Inspection on 23/01/06 for Bramley Avenue (73)

This inspection was carried out on 23rd January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Bramley Avenue (73) 15/08/06

Bramley Avenue (73) 11/03/05

Bramley Avenue (73) 14/07/04

Bramley Avenue (73) 01/03/04

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

Newton Court (1-2)

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

CARE HOME ADULTS 18-65 Bramley Avenue (73) Melbourn, Near Royston Cambridgeshire SG8 6HG Lead Inspector Shirley Christopher Unannounced Inspection 23 January 2006 1:00 Bramley Avenue (73) DS0000015150.V269348.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 Bramley Avenue (73) DS0000015150.V269348.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. Bramley Avenue (73) DS0000015150.V269348.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bramley Avenue (73) Address Melbourn, Near Royston Cambridgeshire SG8 6HG 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) 01763 261682 01763 228116 bramley@grantahousing.org.uk Granta Housing Society Limited Naomi Lucas Care Home 5 Category(ies) of Learning disability (5), Physical disability (5) registration, with number of places Bramley Avenue (73) DS0000015150.V269348.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th August 2005 Brief Description of the Service: Bramley Avenue is home for up to five adults who have a physical and learning disability. The home is purpose built and has five single bedrooms. It also has a large, fully enclosed sensory garden, which is designed to be fully accessible and has a large fishpond, patio area and barbeque area. There is a separate kitchen, living room, utility room, which was being refurbished and a multisensory room, which care staff fundraised for. The house is in a no through road, with sufficient parking. It is close to local amenities and is situated in the village of Melbourne. It has good links to the City of Cambridge, which is twelve miles away and Royston, four miles away. Care and support is provided by Granta Housing LTD and is over a twenty-four hour period. Care staff provide a comprehensive package of care including day care. The staffing rota reflects the individual needs of service users. Increased staffing levels are provided when specific activities are offered, such as swimming. Bramley Avenue (73) DS0000015150.V269348.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was undertaken on the 23 January 2006 at approximately 1.00 pm and lasted just over two hours. In this time the manager was spoken to at length. Four care staff were spoken to and the inspector was introduced to all the residents. A tour of the home was conducted and some records were inspected including: residents’ medication records, finances, menus, residents review, 2 staff files and induction standards for new staff. A pre inspection questionnaire was also returned to the CSCI following the last inspection. This demonstrated how the home is meeting certain minimum standards and requirements. What the service does well: What has improved since the last inspection? The home has had some success with staff recruitment, although it does still have three full time vacancies. It is a large staff team and care shifts are adequately covered. On the day of inspection, the laundry room had been stripped, ready for redecoration. The manager also stated that one of the walls outside two of the residents bedrooms was going to be painted with drawings, completed by a local artist, to incorporated both of the residents personalities. A sketch of spider man had already been done. Bramley Avenue (73) DS0000015150.V269348.R01.S.doc Version 5.0 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. Bramley Avenue (73) DS0000015150.V269348.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 Bramley Avenue (73) DS0000015150.V269348.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): 3 Care staff individually and collectively meet the needs of the residents in a comprehensive way. EVIDENCE: Most of these standards were not inspected, as the residents have lived at the home since it opened over ten years ago and there has not been a recent admission. At the last inspection the manager confirmed that she has a comprehensive admissions policy and residents are issued contracts. Residents’ needs are kept under review and new staff go through an intensive induction which meets both the standards set by the organisation, and also identifies needs specific to the residents at Bramley Avenue. Care staff are offered good training opportunities. The manager stated that residents do not have an allocated care manager, but care staff hold an annual in-house review. Key workers write a report, set goals and enclose photographs, to make the plan more accessible to residents. They are involved with the review, as are family members should they wish to attend. A copy of the review is sent to the Learning disability partnership. Bramley Avenue (73) DS0000015150.V269348.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): 6,7,8 Residents are involved and consulted about every aspect of their daily life. Decisions are reached following consultation. Care staff act in the residents’ best interestS. EVIDENCE: The only documentation seen in respect to residents was the review prepared by the key-worker. At the last inspection a residents care plan was seen and was extremely comprehensive. There is ongoing evidence that the home work in a consultative way with other professionals and non-professionals to improve the lives and care given to residents. Care staff support residents appropriately. This was assessed through discussion with staff and observation. There are good staffing ratios on every shift, providing the opportunity for one to one personal care, which can be given in an untimely fashion. Care staff involve residents as far as possible in every aspect of their lives and develop positive relationships with them. Individual, achievable goals are set for each residents and emphasis is place on community participation, using mainstream rather than specialist services. Bramley Avenue (73) DS0000015150.V269348.R01.S.doc Version 5.0 Page 10 Residents have limited verbal communication and care staff rely mostly on other forms of communication with them such as gestures, photographs and pictures. A low turn over in staff have helped staff to get to know residents really well and intuitively know what they want, but at the same time still promoting choices. ‘Speaking up’ are involved with the residents. Bramley Avenue (73) DS0000015150.V269348.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Residents have the opportunity to take part in appropriate activities within the community. They are supported by well-trained staff who are able to meet their social and physical needs. EVIDENCE: All the residents were at home on the day of inspection. Staffing levels are maintained throughout the day and increased to enable residents to take part in specific activities, which require a higher staff ratio such as swimming and annual holidays. Residents take part in community-based activities, rather than attending day services for people with disabilities. Individual interests and hobbies are reflected, particularly within residents’ bedrooms. One resident likes football and fish, both are clearly evident in his room. He is a season ticket holder for a well-known football team and regularly attends matches. More recently he had a personal introduction to the football team at the care staffs request. Other examples of activities participated in include, music groups, swimming, art therapy, picnics, aromatherapy, massage, the Cambridge Corn Exchange. Local facilities are accessed including the shops, health care centre and mainstream optical and dental surgeries. There are no Bramley Avenue (73) DS0000015150.V269348.R01.S.doc Version 5.0 Page 12 volunteers at this service but there are some links with family members and the home has engaged the support of an advocacy project, speaking- up. The house is well equipped with multi sensory equipment and a multi sensory garden. Care staff prepare all the meals. All staff have completed a basic food hygiene course. A number of residents are peg fed. Care staff are appropriately trained and have good links with the eating and drinking unit attached to the learning disability partnership. The nutritional sister at Addenbrookes hospital provides training to care staff. Staff are then assessed to see if they are competent by the district nurses, who sign of the training and issue and renew certificates. There are comprehensive risk assessments around the safe preparation of food and the risks of chocking (Identified as low.) The dietician is involved and nutritional reviews are carried out by the hospital. There is a planned weekly menu. Bramley Avenue (73) DS0000015150.V269348.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20 Policies and procedures are in place to ensure that care staff know how to meet the residents health care needs in a safe way. Staff are appropriately trained and risk assessments underpin practice. EVIDENCE: Health care records were not inspected, but the manager explained the support the home receives from other professionals particularly members of the learning disability team, the district nurses and Addenbrookes hospital. Care staff receive appropriate training and their competence is assessed. The manager confirmed that care staff have a first aid qualification. A number of residents’ medications were checked and were accurate. The home have their medication supplied by Boots the pharmacist. Boots complete regular medication audits, the last one being in May 2005 and staff training. The manager has introduced a quiz to periodically retest staffs’ knowledge. Agency staff and bank staff do not give out medication. The learning disability partnership provides training for the rectal administration of diazepam. There are written protocols in place for this. Medication policies and procedures are revisited at staff meetings. Bramley Avenue (73) DS0000015150.V269348.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): 22,23 The home has adequate systems in place for the protection of the residents. EVIDENCE: No complaints have been received about this service either to the home or the CSCI. The complaints procedure, including a self-addressed envelope is kept in resident’s bedrooms. The protection of vulnerable adults is covered as part of all staffs’ induction and the manager has attended a three-day course. Training should be updated annually. No polices and procedures were inspected on this occasion. Granta has good staff recruitment and selection procedures. Bramley Avenue (73) DS0000015150.V269348.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): 24,25,26,27,28,29,30 The home provides a comfortable, relaxing environment for residents. EVIDENCE: The manager confirmed that the fire officer had undertaken a recent visit and the CSCI should have had a copy of this report. A tour of the home was undertaken and no immediate hazards were identified. The house is fit purpose for the current residents. There is wheelchair access and rooms are sufficiently large to allow for safe moving and handling of residents, although bedrooms fall slightly short of the minimum recommended size. Good use of the space has been made and bedrooms are highly individualised and decorated in a creative, thoughtful way. Two bedrooms have overhead tracking. The communal areas are equally stimulating with a large fish tank in the living room and a waterbed. Doors open out on to a fully enclosed garden, which is designed in a way to make it stimulating and relaxing. It has a patio area as well as a multi sensory workshop. The home has a separate laundry area, which was being refurbished on the day of inspection and a large kitchen /diner. Bramley Avenue (73) DS0000015150.V269348.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 The home has thorough staff recruitment and selection procedures and the organisation provide good support and training to its staff. EVIDENCE: The home has a large staff team and is currently has three full time vacancies, which are being covered by regular agency and bank staff. The manager ensures that all staff are properly vetted and less experienced staff appropriately supervised. Because of the nature of the job bank and agency staff are not permitted to peg feed or administer medication. The rota showed that there are four staff on in the morning, three in the afternoon, with some cross over. The manager’s hours are mainly supernumerary. At night there is one waking night staff, who is supported by another member of staff sleeping in. The manager confirmed that all staff complete an induction and all the mandatory training is up to date. One member of staff has just finished a foundation course in learning disabilities and is going on to do NVQ 2. Another member of staff is doing NVQ 2. One senior is just finishing level 3 and the other senior has level 2. All other permanent members of staff have an NVQ qualification. The manager has completed the Registered Managers award and levels 3 and 4 NVQ. More specialist training completed by staff includes resuscitation, peg feeding, stesolid training, and a total communication course, which is being offered to all new staff. Bramley Avenue (73) DS0000015150.V269348.R01.S.doc Version 5.0 Page 17 Two staff files were inspected and provided evidence of all the necessary pre requisite checks including, a fully completed application form, CRB and POVA clearance before employment, photographs, Health clearance, personal identification and evidence of valid MOT/ certificate of insurance, as staff escort residents, for which they undertake a specialised driving course. New staffs’ appointment is subject to the necessary checks and a six- week induction. The probationary period is six months. Staff’s knowledge is periodically tested through quizzes and questionnaires. Regular staff meetings and supervisions either every month or two monthly are held. Annual appraisals are also conducted. Bramley Avenue (73) DS0000015150.V269348.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41 The home is well run and is done so in the interests of residents. EVIDENCE: The manager is suitably qualified and experienced. She keeps herself professionally up to date and receives regular support and supervision from her line manager. She has good systems of support in place for care staff thought regular supervision, team meetings and annual appraisals. Granta had good staff training opportunities and hold annual conferences. At the last conference Granta celebrated culture and diversity and were asked to design masks celebrating the uniqueness and personality of individual residents. The service has an established quality assurance system, which looks at different aspects of care provision. The last one looked at service user involvement and mainly involved care staff sitting down with residents trying to establish their views on different things. This was done in consultation with relatives. A copy of the report must be made available to the CSCI. Bramley Avenue (73) DS0000015150.V269348.R01.S.doc Version 5.0 Page 19 The line manager regularly audits the service to ensure that it is meeting the set standards and a copy of the report is forwarded to the CSCI. A number of resident’s finances were audited and found to be correct. Resident’s monies are externally audited and checked by the line manager as part of their monthly audit. A number of records were inspected including, residents medication records, finances, menus, residents review, 2 staff files and induction standards for new staff. These were all satisfactory. The regulation 37 forms and the pre inspection questionnaire returned before the inspection also provided information of how the home were meeting the national minimum standards. Bramley Avenue (73) DS0000015150.V269348.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 X 4 X x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 4 3 X x Standard No 24 25 26 27 28 29 30 STAFFING Score 4 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 4 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bramley Avenue (73) Score x 4 3 X Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 3 X x DS0000015150.V269348.R01.S.doc Version 5.0 Page 21 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 YA39 Regulation 24 (2) Requirement The registered person must supply the Commission with a copy of any review conducted with regards to improving the quality of care given to residents. Timescale for action 28/02/06 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 Bramley Avenue (73) DS0000015150.V269348.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE 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 Bramley Avenue (73) DS0000015150.V269348.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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