Inspection on 07/02/06 for Bramley Gardens

This inspection was carried out on 7th February 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bramley Gardens 18/04/07

Bramley Gardens 20/06/05

Bramley Gardens 08/02/05

Bramley Gardens 13/07/04

Bramley Gardens 10/02/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Snydale Care Home

Whitwood House

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

CARE HOME ADULTS 18-65 Bramley Gardens Skelton Lane Leeds West Yorkshire LS14 1AE Lead Inspector Sue Dunn Announced Inspection 7th February 2006 10:40 Bramley Gardens DS0000001426.V273554.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 Gardens DS0000001426.V273554.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 Gardens DS0000001426.V273554.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bramley Gardens Address Skelton Lane Leeds West Yorkshire LS14 1AE 0113 273 3771 0113 2323872 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) Home Farm Trust Mrs Sandra Farrell Care Home 34 Category(ies) of Learning disability (30), Physical disability (4) registration, with number of places Bramley Gardens DS0000001426.V273554.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th June 2005 Brief Description of the Service: The home is made up of a collection of two storey houses, some divided into flats which are clustered together on the same rural site on the outskirts of Leeds. The properties are built around a secure central courtyard. The nearest amenities are a short walk away and a half hourly bus service into the city centre and Wetherby passes the front entrance. The home has an overall scheme manager and a registered manager. A group of team leaders take direct responsibility for the houses. A manager of day services coordinates services within and beyond the home. There is a wide and varied programme of social, educational and recreational activities. Service users are encouraged to make choices and decisions about how they conduct their own lives and receive the support which enables them to be involved in all aspects of daily living. Bramley Gardens DS0000001426.V273554.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on an announced inspection, which was carried out by one inspector between 10.40am and 18.30pm. The purpose of the inspection was to ensure the home was operating and being managed in the best interests of the residents. During the inspection all the houses were visited, the scheme manager, the registered manager and the chief executive were spoken with. There was a good response from service users and relatives who completed and returned comment cards sent out before the inspection. Two team leaders and several residents and staff were spoken with, three care files and a selection of records was inspected. The home relies on the support of health care professionals in their care of service users. At the time of the inspection the conflicting needs of the service users in one house was having an adverse effect on the whole group. The manager and staff were trying to manage a situation in which medical decisions were beyond their control. There has been a satisfactory response from the mental health team since the inspection. What the service does well: What has improved since the last inspection? The home has a full staff complement of team leaders and has reached its target of 50 staff with the NVQ award. Bramley Gardens DS0000001426.V273554.R01.S.doc Version 5.0 Page 6 Service users had made efforts to prepare their homes for the inspectors visit and were proud of the results. Staff in one house were aware of concerns about weekend activities and were having an away day to look how they could plan suitable activities for the weekends. The system for monitoring and checking residents finances has been reviewed and tightened up. 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 Gardens DS0000001426.V273554.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 Gardens DS0000001426.V273554.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): 1,2,4,5 Service users or relatives are provided with information to enable them to make an informed choice about the home. Relatives should be made aware that the home’s inspection reports can be found on the internet. EVIDENCE: The Homes Statement of Purpose and Service user guide has been reviewed and updated. Readers are informed that a copy of the inspection report can be requested from the main office. Some of the people who returned comment cards were not aware of this and may benefit from knowing that they can access the report on the CSCI website once it becomes a public document. Files included a copy of the contract stating terms and conditions in pictorial format. Bramley Gardens DS0000001426.V273554.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): 6,7,8,9,10 The inspector was satisfied that overall residents’ health and social care needs were met. Care plans which residents had been involved in provided clear and detailed instructions for staff to follow. The manager and staff were doing what they could to get a satisfactory level of support to meet the needs of residents in one of the houses. However the decisions to resolve this were beyond their control. Residents were treated with respect and their privacy was upheld. Staff had a good understanding of each persons’ preferences. EVIDENCE: Five care files were inspected. The files were orderly and laid out in a consistent way which made information easy to find. One file gave detailed information about the person’s daily routines, strengths and the support he would need. There was an action plan for meeting his health needs and evidence that assessments relating to specific health care needs had been carried out by other professionals. Risk assessments had recently been reviewed and signed by staff to show they had been read. However, the risk management plan arising from the assessment was not immediately apparent because of the way it was stored in the file. Some staff had not recorded in the Bramley Gardens DS0000001426.V273554.R01.S.doc Version 5.0 Page 10 daily logs what they had done to provide support or to make reference to the progress of the care plans. This is a training and supervision issue An intensive amount of work had been done by the staff and other professionals for a person who was displaying challenging behaviour which was affecting other people in the same house. The frequent incidents and the factors leading up to them were recorded. Areas of risk had been assessed but these were generalised and should have been developed further to show how specific risks to other service users in the house were managed. Staff were able to describe what they did to protect other people in the house but this placed staff at risk of assault and was not recorded as an agreed strategy. A health and safety sheet in another persons file was undated and did not make reference to the situation current in the home. The Mental Health team were reviewing medication and had introduced a behavioural strategy for staff to follow. (A copy of this was on file but undated). The staff had concerns that the unpredictability of the situation and the ineffectiveness of the behavioural plan was placing everyone in the house at risk. The manager was concerned that the home was not meeting the needs of anyone in the house, families of other residents were worried and complaining and she felt she was ‘banging her head against a brick wall’ to get the professional support needed to try to resolve the situation. Service users in the other houses were leading fulfilling lives based on their aspirations. Two young people had moved into their own flats on the site which they had been helped to prepare to their own preferences. Both had increased in confidence and were making good progress. It was apparent from talking to residents and reading care files that people got the support they needed to make choices and decisions about their lives. Bramley Gardens DS0000001426.V273554.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 are encouraged to participate in social and leisure activities, to maintain links with their friends and family and to exercise choice and control over their lives. Some residents rely on staff in order to help them do this but there was evidence that this had been affected by shortfalls in communication within staff teams. There should be evidence of the range of leisure options which people who remain at home at the weekends can choose from. Staff have recognised this as an area which needs developing. EVIDENCE: Each resident has an individually planned programme of activities which includes educational, social and recreational opportunities. One person was planning a holiday with a group of friends. Three of the people spoken with had part time jobs in the local community. Some people go to relatives at the weekend. It was not clear in the care plans or diaries seen how the home offers a balanced choice at weekends between relaxation and leisure. Several relatives felt that they would like to see ‘more activity’ at the weekends and thought that the use of ‘agency’ staff and the lack of senior Bramley Gardens DS0000001426.V273554.R01.S.doc Version 5.0 Page 12 managers on site at weekends affected this. A group of staff in one house were looking at ways of improving planning for the weekends. Systems are in place for key-working staff to make routine monthly contact with families but there was evidence that this is being overlooked. Staff should be sensitive to the fact that contact is important for any parent of children at whatever age. Examples were given of messages not being passed on to residents and between staff so people were out when visitors called. If residents choose to go out their visitors should be contacted as a matter of courtesy. Relatives spoke of difficulties contacting people on the house telephones out of office hours. It is appreciated that residents lead busy lives and may benefit from the installation of an answer phone machine in their houses. The main meal of the day is served in the evening. Residents are assisted by staff to shop and cook. People in two of the houses had signed up to a healthy eating programme. The manager stated she monitors the food receipts to ensure fresh fruit and vegetables are purchased. Bramley Gardens DS0000001426.V273554.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): 18,19 Health care needs are identified and monitored. The home is able to meet the health and personal care needs of the majority of service users and works in cooperation with other health professionals. The home however has recently been expected to continue to provide care beyond their remit due to a shortage of hospital beds. This has affected the quality of life for other residents and increased stress within the staff team. EVIDENCE: It was evident that staff monitor the physical and mental health of residents who get support from other health professionals. Limited resources within the health services has been a recent matter for concern because of the affect this has had on the quality of life for a small group of people in the home. The manager had been doing what was in her control to get the help needed from other professionals. The matter had been resolved at the time of writing and efforts were being made to help other residents return to a more relaxed routine. Bramley Gardens DS0000001426.V273554.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 a detailed complaints and adult protection procedure which is robust and protects service users. Staff are aware of and protected by the whistle blowing policy. EVIDENCE: Several relatives stated on their comment cards that they were satisfied with the way any complaints had been dealt with. Care files showed that residents were able to express their views and the home took action to deal with their complaints. For example, one person had complained about having to overlook the refuse bins and arrangements had been made to screen the bins. The home has a good record of dealing speedily and appropriately with any allegation of abuse and notifying the CSCI of any events which affect the well being of residents. An investigation into a recent allegation is currently ongoing. Bramley Gardens DS0000001426.V273554.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): 24,29,30 The home offers a clean, safe, environment for the residents and provides appropriate specialist equipment. Systems are in place for the upkeep and maintenance of the building EVIDENCE: All the houses were visited as the staff and residents had made a great effort to show their homes in a good light and were proud of their efforts. The upkeep and maintenance in each of the houses is ongoing and the houses were clean and hygienic. The manager reported that there had been a build up of the list of repair work during a period of absence by the maintenance person. The work to repair damage caused by flooding in house 2 over the Christmas period was almost completed. Care files showed records that staff carried out routine safety checks on bed rails. Bramley Gardens DS0000001426.V273554.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): 31,32,33,36 The staff training and supervision programme aims to ensure staff are trained to be able to understand and meet the needs of the service users within the remit of the home. This should include the importance of maintaining contact with families. The staff and manager were aware that they were currently not equipped to meet the needs of the residents in one of the houses. Action was being taken to try to support staff. EVIDENCE: The home currently has a full team of 5 team leaders and one team leader for day services. Each has management responsibility for the operation of groups of houses and reports to Sandra Farrell the overall registered manager. The senior staff spoken with were knowledgeable about the needs of residents in their care and keen to do a good job. However the stress levels were apparent in the staff team in one of the houses who feared for their safety and that of residents in the house for reasons mentioned earlier in the report. The staff team in one of the houses was having an away day on the day of the inspection to look specifically at forward planning for events at weekends. The Manager and staff have worked hard to achieve the target of 50 of care staff with the NVQ award and have an ongoing programme to maintain competency levels. Bramley Gardens DS0000001426.V273554.R01.S.doc Version 5.0 Page 17 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): 37,38,39,40,41,42,43 The home is well managed and the manager is well able to discharge her responsibilities. She offers good leadership to the staff and ensures the residents are protected and cared for in a correct manner. EVIDENCE: The home is managed in the interests of residents but inevitable changes of the staff in a home of this size can lead to breakdown in communication. Reviews of care plans and the use of advocates if required ensure that residents are able to comment on the service they receive. The home has clear policies and procedures for the protection of residents which have been seen to be followed. The system for monitoring residents personal finances has recently been reviewed and tightened up. Regular and routine health and safety checks are carried out and recorded. The safety check records for fire, hoists, electrical installation and personal items of electrical equipment were up to date and in good order. Bramley Gardens DS0000001426.V273554.R01.S.doc Version 5.0 Page 18 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 3 3 x 3 4 Standard No 22 23 Score 4 4 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 4 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x 3 4 LIFESTYLES Standard No Score 11 4 12 3 13 3 14 4 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 4 3 x x 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bramley Gardens Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 4 3 3 3 3 3 DS0000001426.V273554.R01.S.doc Version 5.0 Page 19 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. Standard Regulation Requirement Timescale for action 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 2 3 4 5 6 Refer to Standard YA1 Good Practice Recommendations Relatives should be made aware that they can access the homes inspection reports on the internet YA41YA9,41 The guidance on risk management should be easily accessible in each file YA41YA6, Staff must ensure all documents are dated and signed YA12 The home should introduce more options for weekend activities and stimulation. YA15 The manager should ensure staff support residents in their communication with families YA19 The home should ensure the Statement of Purpose and their registered category of care is made clear to health service staff who have contact with the home to ensure service users receive appropriate support when needed and the home is not operating outside its registration Bramley Gardens DS0000001426.V273554.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Gardens DS0000001426.V273554.R01.S.doc Version 5.0 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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