Inspection on 29/06/07 for Bramerton

This inspection was carried out on 29th June 2007.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bramerton 25/06/08

Bramerton 17/10/06

Bramerton 08/02/06

Bramerton 21/11/05

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 Ruth Lough Unannounced Inspection 29th June 2007 10:30 DS0000011296.V340662.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 DS0000011296.V340662.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. DS0000011296.V340662.R01.S.doc Version 5.2 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) steve.kaye@choiceltd.co.uk Choice Limited Mr Stephen A Kaye Care Home 10 Category(ies) of Learning disability (10) registration, with number of places DS0000011296.V340662.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th October 2006 Brief Description of the Service: The home is owned and run by CHOICE Ltd and provides care for people with learning disabilities. The home is a large detached house. A large garden surrounds the property and the front entrance has a secure gate. There is a separate building within the grounds that is used for various activities. The house has four floors; residents’ rooms are on the two upper floors. All of the residents have individual rooms, of varied size and shape. The ground floor has two lounges, the dining room and kitchen. The basement has three sitting areas. The Registered Manager has confirmed that the current weekly fees charged are £1291 - £1674 for the residents living in the home. This includes the provision of day care services and is based on an individual assessment of their needs. DS0000011296.V340662.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit that was generated from the adequate outcomes for residents found in the previous process in October 2006. This one day key inspection visit was carried out to assess that the previous requirements made had been met and that the safety and welfare of residents had been protected by actions by the home to rectify the concerns identified. Part of the process was obtaining information prior to the visit provided by a self assessment of the service and surveys and comment cards received back to the Commission from residents, their relatives, staff and healthcare professionals who come in contact with the home. Five of the ten residents, all who were assisted by staff, completed and returned surveys. Three relatives, six staff and GP all provided information in the returned surveys they had completed. The inspection visit included reviewing records kept in the home, discussion with staff and residents, where able, and observation of the interaction of the staff with the people living there. What the service does well: What has improved since the last inspection? They have ensured that the staff are better equipped with knowledge for health and safety in order to protect the residents and themselves. The home is undergoing a programme of refurbishment to provide better toilet and shower facilities on the ground floor for residents to use. DS0000011296.V340662.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000011296.V340662.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000011296.V340662.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has the necessary assessment processes in place should they wish to admit a new person. EVIDENCE: The manager confirmed that there is a comprehensive assessment of need process in place should they wish to admit a new resident to the home. They use a variety of specialist services, including Psychiatry, Psychology, Speech and Language Therapy, Dietician and Behaviour Therapist as part of the process. DS0000011296.V340662.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The individuals needs are set out in support plans that include assessing the risks and how to manage their behavioural needs but lacks information about how the personal care support is to be provided. Keeping personal records confidential and in the best interests of the individual could be compromised by how they are currently managed. EVIDENCE: The care and support planning for two residents living in the home were reviewed as to assess that their needs are being identified and met. The manager stated that they had implemented new document records called the ‘Service User Plan’ and ‘My Profile’. They also had additional information in the risk assessments, behavioural plans and medical files. The records that should provide information about the specific needs of the individual, such as Asperger’s, Autism and any physical health needs, are very minimal. The care plans also do not give staff guidance of how to provide the personal care support that they might need or the preferences they might have. DS0000011296.V340662.R01.S.doc Version 5.2 Page 10 Only the behavioural plans indicated that the individual’s choices had been recorded. Each part of the care and support plans for the individual resident is kept in separate topical organisational files with other resident’s information. This is not ensuring confidentiality is kept and that the right of the individual to access their personal information could compromise others. In discussion during the inspection visit it was identified that there had been an omission by the home staff in implementing a personal care plan document when transferring information over from the previous recording tools. The home has implemented assessing risks to the individual or how they could be a risk to others and have Behavioural Management plans in place. These plans are very detailed and provide staff with comprehensive information about behaviour patterns and the management strategies for the individual. The development and review of the Behavioural Management Plans are the responsibility of the individual’s Clinical Psychologist who they see on a very frequent basis. The senior staff review the care and support plans regularly and each resident is assigned a Key worker. DS0000011296.V340662.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are supported to have fulfilling lifestyles that ensures that their choices and wishes are listened to and acted upon within the limits of risk taking to achieve these. Any identified ethnicity and cultural needs are met. The care and support plans do not provide sufficient recorded information of how this is met. EVIDENCE: The residents who were supported by staff to respond to the survey gave indications that they felt they could live the way they wanted to. One parent wrote, “Our son is given every opportunity to live his life the way he chooses. His daily activities are those that he would choose, but if he prefers to stay in his room, this is respected.” The people living in the home are enabled to pursue continuing with education and learning through local colleges and have individual plans for personal development activities that are provided both in the home and externally. All activities are arranged with involvement of the Clinical Psychologist to ensure that it appropriate to the individual. Any DS0000011296.V340662.R01.S.doc Version 5.2 Page 12 Behaviour Management plans and risk assessment are in place before the activity commences. Staff have implemented programmes of activities for the residents to be part of the local community including visits to pubs, cinema and concerts. They have also ensured that they have access to maintain contact with local places of worship or people from their chosen religious organisations should they wish within the limits of risk to other people whilst doing so. The individual’s ethnicity and cultural needs are recognised and is reflected in their activities programme where possible should they wish and if required in the meal and menu planning. There is a daily activities plan that ensures that there is oneto-one support and group activities where possible. On observation it was evident that the residents enjoy the periods of individual support with staff. The majority of the residents are able to have annual holidays away from the home. If this is not possible they are supported to have daily trips instead. One parent wrote, “ Our sons annual holiday is carefully chosen to fit his needs and pleasures. His general mood is taken into consideration and respected.” Residents are supported to continue with their relationships with their families either by them visiting the home or by staff enabling the individual to go and visit them. There are activities and social occasions that the provider organisation arranges where the residents have the opportunity to meet others living in similar homes in the local area. Through discussion with the staff team members present and observation of the relationships with the residents it was evident that they had a good understanding of their choices of how they wish to live, likes and dislikes and how to provide any physical support they may need. But this information was not fully recorded in the care and support plans. The home has two designated staff employed whose main roles are to provide the meals and housekeeping tasks. Through discussion with one of the staff members responsible for menu planning and meal preparation they confirmed that individual’s choices, dietary and cultural needs, were being met. Much of the information has been obtained from many years of supporting the individual and observing how much they enjoy the food provided, their reaction to changes and giving them new experiences to try. The residents are provided with two hot meals a day, although alternatives are available should they not wish to eat the planned meal. Meals are usually taken in the dining room, but these have to take place in two sittings as to ensure that all the residents have an enjoyable experience. Those who wish to can take their meals in the quieter areas of the lounges, their bedrooms or garden in the summer months. DS0000011296.V340662.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents are provided with the support they need to meet their current healthcare needs. The recorded instruction in the care and support planning documents do not give clear information of how personal care needs are to be met. The staff are not given sufficient information and guidance to protect the people who use the service with the medication and other health related support they may need. EVIDENCE: The care and support records reviewed did not provide information of how the staff assist the individual to carry out the activities of daily living or about their preferences to how this is done. The manager did provide information in the pre- inspection self assessment documents and during the inspection visit that there was a varying amount of personal care support required by the residents. This ranged from full care to achieve bathing, dressing and toilet needs being met to a minimal amount of prompting by staff for some activities. The residents are given the opportunity to make choices of what they wish to wear but are guided by staff to the appropriateness of their choices. DS0000011296.V340662.R01.S.doc Version 5.2 Page 14 The residents who were in the home during the visit appeared to be dressed in clean and well cared for clothing. None of the current residents require aids or specialist equipment at present to maintain their personal care. Each resident has a key worker who takes a lead in the development of the support they need and all changes are made in conjunction with the information from the psychologists and any psychiatrists involved in the individuals care. Implementing a written detailed personal care support plan would ensure that staff provide continuity when the key worker is not there. The physical and mental healthcare needs of each person is monitored through various methods. The mental and physcological needs are assessed and recorded in great detail by the professionals who have regular imput on a weekly and monthly basis. Physical health is monitored through assessing their weight and annual health checks by their own GP, dentist and if required optician, or specialist healthcare practitioner. Information is recorded about some of the specific health care needs such as epilepsy. Through discussion with senior staff they have already identified that they would like to improve how they could manage the residents future health care needs and it was recommended that they implement a health care history that could aid them to monitor gradual changes that may occur as they grow older. Any correspondance regarding health appointments and treatment are kept. The medication needs for the individual are kept in the Service User Plan and with the medical and health care information. Staff are provided with the necessary training in the induction programme and periodical retraining. The home currently does not provide support with controlled medications but does need staff to be trained for administrating emergency medications through invasive techniques such as rectal Diazepam. For this, staff obtained specialist training and supervision by the District Nurse. They are in the process of securing this for Buccual administration that the GP wishes to prescribe in the future for some of the residents. The medication policy and procedure that was available in the home was reviewed and the information was seen to not be sufficient in providing staff with the clear boundaries and limitations of administration for designated tasks made by a healthcare practitioner. These need to be developed further and to ensure that they include the new information for the planned changes for Buccual administration of medications. The recent unexpected sudden death of one of the residents living in the home has affected both the people living and working there. Staff and residents have supported each other through the events of the last few weeks and are in the process of creating a perment memorial in the garden in rememberance to him. The staff have been guided by the psychologists and psychiatrists of how to support the residents. One relative praised the “amazing support given by care staff durign a very difficult time.” DS0000011296.V340662.R01.S.doc Version 5.2 Page 15 The manager stated that this has prompted the staff to review what information they have about residents choices and wishes for aging, ill health and death while they are able to consult with families and supporters of the individual. DS0000011296.V340662.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Concerns, complaints and comments about the service are listened to and acted upon. The people who use the service are protected abuse, neglect and self-harm by the information and training provided to staff and the processes that are in place. EVIDENCE: The information from the completed surveys from the residents indicates that they know who to speak to if they have and concerns. One relative wrote, “ They had never had the need to raise any concerns.” Another stated that they,” found the manager and staff were easy to approach and very supportive.” The home has a policy and procedure for managing concerns and complaints received about the service they provide. Some residents are given a copy in the Statement of Purpose and Service User Guide in a format they may be able to understand and others have the information explained where possible. The manager gave information that the home had received six complaints in the last 12 months about the disruptive behaviour of one resident and how this affected the neighbours. Strategies were put place to minimise or eliminate the major concerns and the neighbour has been informed of the outcomes partly by letter and also verbally by the manager. The information held about these complaints, subsequent investigation and actions carried out are noted in different records including the behavioural management plan for the individual. DS0000011296.V340662.R01.S.doc Version 5.2 Page 17 Currently they do not use a method of monitoring minor concerns as these are usually dealt with by staff on an ongoing process of providing the support, managing changes in behaviour and ensuring that the practical care is given to the individual. The Commission has not been in receipt of any concerns about the service during this period since the last inspection process. The home has policies, procedures and information in place for safeguarding and protecting adults. The home keeps a copy of the local interagency protocol for staff to read and has document tools to use, should concerns be raised. The manager confirmed that all staff have had the necessary training about safeguarding adults and they are looking to improve their knowledge to implement the planned restraint strategies for any aggressive behaviour that may put the individual resident or others at risk. Any interventions for restraint are recorded, analyzed and used within the review of care provision and passed to the clinicians involved in their care. DS0000011296.V340662.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The condition of the fabric and décor of the home is poor in parts and compromises the health and safety of those living and working there. EVIDENCE: The home is a very large late Victorian/ early Edwardian property and was not built for its current purpose. The home is on four levels with bedrooms on the first and second floor and communal spaces on the ground and lower ground floors. All service users have their own bedrooms that are variable in size, three of which are 6.69, 7.95, and 7.95 square metres, and are under the present requirements of 10 square metres for minimum floor space per individual. The home was in existence prior to 16th August 2002 and those residents affected by this are compensated with the number of communal areas in the home. However, one larger bedroom is now vacant and the manager is looking to put physical changes in to ensure that all the residents have equally sufficient personal space to accommodate their possessions and suitable to their lifestyle and needs. DS0000011296.V340662.R01.S.doc Version 5.2 Page 19 The home is situated away from a busy residential area but is surrounded by large family properties with larger than average gardens that offers some privacy and protection to both residents and neighbours. The home is currently accessible to all the residents living there as they do not have any mobility or health needs that require extra equipment or a lift to the upper or ground floors. There are two lounge areas, large hallway and a good size dining room that could accommodate all the residents. On the lower ground floor there are three main areas that could be used by the residents, these include a sensory room, sitting room and a room with soft furnishings where they can listen to music comfortably. The grounds are secure and keep the residents safe from the main road to the front by a high gate and fencing to the perimeter. The garden offers some privacy and good space for all the residents to enjoy. There are areas for activities and for quietly sitting in the summerhouse and watching what is going on in the garden. To the rear of the main building there is a large converted garage that is divided into three areas that can support activities as a group or singular one-to- one time with staff and an area where those more able can learn to cook and carry out small domestic tasks without being disturbed by other residents. The residents are supported to personalise their bedrooms, some of which reflect the person’s individuality more than others. Several of the bedrooms are very minimal in furniture, fittings and décor and the manager stated this was because of the behavioural problems of the individual, the risk of self – harming and the constriction of the size of the room. The lounges and dining areas that are situated on the ground floor are kept clean and tidy and pleasant to use. They may lack some of the more homely additions such as ornaments, pictures, curtains and cushions because of the behaviour needs of some residents, but effort has been made to maintain the furniture and décor pleasant. Several areas of the home such as some of the bedrooms, stairways, corridors and bathrooms are in poor decorative state and carpeting and flooring is stained and odorous in parts. Staff are supported by the housekeeping and maintenance staff to keep the home clean and tidy to live in but are constantly challenged by the behavioural needs of some of the individuals living there. The condition of the environment of the home was a previous concern identified during the last inspection process in October 2006, some work has been carried out to rectify and improve conditions but in some areas the environment remains poor. Care staff could be supported better, by increasing housekeeping and maintenance hours to be able manage the situation more effectively. DS0000011296.V340662.R01.S.doc Version 5.2 Page 20 The home is in the process of carrying out refurbishment to part of the ground floor to improve the facilities for toilets and a shower that is situated off the central hallway and this currently compounds the problems of keeping the home in a clean and hygienic state. The manager confirmed that until this work was complete a planned programme for general refurbishment had not yet commenced. On a tour around the home it was identified that a number of bedroom doors were possibly not meeting with fire regulations. One door did not appear to close effectively at the bottom leaving a gap to the doorframe and to the floor of the bedroom where carpet had been changed to a vinyl covering. A gap at the bottom of the doors was repeatedly seen in two other bedrooms that were reviewed. Compliance with fire regulations was of a concern previously and the manager was required to ensure that these were met and although some remedial work has been done since then they still have not sought professional advice from the fire authority to ensure they have the necessary safety in place. DS0000011296.V340662.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has suitably recruited and trained staff to meet the needs of the residents living there. EVIDENCE: The manager provided information about the staff team including the employment processes and the training and development put in place to ensure that they have the skills and knowledge for the roles they carry out. The recruitment records for two staff were reviewed and provided evidence that the required checks had been carried out and including identity and criminal records checks. Both employees had been recruited from oversees through a recruitment company and the homes manager had been involved in the interview and selection process both in their country of origin and in England. What could be improved is the method or recording the interview process and the decision making to employ that would evidence exploring the full work history and any gaps in training and employment. The manager stated that there is now a training and improvement plan in place to ensure that staff are provided with the necessary skills to carry out the roles they are employed for. Of the twenty- six staff employed only five DS0000011296.V340662.R01.S.doc Version 5.2 Page 22 staff have not completed an NVQ in care. Some care and support staff have already obtained professional qualifications in Psychology in their home country before coming to England. The training programme has included the mandatory health and safety training that was identified as a deficit in October 2006 with the majority of the key topics covered. Staff training records supported that they had routinely been provided with training in the induction process and following this for the specialist knowledge they need to have in regard to learning difficulties, epilepsy, challenging behaviour and where required the use and administration of rectal diazepam. The planned programme includes Makaton, Autism and Communication as these are the in the focus by management to improve the staffs skills in communicating with those residents who are unable to express or verbalise well. What was not included in the planned programme was Infection Control that could help staff in the daily management of the homes hygiene control. One relative wrote about the staff, “ Our son is not always easy to understand and care for but the care staff are exceptionally patient, imaginative and enthusiastic giving him a very happy and active life.” DS0000011296.V340662.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care and support provided to the residents is managed well and ensures that staff are able to meet their needs and keep them safe. But the condition of some parts the home is not managed well and does not give the residents a good standard of facilities that they are entitled to. EVIDENCE: A relatives comment about what they thought the service does well was “Everything” and “ We are totally happy with Bramerton.” The home manager has been managing the service and supporting this group of residents for over fourteen years. He has qualifications that are applicable to his role such as RMNH, NVQ 4 and Registered Managers Award and has ensured that he has continued to develop his knowledge through training in DS0000011296.V340662.R01.S.doc Version 5.2 Page 24 topics such as Speech and Language and management training updates through the provider organisation. The staff are effectively managed and there are no deficits in the time spent actively supporting the residents who some have very profound needs. One staff commented, “There is a general openness so new ideas can be discussed,” and another wrote “ There is a very good rapport between the residents, relatives and staff.” However, the environment they live in still is not in good condition in some parts and could put residents and staff at risk for fire safety and control of infection and in some areas is not pleasant to live in. Three requirements made in regard to these concerns should have been met by December 2006 and still remain outstanding. Staff do give the residents opportunity to express their feelings about the home and the staff who work there and much of this is recorded in the twiceyearly formal reviews of care. Where the resident is unable to verbally comment they assess this through the moods and body language of the individual on a continual ongoing process of ensuring that they are meeting their needs. Families and care managers are also invited to the reviews of care were they are given the opportunity to comment about the service. Staff are able to give their view through the regular staff meeting and the supervision programme. Annual questionnaires are also sent out to residents, relatives and other health and social care professionals who come in contact with the home. Information obtained from these processes is used to develop the individual’s care and support programme and the business plan for the home. The provider carries out regular Regulation 26 visits as part of the overall quality assurance monitoring. The home has health and safety policies, procedures and information for the safe working practices that should protect the residents and staff. What has improved is that the staff have been provided with the necessary training for the key topics for this such as Fire safety, Food hygiene and First aid. There are regular fire drills and testing carried out and some fire safety work has been carried out with the main fireboard in the home being replaced in the last few weeks. The manager has already identified that this change may not been reflected in the current fire procedure documents that are in the home. Small alterations to the individual’s fire risk assessment records would ensure that Fire Officers have the most up to date information if they need to retrieve and evacuate residents should an incident occur. DS0000011296.V340662.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 1 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 x 2 X 3 X X 2 x DS0000011296.V340662.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 YA10 Regulation 17 Requirement Timescale for action 31/07/07 2 YA18 15 3 YA20 13.2 4 YA24 23.2 (b) That the personal records about the people who use the service is kept in accordance to Data Protection and ensuring that confidential information is not shared inappropriately. That the care and support 21/08/07 planning documents provide information to staff of how the personal care needs of the individual are to be met. That the medication policy, 21/08/07 procedures and information gives better information about the limitations of medication practices and the designated nursing tasks they may be required to carry out. They must ensure that the 15/10/07 premises is kept in a good state of repair so that the residents can have a safe comfortably furnished and well decorated environment that will meet their needs. Previous requirement made that was not met by 15/12/06. DS0000011296.V340662.R01.S.doc Version 5.2 Page 27 5 YA24 23.4 6. YA24 23.4 (a) 7. YA30 23(2)(d) They should consult with the appropriate fire authority to make sure they have the necessary fire safety precautions within the home. They should ensure that the fire precautions in the home all function, as they are required to and, any repairs or malfunctioning are attended to urgently. The Registered Manager must ensure that all areas of the home are clean and hygienic at all times. Previous requirement made that was not met by 30/11/06. 10/08/07 10/08/07 30/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA19 Good Practice Recommendations That staff put in place a method of recording the individuals medical and health life history that may assist them to monitor their needs and plan for possible health concerns in the future. That they review how they record, analyze and manage and concerns or complaints received for quality assurance purposes. That they review and possibly increase housekeeping and maintenance staffing hours to meet the needs of the residents in the home. That they record the interview process and the reason to employ the applicants when carrying out the recruitment process. That they update the documented information they provide to Fire Officers if they need to retrieve residents should a fire occur. 2 3 4 5 YA22 YA24 YA34 YA42 DS0000011296.V340662.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Oxford Office Burgner House 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. Extracts may not be used or reproduced without the express permission of CSCI DS0000011296.V340662.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. 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