Inspection on 21/11/05 for Bramerton

This inspection was carried out on 21st November 2005.

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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bramerton 25/06/08

Bramerton 29/06/07

Bramerton 17/10/06

Bramerton 08/02/06

Bramerton 07/10/04

Bramerton 22/07/04

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 Bramerton Upper Bray Road Bray Maidenhead Berkshire SL6 2DB Lead Inspector Unannounced Inspection 10:30 21 November 2005 st Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 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 Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 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. Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bramerton Address Upper Bray Road Bray Maidenhead Berkshire SL6 2DB 01628 771058 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) stevenkaye@choiceltd.co.uk Choice Limited Mr Stephen A Kaye Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd July 2004 Brief Description of the Service: The home is owned and run by CHOICE Ltd and provides care for people with multiple needs. The home is in a large detached house on the outskirts of a village. The house is set in a large garden, to the front is a secure gate with a tarmac car park and shrubbery and the rear is a large grassed area and patio. There is a large shed that is split into 3 distinct areas used for various activities. The house has three floors; residents’ rooms are on the first and second floors. All of the residents have individual rooms, of varied size and shape. The ground floor houses 2 lounges, the dining room and kitchen plus there are three further seating and recreational areas in the cellar. Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection during the weekday lasting for 6 hours. During this time the registered manager facilitated a full tour of the building. A significant proportion of this inspection was spent observing the busy daily life of the service users and staff supporting them in the home. During this time all service users were met and most staff on duty were spoken to gain their views about the home. Some service users had difficulty expressing their views or communicating verbally with the inspector. Views therefore were collected indirectly through observation and staff assistance. The deputy manager assisted during the inspection to explain the daily life and practise observed within the home. Time was spent with the registered manager reviewing standards within the home. Care records and records kept within the home were also examined to confirm observations and discussions during the inspection. Feedback was given to the registered manager and deputy manager on completion of the inspection. What the service does well: What has improved since the last inspection? What they could do better: The home requires some ongoing work to the décor as evidenced through general signs of wear and tear. The registered manager has identified work needing to be done and allocated the appropriate funds, however one basement lounge was below the minimum standard and it is a requirement that the CSCI is notified when the identified deficiencies are remedied. Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 Page 6 The home has a comprehensive recruitment policy fully understood by the registered manager, however it is a requirement that checks against the POVA register must be competed and evidenced for all new staff before commencing employment. 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. Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 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 Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The home has a comprehensive policy and procedure for referral, transition and admission for new service users. EVIDENCE: The service users within the home have been resident for many years. There is a clear and detailed admission policy and procedure within the statement of purpose. Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Service users risks are minimized through an effective risk management framework. EVIDENCE: Four service users support needs were focussed on during the inspection. Risk management plans were viewed for these four service users who have complex support needs and require further support to ensure their safety. Risk management plans are identified, competed and reviewed by the staff team and the in house psychology team. These plans are easy to read, very clear and comprehensive and refer staff to further support guidelines as necessary. Staff had signed these plans as having read and understood their content. All staff spoken to had an excellent understanding of these risk management plans and were clear on their content, this also included a staff member very new to the team. Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, and 17 Service users clearly benefit from a good range and choice of occupational activities provided both within the home and in the local community. Service users are actively supported by staff to maintain their relationships. The daily routines within the home are flexible and inclusive with service users being supported by a competent staff team. Service users enjoy an appropriate menu that is flexible and takes into account cultural and other dietary needs. EVIDENCE: The home has three dedicated day services staff that organise and facilitate a good range of occupation and activities for service users in combination with the staff team. Service users are offered purposeful activities both internally and externally. Day care programs were examined and explained by staff on duty. These detailed structured and planned activities with additional daily activities recorded for each service user. The home provides its own day care space located within the grounds of the home used for education and therapeutic activities such as arts, crafts and communication programs. External pursuits were seen to include use of local colleges, a good range of activities in the local community as well as utilizing more specialist resources. The home has ample transport, which was used during the inspection. Choice Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 Page 11 and flexibility is also offered during the day as evidenced by a service user’s request for an alternative external activity, which was provided. Service users are assisted by the staff and management team to maintain friendships with each other and contact with family. The deputy manager evidenced two service users where staff support was provided either in accompanying day trips to relatives or collecting relatives on the homes transport to spend time with a service user within the home. A service user spoken to was enthusiastic about arranging a future Christmas party for service users, staff and relatives at the home. A large proportion of the inspection was spent observing daily life and routines within the home. Staff were seen to treat service users with dignity and respect and interacted and communicated with service users in an inclusive manner. Staff were relaxed and friendly and were able to deal with more challenging behaviour observed during the inspection, appropriately and in line with care guidelines examined later. The home was observed to be very busy at times and service users were observed to have the freedom to move around the house as they wish and choose when to be alone or with other service users. Service users were observed to be encouraged to participate and take responsibility for some housekeeping tasks in line with their wishes and abilities. Service users able to comment expressed their satisfaction with the daily life and routines at the home. Lunch times was observed with most service users eating in the dining room with the staff providing an inclusive atmosphere. Observation also evidenced that service users were able to choose where and when they eat. Two service users confirmed that they were happy with the meals provided. The menus for service users were examined and found to be varied over a three-week cycle. The cook was able to evidence that feedback regarding the menu takes place and new meals choices are provided. Dietary requirements including allergy and cultural specific needs are understood and met. Alternatives to the menu are provided on request. During the afternoon service users were in the kitchen and observed to help plan and prepare the evening meal with staff supervision. Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Service users personal and health care needs are fully met. Service users are supported effectively and individually. EVIDENCE: Service users were observed to require support for a range of personal support needs. Staff on duty spoken to were able to demonstrate a good understanding of individual service users support requirements including communication, personal care and understanding and comfortably dealing with behaviours exhibited during the inspection. One service user was able to confirm some elements of their personal support and confirmed that they were happy with the staff assistance provided. The same service user prefers their personal care needs assisted by staff of the same gender and this is always provided without exception. During the inspection one service user had decided to get up later in the morning staff respected this and provided personal care and breakfast flexibly. Staff on duty were able to discuss the types of support provided through a key worker system. Discussions evidenced an effective system. Monthly reports completed by key workers were regular and up to date on service users care files. Time is scheduled for one to one time on the day care rota. Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 Page 13 The registered manager described the healthcare arrangements for service users. The service users use a local GP surgery it was confirmed that there is a supportive relationship and good access as required. Service users have an annual health check and records for four service users confirm these have occurred. Four service users records were examined and found to contain records of health related visits and confirmed access to all local NHS healthcare facilities in the community. The provider has an in house psychology department and a psychology assistant visits weekly and monitors behaviours and emotional health needs. The deputy manager and a senior support worker explained the homes medication system. No service users at the home are currently able to manage their own medication and thus require the staff support. The home uses the Boots system and the systems in place for ordering and returning medicines were seen to be satisfactory. A sample of medication administration sheets were examined and all were signed appropriately by senior staff and a witness with no gaps evident. Senior staff spoken to were clear on using “as and when required” medication for service users and understood the policy examined in regards to this topic. The home has a policy for administering non-prescribed medications, which gives clear guidance for staff and is signed by the homes GP. Staff’s training records demonstrate that senior staff are provided with appropriate training in the handling and administration of medicines. Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22-23 were not assessed during this inspection. EVIDENCE: Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 30 The homes environment meets the needs of the service users and is clean, comfortable and safe. The manager has identified all areas requiring work and allocated the appropriate funds, however the CSCI must be notified when work is completed to bring the basement lounge identified during the inspection to the required minimum standard. EVIDENCE: The registered manager facilitated a full tour of the building covering all areas. The home was viewed to be bright and cheerful and generally clean and tidy. However the home is tired and worn in many areas particularly in some communal spaces and corridors. The registered manager was very aware of refurbishment and redecoration needs of the home and the identified areas had appropriate funds allocated by the manager as evidenced in the capital expenditure report. It was noted during the inspection that the home is a busy environment and its use by the service users significantly add to the wear and tear of the home. This was evidenced in some damage to curtains as well as general paintwork, particularly skirting boards and doorframes. There had been some recent work to replace damaged doors and repair frames downstairs as part of the maintenance program. Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 Page 16 Service users bedrooms were seen to be clean and tidy and personalised to suit individual tastes. Bedroom furniture appeared to be appropriate and included sofas in many rooms for comfort. Two service users commented that they were “happy” with their bedrooms. One service users bedroom was very sparsely furnished, however this suited their current needs. The manager had identified a way to install curtains that could not be damaged and funds had been already been allocated. Partly frosted windows ensured privacy for this service user. There is an excellent provision of communal space for service users within the home. On the ground floor there are two lounges observed to be used and enjoyed by service users during the inspection. In the basement there are two further lounge areas and a TV room. Two service users on a regular basis use one of these basement lounges and their access is via a keypad on the outside of the door to prevent confrontation from another service user whist in use. From this lounge is a sensory room, which is not currently used, as it is damp and musty and would require an appropriate means of ventilation. The other lounge located in the basement is not used so frequently by the service user it was intended for. This room had an unpleasant odour and furnishings were old. This had been identified by the manager who was waiting for a new carpet to be fitted. It is a requirement that confirmation is provided when this work is completed. Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 34 Service users benefit from a stable and effective staff team that are provided in sufficient numbers. The home has a comprehensive recruitment policy fully understood by the registered manager, however it is a requirement that checks against the POVA register must be competed for all new staff before commencing employment. EVIDENCE: The rotas for the past four weeks were examined to check the numbers of staff on duty. There are four support workers during the day shifts and usually three day service staff to support service users occupation and activity. An additional staff member working 9-5 is often provided during the weekend to ensure day care activities can be provided as required. There are two waking staff during the night. Observations made during the inspection demonstrated a staff team with a good skill mix to support service users. Two service users were able to comment that they felt comfortable and were happy with the staff at the home. There are currently no housekeeping staffs to undertake domestic duties as support workers complete this during the day. There has been a low turnover of staff at the home and no reliance on agency staff. The registered manager described the process and channels used for recruiting new staff. There has been a recruitment drive from Europe this year using an agency to assist the provider; the manager was involved in the interviewing process. Four experienced staff have started this year at the home. The Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 Page 18 recruitment record for one recent new starter was examined and all necessary documents and references were in place and stored within the home. A non-UK police check had been carried out prior to the staff member starting work to check their fitness. However no CRB check had yet been applied for to ensure a POVA check had been competed prior to the commencement of employment, which is a statutory requirement for all new staff including those from recruited from abroad. This was also illustrated in particular as another new support worker recently recruited from abroad had previously lived in the UK and had not as yet applied for a CRB check. Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37 – 43 were not assessed during this inspection. EVIDENCE: Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X 3 2 X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bramerton Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000011296.V253481.R01.S.doc Version 5.0 Page 21 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. 1 Standard YA24 Regulation 23(d) & 16(2)(c) Requirement That the registered manager informs the CSCI when work is completed to bring the basement lounge identified during the inspection to the required minimum standard. The registered manager must ensure all new staff have been checked against the POVA register before employment commences, which currently requires a CRB check to be applied for as specified in the department of health guidelines and regulations. Timescale for action 28/02/06 2 YA34 19 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bramerton DS0000011296.V253481.R01.S.doc Version 5.0 Page 23 - 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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