Inspection on 26/10/06 for Bramblegate

This inspection was carried out on 26th October 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bramblegate 30/06/08

Bramblegate 21/05/07

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Bramblegate 92 Ringwood Road Walkford Christchurch Dorset BH23 5RF Lead Inspector Heidi Banks Key Announced Inspection 26th October 2006 10:00 Bramblegate DS0000065593.V314354.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.V314354.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.V314354.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.V314354.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th July 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. Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key announced inspection took place over the course of six hours on a weekday. The purpose of the inspection was to assess outcomes for service users against the key National Minimum Standards. The inspector was assisted by the service users and the Registered Manager of the home throughout the inspection. There are three service users living at Bramblegate at the present time. The age range of the residents is currently between 18 and 29. During the course of the inspection the inspector was able to talk with all three service users. The inspector was also given a guided tour of the home with access to two of the service user’s bedrooms with their consent. Three completed service user surveys and a pre-inspection questionnaire completed by the Registered Manager were received prior to the inspection, information from which is reflected throughout this report. A random unannounced inspection of the service took place on 27th July 2006, information from which will contribute to this report. A total of twenty-three standards were assessed during this inspection. What the service does well: Bramblegate provides support that achieves very positive outcomes for service users in many areas of support including the promotion of their independence in their home environment and access to their local community. Service users lead ordinary lives and are enabled to participate in a range of meaningful activities that meet their needs, preferences and personal goals. This acknowledges their rights and responsibilities as individuals in the home and as citizens in their community. Service users are fully involved in menu planning within the home and their participation in grocery shopping is promoted with attention paid to their individual dietary needs and making healthy choices. The personal and health care support offered to service users is individualised and discussion with service users indicated that they are aware of action being taken to meet their needs and are involved in the decision-making process with regards to this. Procedures are in place to safeguard service users with regards to medication practices in the home. The home has a complaints procedure of which service users are aware and use to positive effect. The home has a policy on the protection of vulnerable adults from abuse and staff are encouraged to access external training on abuse awareness in addition to an introduction to procedures at induction. This helps to protect service users from harm. Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 Page 6 The home environment clearly meets the needs of the service users who are working towards their independence and thus benefit from the en-suite and kitchenette facilities available to them in their bedrooms. It is well-maintained and there are systems in place to promote good hygiene and thus protect service users from the risk of infection. The Registered Manager has appointed a Home Manager to support him with aspects of managing the home on a daily basis and outlined plans in place to ensure that the Home Manager is adequately supervised and supported in his role. What has improved since the last inspection? What they could do better: Four requirements and three recommendations have been made as a result of this inspection. Risk assessments must be reviewed on a regular basis to ensure their continued relevance to the service user concerned. The registered provider must ensure that systems are in place at the home to monitor the quality of the service and assess outcomes in relation to the home’s Statement of Purpose and service users’ needs. Record-keeping in relation to health and safety within the home must be reviewed to ensure that care workers’ attendance at fire training sessions and staff / service user participation in drills is clearly documented. This will help ensure that gaps in individuals’ training can be easily identified and addressed. All staff working within the home must have suitable training in First Aid with updates provided at suitable intervals. Although service users’ involvement in their individual plans is indicated by an account of their views and their signature, the provider should consider ways in which plans can be made more meaningful for each individual and ‘owned’ by the service users themselves. Training for care workers in the home should be developed to ensure that at least 50 of staff have an NVQ in Care to Level 2 standard or above and that specialist training is provided that links with the objectives of the home and service users’ individual needs. Please contact the provider for advice of actions taken in response to this Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 Page 7 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.V314354.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments are carried out prior to the admission of service users to the home to ensure that their needs can be met by the service. EVIDENCE: The records for one service user were reviewed for evidence of assessment documentation. There was evidence on file of an initial assessment which had been undertaken prior to the service user’s admission to a Principle Care home. This included information about the service user’s history, previous care, education, health, disability, medication, likes and dislikes, personal support needs, communication and behaviour. There was also information on file about the service user’s expectations of the placement. A report from the service user’s educational placement was also on file which offered comprehensive information about the service user’s health and social needs. Part of the assessment process involved staff from Principle Care making a visit to the prospective service user’s school to meet with both him and his care workers and the service user making visits to the home including an overnight stay. This had been documented on file. Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service should look at ways in which they can promote service users’ ownership of their support plans so that service users are fully involved in their development and the format is meaningful to them as individuals. Systems are in place to involve service users in decision-making about their lives and home to ensure that their choices and views are taken into account. Risk assessments should be updated on a regular basis to ensure that information within them continues to be relevant and current. EVIDENCE: The plan for one service user was reviewed at this inspection. This showed goals relating to the individual’s physical, mental and emotional health needs and took account of the service user’s likes and dislikes and action to be taken for the ‘desired outcome’ to be achieved. This had been signed by the service user and the manager. There was evidence on file to Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 Page 11 indicate that a review had taken place in May 2006. The review paperwork included information about the service user’s road safety skills, behaviour, personal care, domestic activities, community activities, personal relationships health and budgeting / finance issues and again showed evidence that the service user’s personal likes and dislikes had been accounted for. The review meeting had been attended by the service user, Registered Manager, Home Manager and a representative from the Local Authority. The views of the service user had been reflected in the review document and his signature obtained. It is recommended that the home consider ways in which they can promote service user ownership of their support plans and ensure that they are in a format that is meaningful to the service user. Discussion with all three service users both at the random unannounced inspection in July 2006 and at this inspection demonstrated that their participation in decision-making in the home and with regards to their individual lives is encouraged. This includes 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. A risk assessment for one service user was reviewed. The documentation listed potential hazards to the service user, the level of risk and action to be taken to minimise risks. Areas covered included risks to the service user from abuse, the home environment and community access. The assessment documentation includes a list of ‘agreed restrictions’ within the home. For example, restricted access to the sleep-in room at night and confidential documentation and the level of support required in the community. This had been signed by the service user. It was apparent that the risk assessment had been completed in July 2004, prior to the individual’s move to Bramblegate and therefore must be reviewed in order to be relevant to his current placement. Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users enjoy a lifestyle that promotes their rights to live ordinary lives in their community and take part in activities that interest them and develop their potential. They are encouraged to have contact with friends and family and take responsibility for contributing to the running of their home environment. Service users are involved in menu planning and are supported to choose healthy options that meet their needs. EVIDENCE: Service users spoken with stated that they have opportunities to engage in a variety of activities. All three service users attend local colleges where they undertake courses of their choice. Two service users are undertaking a ‘Learning for Independence’ course where they learn numeracy, literacy, information technology and communication skills. One service user spoken with reported that he was looking forward to doing work experience as part of Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 Page 13 this course. Service users also attend other educational centres to do a range of courses of personal interest to them including fitness, drama, pottery and ‘Worldwise’. One service user is maintaining a portfolio of his educational achievements which included completion of a Basic First Aid course in March 2006. The day of the inspection fell within service users’ half-term holiday. On the day of the inspection, two service users were due to visit an outdoor activity centre near Southampton. Discussion with the service users indicated that they very much enjoy their visits to the centre where they take part in a variety of activities including water sports. The Registered Manager stated that one service user has expressed an interest in getting a job and living more independently in a flat. The manager reported that he would look at options with regards to this to help the service user achieve this goal. Service users spoken with reported that they make use of local facilities including shops, markets, the cinema, pubs and leisure centres. One service user reported that he has a good relationship with the owner of a local grocery shop and was considering working there in the future. Service users also reported that they take advantage of the home’s location and go for walks in the New Forest and local places of interest on a regular basis. Bramblegate does not have its own vehicle to access the local area but service users stated that they go out in staff vehicles. The majority of staff working at the home are car drivers. It was clear from discussion with a member of staff on duty at the inspection in July 2006 that supporting service users with accessing their local community is very much part of the Support Worker’s role in the home. Daily records confirmed that during the half-term holiday service users had been supported to go to Mudeford Quay, Stanpit Marsh, swimming at the local leisure centre, Gateway Club, shopping and local pubs. All service users responding to the survey indicated that they can 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 where service users can congregate if they wish. One service user reported that he has a television in his room where he can relax and watch DVDs. Two service users are reported to have Play Stations in their rooms, as this is an activity they enjoy. Service users recently went on a week’s activity holiday with staff to Wales. Service users confirmed that members of their family visit the home and they enjoy visits to their family home. Two service users spoken with indicated that they have made friends with people they have met at college but also have friendships with residents from other Principle Care homes. Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 Page 14 Service users spoken with reported that, on the whole, they feel that their rights are respected in the home. They have access to all communal areas of the home and their privacy in their bedrooms is respected. All service users have keys to their bedrooms. Service users are encouraged to take responsibility for maintaining their home environment in terms of domestic tasks and cooking. This supports the home’s ethos that service users are working towards their independence. A rota has been developed with input from service users to ensure that the allocation of tasks is fair. Service users are kept up to date about developments in the home and reported that they are aware that there may be a fourth service user moving into the home in the near future. One service user spoke of having told the manager that she wanted a pet. She had chosen a pet rabbit and had taken responsibility for clearing the shed to make a suitable home for it and for looking after it on a daily basis. Service users were enabled to speak 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 options are discussed at weekly house meetings to ensure that service users have the opportunity to choose what they want to eat. Two service users spoken with stated that the food offered at the home is good. At the time of the random unannounced inspection in July 2006, groceries were being ordered from a supermarket via their website. The Registered Manager stated that this practice has been reviewed and service users now go with staff to a local farm shop and supermarkets to be fully involved in the purchase of groceries. During the inspection one service user went shopping with a member of staff and was keen to show the Registered Manager her purchases on her return, particularly those which she felt were healthy options. The service user has diabetes and spoke of needing to keep healthy and the encouragement she receives from staff to choose healthy foods. There is written information on file from Diabetes UK regarding eating well with diabetes and alcohol and diabetes for the information of staff. It was evident that service users were being encouraged to eat freshly prepared rather than tinned foods to avoid foods that may be high in salt and sugar content. Records of food that is eaten by service users are maintained in the home. Service users were seen to make drinks for themselves as they wished and they reported that they can use the kitchen facilities to prepare snacks for themselves. One service user reported that he regularly uses the kitchenette facility in his bedroom to prepare drinks for himself. Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 Page 15 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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that service users’ views and abilities are taken into account with regards to their personal care and that their health care needs are met through liaison with generic and specialist services. Procedures are in place at the home in relation to medication administration which protects service users in this area of their support. EVIDENCE: The service users at Bramblegate are largely 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 in this area. Staff working at the home are both male and female and on the day of inspection a male member of staff was on duty. However, it was noted that when a female service user was attending a health care appointment that day a female member of staff was provided to support her with this. The induction programme for staff was seen and information covered includes the promotion of privacy and dignity, self-esteem and health and safety in the delivery of personal care. Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 Page 16 The 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. A log of medical appointments was in place but was not fully up-to-date. Discussion with two service users about their health care needs demonstrated that they were aware of issues relevant to them indicating that staff are making efforts to educate them about their health needs and discuss the outcomes of their appointments with them. Medication is collected from a local pharmacy. This is then re-dispensed by a member of staff into individual monitored dosage systems. Although redispensing of medication is not recommended, the home has put some safeguards in place to minimise risks associated with this process. This includes the checking of medication by the same two members of staff each week. Medication administration record charts are produced by the home and showed evidence that they are checked each time they are printed to ensure that the information they contain is accurate. Each record has a photograph of the service user on it to aid identification and the allergies of service users had been listed. A sample of medication was checked against the medication administration records and was seen to be correct suggesting that medication had been given as prescribed. During the inspection one service user attended a health care appointment for a review of medication supported by a member of staff. The home has a policy in place on the control, administration, selfadministration, recording, safekeeping, handling and disposal of medicines. In-house training is in place for all staff and there was evidence to indicate that training has been sourced from a local college and pharmacy to provide further education for staff in this area. Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 Page 17 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place within the home to ensure service users have opportunities to be heard and their views are acted upon. Policies and procedures exist to protect service users from harm and a multi-agency approach is used to ensure appropriate action is taken to safeguard them. EVIDENCE: The home has policies on ‘Concerns and Complaints’ and ‘Whistleblowing’ 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 out of 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. One service user spoken to during the inspection stated that he felt he could talk to the Registered Manager about important issues and feels he gets on well with him. One service user who had voiced a complaint at the random inspection of the service in July reported that this had now been resolved and things were ‘much better’. House meetings are held on a weekly basis where issues relating to the home can be discussed. All service users at the home showed awareness of the role of the Commission for Social Care Inspection and stated that they would contact the Commission if they felt their views were not being heard at the home. Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 Page 18 The home’s complaints record was inspected. This showed evidence of several issues having been raised by service users often by way of written notes addressed to the manager. The action taken by the manager in relation to issues raised had also been documented. The home has a policy on ‘Adult Protection and the Prevention of Abuse.’ This highlights the role of key agencies in dealing with adult protection issues. Staff are introduced to this during their induction programme. Five of the twelve members of staff who work at Bramblegate have undertaken the external training ‘No Secrets’ with the local authority. At the time of inspection, a further two care workers had been booked onto training to take place later that month. Discussion with the Registered Manager indicated that places on local authority training courses are taken up as they become available with the aim of all staff undertaking external training in this area. All service users spoken with talked of whom they would contact if they were being abused. 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. Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 Page 19 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 and 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has been refurbished to meet the specific needs of the service user group and ensure that their independence is promoted within their living environment. Systems are in place to ensure that safe hygiene practice is maintained within the home and that service users are protected from infection. EVIDENCE: Bramblegate is a family-style home which has been extensively refurbished to provide 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. Individual bedrooms are personalised to the taste of service users with service users choosing the décor and furnishings. Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 Page 20 Service users have keys to their rooms and are able to access their rooms as they wish. The home is furnished to a high 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. Observation of service users in the home indicated that their ownership of the home is promoted and they are encouraged to take responsibility for its maintenance and upkeep. There is a shed in the rear garden which one service user has been able to use for her pet rabbit and a large garden and out-house which the service users have access to at all times and can be used for barbeques and socialising with friends from other Principle Care homes. Comments received from service users about their home environment in surveys included ‘it’s nice and cosy’ and ‘it’s not bad’. The home presents as clean and service users are involved in maintaining good hygiene within the home. All sinks in the home have anti-bacterial soap dispensers and paper towels. There is a separate laundry room in the home with a washing machine, tumble dryer and ironing facilities. Care workers are introduced to procedures around hygiene, kitchen systems and laundry systems during their induction programme. Information supplied by the Registered Manager in a pre-inspection questionnaire indicates that the home has policies in place on communicable diseases and infection control and the disposal of clinical waste. Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Further development of the home’s training programme for staff is needed to ensure staff have the necessary qualifications, skills and knowledge to meet the needs of the service user group. Staffing levels are adequate to meet the requirements of service users and recruitment practices within the home are sufficiently robust to promote the protection of service users. EVIDENCE: There are twelve care workers employed by Principle Care Limited who work at Bramblegate. The core training checklist in relation to these twelve care workers was reviewed. Of the twelve, two care workers have a qualification to NVQ Level 3 standard and one is currently working towards her NVQ Level 2. All care workers undertake an in-house induction programme which covers fire safety, hygiene, personal care, kitchen and laundry systems, day care, files and records, medication administration and adult protection. Managers within the Principle Care group facilitate learning for the induction programme. One care worker who commenced working at Bramblegate in September 2006 has Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 Page 22 recently completed his induction. It was evident from records that he has signed to indicate that he had been instructed, read and understood each part of the induction programme. The care worker had also given feedback on the induction programme stating that he had found it ‘well-planned, clear to read and understand’. The Registered Manager confirmed that he is aware of the recent introduction of the Common Induction Standards and is working to ensure that the home’s induction programme meets these. Management within the Principle Care group are continuing to make efforts to identify suitable specialist training relevant to the service user group including Equal Opportunities and Sexuality and Personal Relationships. As yet, suitable courses have not been identified. The Registered Manager of the home is a trained instructor in Crisis Prevention and Intervention (CPI) and is able to facilitate training for care workers and provide updates on a yearly basis. However, it was noted from the core training checklist, that the column for two care workers had been left blank (one care worker had recently joined the team at Bramblegate). Following the inspection, the Registered Manager confirmed that all staff employed before July of last year hold current and valid certificates in CPI and that staff receive timely annual updates. He reported that training for newer staff will be arranged in the Spring. Service users spoken to at the random inspection in July 2006 stated that they felt they would benefit from there being more staff on duty at the home in the evenings so that they could do different activities if they wanted. This information was passed onto the manager of the home who responded that staffing ratios are usually two staff to three service users and it is only on rare occasions that it falls to just one member of staff in the event of, for example, staff sickness. This information was supported by a copy of the staff rota provided with the pre-inspection questionnaire which indicates that from 16002300 hrs there are two members of staff allocated to work at Bramblegate. It was recommended at the random inspection that this situation is kept under review so that the service can ensure that the individual needs of its users are met. Discussion with service users at this inspection indicated that they were happy with the current staffing levels at the home, one service user reporting ‘Things are much better. We have more staff now.’ The records for the most recent member of staff to join the team were inspected for evidence of recruitment documentation. These showed evidence of a completed application form with a full employment history, a structured interview process and proof of identity. There was evidence that a PoVAFirst check, enhanced disclosure from the Criminal Records’ Bureau and two written references had been received prior to the care worker commencing in post and his contract being issued. Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Registered Manager of the home is taking appropriate action to ensure that the home is run in the best interests of service users. There is currently no system in place to review and improve the quality of the service provided and ensure that the home continues to meet its objectives as stated in the Statement of Purpose. Systems are in place to promote the health and safety of service users in the home but some shortfalls were identified including gaps in training and record-keeping which must be addressed for the standard to be fully met. EVIDENCE: The Registered Manager is also one of the Directors of Principle Care Limited. He has appointed a Home Manager who has some delegated responsibilities for the running of the home on a daily basis. The Registered Manager reported Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 Page 24 that recent events in the home had made him aware of the necessity to offer adequate supervision to the Home Manager to ensure that delegated tasks are carried out in a way that promotes the home’s ethos and is in the best interests of service users. The Registered Manager discussed his plan to ensure that this happens in the future and there was evidence to demonstrate that shortfalls had been recognised, acknowledged and were being addressed. There is no formal quality assurance process in place at Bramblegate to ensure that the quality of care is reviewed on a regular basis and an annual development plan is put in place. Information supplied in the pre-inspection questionnaire indicates that a range of policies are in place to promote safe practices in the home. This includes procedures on the control of substances hazardous to health (COSHH), fire safety, health and safety, hygiene and food safety, moving and handling and risk assessment and management. A sample of health and safety records were inspected. A fire risk assessment, dated 15th June 2006, is in place and records showed that weekly checks of fire alarms and fire extinguishers are undertaken. Emergency lighting in the home is checked on a fortnightly basis. There were certificates on file to indicate that inspections of emergency lighting and fire extinguishers by a fire protection agency had taken place at appropriate intervals. There are eleven smoke detectors situated throughout the home and swing free closures on doors. The swing free closure on one door to a room that is currently unoccupied was not working properly and this was being addressed by the Registered Manager who confirmed that the room would not be occupied until the door had been repaired. Induction records indicated that fire safety procedures are covered with staff at this stage of their employment. The Registered Manager stated that new staff at the home also attend a full-day fire training course during their induction which covers the use of fire extinguishers and fire evacuation procedures. The Registered Manager reported that the home aims to hold internal training for care workers every three months. Recording of this fire safety training and staff / service user participation in fire drills needs to be clearer to evidence that these are carried out at appropriate intervals and that care workers who work at Bramblegate undertake fire drills at Bramblegate and not only at other homes in the Principle Care group. The core training checklist indicates that of the twelve care workers employed to work at Bramblegate, seven have a valid certificate in First Aid, a further three care workers have training dates scheduled, one requires update training and one entry was left blank. Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 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 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 4 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 2 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 4 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 2 X Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement 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 registered provider must establish and maintain a system for reviewing and improving the quality of care provided at the care home. The registered provider must ensure that record-keeping in relation to staff fire training and fire drills is clear enough to evidence that all staff working at the home have participated in training and drills at suitable intervals. The registered provider must ensure that all staff working at the home have suitable training in First Aid. Timescale for action 31/01/07 1 YA9 14 2. YA39 24 28/02/07 3. YA42 23 31/12/06 4. YA42 13 28/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Bramblegate Refer to Good Practice Recommendations DS0000065593.V314354.R01.S.doc Version 5.2 Page 27 Standard 1. YA6 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. The registered provider should ensure that at least 50 of care staff in the home achieve an NVQ in Care to Level 2 standard. The home should develop its training programme to ensure that it links to the home’s aims and to service users’ needs. All staff should undertake training in Crisis Prevention and Intervention on commencing employment at the home as part of their initial induction programme. 2. YA32 3. YA35 Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 Page 28 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 © 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 Bramblegate DS0000065593.V314354.R01.S.doc Version 5.2 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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