Inspection on 12/04/06 for Brackendale House

This inspection was carried out on 12th April 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brackendale House 09/05/07

Brackendale House 25/01/06

Brackendale House 19/07/05

Brackendale House 15/12/04

Brackendale House 07/06/04

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 Brackendale House 1-3 St Peters Road Sheringham Norfolk NR26 8QY Lead Inspector Jenny Rose Unannounced Inspection 12th April 2006 09:00 Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 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 Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 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. Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Brackendale House Address 1-3 St Peters Road Sheringham Norfolk NR26 8QY 01263 824995 01263 824995 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) info@prime-life.co.uk www.prime-life.co.uk Prime Life Limited Position Vacant Care Home 14 Category(ies) of Dementia - over 65 years of age (1), Mental registration, with number disorder, excluding learning disability or of places dementia (13), Mental Disorder, excluding learning disability or dementia - over 65 years of age (1) Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Thirteen (13) service users with mental disorder may be accommodated. One (1) service user with mental disorder over 65 years of age, who is named in the Commission`s record may be accommodated. One (1) service user over the age of 65 years, with dementia may be accommodated. The total number not to exceed fourteen (14). Date of last inspection 25th January 2006 Brief Description of the Service: Brackendale House is a private residential care home registered to accommodate 14 service users recovering from mental illness. All the bedrooms are single and on the ground, first and second floors. There are two self contained units on the third floor where two service users, moving towards independence each have a bedsitting room, kitchen and bathroom. The Home is located within easy reach of the facilities of the seaside town of Sheringham. The Home is owned by Prime Life, a national organisation with homes throughout the UK. The current manager is new, but not yet registered, following a period with a temporary manager. Prospective service users have access to a guide to the home and CSCI inspection reports are available on the notice board of the Home. The current weekly fee is £307. Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the home, by two inspectors, Jenny Rose and Dorothy Binns, which took approximately 7.5 hours. The new manager, Sarah Martin was on leave, but Bene Dawson, Director of Adult Services for Prime Life was in attendance throughout the inspection. Preparation had taken place in the CSCI Office; records, policies and procedures were examined and some parts of the building toured. Five residents were seen in private and several groups spoken to, both in the house and in the garden. Three staff members were interviewed in private. The Commission had sent surveys to the home to be distributed to the residents. This had not been done, but six were completed on the day, five anonymously and one with the support of an inspector, on request from the resident. Similarly, the Pre-Inspection Questionnaire had not been returned before the inspection, but the information was available on the day. A further inspection by the Pharmacy Inspector, Mark Andrews, took place later in the day following an Enforcement Notice regarding medicines administration. The conditions of registration were discussed as part of the inspection and it was confirmed that one of the conditions relating to a specific person was no longer relevant. This condition will be removed from the certificate and the information corrected in the next report. What the service does well: What has improved since the last inspection? * Recruitment procedures are now acceptable. * Staff supervision is now in place. * The procedures for recording the residents’ finances are better, but the Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 6 records did not tally with the cash held, although this was in excess, rather than showing a shortfall. * The administration of medication has improved and the Home is now complying with the enforcement notice. Some recommendations have been made. * The local procedures and contact numbers for the Adult Protection Unit are now available for staff, but it would be preferable that these were included in the procedures for this particular home. What they could do better: * There has been a period of instability of management in this home and, consequently, it has fallen to the recently appointed manager to bring new leadership to the staff team, in order to better meet the residents’ changing needs and to create a sense of security. * There is no quality assurance system, seeking residents’ and interested others’ views, pertinent to this particular home and, therefore, there is no evidence of a programme of continuous monitoring and improvement in all aspects of this service. * Although there is a complaints procedure and complaints book, the entries are not filed securely, do not appear to be current and there is no related action plan. A complaints book, properly completed, would further reassure residents and other interested persons that concerns and complaints are listened to and acted upon. * The personal finances of residents should be more rigorously recorded and audited. * There is no current risk assessment for the building and there are, maintenance issues, regarding the hot water and central heating system, in particular. * There is no clear picture available of the number of staff undertaking NVQ training. A training development plan for individual staff, as well as a training needs assessment for the whole staff team, including the new manager, would further ensure a better service for residents. * The keyworker system is also unclear to some of the residents. A more pro-active keyworker system could give more impetus to residents’ personal development and tapping of skills through activities, interests, hobbies and housekeeping tasks and to supporting individuals being able to move to greater independence. * Although there is satisfaction expressed regarding the evening meal, there could be improvements of the midday meal, which was not substantial; it was also repetitive. More resident involvement in menu planning and food preparation, including snacks, could increase resident satisfaction, responsibility and independence. * A copy of the residents’ guide should be more readily available in the home. * The Minutes of the residents’ meetings should be distributed to individual residents. * Medication administration should follow the recommendations from the Pharmacy Inspector. Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 7 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. Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 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 Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,5 Residents’ needs were assessed before they come into the home, so that staff could support them appropriately. In order for residents to know that the home can meet their needs and aspirations, there needs to be a staff training development programme in this home in order to deliver the services and care which the home offers. Residents had contracts and terms and conditions with the home, but a copy of the residents’ handbook was not available. EVIDENCE: There was evidence from the previous inspection that there was a preassessment procedure, drawing on information from other healthcare professionals with sufficient detail to help staff to know what support the prospective resident would need. Also that the home’s own form was completed by the resident, with an advocate, which formed the basis of the care plan. There was evidence that residents receiving respite care discussed with the Community Psychiatric Nurse whether the home would meet their needs and one resident had chosen to come to the home on several occasions and was very satisfied with the care he received there. Another resident commented in the survey, “I liked the home when I came here….years ago, because it was near the sea and the bedrooms looked nice”. However,in order for this home to Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 10 be able to demonstrate that it can deliver a service to meet prospective and present residents’ needs, the staff, individually and collectively need to have the skills and experience which should be underpinned by a staff training development programme. This is dealt with in another section of this report. There is evidence from previous inspections that residents receive contracts. One contract was seen on file and another resident confirmed that he knows he had a contract on admission, also that he had a residents’ guide, but can no longer find them. Another resident remarked in the survey “I don’t know whether or not I received a contract…”the person was admitted to the home several years ago, when it was owned by another company. There is therefore a recommendation all residents are aware of their contracts and that a residents’ guide is available to everyone. There was a copy of the last CSCI Report in the hall, which one resident had read and made several comments upon, including “I hate the word ‘service user’, I want to be (called) a ‘resident’”. Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 The residents were involved in their care plans, which were detailed and reflected their needs, abilities and goals. Residents made their own decisions with regard to money. Where they received support from the staff, the recording procedures had improved, but were not accurate, and this must be rectified and the records audited. There were risk assessments where appropriate, but residents were able to live an unrestricted life. EVIDENCE: Two care plans were case tracked. They were detailed and showed evidence of resident involvement. There were details of residents’ goals in terms of increasing, or maintaining their independence and in the areas where residents needed support. There was also detailed information of residents’ healthcare needs and changes in these needs. There was a full admission form and much information from previous placements, together with evidence of contact with Community Psychiatric Nurses, GPs and other specialist healthcare professionals. Two residents spoken to confirmed that they participated in their care plans. One plan contained information regarding the resident’s wishes for his funeral arrangements, which is an example of good practice. Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 12 The plans were reviewed and staff wrote daily reports. These were sometimes repetitive, but there were comments on mood, behaviour, outings and requests, which is good, but there was not much evidence of them taking action to help residents’ achieve their goals, especially socially or in employment terms. This will be dealt with elsewhere in this Report in connection with more pro-active key working. Risk assessments were in place for areas of concern, in the two care plans which were case tracked, such as residents’ vulnerability to others taking advantage of them and another for a resident, who was at the time selfmedicating, but this had been rescinded at a later date and this was dated and signed by the resident. There was a recommendation in the previous report that a financial profile be recorded for all residents whose benefits or money was administered by the home or organisation. Three records were examined; for one, cash tallied with the record. For two others, there was more cash than shown by the record. There is therefore a requirement for the records to be more rigorously kept and audited, so that the residents can have confidence that their finances are properly administered. Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Within this older group of residents, there are not many who are able, or wish, to develop skills for employment, but there are others who can use skills in tasks in the Home. Most residents can go out on their own and use the facilities in the town and beyond. Residents are able to maintain contact with their family and friends, as appropriate Residents are supported to fulfil their housekeeping responsibilities and their rights respected, but the keyworking system does not appear to be utilised to the full. There have been improvements in the food available, but there are issues surrounding the decisions about menus, preparation of food and the availability of snacks and drinks, together with the involvement of residents in all these tasks. Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 14 EVIDENCE: As noted in the previous inspection report, because of the older age group of most of the residents, they did not feel up to working in paid employment. However, one person worked at a farm group four days a week. Another resident was contracted to do chores around the Home and was observed doing this. The resident expressed some satisfaction at carrying out this responsibility, and saw it as a means of achieving his goal of eventual independent living. The same resident also purchased newspapers in order to keep up with current events: another undertakes food shopping tasks and one resident does woodwork. The garden was looking tidy, cared for and attractive with colourful primroses also some garden statues. This has largely been the work of two residents and other members of the resident group expressed their appreciation of this work. One resident felt that more outings should be available, although another two expressed the view that this did not interest them. This was seen to be a subject of the last residents’ meeting, although, in the absence of the manager, it was not clear as to the outcome of that meeting. There was a comment from a returned survey: “I would like some holidays, we didn’t have any last year”. There was evidence in the care plan, Daily Reports and speaking with one resident that members of staff accompany the resident to the PO on a regular basis. A member of staff spoke of supporting residents by accompanying them into the town for a walk and to have a cup of coffee to increase their social confidence. This member of staff also spoke about the need to be flexible and find suitable opportunities to support individual residents in confidence building in different situations. Three residents spoken to confirmed that they are able to go to the shops and the pub and to use other facilities in the town. Another resident spoke about the contact with her relative on a regular basis and daily phone calls, in which she was later observed to be engaged. One resident was seen dealing with her personal laundry and residents are encouraged to fulfil their responsibilities for household tasks, as was evidenced by the creation of a rota for clearing the dining room. However, the role of keyworkers in supporting individuals in housekeeping tasks, particularly in their rooms and supporting residents in developing particular personal skills and interests through activities, is dealt with elsewhere in this report. One resident cared for his cat in his room, which is an example of good practice. Overall, all the residents spoken to were satisfied with the evening meals and it was observed that the ingredients were fresh, both the chicken and vegetables, and, in the preparation, smelled very appetising. There had been Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 15 an alteration to the evening meal menu, and residents were heard being asked for their choices, with a vegetarian option. Residents were seen having lunch, which they collected from the kitchen hatch, prepared by a member of staff. This was a choice of soup and bread, followed by coffee or tea. Many residents chose to eat together in the dining room, which is an attractive area with flowers on the table, where there was a relaxed atmosphere and flexible timing; one resident was observed coming later for his meal. However, there are several issues regarding breakfast, making snacks and drinks, for some the midday meal was not substantial enough and there were objections from several residents that they were not permitted to take drinks into the smoking room. “It would be nice to be able to have a cup of tea or coffee in the smoke lounge with a fag”, was a remark in the survey and this was echoed by speaking to other residents. This issue was of some importance to those residents affected. Residents also commented that breakfast was made by staff and that hot drinks were only available when staff made them. The kettle and toaster, previously available to residents in a small kitchen area off the lounge was no longer available for residents to make toast, drinks or snacks. There was an 8.00 pm supper of biscuits, crisps and tea or coffee. Two residents spoken to remarked that they could always eat more. “Portions are very small”, was one remark in the survey. Two residents remarked that the lunch-time meal in particular was not filling. It would appear that there should be an opportunity over the whole of the meals issue, not only to develop individual resident’s skills and interests in cookery and meal preparation, but also to develop more independence for residents in being able to prepare snacks and drinks for themselves; also, as a group to be involved in menu planning, as well as in such decisions as to whether drinks should be allowed in the smoking room. There is therefore a requirement for this issue. Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Residents receive the personal support of staff where needed, although a clearer keyworker system would further improve this. Residents are supported to take control of their own healthcare, where appropriate, but this too could be further improved by a clearer keyworker system. The medication systems have greatly improved and medicines were being safely administered on the day of the inspection. EVIDENCE: There is evidence from the care plans and comments from residents that in the main they feel they receive the support of staff in meeting their personal care needs. “I feel safe here”, “I am all right here” were two of the comments made by residents and one comment in the survey was “I find the care and support good and to my needs”, and another: “Although there have been lots of ups and downs it ‘s basically all right here”. One resident spoken to confirmed he was very satisfied with the support he received from his keyworker, in particular. However, one resident spoke of missing the one-to-one talks with the key worker, as this member of staff had left; another was unclear whether he had a keyworker at all. A designated keyworker, whom residents have helped choose, can provide consistency and continuity for residents, communicating their likes and dislikes, partnerships with advocates, family, friends and relevant professionals and support with personal Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 17 care and encouragement of personal skills and there is therefore a recommendation for the keyworker system to be reviewed. There was evidence that residents’ healthcare needs are met through links with healthcare professionals from the care plans and from talking to residents. There was evidence from one care plan that a resident had been supported on an appointment to a specialist and that there was staff support for him to attempt to reduce his smoking for health reasons. One resident was actively involved in reducing his medication, and he remarked that he felt able to speak to his keyworker and to the GP if there were any problems with this. The inspection of the medication standard was conducted later the same day at 19.55hrs by Pharmacist Inspector Mr M Andrews. The reason for his visit was to monitor compliance with a Statutory Requirement Notice issued 22/03/06 and expiring 31/03/06. Ms S Martin (Acting Manager) was on duty at the time of the medication inspection and with whom the findings of the inspection were discussed. The inspector found that since the issue of the Statutory Requirement Notice, the home has worked to resolve previous concerns particularly in relation to the provision of medicines administration in the evenings and has taken steps to ensure medicines are safely and appropriately administered. In addition, measures to ensure medicines remain secure at all times have been effected. Records overall now accurately reflect safe medicine administration practice. A programme of training of staff members in medicine administration practice is now in place. The inspector found that at the time of this inspection the particulars of the notice had been met, however, he made several good practice recommendations in relation to medicine management for the home to now consider. A copy of the full pharmacy inspection report has been sent to the registered provider and is available subject to request. Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 There was a policy and procedure for dealing with complaints, but the complaints book was inefficiently kept. If this were reorganised, the residents and other interested people would feel that concerns and complaints were heard and acted upon. There has been an improvement in the procedures for staff locally for the protection of residents, but a training development programme for individual staff, including specific training in the issues surrounding adult abuse would further protect residents. EVIDENCE: The complaints procedure was displayed in the hall and from previous inspections has been seen in the residents’ guide. No complaints had been received in the Commission, since the last inspection. Some residents spoken to were aware of how to make a complaint. However, from two residents’ comments cards and from two residents spoken to, it was apparent that these residents were not confident that their complaints would be listened to and acted upon. They felt that their concerns ‘stopped at the office’. The complaints book was seen, but contained no complaints after 2004 and these complaints were insecurely filed. There is a recommendation that the complaints book be reorganised, so that complaints are clearly recorded, together with any action taken in mediation. This should form part of the quality assurance process, which would demonstrate that the home takes residents’ views seriously. This is dealt with elsewhere in this Report. Procedures were in place regarding the protection of residents from abuse and these are in the staff handbook, together with a whistle blowing policy. There was a recommendation in the last inspection regarding the availability of Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 19 information setting out the local procedure and contacts in Norfolk. This is now available, but this local information is still contained in a separate booklet and not incorporated into the procedures for the home. There was evidence from two staff files that they had received training in abuse awareness, but one of these staff members was acting as relief from another home owned by the company. This staff member, who was undertaking NVQlll, gave a good account of knowledge of forms of abuse and was clear as to how to act should the need arise. There were two new members of staff on duty, who had not received adult abuse training. One had not finished her induction training, although there was evidence that supervision had taken place. There is a requirement elsewhere in this report regarding training. Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 There is a homely and relaxed atmosphere in the Home and residents have access several communal areas, the garden, as well as to their single rooms. The areas of the Home seen were clean and hygienic, but there were some housekeeping issues in residents’ rooms. EVIDENCE: There are three communal sitting areas, one for smokers, another adjacent to the dining area and a quiet room for viewing videos. The dining room is a pleasant area with pictures and fresh flowers on the table. All residents spoken to were appreciative of the garden, where three residents were able to sit following lunch. It was looking attractive having been planted with colourful primroses and cared for by two of the residents, who take pleasure in doing so. Residents’ rooms seen were personalised to the resident’s taste. The areas of the Home seen were clean and hygienic, but there were housekeeping issues in a resident’s room, one of which was immediately attended to. This issue is dealt with elsewhere in this report in connection with the role of the keyworkers in supporting with good housekeeping tasks. Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 The work of the staff was appreciated by residents, but priority should be given to the development of an individual staff training programme to ensure the proper support of the residents. The recruitment procedures were now acceptable, but in times of staff shortages need to be closely monitored. In order to ensure that the residents’ individual and joint needs are met, there should be a training needs assessment undertaken for the staff team as a whole, including the new manager. EVIDENCE: “The staff are nice, but new, and still getting to grips with things”, was the view of a resident and others spoken to felt they were supported, although it was often felt that staff were very busy. Evidence from the staff files and the staff rota, showed that the only qualified member of staff working on the day, was a relief worker from another home and one member of staff on duty had not completed the induction training. However, staff were observed interacting with residents in a comfortable and respectful way. One member of staff spoke of the job satisfaction in supporting residents in building their self and social confidence. One very new member of staff was working under supervision with some tasks and was undertaking her induction. A Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 22 recommendation from the last inspection was that training in this home needed to be prioritised and therefore there is now a requirement for this. Four staff files were examined and from the requirement in the previous inspection report concerning recruitment process, this appeared to have improved. For the most recent staff members there was a criminal records check completed for one member and Mr Dawson confirmed that the other new member had not started work until after the protection of vulnerable adults list had been checked and she was working under supervision. There was no evidence that a training needs assessment had been carried out for the staff team as a whole, including the new manager. This should be linked to the home’s service aims, which would also provide some consolidation for the staff group in meeting the residents’ individual and joint needs. There was evidence from speaking to residents and from the survey, that some residents had found the changes in management and staff unsettling. However, there was evidence from two staff files that supervision from the manager was now taking place, following a requirement in the last Report, which is an improvement in the rebuilding of the staff team. Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 The changes in the management of this home have resulted in lack of continuity and attention to certain management tasks. However, the recent appointment of the new manager is expected to bring some stability to the management of the home. Although there was an informal process of ascertaining residents’ views, there was no formal quality assurance system, which would assure residents and interested persons that their views underpinned the running of this particular home. The health, safety and welfare of residents was underpinned by the policies and procedures in the home, however, more attention to good housekeeping, particularly in residents’ rooms and including a risk assessment on the building would further protect the health and safety of both residents and staff. Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 24 EVIDENCE: The recently appointed manager was not yet registered. There was evidence that she has begun to introduce improvements, in staff supervision for example. However, there were many tasks, which remained to be addressed, not least of which was the administration of medication, the complaints procedure, the quality assurance and keyworker systems and developing an effective, trained staff team. The fact that the manager has had to spend a great deal of time in the office dealing with these matters could be said to be reflected in three of the completed residents’ surveys on the day and comments from two residents spoken to, who commented that the staff and, particularly the manager, spent a great deal of time in the office and was sometimes too busy to speak to them. There were residents’ meetings, which provide a forum for some residents to put their views and the Minutes of the last meeting on 7 February 2006 were seen to cover a rota for cleaning the tables in the Dining room, issues regarding propping doors open and other housekeeping issues; the in and out board in the hall and discussion of outings and activities. However, one resident spoken to was not aware of seeing the Minutes of the meeting although he had attended. Mr Dawson confirmed that the Minutes had been displayed on the notice board. One resident expressed the feeling that the residents did not have ‘ownership’ of the meeting. There is therefore a recommendation that notice of an intended residents’ meeting, asking for any items for the meeting, and subsequently the Minutes, should be distributed individually to residents rather than only displayed on the notice board. It was disappointing that the surveys sent by the Commission to be distributed to the residents had not been done and that the recommendation from the previous inspection to develop a quality assurance system, local to the home with anonymous surveys and action plan for further development did not appear to have been implemented. There is therefore a requirement for this to be actioned as soon as possible. In one room, the headboard was dropping off the bed and there was no sheet. The keyworkers’ role in supporting residents to clean their rooms could improve some of the housekeeping issues and this is covered elsewhere in this report. The fire records were examined and seen to be in order, as well as the servicing of the fire extinguishers, which were checked in March 2006. There had been a fire drill on 4 April 2006. The Accident Book was not included in the inspection. It was brought to Mr Dawson’s attention that risk assessments on the building were out of date in 2004. These need to be updated and there is therefore a requirement for this. Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 25 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 2 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 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 1 33 X 34 3 35 1 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 2 X 2 X X 2 X Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 26 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 YA7 Regulation 16.2(l) Requirement Timescale for action 13/04/06 2. YA17 16.2(h) 3. YA32 18.1(c) The registered person must provide a place where residents may deposit money and valuables for safekeeping and make arrangements for residents to acknowledge in writing the return to them of any money or valuables so deposited. The registered person must 30/06/06 provide adequate facilities for residents to prepare their own food and ensure that such facilities are safe for use by residents. The registered person must 31/08/06 ensure that the persons employed to work at the care home receive training appropriate to the work they are to perform and suitable assistance for the purpose of obtaining further qualifications appropriate to such work. The registered person shall establish and maintain a system for consultation with residents and their representatives The registered person shall ensure that all unnecessary risks DS0000027481.V290140.R01.S.doc 4. YA39 24.3 31/08/06 5. YA42 13.4 (c) 30/06/06 Brackendale House Version 5.1 Page 27 to the health or safety of residents are identified and so far as possible eliminated 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. Refer to Standard YA5 YA18 Good Practice Recommendations It is recommended that all residents are aware of their contracts It is recommended that there are designated keyworkers, whom residents have helped choose and that this system is utilised to support residents in developing personal, social, employment and other skills, through activities and interests, as well as housekeeping tasks It is recommended that the complaints book is reorganised in order to securely file any complaints together with any action taken as result which would form part of the quality assurance process. 3. YA22 Brackendale House DS0000027481.V290140.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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. 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