CARE HOME ADULTS 18-65
54 Brookvale Road Olton Solihull West Midlands B92 7HZ Lead Inspector
Justine Poulton Key Unannounced Inspection 31st August 2007 10:40 54 Brookvale Road DS0000043666.V338563.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 54 Brookvale Road DS0000043666.V338563.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. 54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service 54 Brookvale Road Address Olton Solihull West Midlands B92 7HZ 0121 708 1553 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) Robinia Care West Midlands Limited Ms Christine Higgins Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Should the standard of care within the home deteriorate due to the manager being responsible for two other homes, then an individual manager will be required. 7th July 2006 Date of last inspection Brief Description of the Service: The service provided at Brookvale Road consists of a domestic three bedroomed house situated in a residential area of Olton in Solihull. The service is registered to provide accommodation and support three adults with learning disabilities. The current service users are three men. 54 Brookvale Road is in a road of similar properties and is within walking distance of local facilities. Solihull town centre is accessible by bus or train, as is Birmingham City Centre. Each service user has single bedroom accommodation. The rest of the house, consisting of a lounge, dining room, kitchen, bathroom, and shower room is shared on a communal basis. There is an office that is also used as a staff sleep in room. The Statement of Purpose for the home was not looked at on this occasion; therefore the fee information is not recorded in this report. 54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the first key inspection in relation to Inspecting for Better Lives. It was carried out to establish the outcomes for people living in the home, and to confirm whether they are protected from harm. Identified key standards were looked at, along with a review of the organisations progress towards meeting requirements made at the previous inspection of this service. The pre fieldwork inspection record was completed, as well as a site visit to the home, during which time staff, service users and the manager were spoken with. A completed annual quality assurance assessment was received from the service prior to the inspection along with four completed surveys from relatives and people using the service. Two people were identified for close examination by reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for service users. Records, policies and procedures were examined and the environment was looked at. All of the service users were at home for all or part of the inspection. The inspector would like to thank the service users, manager and staff for their hospitality and co-operation during the inspection. What the service does well:
The home consistently meets the key national minimum standards ensuring positive outcomes for the people who live there. The home presented with a very relaxed atmosphere. Staff appeared confident and competent in their roles, and were careful to ensure that peoples diverse needs and wants were met. Peoples care plans reflect their assessed needs. They are detailed and informative ensuring that staff are able to provide appropriate support. Similarly risk assessments enable people to take meaningful risks in a safe manner. People are actively supported to make decisions about their lives both on a daily and more long term basis by staff. The people living in this home do not attend formal day services such as day centres. Instead they are supported to participate in their interests, hobbies, chosen college courses and leisure pursuits, as well as with planning holidays. These are varied and reflective of individual likes and dislikes. The involvement of families and friends is important to people, and is encouraged by the home. A clean, tidy, well stocked kitchen enables people to choose from a range of meal options. Support and encouragement with healthy eating is provided which is successfully helping one person work towards his target weight loss.
54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 6 Two of the three people living in the home are independent when it comes to personal care, however staff work with all of the men to ensure that their individual personal care needs are met sensitively and discreetly in line with their assessed needs or as requested. Their health and wellbeing is also promoted via attendance at routine and more specialized healthcare appointments as necessary. Medication is managed safely on their behalf. The home has both a complaints policy and an adult protection policy in place. One person has limited verbal communication. Staff were aware of how this person made his needs known. Complaints received were dealt with appropriately. People living in the service were happy with the outcome of any complaints they had made. Staff were aware of their responsibilities regarding adult abuse. The home presented as comfortable and clean with no offensive odours apparent. It was decorated nicely with good quality furniture and soft furnishings throughout. Staff numbers were satisfactory. Training undertaken by the staff team ensures that a competent and sufficiently knowledgeable team supports the people who live in the home. Management systems in place appear robust. The quality of the service is monitored regularly, and the use of formal systems to test the quality provided ensure that the people living in the home are at the forefront of service development. Health and safety is managed effectively. 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
54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): x x EVIDENCE: The home has had a stable resident group for a number of years, therefore key standard 2 was not inspected on this occasion. 54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 10 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, 9 Quality in this outcome area is excellent. People’s needs are well documented and reviewed so that staff are able to provide them with the support they require, in the manner they prefer it. Risk assessments that support people to live full lives in a safe manner are also in place. This judgement has been made using available evidence including a visit to the service. EVIDENCE: As part of this inspection two people were chosen for case tracking purposes. All of their care planning, personal records, personal details, health action plan and monthly summaries information were looked at. Both care plans followed a similar format, and were written in the first person, ensuring that they were person centred and provided a sense of ownership for the people using the service. Both plans contained a personal service plan; targets, aspirations and progress sheets, and a personal support plan. The required levels of support were detailed, thus enabling staff to provide
54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 11 appropriate care and assistance for each person. Dates were recorded to indicate that peoples care and support plans are reviewed regularly. Records seen also evidenced that risk assessment is comprehensive and detailed ensuring that staff have specific guidelines to follow to minimise risk, and guidance in the event of needs changing. Areas covered with risk assessment included money management, fire risk, vulnerability, self-neglect, using kitchen equipment and horse riding. Again these were reviewed in line with the care plans. It was apparent through reading peoples care plans, talking with them and watching their interactions with staff that they are supported to be as independent as possible. Support and guidance was given with making decisions as necessary and in such a way as to enable people’s levels of independence to be maintained. 54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 12 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, 17 Quality in this outcome area is good. People are supported with a variety of age, peer and culturally appropriate activities that make best use of facilities available. Relationships with families and friends are promoted. A healthy, nutritious diet is provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: None of the people living in the home access formal day service provisions such as day centres. Instead staff support them with activities of their choosing which are planned on a weekly basis. Information recorded within the support plans of the people chosen for case tracking indicates that activities such as playing snooker, horse riding, eating out, going to the cinema and attending college. The home has a large white board in the staff office / sleep in room on which staff record what activities each person has planned each day. One person also has a similar smaller board in the lounge next to where he likes to sit which has information about his planned activities for the day
54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 13 and which staff are on duty to support him with it. It was quite clear during the inspection that the people living in the home need very different levels of support with accessing activities. This was clearly recorded in individual care planning documentation, and staff were seen to provide support appropriately as people went out for various reasons. Information was available within the files looked at with regards to people’s families and friends. It was clear from speaking to one person that he has a close relationship with his family that he enjoys. Records indicated that another enjoys a close relationship with his siblings, which was confirmed by speaking with staff. Letters within this person’s documentation confirmed that staff support him with maintaining these family ties. These relationships are seen as being of prime importance by the home, and are facilitated as appropriate. The kitchen was clean and tidy on the day of the inspection. It was domestic in both size and functionality, and had the necessary checks and records in place. Although food stocks were low upon arrival at the home, this was rectified during the day as one person went out with a member of staff to do the weekly shopping. A menu is planned on a weekly basis at the house meetings and takes into consideration peoples individual likes, dislikes, preferences, and dietary eating plans. 54 Brookvale Road DS0000043666.V338563.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. People who live in the home receive personal support in line with their assessed needs. Their healthcare needs are monitored and addressed. Medication is managed safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person has their levels of personal care and support needed detailed clearly within their care plans. This ensures that staff are able to provide the necessary levels of assistance as directed by their assessed needs. Staff were seen to react sensitively and discreetly to one person when he removed his clothes inappropriately, and provided encouragement to redress. Each person has a health action plan which contained information that confirmed that people are supported with their healthcare appointments such as the dentist, optician and chiropodist at the recommended intervals. GP appointments and medication reviews were also recorded, as were attendance at more specialist appointments and clinics such as with a psychologist or 54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 15 psychiatrist or community nurse. The outcomes of all healthcare appointments were clearly recorded along with any actions necessary. None of the people living in the home currently administer their own medication. Instead they have asked the staff team to undertake this for them. Medication is provided by Boots, in a mixture of blister packs, bottles and packets, and is accompanied by medication administration record charts. A member of staff was observed going through the medication procedure, which appeared robust. Another said that they are not allowed to administer medication to people until they have received training, which was confirmed by the training records looked at. In addition to the prescribed medications people take, they each had a homely remedies agreement in place that was signed by their GP. The medication records for the two people being followed for case tracking purposes were checked and provided no cause for concern at the time of the inspection. 54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 16 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, 23 Quality in this area is good. The homes policies of complaints and protection from abuse ensure that people’s views are listened to and acted upon, and that they are safeguarded from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a service user friendly version of the organisations complaints procedure available to the people who live in the home should they need it, which uses pictures and symbols. A worries and grumbles form is also available for people to use. The annual quality assurance assessment received prior to the inspection records that four complaints have been received by the service in the previous 12 months. These were recorded within the homes complaints log along with the responses made. Of the four complaints received, three were upheld and action to resolve them was taken accordingly. Two of the three people living in the home were asked whether they had any complaints currently, and both responded that they didn’t. One person also said that previous complaints he had made had been dealt with to his satisfaction. The home also has a policy and procedure in place for the protection of vulnerable adults from abuse. Training records confirmed that staff have received training in safeguarding adults. Staff spoken with were knowledgeable about the homes procedure should abuse be suspected or disclosed. 54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 17 Clear audit trails and financial management guidelines were in place for individual personal spending monies. A staff member said that each person’s money is checked on a daily basis, and two members of staff are required to sign for each transaction undertaken. Monies checked during the inspection tallied with balances recorded and receipts available. 54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 18 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, 30 Quality in this outcome area is good. The appearance of this home creates a pleasant, comfortable and homely environment that is well maintained. The home presents as clean and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provided at Brookvale Road consists of a domestic three bedroomed house situated in a residential area of Olton in Solihull. The property is not distinguishable as a care home from those around it. Each person has single bedroom accommodation. The rest of the house, consisting of a lounge, dining room, kitchen, bathroom, and shower room is shared on a communal basis. There is an office that is also used as a staff sleep in room. The décor throughout the home was nice, with good quality soft furnishings and modern furniture. Peoples bedrooms looked at were seen to be decorated to individual taste with plenty of personalisation in the form of pictures, photos and ornaments, and hobbies. The home was clean and tidy with no obvious offensive odours apparent.
54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 19 As the home is a domestic property the washing machine and tumble dryer are situated in the kitchen. A member of staff spoken with said that this did not pose a cross infection risk as an infection control policy was in place that ensures that dirty or soiled laundry is not brought into the kitchen when food preparation and cooking is taking place. 54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 20 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, 35 Quality in this outcome area is excellent. People who live in this home benefit from sufficient numbers of competent, knowledgeable staff. Recruitment practices ensure that they are safeguarded from potential harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs four permanent staff and one part time member of staff. In addition there is a deputy manager and an acting manager that are shared with two other services within the organisation. On the day of the inspection two staff were on duty. Staff spoken with said that they felt that staffing levels were generally satisfactory, and enabled people to live the lives they chose. One member of staff has commenced work at the home since the previous inspection of the service. This person’s staff file was looked at along with one other, and was found to contain all of the necessary documentation including a criminal record check and two written references. This confirmed that a thorough recruitment process that safeguards service users is undertaken. 54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 21 Comprehensive training records were available within the staff files looked at. These confirmed that they were up to date with their mandatory training. Other training provided for the staff team included communication training, epilepsy, autism, makaton and person centred planning awareness. Records also confirmed that new staff are registered on the Learning Disability Awards Framework. Information provided by the annual quality assurance assessment confirmed that three staff have successfully completed their NVQ II or above. 54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 22 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, 42 Quality in this outcome area is good. Management systems in place at the home ensures that the people that live there benefit from a well run service. The quality audit system ensures that people’s views are at the forefront of service provision and development. Health and safety is managed appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home currently has temporary management arrangements in place, as the registered manager is undertaking an acting area manager’s role within the organisation. The team leader from another service has been recruited as acting manager, however he is supported by the manager holding the registration as part of her area managers role. The impact of this, if any, on 54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 23 the service was not apparent at the time of the inspection as it is still quite a new situation. The acting area manager for the organisation said that they survey the people using the service, families and other involved professionals on an annual basis to determine the quality of the service provided. A quality assurance file is in place, which included the returned questionnaires from the 2006 survey along with the collated results. In addition the quality of the service provided is monitored via regulation 26 visits and reports, regular staff meetings, weekly house meetings and a quality assurance checklist that is completed by a peer manager form elsewhere in the organisation. A sample of maintenance records that included the gas safety certificate, portable appliance testing and fire safety records confirmed that these are all undertaken at the required intervals, thus maintaining the health and safety of all who live in, work or visit the home. 54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 24 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 x 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 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 x 4 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 3 x 3 x 4 x x 3 x 54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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. Refer to Standard Good Practice Recommendations 54 Brookvale Road DS0000043666.V338563.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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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