CARE HOME ADULTS 18-65
Bruddel Grove (4) 4 Bruddel Grove The Lawns Swindon Wiltshire SN3 1PW Lead Inspector
Malcolm Kippax Key Unannounced Inspection 27th February 2007 12:25 Bruddel Grove (4) DS0000003203.V320945.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 Bruddel Grove (4) DS0000003203.V320945.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. Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Bruddel Grove (4) Address 4 Bruddel Grove The Lawns Swindon Wiltshire SN3 1PW 01793 642378 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.rethink.org Rethink Ms Thelma June Wilson Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th March 2006 Brief Description of the Service: 4 Bruddel Grove provides accommodation and personal care for up to five people affected by severe mental illness. The home is run by ‘Rethink’ a national charity that provides a range of care and support services around the country. Bromford and Carinthia Housing Association owns the property. 4 Bruddel Grove is located in the Lawns area of Swindon, which is close to Old Town where there are a range of shops and public amenities. It is a detached property at the end of a short cul-de-sac. Two service users have their bedrooms on the ground floor and there are three bedrooms on the first floor. The communal space consists of an open plan lounge-dining room and another smaller room that is used as an area to smoke in. There is garden at the back, with a parking area at the front. Service users receive support from a home manager, a team leader and a permanent staff team. Relief and agency staff were also being used at the time of this inspection. The fee level is £279.65 per person per week. Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit to the home on 27 February 2007 from 12.25 pm - 4.50 pm. A second visit was arranged and this took place on 7 March 2007 between 9.30 am and 12.50 pm. Service users were spoken with and there were individual meetings with two staff members and with Ms Wilson, the home’s manager. There was a tour of the home and a number of the home’s records were looked at. Other information and feedback about the home has been received and taken into account as part of this inspection: • • • The manager completed a pre-inspection questionnaire about the home. Four service users completed surveys about their experience of the home. Comment cards were completed by three relatives and by a health care professional. 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:
The home has a procedure for admissions, which ensures that service users have their needs assessed and get to know Bruddel Grove before moving in. The home works closely with other agencies and outside professionals to help a new service user to settle in as well as possible. There is good information about the support that service users require from staff. This includes the service users’ objectives and their views of what they need, so that the staff team provides consistent support in the way that service users prefer. Service users meet with their key workers on a regular basis, which means that their care plans are kept under regular review and can be updated to reflect changes in their lives. Staff respect the service users’ right to make decisions and assist service users with making informed choices. Service users are supported to take risks as part of an independent lifestyle. They can choose whether to take part in a self-care programme, which includes for example preparing their own meals. Service users feel that ‘house rules’ have been kept to a minimum. They are encouraged to participate in household jobs, but it is recognised that not all service users will manage this on a daily basis. Service users can raise issues and concerns at regular house meetings and people who choose not to attend are asked for their views individually. Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 6 Service users can manage their own personal money and support is available with its safekeeping if needed. Risk assessments are undertaken which support service users with being independent and help to reduce identified hazards. Service users benefit from the support they receive with their relationships. Their relatives can visit in private and are made to feel welcome in the home. Service users like the meals and the arrangements are flexible to fit in with their individual circumstances. Service users have access to the kitchen for making their own drinks and snacks. Personal and health needs are kept under review and service users are encouraged to take responsibility for managing their own health care. Medication is kept securely and administered in a safe way that respects the service users’ views. Service users have the opportunity to raise concerns and receive support from staff that assists them with expressing their views. Staff members receive guidance and training that helps to protect service users from abuse. The accommodation is meeting the service users’ needs. There are good communal areas, in addition to the service users’ individual rooms. The environment is generally homely, clean and well maintained. The staff team includes staff who know the service users’ needs well and undertake relevant training. In the absence of permanent staff, service users are supported by relief and agency staff who they are familiar with. There are recruitment procedures, which help to protect service users from being supported by unsuitable staff. Service users benefit from a well run home and there are good systems for monitoring and improving standards in the home. Service users are asked for their views as part of the home’s quality assurance arrangements. The staff team are aware of ways in which service users may be discriminated against and the organisation provides training in equality and diversity. There are systems in place for promoting and protecting the health and safety of service users and staff. What has improved since the last inspection?
There were no requirements and recommendations arising from the last inspection. Some improvements have been undertaken or started during the last year as part of the home’s own development plans. Work on the installation of a new shower was taking place at the time of the visits, which will provide a better facility for service users.
Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 7 Ms Wilson said that the service users’ nutritional needs had been looked at in more detail in recent months and suggestions made to service users about new meals that they might like to try. During the visits, service users mentioned particular meals that they like. A new file had been produced which included information about a range of meals. This was an interesting and well researched resource that provided service users with good descriptions of meals from different cultures and cuisines. A suggestions box had been put in the front hall as a new means of obtaining feedback from service users and their visitors. The staff team’s interest and involvement in equality and diversity issues has developed and one staff member now attends the Swindon Racial Equality Council. What they could do better:
Some subjects, such as the risk of abuse and spiritual needs are not consistently included in the service users’ care and recovery plans. It is recommended that consideration is given to including certain subjects on a consistent basis. This would ensure that there can be no misunderstanding about whether a service user has needs in these areas. The care and recovery plans were being discussed during monthly meetings between service users and their key workers. The main points arising from these key worker sessions were recorded on a monthly update form, which included a section for recording whether changes were needed to the care plan as a result of meeting. These sections needed to be consistently completed, so that it is clear whether the care plans have to be updated. The bedrooms did not have en-suite facilities although toilets were close by. The possible benefits of an en-suite for one service user in particular were discussed with Ms Wilson and staff. It is recommended that this is looked at further as part of a review of the service user’s needs. There have been some changes in the staff team during the last year, which has affected progress in raising the percentage of qualified staff. An increase in the number of qualified staff is now a priority. Service users are asked for their views, although these could be more fully reflected within the system of quality assurance and the home’s improvement plans. Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 8 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. Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 9 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 Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 10 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 3 Quality in this outcome area is good. This judgement has been made using available evidence including the visits to the home. New service users have their needs assessed and can get to know the home before moving in. This helps ensure that a prospective service user knows what to expect and that the home is suitable for meeting their needs. EVIDENCE: There was an information and referral file that set out the procedure to be followed in the admission of a new service user. The pre-admission arrangements were planned in conjunction with other agencies who already knew the prospective service user. Two new service users had moved into the home since the last inspection. Both service users were met with. They talked about the visits they had made to the home before making a permanent move. They had had the opportunity to meet with the service users and staff. The service users’ records showed that the admission procedure had been followed. Application and risk assessment forms had been completed as part of the referral. Other information was received as the admission arrangements Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 11 progressed, including psychiatric and social histories and more detailed assessments. In their surveys, service users commented: ‘I came to have a look around and liked the place’ and ‘I was shown pictures and visited before I moved in’. Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 12 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 good. This judgement has been made using available evidence including the visits to the home. Service users benefit from the information that has been recorded about how their needs are to be met. This helps ensure that the staff team provides consistent support, in the way that service users prefer. Staff respect the service users’ right to make decisions and assist service users with making informed choices. Service users are supported to take risks as part of an independent lifestyle. EVIDENCE: Three service users’ individual records were looked at. These looked well organised and the information was clearly presented. Each service user had a ‘Care and Recovery’ plan, which covered different aspects of their needs, including ‘General mental health’, ‘Physical health’, ‘Day to day living’ and ‘Health and safety’. Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 13 Issues were identified under each of these headings, together with statements about the service user’s objectives and the action that had been agreed to support these. The plans reflected the service users’ views, for example by highlighting when a service had said that they didn’t need a lot of input in a particular area. The service users had different issues, which were listed on a contents page at the front of the plans. There was discussion with Ms Wilson about whether some issues were relevant to all service users, but were not currently included in each of the plans. For example, the care plan for one service user included statements about their religious and spiritual needs and the risk of abuse, but these were not identified as issues for every service user. Ms Wilson said that not all the service users were assessed as having needs in these areas. The care and recovery plans were being discussed during monthly meetings between service users and their key workers. This gave service users the opportunity to make decisions about their plans on a regular basis. The main points arising from these key worker sessions were recorded on a monthly update form. The forms included a section for recording whether changes were needed to the care plan as a result of meeting. These sections were not being consistently completed. Service users were asked in surveys if they made decisions about what they do each day. Each person responded differently; one person confirmed that they always did and the other three responded ‘usually’, ‘sometimes’ and ‘never’. Service users did not add any comments in connection with this. However in response to another question, each service user confirmed that they could do what they want at different times of day. In response to the question ‘Do the carers listen and act on what you say?’ three service users confirmed that this was always the case and one person stated that they sometimes did. The majority of service users were managing their own personal money. Their personal files included guidance about how they could access this independently and any specific arrangements that had been agreed. Some service users received support with the safekeeping of money and records were kept of deposits and withdrawals. The service user and the staff member both signed the record when a transaction was made. The service users’ files included crisis self-management forms. Risk assessment had been completed in respect of various hazards, including smoking. Control measures had been identified on the assessment forms, which helped to ensure that service users could act independently, but in a safe way. Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 14 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. This judgement has been made using available evidence including the visits to the home. Service users can exercise independence in the home and have opportunities for personal development. Service users benefit from the support they receive, which helps to maintain relationships and develop individual skills. The service users’ rights and responsibilities are recognised within the daily routines. Service users like the meals and receive good attention from staff with nutrition and menu planning. EVIDENCE: Each service user had a daily routine, which they had discussed as part of their ‘Care and recovery plan’. None of the service users had a regular ‘nine to five’ type occupation. Activities were usually arranged on the day to take account of the service users’ motivation and short term needs.
Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 15 Service users were engaged in different activities at the time of the visits. One service user was out seeing a relative. Other people went shopping, which was a regular event during the week. One care plan included guidance for staff to encourage a service user to go out as much as possible. For much of the time, service users occupied themselves in the home. Each service user had responsibility for a daily household job, although checklists were kept which showed that the jobs were not consistently completed. Ms Wilson said that there was a flexible approach as to whether service users could undertake these jobs independently. Some service users were involved in a self-care programme and were choosing to prepare some of their own meals. There was an information pack for service users, which included a list of rules about various ‘dos and donts’ in the home. There was a rule that smokers used lighters rather than matches. The service users spoken with did not feel that there were any unreasonable house rules. They bathed or showered when they wanted and got up and went to bed when they wished. One service user mentioned that they were sometimes aware of other people being up and about during the night. This was later discussed with Ms Wilson. Information about the service users’ family backgrounds was included in their care plans. The plans described the type of contact they had with relatives. One service user said that members of their family visited each week. Other service users said that their relatives visited occasionally. Staff members, in their role of key workers, were supporting service users with their relationships. Family members had been asked to complete satisfaction surveys as part of the home’s system of quality assurance. In their comment cards, the relatives confirmed that they are welcome in the home at any time and can visit in private. They also felt that they are kept informed of important matters. House meetings were arranged, although some service users chose not to attend. The meeting minutes showed that a number of service users had been asked by staff to give their opinions individually, which they may find easier to do than in a meeting setting. The minutes were displayed in the home. Although they were not in the most public area of the hall, it would be worth considering whether there are implications for confidentiality, as the minutes could include comments that had been made by named service users. Service users made their own drinks and snacks during the day in the home’s kitchen. A service user said that they prepared their own breakfasts. The main meals were cooked for service users, except when a service user prepared their own as part of ‘self-care’ programmes. One service user said that they cooked for themselves on two days a week and this would be increasing to three. The menu for the week was compiled following
Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 16 consultation with service users. Records showed when service users had chosen alternatives to the planned meals. There was a ‘Rethink’ policy on nutrition. Ms Wilson said that the service users’ nutritional needs had been looked at in more detail in recent months and suggestions made to service users about new meals that they might like to try. A new file had been produced which included information about a range of meals. This was an interesting and well researched resource that provided service users with good descriptions of meals from different cultures and cuisines. Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including the visits to the home. Personal and healthcare needs are regularly reviewed and service users benefit from the support that they receive. Service users are protected by the home’s medication procedures and practices. EVIDENCE: It was reported in the pre-inspection questionnaire that the service users did not require help with their physical care, although each person had needs relating to their mental health. At the front of the service users’ care and recovery plans there were descriptions of how their illnesses were apparent and their overall objectives in receiving care. The care and recovery plans included sections that covered personal and physical care needs. There was guidance for staff about service users who would need prompting with personal care and some one-to-one attention. The physical health part of the care plans included information about particular conditions, such as diabetes. There was guidance about self-monitoring and
Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 18 the responsibilities that service users took for their own health care. For example it was recorded in one care plan that the service user did not want to stop smoking. The plans included information about sleep patterns and described how the service users’ foot care would be managed. An assessment had been undertaken in January 2007 concerning the risks associated with one service user’s care and clinical needs and how these were managed. In their surveys, each relative confirmed that they are satisfied with the overall care that service users received. A health care professional commented that they are impressed with the standard of individual care. Service users were registered with local GPs. Details of medical appointments were recorded in the service users’ individual records. A staff handover took place during the afternoon, when issues about the service users’ health and welfare were discussed. Staff meeting minutes showed that there had been more detailed discussions about the service users’ needs. Service users received support from outside professionals, including a community psychiatric nurse. Medication was kept securely and dispensed to service users using a monitored dosage system. Staff members confirmed that they received training in the medication procedures. Staff members were consistent in recording the medication that they administered. One service user was prescribed medication for PRN (as required) use. Staff members were aware of the guidance about its use and said that this medication was only given at the request of the service user, who was able to decide when it was needed. The service user was seen to request their medication during one of the visits. Staff members made an appropriate record about this administration at the time. Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including the visits to the home. Service users have the opportunity to raise concerns and receive support from staff, which assists them to express their views. Staff members receive guidance and training that helps to protect service users from harm. EVIDENCE: Each service user confirmed in their surveys that they knew who to speak to if not happy with something. One person mentioned their key worker. Three people confirmed that they knew how to make a complaint. In the comment cards, one relative confirmed that they were aware of the home’s complaints procedure, although two relatives stated that they were not. None of the relatives had needed to make a complaint. The health care professional who completed a comment card confirmed that they had not received any complaints about the home. Within the home, service users had the opportunity to raise concerns and were encouraged to air their views, for example in house meetings and during the monthly key worker sessions. A suggestions box had been put in the front hall as a means of obtaining feedback from service users and their visitors.
Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 20 The Commission has received no complaints about the home in the last twelve months. Ms Wilson said that that no complaints had been made to the home during this time. A book was kept in the office for the recording of any complaints that are received. There was a complaints procedure that outlined the steps to take if there are any complaints. Service users were given a copy of the procedure to keep in their rooms. There was an organisational policy and procedure about responding to allegations of abuse. Staff members were given guidance on the local arrangements for the protection of vulnerable adults and had received copies of the ‘No Secrets in Swindon and Wiltshire’ booklet. A ‘Whistle Blowing’ procedure was also available to staff. One staff member said that they had attended a talk given by a police officer from the local vulnerable adults unit. All new staff had Criminal Records Bureau (CRB) checks and were checked against the Protection of Vulnerable Adults (POVA) register. Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 21 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, 26 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including the visits to the home. Service users live in homely surroundings and have accommodation that reflects their lifestyles. EVIDENCE: Bruddel Grove is an ordinary house in a residential area, providing homely accommodation in pleasant surroundings. The home looked well maintained and decorated. A shower room on the ground floor was being refurbished at the time of the visits. Service users had their own rooms on the ground and first floors. The rooms varied in size and reflected people’s different interests. The main communal room was an open plan lounge and dining room, which was a no-smoking area. There was a second, smaller sitting room where service users could smoke. Service users said that they were satisfied with their rooms and they had what they needed.
Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 22 There was a mature garden at the rear of the property. At a recent meeting, service users had been asked for suggestions about how the garden could be improved. Ms Wilson said that some very tall conifer hedges around the garden were shortly to be cut down. The accommodation seen was clean and tidy. Staff said that as part of their key worker role they supported service users with the cleaning of their own rooms. The bedrooms did not have en-suite facilities although toilets were close by. The likely benefits of an en-suite for one service user in particular were discussed with Ms Wilson and staff. It was recommended that this is looked at further as part of a review of the service user’s needs. There was a weekly cleaning rota and each service user had a daily household task. In their surveys, three service users stated that the home was always fresh and clean. One person thought that this was usually the case. There was a small laundry area that was separate from the kitchen. A service user said that they used the laundry by themselves. Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 23 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, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including the visits to the home. Service users benefit from staff who undertake relevant training, although progress with gaining qualifications has been affected by changes in the staff team. The recruitment procedures help to protect service users from being supported by unsuitable staff. EVIDENCE: Information was provided in the pre-inspection questionnaire about the training undertaken by staff during the last year. This had covered a range of subjects, including anti-discriminatory practice, racial equality, ‘recovery’ training, first aid, basic mental health, medication and working with people who experience psychosis. Much of this training was identified by ‘Rethink’ as being mandatory for all staff. Each staff member had a current first aid certificate. Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 24 Individual files with training profiles were kept in the home for each staff member. Two files were looked at, which contained certificates and gave a chronological record of the training undertaken. The team leader had a National Vocational Qualification (NVQ) at level 4 and had completed the Certificate in Community Mental Health. Another staff member had completed two parts of the certificate but had switched to NVQ at level 3, which Ms Wilson said was now the preferred qualification. One staff member had started their NVQ at level 3, but recently left. Another person with an NVQ at level 2 had also left during the last year. The team leader was undertaking the NVQ assessor’s award. Ms Wilson said that she expected additional staff to start their NVQ following completion of the assessor’s award. Relief staff were available to cover for vacancies in the staff team. A relief staff member was met with. They had previously worked as a permanent staff member and knew the service users well. In their surveys, service users commented that they were always treated well and with respect. Relatives reported that ‘All staff are very hardworking’, ‘they cope well with what can be difficult situations’ and they are ‘Helpful wherever possible’. One relative mentioned a particular staff member and commended her for her efforts. The health professional who completed a comment card confirmed that there was always a senior member of staff to confer with. One staff member had been appointed in November 2006 and Ms Wilson said that further recruitment was planned. Staff recruitment was supported by Rethink’s human resources department and followed the organisation’s policies and procedures. The recruitment and employment record for the newest member of staff was looked at. There was a record of the interview and an analysis of the questions asked. A Criminal Records Bureau (CRB) check and a check against the Protection of Vulnerable Adults (POVA) list were undertaken prior to appointment. Two written references were obtained and there was documentation on file confirming their proof of identity. Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 25 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 good. This judgement has been made using available evidence including the visits to the home. Service users benefit from a well run home. Systems are in place for monitoring and improving standards in the home. Service users are asked for their views, although these could be more fully reflected in the home’s development plans. The staff team are aware of ways in which service users may be discriminated against. The health and safety of service users and staff are promoted and protected. EVIDENCE: Ms Wilson had achieved an NVQ Level 5 in Operational Management and the City & Guilds Advanced Management of Care qualification. She had been employed by ‘Rethink’ for many years and had substantial experience of working with people with mental health problems. Ms Wilson had attended
Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 26 training events during the last year including health & safety for managers and negotiation skills for managers. Ms Wilson said that she had also attended an employment tribunal. The day to day management tasks were shared between the home’s manager and the team leader. ‘Rethink’ overviewed the running of the home with monthly visits and through the organisation’s quality assurance system, which involved the carrying out of an audit to look at the home’s performance in relation to some key principles and outcomes. The home had been awarded ‘Green’ (safe) status following the most recent audit. The Rethink audit included completion of a user-involvement checklist and looked at how service users are surveyed about their views. The checklist had last been completed in January 2006 and Ms Wilson said that this was due to be done again. Within the home, satisfaction surveys had been given to service users to complete in 2006. The results had been collated, although the comments from service users were very limited. There were other means by which service users gave feedback, for example through house meetings and key worker sessions, as well as on more informal occasions. This feedback appeared to be informative, but it was not directly contributing to the home’s improvement and development plans. The home had an action plan for achieving ‘Cultural competence’, which was one of the standards that the home was expected to achieve as part of the organisation’s quality assurance audit. Training in anti-discriminatory practice had been held and a member of staff attended the Swindon Racial Equality Council. Ms Wilson said that the current service users’ racial and ethnic backgrounds meant that staff did not have the opportunity to put some of their learning into practice, but she thought that the staff team would be in a good position to respond if a service user from a different background moved into the home. Staff had attended fire marshal training and courses in first aid and health & safety during the last year. Ms Wilson had provided information in the preinspection questionnaire about the arrangements being made for health and safety. Some records were sampled during the visits. Risk assessments had been undertaken concerning some environmental hazards and others which involved individual service users. A fire risk assessment was carried out in January 2007. A check of the home’s fire log book showed that a fire drill had been undertaken on 1 February 2007 and the fire alarms were last tested on 7 March 2007. Some weekly safety checks were carried out and recorded in a kitchen file. Ms Wilson said that she also completed a monthly health & safety checklist on behalf of Rethink. The staff members met with said that they thought that their safety, and that of the service users, was taken seriously.
Bruddel Grove (4) DS0000003203.V320945.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 3 3 3 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 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 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X 3 3 X 3 X X 3 X Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations That consideration is given to including some subjects, such as the risk of abuse and spiritual needs, on a consistent basis within the service users’ care and recovery plans. This would ensure that there can be no misunderstanding about whether a service user had needs in these areas. That consideration is given to providing an en-suite facility as a means of meeting the needs of one service user, as identified. That all the ways in which service users give feedback about the home and the service they receive are seen as part of quality assurance and then reflected in the home’s annual development and improvement plans. 2. YA30 3. YA39 Bruddel Grove (4) DS0000003203.V320945.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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
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