Inspection on 18/10/07 for 90 Brackenborough Road

This inspection was carried out on 18th October 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

90 Brackenborough Road 03/05/06

90 Brackenborough Road 08/12/05

90 Brackenborough Road 13/06/05

90 Brackenborough Road 08/03/05

90 Brackenborough Road 04/10/04

90 Brackenborough Road 04/03/04

90 Brackenborough Road 03/11/03

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

CARE HOME ADULTS 18-65 90 Brackenborough Road Louth Lincolnshire LN11 0AQ Lead Inspector Ken Hague Key Unannounced Inspection 18th October 2007 09:30 90 Brackenborough Road DS0000032053.V352890.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 90 Brackenborough Road DS0000032053.V352890.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. 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 90 Brackenborough Road Address Louth Lincolnshire LN11 0AQ 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) 01507 600590 F/P 01507 600590 Northern Life Care Limited T/A U.B.U. Mr Paul Smith Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Conditions of Registration. The placement of any service user in the home must not exceed a period longer than six months. 3rd May 2006 Date of last inspection Brief Description of the Service: 90 Brackenborough Road is a care home owned by Northern Life Care Ltd. There is a registered manager in post. The care home is a detached house situated on the very edge of the town of Louth, which has been adapted by the company to provide respite care for service users with a learning disability. The home has enclosed gardens at the rear. Car parking is available on the road outside the property and there is a small car park directly at the front of the home. It is a two-level building; access to the first four is via a staircase. There are no facilities for service users with a physical disability to use the top floor of the care home, although there are facilities on the ground floor to enable wheelchair users to be offered services and respite care. The accommodation consists of a communal lounge, dining room, kitchen and utility room. On the ground floor there are three bedrooms and two bathrooms. On the upper floor there are two bedrooms and one bathroom. Lincolnshire County Council have contracted with Northern Life Care Ltd to provide respite care for people with learning disabilities. There is no other care home offered as an alternative choice. The garden has an attractive patio area for residents to sit in. The building and garden are on level ground and accessible for wheelchair users. The owners of the home visit regularly and work closely with the manager and the staff working in the home. Information about the day-to-day operation of the home, including a copy of the last inspection report, can be found in the home statement of purpose and service user guide. These documents are made available to all new potential residents and explain the resources and services offered, by the care home. A dedicated intermediate care service is not provided by the home. 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced 5 days before the visit and took place over 4 hours. The registered manager was present throughout the inspection. Feedback was given at the conclusion of the site visit. The main method of inspection used was called ‘case tracking’ which involved selecting two residents and tracking the care they receive through the checking of their records, discussion with them and the staff, and where more appropriate observation of interaction between staff and residents and related care practices. A sample of care records was examined. It is normal procedure to obtain written feedback from residents prior to the site visit using a document called “have your say”. However it was not possible to do this as residents stay at the home for such short periods often spending only four nights in respite care. Therefore the opinions of the 2 residents and a staff member were sought during discussions held at the site visit. Their views are reflected within this report. On the day of the visit 3 people were living at the home. What the service does well: What has improved since the last inspection? What they could do better: Although people consulted said that they were very happy with the service provided, the care records, particularly care plans and assessments, fail to evidence the care practice of the home. The failure to identify and record individual residents needs on care records places residents at potential risk. 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 6 A resident staying at the home on the day of the site visit was over 65 years old. The registration of the care home does not allow a resident to stay there over the age of 64. The managers of the care home must ensure that they only admit residents who fall within the registration category of the home. The requirement identified at the last inspection has not been addressed. 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. 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 Quality in this outcome area poor. This judgement has been made using available evidence including a visit to this service. The care home has not consistently carried out written assessment for new residents. This could result in a resident’s needs not being met. EVIDENCE: Two residents were case tracked during the site visit. There was no evidence on their care records of an assessment being carried when they were admitted to the care home. No risk assessment was in place for either of the residents although one had been staying at the home since August 2007. One resident cannot use a microwave as he has been fitted with a pacemaker. The manger had failed to record on the residents care records the management strategy of this risk. The registered manager confirmed that no written assessment had been recorded at the time of these residents admission. He stated that in both cases the residents had been admitted as emergency admissions. However one of the residents have been staying at the home since August the second resident had been at the home almost 2 weeks. 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 6,7 & 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care Plans are not consistently written when residents are admitted to the home. This could result in the resident’s needs not being met. EVIDENCE: There were three residents at the care home on the day of the site visit. Two of these were case tracked and their care record studied. Neither of the residents had a completed care plan on their personal care records. The personal goals of residents were not recorded or their choices and wishes. There were no risk assessments in place although one resident had an identified risk. There was no evidence of the reviewing of the service being provided to the residents being case tracked. The registered manager stated that these residents have been admitted in an emergency. He stated that care records for other residents were of a higher standard The care records of another service user were chosen at random. These records were of a slightly higher standard however evidence of the reviewing of care plan have not been consistently completed and dated. There was no 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 10 evidence of this residents being involved in the writing or reviewing of their care records. The staff member interview stated that care records are not completed consistently and often people were admitted without any paperwork being completed. A member of staff stated that in August 2007 she had been asked to take a resident to Grimsby Hospital and was extremely embarrassed to find that she had no details whatsoever to give or to discuss with the consultant 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13, 15,16 & 17 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The home has no formal activities programme. This restricts resident’s choices of daily lifestyle. Staff work closely with resident’s carers ensuring links to their home and the community are maintained. Meals are well managed and reflect resident’s likes and dislikes. EVIDENCE: The registered manager stated that only five residents had attended a day centre or work placement while staying at the home. There are currently 37 residents using the home for respite care periods. There is no additional staff employed for social activities. There is no transport provided to take residents into the community. A resident taking respite care on the day of the site visit was enabled to attend a work placement in the Mablethorpe area. The manager stated that it was recognised by the care home managers that activities needed to be reviewed to ensure all residents have a choice of social activities. 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 12 The home does not have a set menu. The registered manager stated that residents are asked daily what they would like for their meals. A resident confirmed this to be the case and said “the food is very good I am asked by staff what I would like for each meal”. Staff and the registered manager stated residents are advised on healthy eating choices. 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 13 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): Standards 18,19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s health care needs are met in the way they personally choose to receive help. The update medication policy of the care home is being followed ensuring that medication is administered safely. EVIDENCE: Staff have an in-depth knowledge of the residents needs. This was evidenced in staff discussions and discussions with the registered manager. Staff and the registered manager accepted however that this information is not recorded in care records. They do however understand each individual resident’s needs and provide a very personalised individual service to each resident. A long discussion was held with a resident who stated he was very satisfied with the support he received. He stated “staff are good here, they help me. I like staying here.” Observations made during the site visit supported the fact that residents are treated with privacy, respect and dignity. Observations, and discussions with staff and residents, provided evidence that the emotional needs of residents are been sensitively met. Observations 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 14 provided the most evidence to support this judgement, as only one resident was able to take part in a detailed discussion. Staff and the registered manager confirmed that the medication policy of the care home is been followed. Staff discussions and the inspection of records supported the statement. No residents were self-medicating on the day of the site visit. 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 15 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): Standards 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from updated comprehensive complaints and adult protection procedures EVIDENCE: A resident confirmed that they are able to raise concerns with staff. A copy of the complaints procedure is in the service users guide. The complaints procedure is also displayed within the care home. Staff demonstrated, a knowledge of the complaints procedure and stated that in their opinion residents are able to raise concerns. There have been no adult protection inquiries held since the last inspection. There was one formal complaint made to the care home since the last inspection. This was resolved to the satisfaction of the complainant. Staff have received training in the protection of the residents from any possible abuse. 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 16 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): Standards 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a clean well maintained care home, which provides them with a comfortable and safe accommodation. EVIDENCE: A tour of the building showed that the home is well maintained with well-kept lawns and gardens. Tables and chairs were available in the garden to allow residents to sit out in warm weather. Bedrooms had been personalised by the residents. Two residents stated that they were very happy with their bedroom, one said “my bedroom is very nice”. On the day of the inspection the home was clean, tidy and odour free throughout. The home has an ongoing maintenance programme. 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 17 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): Standards 32,34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported by trained staff who have been recruited safely using the up-to-date recruitment policy of the care home. Staff training records did not however demonstrate that a competent person is carrying out training in respect of medication. EVIDENCE: Staff stated that they felt there is good supportive teamwork within the care home. They feel that staff numbers are sufficient to answer the needs of the residents. Staff roles and responsibilities are clearly identified and set out in job descriptions. They stated that they believe that they understand the needs of the residents and have received training to meet these identified needs. A member of staff described the medication policy of the care home. However a second member of staff who was not an approved trainer had trained her. Evidence could not be found that the induction process for new members staff ensures they fully understand how to protect residents from possible abuse. A new member of staff interviewed had in addition to her induction training completed part of an NVQ course. This had provided her with additional 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 18 training in the recognition and management of abuse. It was unclear from discussions with her that the company’s induction training had provided her with sufficient knowledge without the NVQ training. 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 19 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): Standards 37,39 & 42 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Residents are happy with the management of the care home. However, a resident was placed outside of the registration of the care home. The failure to write care plans and assessments in care records places residents at risk. EVIDENCE: Residents stated that the care home is a good home, which meets their needs. They have confidence in staff and a good relationship with the registered manager. A resident stated, “I feel that home does attempt to meet my individual needs and staff are sensitive to my choice and wishes. However care records do not provide evidence of good quality care practice. Agency staff are used occasionally at the care home. Staff are being supervised in accordance with national guidelines. The Staff training plan need to the reviewed to ensure that approved trainers provide 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 20 medication training and that induction training ensures a basic knowledge in the recognition and management of abuse is given to new staff. . 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 21 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 1 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 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 x 3 X x 3 x 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 22 Yes 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 YA2 Regulation 14-1 Requirement All new residents must receive a full assessment before being admitted This is to make sure the resident’s needs, can be met by the resources of the home.. Residents must have written care plans which sets out their identified needs and how these are to be met by the staff and resources of the home. To ensure resident’s needs are met. This was a Requirement in the last key inspection report 3 YA35 13-1 (2) Medication training must be provided by an approved trainer. This is to ensure the training is up to date and results in the trainee becoming competent in this area Residents admitted to the care home, must not be outside the category of registration. 01/02/08 Timescale for action 14/11/07 2 YA6 15 14/11/07 4 YA37 12 14/11/07 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 23 This contributes to ensuring that their needs can be met. 5 YA14 16 –2 (M) The managers should review the activity programme. This is to ensure all residents needs are met and choices are offered. 14/11/07 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 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 90 Brackenborough Road DS0000032053.V352890.R01.S.doc Version 5.2 Page 25 - 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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