself is in part of the garage. This is not ideal, for example since the room is quite dusty, there are chemicals and paint stored there and as the freezer is next to the boiler. Consideration should be given to how to make food storage arrangements more suitable, such as through creating a separate, sealed area within the room. A weighing chair in the bathroom was becoming rusty. Consideration should be given to replacing this (or accessing alternative arrangements for people who need to be weighed sitting down). • It was agreed that the kitchen/dining area was slightly cramped at times, particularly when mobility aids were being used. However, there appeared to be no obvious solutions to this and the manager said that the space was suitable provided certain routines were kept to such as the order at which people arrived at and left the dining table. The home appeared generally clean and fresh throughout. Some staff commented that hygiene occasionally slipped and that they needed to remind colleagues about certain issues at times. Some out of date yogurts (by several days) were found in the fridge suggesting that the system for date checking was not satisfactory. Some specialised equipment and adaptations were seen to be in use in the home. Some more items related to people’s needs arrived during the inspection and were quickly put into use. It was reported that a hoist was going to be obtained in respect of one person’s changing mobility needs. 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 Page 21 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, 33, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst staff are skilled and caring, aspects of communication within the team need addressing in order to improve confidentiality and the flow of information. Staffing levels and the use of less trained temporary workers may be impacting on the quality and consistently of service users’ care. Appropriate recruitment and selection procedures are effective in helping to keep service users safe from harm. Good structures and plans are in place around staff training which will promote the delivery of high quality care. EVIDENCE: The manager reported that over 50 of the staff team were qualified to NVQ level 2 or 3 in care and that more NVQ training was planned for the near future. Staff were observed to interact with service users in a warm, friendly and respectful manner. Some observations were made to the manager for ways in which aspects of interaction might further improve, including staff always 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 Page 22 talking to the person to inform them of what they are doing/about to do. Service users appeared to find staff approachable and appeared relaxed and comfortable throughout the inspection. One person spoken with indicated that they like the staff. Staff were observed meeting and discussing issues in a professional manner with external health and social care workers visiting the home. Some staff expressed concern over aspects of communication within the team, giving examples of issues which had not been clearly communicated, resulting in confusion (such as about medical matters). The manager acknowledged this, saying that it would form part of the discussion during a planned away day. Staff were heard handing over some sensitive information about one service user in the kitchen, following a medical appointment. Another service user was present. Service users’ confidentiality must be respected at all times. Staff spoken with demonstrated a good understanding of people’s needs and conditions, although some felt that they would benefit from more input around particular issues such as diabetes. The manager said that this input was awaited from a diabetes specialist in the community. The manager talked through his understanding of the principles and policies for recruitment and selection. This included demonstrating an awareness of equal opportunities issues. Staffing files viewed contained appropriate documentation. Some were missing papers such as the application form but it was accepted that given the length of service in these cases (over ten years) it would not be reasonable to chase this up. Repeat CRB checks had been completed where there was no evidence on file of one having been done. A recent recruitment exercise had not resulted in candidates being appointed. The home continues to be short of one senior care worker. The manager said that this would be readvertised. The hours were being made up with bank workers and also through existing staff working extra hours. Staff reported that this was resulting in pressures on the team, particularly since bank workers could not always perform certain tasks (although the manager described plans for some bank staff to receive training in order that they could take on more roles). As noted, there was evidence that staff were not able to take people out as much as they wished to and as much as service users indicated that they would like, particularly since one person is now assessed as requiring 2:1 support in the community. Staff described having to cancel activities at times due to ongoing staffing issues, though added that at times there were up to four people on a shift, greatly increasing the opportunities available for service users. 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 Page 23 The manager reported that formal consideration was still being given as to whether waking nights should be reinstated. Staff spoken with felt that this should be done, although the manager was more cautious about this. The manager said that he was impressed with the training offered by the Trust so far. Discussion and records provided evidence that staff were either up to date with core training or that this had been identified and was booked. As noted, training was planned/had taken place about health action planning and in NVQs in care. One person had also completed training in person centred planning with further training planned for them and other staff in the future. On one day of the inspection some staff attended another home for training about using a sensory room. Two staff were booked on training about adult protection in October. The manager said that all staff would attend this in due course. This is good practice. Some staff were booked onto an assertiveness course. Training was planned in use of the computer. The manager also reported that training was planned about autism, dementia, epilepsy and mental health & learning disability. If training comes together as planned this represents a very positive programmes of professional development for the staff team. Progress will be considered in future inspections. The Trust was conducting a training needs analysis at the time of the inspection. 3 Brae Walk DS0000066771.V308177.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally well-run, promoting positive outcomes for service users. A reasonable quality assurance framework is in place, helping the service to identify what it does well and how it could improve. Appropriate systems are in place for maintaining service users’ and staff members’ health and safety. EVIDENCE: Staff spoken with gave positive feedback about the manager. Comments included that he was easy to talk to, a good team worker and fantastic with the clients. 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 Page 25 The manager said that he had introduced a new supervision format. He added that he was attending training about supervision and appraisal in November 2006. The manager has completed the Registered Manager’s Award and reported that he had just also finished NVQ level 4 in health and social care. He plans to do the NVQ assessor’s award in due course. The manager reported that the home was overspent in certain areas, resulting in some difficult decisions having to be made. The impacts of this will be monitored during future inspections. As noted, there are some areas where overall management and quality assurance could improve such as checking of service users’ finances. Regulation 26 reports are being forwarded by the Trust. Some visits are being conducted by other home managers. The manager said that he found this peer review helpful. As noted, care plans and risk assessments are being audited. The manager had devised and implemented some surveys for staff, service users and other people involved in their care. In the absence of a survey tool agreed for use by the Trust the manager has obtained permission to continue using these periodically. However, he understands that a tool will soon be introduced. In addition managers are being asked to complete a self-audit based on some core standards which may be subject to unannounced checks. Staff spoken with generally felt that the home was a safe place to live and work. A comprehensive health and safety file included relevant policies and information. The fire log provided evidence of checks on alarms and emergency lighting at suitable intervals. Portable appliance testing had been done in February 2006. The manager said that gas appliances and wiring were tested just before the transfer to the new provider earlier in the year. The manager confirmed that the adapted bath had recently been serviced. Records of various other routine health and safety checks were seen. 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 Page 26 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 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 2 33 2 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x x 3 x 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 Page 27 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. 1 Standard YA12 Regulation 12 (1) a 16 (2) 12 (1) a 17 (2). Sch. 4 Requirement Arrange appropriate activities for all service users taking into account their individual needs and interests. Address the bullet points made in the text about service users’ finances, including providing refunds where appropriate. Fully clarify the terms and conditions applying to service users in respect of what costs they are expected to meet and what is included as part of fees. Ensure that staff and, as far as possible, service users and others involved in their care are aware of this. The above must include clarification about arrangements for paying for service users’ and staff members’ meals on holiday. 3 YA24 12 (4) a 23 Forward a copy to CSCI. Address the following issues with the environment: • The first floor bathroom must be adapted to meet Version 5.2 Page 28 Timescale for action 31/10/06 2 YA23 31/10/06 31/12/06 3 Brae Walk DS0000066771.V308177.R01.S.doc 4 YA32 12 (1), (4) & (5) the needs of the service users living on the first floor, including fitting appropriate aids in accordance with specialist assessment. • Replace the curtains in the lounge. • Clean or replace the lounge carpet. • Address the décor issues in one person’s bedroom as described in the text. Service users’ confidentiality 10/09/06 must be respected at all times. 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 3 4 5 Refer to Standard YA6 YA16 YA17 YA18 YA19 Good Practice Recommendations Entries in daily records should be made fuller and more meaningful, as outlined in the text. Consider the issues raised in the text about the way service users are sometimes addressed. Consider whether some service users might find a photo/picture menu helpful. Consider how service users could be asked more discreetly and sensitively whether they need to use the toilet. Establish a health action planning system. Use this to replace the existing healthcare recording arrangements as far as possible in order to create a more accessible, legible and organised system. • Establish a formal means to assess, record and review whether each care worker is sufficiently competent in medication administration. Document this in the care worker’s training file. • If the problem of dampness in the medication fridge continues this should be replaced, ideally with a dedicated, lockable medication fridge. In the meantime the medication could be stored in a plastic container with a lid to avoid the boxes becoming DS0000066771.V308177.R01.S.doc Version 5.2 Page 29 6 YA20 3 Brae Walk 7 YA23 8 9 10 11 YA24 YA30 YA32 YA33 wet. • Continue to closely monitor and address ongoing issues with occasional gaps in the MAR chart signatures. • Entries in service users’ financial records should be consistently double signed. • The manager should regularly audit service users’ financial records to ensure that correct procedures are being consistently followed. Address the bullet point recommendations made in the text of the report about the environment. Review arrangements for date checking of food. Consider how to address concerns and shortfalls regarding communication within the team. Continue with efforts to recruit a senior care worker. In the meantime make arrangements such that bank workers can carry out more of the roles and responsibilities of permanent staff. Conduct a staffing review based on service users’ needs to consider whether overall staffing levels are sufficient, particularly in respect of activity provision. Formally assess whether waking night shifts should be reintroduced, basing this on service users’ needs and general risk management, taking into account the views of staff. 3 Brae Walk DS0000066771.V308177.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 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 3 Brae Walk DS0000066771.V308177.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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