CARE HOME ADULTS 18-65
Bramblegate 92 Ringwood Road Walkford Christchurch Dorset BH23 5RF Lead Inspector
Tracey Cockburn Unannounced Inspection 21st May 2007 12:00 Bramblegate DS0000065593.V339994.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 Bramblegate DS0000065593.V339994.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. Bramblegate DS0000065593.V339994.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Bramblegate Address 92 Ringwood Road Walkford Christchurch Dorset BH23 5RF 01425 276846 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) Principle Care Ltd Mr Mark Richard Hulme Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Bramblegate DS0000065593.V339994.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th October 2006 Brief Description of the Service: Bramblegate opened as a residential care home in December 2005. It is one of three homes owned and run by Principle Care Limited. It is a detached house situated along a main road in Walkford and is located opposite another home in the Principle Care group. The property is in keeping with the neighbourhood. The home is registered to provide accommodation and support for four adults who have a learning disability. The philosophy of the home is to provide support to individuals who are moving onto greater independence. It is a family-style home and all four bedrooms are single with en-suite and kitchenette facilities. Three bedrooms are situated on the first floor and one bedroom is on the ground floor. There is a lounge / dining room area, separate kitchen and a garden to the rear of the house. There are areas for parking at the rear and side of the property. There is also an office which doubles as a staff sleep-in room. Local shops are within walking distance and there is a bus route into the neighbouring town of Christchurch. Fees charged by the home are variable and are assessed on an individual basis according to the needs of the service user. The current scale of charges, from information provided on 23rd November 2006, is from £900 - £1600 per week. For further information on fair fees and contracts access the website: www.oft.gov.uk Bramblegate DS0000065593.V339994.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The site visit to the home began at lunchtime on the 21st May 2007, this was completed in just over 2 hours. This was an unannounced key inspection. At the time of this visit there were two residents at the home and 1 member of staff, the deputy manager. During the course of this visit residents took the inspector round the home. Both residents were talked to privately. Care files were looked at as were daily records, staff team rotas for the week, medication logs and fire records. Planning prior to the site visit included reviewing all documentation received from the home. 5 survey forms were returned, 4 from people who use the service and 1 from a relative. What the service does well: What has improved since the last inspection? Bramblegate DS0000065593.V339994.R01.S.doc Version 5.2 Page 6 At the end of the inspection in October 2006 there were 4 requirements and 3 recommendations. Record keeping relating to fire training and fire drills has improved this means that the people who live in the service are protected by the training and recording in place for staff. All staff working in the home has or are receiving training in first aid. The home has developed a training programme ensuring that staff have the skills they need to do the job. 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. The summary of this inspection report can be made available in other formats on request. Bramblegate DS0000065593.V339994.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 Bramblegate DS0000065593.V339994.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): 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Comprehensive assessments ensure that individual needs are identified before they move into the service. EVIDENCE: The care file for 1 service user was reviewed this contained detailed information completed prior to moving into the service. The care plan contained information transferred from the assessment. There are restrictions in this person’s life and this is clearly documented with the comments of the person concerned. The care plans details the agreement with the multi disciplinary team on why restrictions are a necessary part of this person’s life. This included information about the service user’s history, previous care, education, health, disability, medication, likes and dislikes, personal support needs, communication and behaviour. Bramblegate DS0000065593.V339994.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): 6,7,9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Individual plans of care reflect changing needs and goals including decision making and risk taking. This means the people supported in the service are involved in the process of choice and change. EVIDENCE: One individual’s plan of care was examined, this contained detailed information on all aspects of the care and support this person needs. The plan detailed the structured environment this person needs to feel safe and able to cope with the world. The plan also details the communication needs of this person and what certain phrases or expressions can mean in terms of their mental health need. There is a behaviour plan which sets very clear boundaries for staff supporting this person, including the use of language, what to look out for, what staff should wear, that staff should not give personal information about themselves. There was evidence that the individual concerned had been
Bramblegate DS0000065593.V339994.R01.S.doc Version 5.2 Page 10 involved in the care plan and agreed to the actions being taken and the reason why. There was also evidence of involvement of a CPA review in the past few months. The plan was not in an accessible format however the person had signed the plan and a note said that the plan had been explained to them. There is evidence that people who live in this service are able to make decisions about their lives within the structured boundaries set out in their care plans. One service user said that they would like more independence and they felt restricted in making choices for themselves. There was evidence in files that people who live in the service are able to make decisions about where they go, what they eat who they see, what activities they participate in. Their individual records also evidenced making choices about the decoration and furnishing of their rooms, menu choices and activities. House meetings are held each week to give service users opportunities to discuss issues and choices as a group and make plans for the week ahead. Both the people at home at the time of the inspection said they were able to make choices about their lives. Service users are supported to manage their own finances and this is documented. Risk assessments are very detailed. There was one risk assessment, which had not been updated since the person moved into the home and therefore was not an accurate reflection of the risks at the home in which they now live. Bramblegate DS0000065593.V339994.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): 12,13,15,16,17 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. People who live in this service are enabled to lead an ordinary life in the community. EVIDENCE: All service users responding to the survey indicated that they could do what they want to do during the day, in the evenings and at weekends. Service users reported that they enjoy a variety of leisure activities in their home. There is a television in the communal lounge. One service user said that he has a television in his room where he can relax and watch DVDs. Service users are encouraged to take responsibility for ensuring the home is clean. They do this by having a weekly rota of chores to do such as vacuuming the carpets, putting out the rubbish, keeping the kitchen clean. This supports the home’s ethos that service users are working towards their independence.
Bramblegate DS0000065593.V339994.R01.S.doc Version 5.2 Page 12 The rota has been developed with the people who use the service this ensures that the allocation of tasks is fair. Service users spoke to the inspector in private during the inspection. Service users participate in meal preparation on a daily basis supported by a member of staff. Meal choices are discussed at weekly house meetings to ensure that service users have the opportunity to choose what they want to eat. One service user said that they sometimes have disagreements but they are resolved. Service users were seen to make drinks for themselves as they wished and they reported that they could use the kitchen facilities to prepare snacks for themselves. Bramblegate DS0000065593.V339994.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): 18,19,20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live in the service are supported to have their physical, personal and emotional needs met. EVIDENCE: The service users at Bramblegate are independent with regards to many aspects of their personal care. The ethos of the home is therefore to promote this by supporting service users to build on their skills. An individual support plan for one service user was seen and showed evidence of liaison with both generic and specialist health care services to ensure the service user’s needs are met including the Primary Health Care Team, Psychiatry, Psychology and Dentist. The home has a policy in place on the control, administration, selfadministration, recording, safekeeping, handling and disposal of medicines.
Bramblegate DS0000065593.V339994.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service feel listened to and there are policies, procedures and training in place to protect them from harm. EVIDENCE: The home has policies on ‘Concerns and Complaints’ and ‘Whistle blowing’ to which staff are introduced at induction. All three service users responding to the survey indicated that they know who to speak to if they are not happy and know how to make a complaint. One of the three service users indicated that their care workers always listen and act on what they say; two indicating that they feel that staff ‘usually’ listen to them. A recent adult protection issue at the home was responded to in accordance with local procedures with relevant agencies being informed promptly and ongoing liaison taking place with the multi-disciplinary team. The allegation was later retracted. Bramblegate DS0000065593.V339994.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service live in an environment, which is homely, comfortable and safe. EVIDENCE: Bramblegate is a family-style home, which provides individual, en-suite rooms with kitchenette facilities for each service user, which include a work surface, sink, refrigerator, kettle and toaster. This clearly meets the needs of service users who are working towards greater independence and are able to prepare drinks and snacks for themselves in the privacy of their own rooms. The home presents as homely, bright, clean, airy and in good decorative order. Service users have keys to their rooms and are able to access their rooms as they wish. The home is furnished to a good standard and the kitchen is domestic in style. Service users have freedom to access all communal areas of the home, using kitchen and lounge facilities as they choose.
Bramblegate DS0000065593.V339994.R01.S.doc Version 5.2 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Improvements in training have meant better outcomes for the people using the service. EVIDENCE: Staff have received the training they need such as fire training and first aid, which was a requirement of the last inspection. Care staff are working towards National Vocational Qualifications but no evidence was seen at the inspection that 50 of staff have this qualification. People who live in the service said that the staff that support them are interested in their lives and support them well. Records for individual service users contained information, which demonstrated that staff in the home have regular contact with other professionals such as social workers, nurses and other therapists.
Bramblegate DS0000065593.V339994.R01.S.doc Version 5.2 Page 17 There has been no new staff employed since the last inspection. At the inspection in October 2006, this standard was fully met. The service has recruitment procedures in place and at the previous inspection there was evidence that the procedures had been followed correctly. Bramblegate DS0000065593.V339994.R01.S.doc Version 5.2 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Requirements from the previous inspection have not been fully met which means the service is not running as well as it could. EVIDENCE: Evidence of a quality assurance system was not seen at the time of the inspection however people who live in the service said that they are able to express their opinions about the service. 1 person said they felt listened to. The requirement has therefore been repeated. Fire safety checks were up to date. 10 staff received fire training in April 2007. There was also evidence of further training being sourced for staff. The home has a range of policies to promote safe practices in the home.
Bramblegate DS0000065593.V339994.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 3 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 1 X X 3 X Bramblegate DS0000065593.V339994.R01.S.doc Version 5.2 Page 20 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 YA9 Regulation 14 Requirement Timescale for action 31/07/07 2. YA39 24 Risk assessments for service users must be reviewed on a regular basis and correspond with the actual home he or she is living in. The previous time scale of 31/01/07 was not met The registered provider must 31/08/07 establish and maintain a system for reviewing and improving the quality of care provided at the care home. The previous timescale of 28/02/07 was not met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations The registered provider should look at ways in which they can promote service user ownership of the support plans and ensure they are in a format that is meaningful for the individual and which they can develop in their own way. Bramblegate DS0000065593.V339994.R01.S.doc Version 5.2 Page 21 2. 3. YA24 YA32 The registered provider should ensure that the maintenance programme is up to date and the paintwork on window frames is attended to. The registered provider should ensure that at least 50 of care staff in the home achieve an NVQ in Care to Level 2 standard. Bramblegate DS0000065593.V339994.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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