Inspection on 13/04/05 for 8 Brantwood Road

This inspection was carried out on 13th April 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

8 Brantwood Road 24/10/08

8 Brantwood Road 18/10/06

8 Brantwood Road 29/11/05

8 Brantwood Road 20/01/05

8 Brantwood Road 02/08/04

8 Brantwood Road 17/02/04

8 Brantwood Road 08/07/03

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

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

CARE HOME ADULTS 18-65 8, Brantwood Road Luton Bedfordshire LU1 1JJ Lead Inspector Ansuya Chudasama Unannounced 13 April 2005 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 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 Stationary 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. 8, Brantwood Road I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 8, Brantwood Road Address Luton Beds LU1 1JJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01582 481589 Advance Housing and Support Ltd Care Home 6 Category(ies) of MD - Mental Disorder (6) registration, with number of places 8, Brantwood Road I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th January 2005 Brief Description of the Service: Advance Support is part of Advance Housing and Support Ltd, a charitable organisation providing services within the community to meet the needs of people who have either a learning disability or a mental health problem. 8 Brantwood Road is a semi-detached house and is located near the centre of Luton and overlooks the park. The home provides accommodation for five service users with mental health needs. All the service users have single rooms. The first floor has four bedrooms, a bathroom and utility room. The downstairs has one bedroom, a lounge and kitchen/diner and, a toilet and an office. There is also a small garden at the rear of the house. At the front of the building is a small driveway. The accomodation is not suitable for service users with mobility problems. 8, Brantwood Road I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken by two inspectors and started at 14.10 and it took place over 2 hours. The inspection was undertaken as a result of the concerns that were raised regarding poor care practices being carried out in the home. The inspection comprised of a tour of some of the communal areas, talking to staff, and all the service users. Two service users’ files and other records were also inspected. The home had four service users and one vacancy at the time of the inspection. The home is registered for six service users. However one of the service users’ bedrooms downstairs was turned into an office. Therefore the registration certificate needs to be changed to reflect the current situation. What the service does well: What has improved since the last inspection? The home had not met any of the requirements from the last inspection. There were significant concerns about the outcomes for service users identified in relation to risk management, medication, and health care needs. The overall impression gained at the inspection showed that the home was not being managed effectively and there were no management structures in the home. 8, Brantwood Road I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 Page 6 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. 8, Brantwood Road I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection 8, Brantwood Road I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 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 standard(s) 2,3,4 The home did not undertake detailed assessments of service users, which meant that care would not be provided in a safe or consistent manner. EVIDENCE: The service users’ files inspected showed that a needs assessment was not available for a service user who had been recently admitted to the home. This situation was also seen at the last inspection visit. A requirement was issued to ensure that proper assessments were carried out on all prospective service users admitted to the home. A trial stay assessment undertaken on the day the service user was admitted to the home was not completed in much detail or signed by the person completing this form. There was no evidence to show that the service user had been involved in the process. The service user spoken to and records inspected confirmed that visits to the home had been undertaken prior to their admission. 8, Brantwood Road I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 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 standard(s) 6,7,9 Service users care plans did not contain sufficient details in how their goals and aspirations were to be met, so therefore development in independent living skills was not demonstrated. EVIDENCE: Service users care plans inspected were not signed by the service user or by the person completing them. The service users had not been involved in drawing up their care plans. The plans seen did not cover all the areas set out in standard 2, and did not state how the service user’s goals and aspirations were to be met. The plans seen were not individualised to meet each service users needs. One service user spoken to stated that they had not started working towards their goals. The care plans had not been reviewed with the service user to reflect their changing needs. The risk assessments undertaken for service users did not state how the risks were to be managed. They also needed to be reviewed and expanded to cover all areas of risks identified. Service users meetings were not held on a regular basis. The last one was cancelled and there was no explanation to state why this was the case. 8, Brantwood Road I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12,14, 15,17 Plans for meals were not routinely discussed with service users, limiting their input and knowledge in this area. Service users have limited opportunities to develop their independent skills, and therefore reducing their ability to move towards independent accommodation. EVIDENCE: One service user’s care plan inspected had goals identified for developing independent skills. However there was no information to state how this was to be achieved. The service user spoken to stated that she had not started work on achieving her independent skills to move towards independent living. The service user helped with house tasks when asked to undertake them. It was also stated that the staff did the cooking and there was no evidence to show that other service users helped with meal preparation. One service user spoken to stated that the home did not have written menus and she was not aware what was being offered for the evening meal. The service user stated that she had in the past sometimes helped with meal preparation. The staff member on duty was observed cooking the evening meal. Service users 8, Brantwood Road I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 Page 11 spoken to stated that the meals provided were very nice. The inspectors were informed that food shopping was not undertaken on a regular basis. Evidence from this inspection also indicated that staff had to save some money from the service users food money to buy a new cartridge for the fax machine. One service user’s care plan stated that once a month the person was to have a day out with a staff member but there was no evidence to show that this happening. The staff worked on their own and would not have been able to undertake this task. 8, Brantwood Road I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 Page 12 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 standard(s) 18,19,20 Limited progress had been made on improving arrangements to ensure that the health care needs of service users were identified and met. These shortfalls have a potential to place service users at risk. EVIDENCE: All service users were able to manage their own personal care needs. A service users’ care plan inspected did not have any information recorded to show how the home was supporting the service user to manage their blood pressure. Medical records read stated that the service users memory was good but staff spoken to stated that the service user was forgetful but there was no evidence to show that the service users needs had been reassessed. There was evidence to show that health professionals were involved when needed. Records showed that one service users medication was incorrect and staff had not picked this up when the medication was received from the chemist. The error was corrected after nine days. 8, Brantwood Road I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 Page 13 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 standard(s) 22,23 Concerns raised by a staff member regarding poor care practices were not acted upon in order to safe guard service users from abuse. There were no clear systems put in place by the home to ensure service users money was being managed appropriately and therefore this could put them at risk of financial abuse. EVIDENCE: Concerns were raised by a member of staff to the CSCI regarding poor care practices being carried out by the home. The staff member had raised these concerns to the organisation but felt that she was not listened to and nothing was done. The concerns raised were investigated at this inspection and all were up held. The service users spoken to stated that they wanted to know what benefits they received and how much rent they paid. The care plans seen did not state how service users finances were managed. One service user stated that they needed staff support to use the new post office system. There was no evidence in the file to show when the staff were going to help the service with this task. Records also showed that there was confusion about paying for taxi money when getting service users medication or attending appointments. The home needs to have clearer systems so all staff and service users know clearly who has to pay this cost. This needs to be recorded in the service users’ guide. One service user stated that she had an incident with a member of staff and was upset. However this was not recorded in the complaints book and the inspectors were unable to ascertain how this situation had been resolved by management. 8, Brantwood Road I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 Page 14 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 standard(s) 24,25,26,30 The environment was mostly suitable for service users needs but the general atmosphere had compromised the needs and preferences of some service users and staff. EVIDENCE: The premises were suited to meet the needs of the service users. The service users spoken to stated that they liked their bedrooms and enjoyed living at the home. At the last inspection it was stated that some of the old and worn out furniture needed replacing. However this situation had not changed since then. The home was clean but smelled of tobacco smoke. It was stated that the service users smoked in the kitchen/dinner and this was seen to be unhygienic. A complaint was made by a service user to the inspectors because there were no communal areas that were smoke free. The service user stated that she did not smoke and her needs were not being met. This issue was raised at the last inspection and there was no evidence to show that management was addressing this. 8, Brantwood Road I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 Page 15 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,36 The staff at the home worked at two homes and did not provide continuity of care to meet service users needs. EVIDENCE: The staffing arrangements at the home had changed and the inspectors were informed that the staff worked at this home and at another sister home. The home had a key worker system, however evidence showed that this was not working well due to staff working at two homes. There was no evidence to show what work was being undertaken with service users to meet their needs. There were also no records to show that the staff who worked at the sister home had received an induction about the service users goals and aspirations. Evidence showed that the new staffing arrangements in the home did not provide continuity to service users. The rota also showed that many of the staff were working long hours in excess of 50 hours per week between the two homes, and had no days off in nine days. The manager was also seen to be working long hours and shifts at the two homes. The staff received handover at the sister home in the mornings but this was within the working time, and no extra time had been allocated before the shift started. The staff member spoken to on duty stated that she had regular supervision. It was also stated 8, Brantwood Road I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 Page 16 by staff that they were not going forward and when asked why this was the case, it was stated that the manager had too much to do and worked shifts. The inspectors were informed that there were no senior care staff and team work at the homes. 8, Brantwood Road I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, The manager worked shifts on the rota and is therefore unable to manage the home effectively. EVIDENCE: Evidence showed that the home was not being managed effectively. It was stated by the staff spoken to that the manager worked at two homes on shifts on her own, and she had too much work to do. The manager was therefore unable to undertake her managerial responsibilities as she worked hands on as a member of staff. There were no quality assurance systems put in place to observe the work undertaken by staff and the manager. Discussions with service users showed that the manager needed to maintain professional boundaries with them. For example it was stated by a service user that the manager informed him that one member of staff complained about every one and even about him. 8, Brantwood Road I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 Page 18 The service users’ files for those who had recently moved out were not available in the home. Their files had been transferred to the homes that they had moved into. However these records must be retained in the home for not less than three years from the date of the last entry. The service users’ files also needed to be better filed and in on order that was easy to understand. 8, Brantwood Road I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 1 2 3 x Standard No 22 23 ENVIRONMENT Score 1 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 2 x 1 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 x x x 2 Standard No 11 12 13 14 15 16 17 1 2 x 2 3 x 1 Standard No 31 32 33 34 35 36 Score 2 x 2 x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 8, Brantwood Road Score 3 2 1 x Standard No 37 38 39 40 41 42 43 Score x 1 x x x x x I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 Page 20 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. 1. Standard Ya6 Regulation 15-(1) Requirement The registered person must explain in detail how service users goals are to be achieved in their care plan. The plan must also be reviewed to meet the changing needs of service users.This time scale of 30.2.05 not met. An immediate requirement was issued on the day of the inspection for this to be complied by the 11.05.05. The registered person must provide staff training on how to implement care plans. This time scale of 30.2.05 not met. The registered person must provide a strategy for recruiting and retaining staff to provide continuity for the service users. This time scale of 30.2.05 not met. The registered person must review individual service users’ risk assessments. These must be expanded upon to cover all areas of risk and provide comprehensive assessments of risk and control measures that are put in as a result. These must be regularly reviewed. This time scale of 28.2.05 not met. Timescale for action 11.5.05 2. Ya6 18-(1)c 31.7.05 3. Ya33 18 31.7.05 4. Ya9 13 11.5.05 8, Brantwood Road I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 Page 21 5. Ya39 24 6. Ya42 12-(1) 7. Ya2 14-(1) 8. Ya41 17-(3) 9. ya22 22-(3) 10. Ya37 9(1)(2) 11. Ya33 18 12. Ya20 13(2) An immediate requirement was issued on the day of the inspection for this to be complied by the 11.05.05. The registered person must fully implement the quality assurance programme, including seeking the views of staff. The registered person must ensure that comprehensive risk assessments are carried out for the environment and generic activities. This time scale of 28.3.05 was not met. The registered person must undertake a needs assessment for all new service users admitted to the home and review those of existing service users. This time scale of 28.2.05 was not met. The registered person must ensure that records referred to in the regulation shall be retained for not less than three years from the date of the last entry.This time scale of 28.2.05 was not met. The registered provider must ensure that all complaints made to the organisation are fully investigated. The registered person must ensure that the manager applies for registration with the CSCI. This was not met from previous inspection reports. The registered person must ensure that the manager is supernumerary on the staffing rota to manage the two homes. The manager must be supported to undertake her role by management. The registered person must ensure that all service users receive the prescribed medication and that accurate 01.9.05 31.7.05 31.7.05 31.06.05 31.7.05 31.6.05 31.6.05 15.4.2005 8, Brantwood Road I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 Page 22 records are kept. An immediate requirement was issued for this to be complied by at all times 13. 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. 6. 7. 8. 9. Refer to Standard Ya8 Ya17 ya8 Ya9 Ya33 Ya41 Ya22 Ya24 Ya30 Good Practice Recommendations The registered person should review the adult abuse policy The registered person should ensure that the food shopping money for service users is not used for any other purposes. The registered person should ensure that service users are involved in meal preparation and when shopping. The registered person should involve service users when undertaking risk assessments on them. The registered person should ensure that there is appropriate time built in for handovers. The registered person should ensure that the names of service users living in the home are recorded in the admissions register. The registered person should up date the complaints policy The registered person should replace worn out unsuitable furniture The registered person should find an alternative option where the needs of the service users who smoke and those people who do not smoke conflict. Also ensure that service users do not smoke everywhere in the home. 10. 11. 12. 13. 8, Brantwood Road I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF 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 8, Brantwood Road I51 S14993 8 BRANTWOOD V223688 130405 Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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