Inspection on 27/09/07 for Brambletye

This inspection was carried out on 27th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brambletye 16/01/07

Brambletye 22/11/05

Brambletye 28/06/05

Brambletye 11/10/04

Brambletye 02/06/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Brambletye New Mill Road Finchampstead Berkshire RG40 4QT Lead Inspector Sandra Holland Unannounced Inspection 27th September 2007 10:50 Brambletye DS0000051756.V349585.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 Brambletye DS0000051756.V349585.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. Brambletye DS0000051756.V349585.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brambletye Address New Mill Road Finchampstead Berkshire RG40 4QT 0118 973 4539 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) www.new-support.org.uk New Support Options Ltd To be confirmed Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (5) of places Brambletye DS0000051756.V349585.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of service users to be accommodated at any one time should not exceed 5 (five) 16th January 2007 Date of last inspection Brief Description of the Service: The house is owned by the Maidenhead/Windsor Housing Association, and the care is provided by New Support Options. The home is registered to provide accommodation for up to five service users who have learning disabilities. Presently, only four service users are accommodated. The home is in a very rural location, not on a public transport route. It is situated approximately five miles from Wokingham Town Centre, with Bracknell and Reading also within a short distance. The home has its own adapted vehicle and service users are able to use taxis if necessary. All accommodation at the home is on the ground floor. There is spacious communal accommodation and a large garden that is accessible to all service users. There are four bedrooms, one room has an en-suite shower room and one room has a lounge area and en-suite bathroom. The fees at this service are £ 1617.61per week. There are additional charges for toiletries; hairdressing; clothing and other personal effects the service users might wish to have. Brambletye DS0000051756.V349585.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection site visit was carried out by the Commission for Social Care Inspection (CSCI) under the Inspecting for Better Lives process. A full analysis of all information held about the home was undertaken prior to the visit. Mrs Sandra Holland, Regulation Inspector carried out the inspection over five and a half hours. In the absence of the manager, the staff on duty assisted the inspector and provided all the required information. The New Support Options service manager arrived to receive feedback at the end of the visit. All areas of the home were seen and a number of records and documents were sampled, including service users individual plans, staff training records and medication administration records. An Annual Quality Assurance Assessment (AQAA) was provided to the home and this was completed and returned. Information supplied in the AQAA will be referred to in this report. A number of CSCI feedback forms were supplied to those involved in the support of service users and three of these were completed and returned. These are referred to at Standard 39 which relates to quality assurance. Information supplied in the AQAA stated that to promote equality and diversity in the home, the people living there are supported to live the life they want to live and are supported to participate in their choice of religion. Staff who work at the home receive training within their first six months employment in “Our Approach”, which includes looking at equality and diversity issues, and staff are encouraged to share their own diversity with the people they support. Due to communication difficulties, it was not possible to obtain the direct views of service users, so their responses were assessed by observing body language, facial expressions and interaction with staff. The inspector would like to thank service users and staff for their hospitality, time and assistance. What the service does well: The service provides a high level of individual support and care to service users who have very complex needs. Service users are supported to take part in a variety of activities and to be members of their local community. Brambletye DS0000051756.V349585.R01.S.doc Version 5.2 Page 6 The home was well presented in a homely style and was freshly aired, which was positive to note given the dependency levels of the people who live there. It is well equipped with aids and adaptations to assist in the support and care of the service users. A number of compliments have been received by the home and some of these referred to the smooth arrangements for moving in and the “very caring staff” who were “so kind and patient”; the “lovely atmosphere”; and of “always being made so welcome and the home is kept very nice” An excellent emergency plan has been drawn up in case the home needs to be evacuated at any time. What has improved since the last inspection? What they could do better: Where a variable dose of medication has been prescribed, it is good practice to record the actual dose administered to ensure that an accurate record is maintained and an audit trail can be followed. An assessment should be carried out of any risks that may be associated with one member of staff being left in the home with service users. The specified staff recruitment information and documents must be obtained before a person is employed to work at the home, to ensure service users are safeguarded from people who are not fit to work in a care home. The specified Brambletye DS0000051756.V349585.R01.S.doc Version 5.2 Page 7 staff employment information must be kept in the home and be available for inspection. 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. Brambletye DS0000051756.V349585.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 Brambletye DS0000051756.V349585.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 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of service users were assessed and service users and their representatives were able to visit the home, before they moved in. EVIDENCE: Staff advised that the four service users who live at the home all moved in when the home was reopened in November 2006. Before the service users moved in, a transition plan was drawn up to ensure that the moves were managed effectively, with the minimum disruption to the service users’ lives. It was clear from the information seen, that service users’ were involved in a five-month transition period. This included an assessment of their needs and a number of visits, both to the service users at their previous homes, and to Brambletye, to see if it suited the service users. All those involved in the support of service users were included in the transition, including their families or representatives, and care managers, where a local authority supports service users financially. A review of each service users’ placement at the home was carried out in December 2006 under the care management process, to ensure that service users and their representatives were happy with the home and that service users were receiving the care and support required, staff stated. Brambletye DS0000051756.V349585.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. A detailed individual plan has been drawn up to guide staff to the support and care needs of service users, and this includes assessments of risks to service users. EVIDENCE: The individual plans belonging to two service users were sampled and it was positive to note the comprehensive amount of information that was available to guide staff in the care and support of service users. Each individual plan began with a photograph of the service user to whom it belonged, and contained a statement of ownership, to remind any reader that the plan is the property of the service user and should only be read with their agreement. Each individual plan was divided into sections for ease of use and included a personal profile, a health profile, a communication profile, risk assessments, support guidelines and correspondence. Specific information had been obtained and included in the individual plans, regarding medical conditions Brambletye DS0000051756.V349585.R01.S.doc Version 5.2 Page 11 affecting service users. It was noted that all areas of the individual plans had been reviewed and updated as required. A daily diary is maintained for each service user to record the events taking place, or which had taken place and the support that had been provided. These were seen to record the activities the service user had been involved in, visitors to service users and visits by healthcare professionals. Staff advised that all the service users’ living at the home require support with decision making, due to their profound communication difficulties. Service users’ likes and dislikes have been recorded to enable staff to take these into account when supporting service users. All four service users have relatives who visit and support them, and staff consult with relatives when decisions need to be made on behalf of service users. A number of risks to service users have been identified, recorded and assessed. These included the risks associated with travelling in the home’s vehicle, the use of bed rails and profiling beds, moving and handling, bathing, the use of specialist methods of being fed and financial vulnerability. The assessments were very detailed and recorded the level of any risk, measures that could be taken to minimise or remove the risk, and had been reviewed as required, or when a change in the risk was noted. Brambletye DS0000051756.V349585.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 good. This judgement has been made using available evidence including a visit to this service. Service users are supported to take part in a range of community and other activities and to maintain contact with their families. The dietary needs of service users are well met. EVIDENCE: Staff advised that a weekly plan of household activity is drawn up and this includes the various activities that service users will take part in. This was seen to include music therapy, cooking, bowling, watching DVD’s, pamper sessions, foot massage and going out to places such as a garden centre or a market. Three service users are supported to attend day services and a local social club. Information supplied in the AQAA indicated that service users are encouraged and supported to try new experiences and community activities, such as the Brambletye DS0000051756.V349585.R01.S.doc Version 5.2 Page 13 cinema and attending football and ice hockey games. A wheelchair accessible vehicle is available to transport service users to their planned and spontaneous activities. As only some of the staff can drive the vehicle, this is taken into account when the staff rota is planned, staff advised. Each service user has family members who are involved in their support, and staff stated that this is actively encouraged. Many family members visit at the home and where they are able to, service users out with or go to stay with, their family. Service users are encouraged to be part of the daily life in the home, but due to the level of their disabilities, physical involvement is very limited. Staff were observed to talk to service users as they were carrying out household tasks, such as bringing in the shopping or cleaning in the communal areas. Two of the four service users receive their food and nourishment in a specialised liquid form and staff have received training to enable them to assist service users with this, staff stated. A dietician is involved in the support of service users who have particular nutritional needs, and the dietician was seen to visit a service user on the day of inspection. Meals are served family style at the dining table, which is large enough to accommodate service users and staff. Service users are encouraged to be as independent as possible and aids to independence, such as plate guards, have been provided. Where necessary, food is served in an alternative form, such as pureed, to meet service users’ needs. A record is maintained of the meals served to enable monitoring of each service user’s diet. Brambletye DS0000051756.V349585.R01.S.doc Version 5.2 Page 14 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. Personal support is provided in a way that promotes service users’ privacy and dignity. Service users’ healthcare needs are well met and medication is administered appropriately. EVIDENCE: Information supplied in the AQAA stated that service users are supported with personal care at the times of their choosing, and the privacy and dignity of service users’ is maintained. This was observed during the visit to the home, as support with personal care was offered and provided very discreetly and in the privacy of the service users’ own rooms or bathrooms. Staff were observed to explain to service users what they were going to do, such as move the service user to another room, and to speak in a sensitive manner. All of the service users have specific communication difficulties, but staff advised that there are aware of the ways in which service users communicate and understand these. Staff said they have to assist service users in ways to suit them, based on their knowledge of the service users’ likes and dislikes. Brambletye DS0000051756.V349585.R01.S.doc Version 5.2 Page 15 It was noted that the home was very well equipped with aids and equipment to assist service users and staff. These included mobile hoists, electrically operated beds, adapted wheelchairs and armchairs, hoists attached to the ceiling and an adapted bath. From the records seen and speaking to staff, it was clear that service users’ healthcare needs are well met and that a wide range of healthcare professionals are involved in the supported of service users. These include general practitioners (GP’s), occupational therapist, physiotherapist, hospital specialists, speech and language therapist, dietician, dentist and optician. Staff advised that the local GP was particularly understanding and supportive of the needs of service users. A detailed healthcare profile forms part of each service users’ individual plan, to guide staff to their healthcare needs, and to record visits to, or the involvement of, healthcare professionals. Medication and printed medication administration record (MAR) charts are supplied to the home by a national pharmacy chain, staff advised. Much of the medication which is prescribed to service users, is prescribed in liquid or soluble form to suit their specific needs. Other medications in solid forms are supplied in “blister” packs, with each blister containing a single dose of individual medications. Medication was seen to be stored appropriately and secure facilities were available to store any medication requiring chilled storage. A number of medications were checked at random and the amounts held accurately matched the record held. It was noted that one medication had been prescribed to a service user with a variable dose, although the actual dose administered was not recorded. It is recommended that the actual dose administered is recorded so that it is possible to know how much medication should be present, and to effectively follow an audit trail. Brambletye DS0000051756.V349585.R01.S.doc Version 5.2 Page 16 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. The home’s complaints procedure is made available to service users and those involved in their support, but only one complaint has been received in the last year. Staff have received training in abuse awareness and understand their role in the protection of service users. EVIDENCE: The home’s complaints procedure was seen displayed in each service user’s room and was in an accessible format. As service users are not able to access the complaints procedure due to the level of their disabilities, their relatives have been advised of this, staff advised. Feedback from the relatives of two service users indicated that they knew how to make a complaint, and who to speak to if they were not happy with any aspect of a service user’s support or care. It was positive to note that only one complaint has been received in the last year and staff were able to advise of the nature of the complaint and the actions taken to resolve it. A record is maintained of compliments received at the home, as well as of complaints. A number of compliments had been received after the home reopened last November, and some of these referred to the smooth arrangements for moving in, the “very caring staff” who were “so kind and Brambletye DS0000051756.V349585.R01.S.doc Version 5.2 Page 17 patient”, the “lovely atmosphere” and of “always being made so welcome and the home being kept very nice”. The home has a policy and procedure to guide staff in safeguarding service users from abuse or harm and this was seen to link with the local authority multi-agency procedure for Safeguarding Adults (formerly the Protection Of Vulnerable Adults). An up to date copy of the East and West Berkshire multiagency procedure was held in the home for staff to refer to if abuse was ever suspected or alleged. Staff advised that the updated Berkshire procedure had only recently been received and was to be shared with staff at the next staff meeting, to ensure that they were aware of it. A referral has been made during the last year under the Berkshire multiagency procedure but it was agreed that New Support Options would follow this up. Staff were able to advise of the actions taken at the time and subsequently, to ensure that service users are fully safeguarded. Other information was available to guide staff if they had any concerns about service users, including a whistle blowing procedure and a Department of Health document called Valuing People. Records indicated that all staff had received training in abuse awareness within the last year, as part of a New Support Options training called “Our Approach”. Small amounts of money are securely held on behalf of service users to enable their day to day spending. All transactions are recorded by two staff to safeguard service users and staff, and receipts are obtained and kept to account for monies spent. The area manager carries out regular checks of the monies held, and more occasionally by the New Support Options finance director, staff advised. The amounts of money held were checked with the records held and all accurately matched. Brambletye DS0000051756.V349585.R01.S.doc Version 5.2 Page 18 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, 25, 26, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a spacious and well-equipped home, which has been adapted to suit their needs. The home was bright, cheerful and homely and appeared to be comfortably furnished. EVIDENCE: The home was observed to be attractively decorated, cheerful and bright and was furnished in a homely style, to suit service users’ needs. It was positive to note that some items of furniture have been made especially for individual service users to ensure they suit their specific needs, and occupational therapists have been involved in assessments for these. All areas of the home, including the front door and door to the garden, are wheelchair accessible. The home appeared to be well maintained and information supplied in the AQAA stated that any maintenance issues are reported promptly to the housing association which owns and maintains the property. Brambletye DS0000051756.V349585.R01.S.doc Version 5.2 Page 19 Each service user has their own single bedroom, which has been made personal with their own belongings, including televisions, photos, pictures and music facilities. Where required, service users have been provided with specially adapted beds to suit their needs, and to assist staff in providing the support needed. Two service users have their own en-suite bathroom or shower room, and there is a spacious and light communal bathroom. This has a specialist, easy access bath and hoisting equipment. Waterproof pillows are also provided to ensure service users’ comfort in the bath. The home was very clean, tidy and freshly aired, which was positive to note given the highly complex level of service users’ needs. Feedback from service users’ relatives indicated that the home was always fresh and clean and that “the home is a credit to the staff”. Personal protective equipment including gloves and aprons are provided and used in the home, along with liquid soap and paper towels, to prevent infection or the spread of infection. Staff advised that the home has a contract for the collection of clinical waste, and this was seen to be stored appropriately, outside the home. A laundry room is available and is situated away from food storage or preparation areas. Staff advised that the washing machine has the appropriate settings for the types of laundry to be dealt with. Brambletye DS0000051756.V349585.R01.S.doc Version 5.2 Page 20 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 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A small team of appropriately trained staff are employed to meet service users’ needs. The recruitment procedures must be more robust to ensure that service users are safeguarded from people who may not be fit to work in a care home. Specified staff recruitment information and documents must be kept in the home and be available for inspection. EVIDENCE: From the information supplied and records seen, it was clear that service users are supported by a small team of staff, who have been employed to meet their needs. A small number of agency staff are also employed on a temporary basis, to assist in the support of service users, until further staff are recruited. The same agency staff are requested to work in the home wherever possible, to ensure continuity and consistency of support for service users. A keyworker system is in place for the same reasons, staff advised. Staff stated that they carry out all roles in the home, including shopping, cooking, housekeeping, personal care and laundry. Staff also support and transport service users to their planned and spontaneous activities. It was Brambletye DS0000051756.V349585.R01.S.doc Version 5.2 Page 21 positive to observe the relaxed and friendly manner in which staff were supporting service users and it was clear that staff had a good understanding of each service users’ individual needs and how they communicated. Information supplied in the AQAA indicated that four staff have achieved a National Vocational Qualification (NVQ) to level 2 or above and another member of staff is currently working towards this. The home is on target to achieve the recommended ratio of 50 of staff trained to this level. Information in the AQAA stated that satisfactory recruitment checks had been carried out for all staff who have worked at the home in the last year. It was not possible to confirm this at inspection, because the manager is the only person who holds a key to access recruitment information and documents, and she was not available on the day of inspection, staff advised. A number of these records are required to be kept in the home and to be available for inspection, so arrangements must be made for access to these in the absence of the manager. The information and documents relating to recently employed staff were supplied to CSCI for review as this report was being drafted. It was noted that for one member of staff it was not clear if all the required documents and information had been obtained, as no completed application form and only one written reference was supplied. From the information available it could not be confirmed that a Criminal Records Bureau (CRB) disclosure had been obtained, or that any check had been carried out as to the person’s physical and mental fitness to work in a care home. From the records seen, it was clear that staff have received training required by law, including fire safety, first aid and food hygiene. They have also received other training to develop their knowledge and skills, such as NVQ’s, epilepsy, effective communication and how to manage the specialist method of feeding required for two service users. It was positive to note that agency staff had received an induction into the support required by service users, and had received some of the training courses, to ensure that they were equipped to provide effective support to service users. A requirement has been made regarding Standard 34, that the recruitment information and documents specified in Schedule 2 must be obtained before a person is employed to work at the home, and the information and documents specified in Schedule 4 must be kept in the home and be available for inspection. Brambletye DS0000051756.V349585.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home, which is effectively managed and run in their best interests. EVIDENCE: The area manager advised that the manager had been a deputy manager for a number of years at another home within the New Support Options organisation, prior to her appointment as manager of Brambletye. The manager has recently completed the process to be registered by CSCI and is currently undertaking the NVQ Registered Manager’s Award (RMA) and NVQ level 4 in care. Information supplied in the AQAA stated that management tasks in the home are shared between the manager and senior support workers and that area managers carry out regular management audits. It is clear from the outcomes Brambletye DS0000051756.V349585.R01.S.doc Version 5.2 Page 23 for service users, feedback that has been provided and the standard of record keeping, that the home is being effectively managed. No formal survey of the quality of the service provided has yet taken place, as the home has only been open for ten months. The manager stated in the AQAA that anything that had not gone so well when the home first opened has now been reviewed and the team have worked very hard to rectify these. The “team have also worked hard in building good relationships with service users’ families and aim to ensure that there is a warm, friendly atmosphere for the service users to live in”, the AQAA stated. The area manager advised that other methods of reviewing the quality of the service include visits to the home carried out under the requirements of Regulation 26, and audits of the home, such as management and health and safety. Regulation 26 of The Care Homes Regulations requires organisations which are not in day-to-day control of homes to appoint a person to visit the home on a monthly, unannounced basis. The visitor is required to speak to service users and staff and look around the premises, before writing a short report of their findings. A copy of the report must be supplied to the manager and kept in the home. A survey titled 10 Big Questions will be supplied to service users and their relatives to obtain their views on the service provided, the area manager advised. Three CSCI feedback forms were completed and returned by relatives of service users. These indicated that service users and their relatives were given enough information about the home before they moved in, to help them decide if it was the right place for them. The forms also indicated that relatives act on behalf of service users because of their communication difficulties, that relatives know how to complain, that staff treat service users well, as far as they are aware and the home is well kept. Further information in the AQAA indicated that equipment and systems in the home have been maintained and serviced as required, to ensure the health and safety of those living and working there. These included hoists, fire safety equipment, the heating system and gas appliances. It was positive to note the very detailed planning that had been carried out to prepare for an emergency evacuation of the home, should it ever be needed. A fire proof box has been obtained and has been prepared with essential information, such as a place of refuge, contact details for all staff, head office support staff, general practitioners, service users’ next of kin and medication information. This also contains emergency keys and “space blankets”, which could be used to keep service users warm, but take very little space in storage. This is kept in a designated place to be ready for easy collection, should it be needed. Brambletye DS0000051756.V349585.R01.S.doc Version 5.2 Page 24 On the inspector’s arrival at the home, it was noted that only one member of staff was present with two very dependent service users. One other member of staff on duty had taken a service user to do personal shopping, and another member of staff was out doing household shopping for the home. The risks associated with leaving one member of staff in the home were discussed with staff. It is recommended that an assessment is carried out to ensure that any risks this may involve, to either service users or staff, are considered, recorded and include actions to minimise any identified risks. Brambletye DS0000051756.V349585.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 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 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 2 X 3 X 3 X X 2 X Brambletye DS0000051756.V349585.R01.S.doc Version 5.2 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 YA34 Regulation 17 (2) Timescale for action A person must not be employed 11/10/07 to work at the care home unless the person is fit to work at the care home and the information and documents specified in Schedule 2 have been obtained in respect of that person. The records and information specified in Schedule 4 must be kept in the care home and be available for inspection. Requirement 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 YA20 Good Practice Recommendations It is good practice to record the dose of a medication actually administered, where a variable dose is prescribed. This will enable an accurate record to be maintained of the amount of medication which should be present and enable an audit trail to be followed. DS0000051756.V349585.R01.S.doc Version 5.2 Page 27 Brambletye 2 YA42 If staff are to be left to work alone in the home whilst service users are present, it is good practice to carry out an assessment of any risks which may occur. Brambletye DS0000051756.V349585.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Oxford Office 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU 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. 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