Inspection on 26/04/04 for Bramshaw House

Care Homes For Adults (18 ­ 65)Bramshaw House13 Shakespeare Road Worthing West Sussex BN11 4ARAnnounced Inspection26th April 2004 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: · Promote improvement in social care · Inspect all social care - for adults and children - in the public, private and voluntary sectors · Publish annual reports to Parliament on the performance of social care and on the state of the social care market · Inspect and assess `Value for Money of council social services · Hold performance statistics on social care · Publish the `star ratings for council social services · Register and inspect services against national standards · Host the Childrens Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of Establishment Bramshaw House Address 13 Shakespeare Road, Worthing, West Sussex, BN11 4AR Email address Tel No: 01903 238945 Fax No:Name of Registered Provider(s)/Company (if applicable) Miss Rebecca Karen Ward Mr Jonathan Shepherd Name of Registered Manager (if applicable) Miss Rebecca Karen Ward Type of Registration Care Home No. of places registered (if applicable) 10Category (ies) of Registration, with (number of places) Learning disability (10), Physical disability (10) Registration Number H110001182 Date first registered 1st December 2003 Was the home registered under the Registered Homes Act 1984 as amended? Do additional conditions of registration apply? Date of last inspectionDate of latest registration certificate 1st December 2003 X X N/A If Yes refer to Part CBramshaw HousePage 1 Date of inspection visit Time of inspection visit Name of inspector Name of inspector Name of inspector 1 2 326th April 2004 8.30 am Ms G MooreyID Code106133Name of inspector 4 Name of specialist (e.g. Interpreter/Signer) (if applicable) Name of establishment representative at the time of inspectionBramshaw HousePage 2 CONTENTSIntroduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspectors Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Inspection Methods & Findings National Minimum Standards for Care Homes for Adults (18 ­ 65) 1. Choice of Home 2. Individual Needs and Choices 3. Lifestyle 4. Personal and Healthcare support 5. Concerns, Complaints and Protection 6. Environment 7. Staffing 8. Conduct and Management of the Home Part C: Part D: D.1. D.2. D.3. Compliance with Conditions (if applicable) Providers Response Providers Comments Action Plan Providers AgreementPart B:Bramshaw HousePage 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the Commission for Social Care Inspection (CSCI) is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000 as amended. This document summarises the inspection findings of the CSCI in respect of Bramshaw House. The inspection findings relate to the National Minimum Standards (NMS) for Care Homes for Adults (18-65) published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum Standards will form the basis for judgements by the CSCI regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the Standards. The report will show the following: · Inspection methods used · Key findings and evidence · Overall ratings in relation to the standards · Compliance with the Regulations · Required actions on the part of the provider · Recommended good practice · Summary of the findings · Providers response and proposed action plan to address findings This report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000. The following inspection methods have been used in the production of this report. The report is based on the findings of the specified inspection dates.Bramshaw HousePage 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED. Bramshaw House offers a home to ten adults with physical and learning disabilities aged between 18-60 years old. There are currently three service users within the home, the other vacant placements have been filled and new service users are due to begin their placements over the up coming months. The service is based in a detached house in Worthing it has been adapted to meet the needs of the service user group. The home is in a residential area and is situated within five minutes of the town centre and sea front. There are local amenities such as shops, swimming pools, cinema, pubs and restaurants. The home offers the service users a full lifestyle and enables each person to live their life to their maximum potential. The homes registered provider is Rebecca Ward who is also managing the home at the present time.Bramshaw HousePage 5 PART ASUMMARY OF INSPECTION FINDINGSInspectors Summary (This is an overview of the inspectors findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.) Bramshaw house is a new service that opened in December 03 it currently has three service users who were all fully assessed before being accepted for a placement within the home, this was evident from the service users files. The home has worked hard in implementing working practices, policies, procedures and guidance that comply with the National Minimum Standards for Younger Adults. The service has all of the required policies and procedures, and meet the Health and Safety needs for the home. The service operates a full assessment process and the service users files are clear, well ordered and organised, containing the relevant information and care plans which are reviewed on a monthly basis. They currently have eleven staff and are still recruiting in light of the increasing number of service users. The staff team have various levels of experience and qualifications and the home will review the number of staff on the rota when service users numbers and needs change. The home does need to pursue required records for staff and hold copies of these on file. The home does need to review some of its policies to add required areas for the procedure to fully meet the standard. The home could in the future consider looking at introducing appropriate formats for documents relating to the service users as the group changes and needs differ. The home needs to implement the Regulation 26 reports and send them to the Commission for Social Care Inspection. The following information is a summary of the inspection report: Choice of Home, Standards 1-5. ST1=3 ST2=3 ST3=3 ST4=3 ST5=3. Individual Needs and Choice, Standards 6-10. ST6=3 ST7=3 ST8=3 ST9=3 ST10=3. Lifestyle, Standards 11-17. ST=113 ST12=3 ST13=3 ST14=3 ST15=3 ST16=3 ST17=3. Personal and Healthcare Support, Standards 18-21. ST18=3 ST19=3 ST20=2 ST21=3. Concerns, Complaints and Protection, Standards 22-23. ST22=3 ST23=3. Bramshaw House Page 6 Environment, Standards 24-30. ST24=3 ST25=3 ST26=3 ST27=3 ST28=3 ST29=3 ST30=3. Staffing, Standards 31-36. ST31=3 ST32=3 ST33=3 ST34=2 ST35=3 ST36=3. Conduct and Management of the Home, Standards. ST37=3 ST38=3 ST39=2 ST40=3 ST41=3 ST42=3 ST43=3. Overall the home received the following: No scorings of one, Three scorings of two and Forty scorings of three.Bramshaw HousePage 7 Requirements from last Inspection visit fully actioned? If No please list belowNASTATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report which indicate a non-compliance with the Care Standards Act 2000 and accompanying Regulations. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard Required actions Timescale for actionAction is being taken by the Commission for Social Care Inspection to ensure compliance in regard to the above requirements. RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented No. Refer to Good Practice Recommendations StandardCONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS).MET (YES/NO)Bramshaw HousePage 8 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001, and the National Minimum Standards. The Registered Provider(s) is/are required to comply within the given time scales. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard * Requirement Timescale for action 1 26 The home needs to implement the Regulation 26 inspection visits and reports that will be undertaken by an appropriate person. 31st May 04.RECOMMENDATIONS Identified below are areas addressed in the main body of the report which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s). The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Refer to Good Practice Recommendations Standard * 1 2 3 1,5,8,10 ST9 ST 20,21 The home needs to consider the use and implementation of appropriate documents related to the service users. The home needs to review its current risk assessments and update them to cover a range of situations within the service. The home to ensure that policies and procedures cover all aspect the are mentioned within the standards.Bramshaw HousePage 9 4ST34The registered manager of the home needs to ensure that full staff records are held for all members of the staff team.* Note: You may refer to the relevant standard in the remainder of the report by omitting the 2-letter prefix e.g. YA10 refers to Standard 10.PART BINSPECTION METHODS & FINDINGSThe following inspection methods have been used in the production of this report Direct observation Indirect observation Sampling · Pre-inspection questionnaire · Records · Care plans / Care pathways · Meals · Activities · Other enter details here `Tracking care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Service user survey Relatives/significant others survey/feedback Visiting professionals survey / feedback Tour of premises Formal interviews Document reading Additional inspection information: Number of service users spoken to at time of inspection Number of relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the responsible individual seen CRB check for the manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total No. of care staff employed (excluding managers) Total No. of staff with nursing qualifications employed Date of inspection Time of inspection Bramshaw House YES YES YES NO NO NO NO NA YES NO NO NO YES YES NO NO NO YES YES YES 2 0 0 YES YES YES YES 11 0 26/04/04 8.30AM Page 10 Duration of inspection (hrs)9The following pages summarise the key findings and evidence from this inspection, together with the CSCI assessment of the extent to which the National Minimum Standards for Adults (18-65) have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met (Commendable) (No Shortfalls) (Minor Shortfalls) (Major Shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable.Bramshaw HousePage 11 Choice of HomeThe intended outcomes for the following set of standards are: · · · · · Prospective service users have the information they need to make an informed choice about where to live. Prospective service users individual aspirations and needs are assessed. Prospective service users know that the home they 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.Standard 1 (1.1 ­ 1.4) The registered person produces an up to date statement of purpose setting out the aims, objectives and philosophy of the home, its services and facilities and terms and conditions; and provides each service user with a service users guide to the home. The statement of purpose should clearly set out the physical environmental standards met by the home in relation to standards 24.2, 24.9, 25.3, 25.5, 27.2, 27.4 and 28.2; and a summary of this information should appear in the service users guide. 1050,00 X Range of fees charged From To £ £ (per week) YES Any charges for extras If yes, please state what the extras are Key findings/Evidence Hairdressing, Personal items, Individual services such as Chiropodist. 3 Standard met?The Statement of Purpose meets and covers this Standard and all the requirements made in Schedule 3, the home as a new service needs to update the Statement i.e. staff employed as the service progresses. The home is working within the ethos set out by the document. The home has a Service Users Guide that has recently been updated to contain the contract each service users retains a copy. The guide is currently only produced in written word the home feed the details of the document to the service user on an individual basis using their preferred term of communication. The inspector suggested that the home would possibly want to use a more appropriate format so that it is generally more accessible.Bramshaw HousePage 12 Standard 2 (2.1 ­ 2.8) New service users are admitted only on the basis of a full assessment undertaken by people competent to do so, involving the prospective service user, using an appropriate communication method and with an independent advocate as appropriate. 3 Key findings/Evidence Standard met? All three of the current service users have been fully assessed and have had a planned move into the home. There are comprehensive assessments from Social Services and the home has undertaken its own assessments, to produce a full care plan. Currently the home does not have any self-funding service users and all placements have been assessed by the Care Managers, families and advocates as being appropriate for the service users. The home has a comprehensive policy in place for the process of the referrals and admissions procedure. Standard 3 (3.1 - 3.10) The registered person can demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 3 Key findings/Evidence Standard met? The home has made contact with and used the Community Team, Physiotherapy, Speech and Language Therapy and sort guidance on working with sexuality. The manager has said that the home will look into possible communication training, currently the home has two service users who can verbally communicate and one service user who is blind and does not have full verbal communication, the staff are able to understand the service user as he has his own way of communicating, the staff have learnt to pick up the individual signs through developing the relationship with the service user. The staff employed at the home have varied levels of experience in the work they undertake with the service users. The home is dedicated to having a skilled staff team and has and is implementing a full training programme. The home has all the relevant policies and procedures in order to protect the rights and safety of the service users in the home. One of the service users has an advocate and two other groups have been identified locally and are going to provide the advocates if needed. The home has a full assessment process in place and would refuse service users to whom they could not give a comprehensive service. The home only offers long-term placements.Bramshaw HousePage 13 Standard 4 (4.1 - 4.5) The registered manager invites prospective service users to visit the home on an introductory basis before making a decision to move there, and unplanned admissions are avoided wherever possible. 3 Key findings/Evidence Standard met? All of the service users have had planned moves to the home. The placements offered are assessed after 4-6 weeks and then at the end of three months, during this period the care plan will be individually designed for each service user based on their care needs. The care plans are reviewed on a monthly basis. Each move into the home is planned individually and can vary in visits and overnight stays. Service users are encouraged to select colours and decoration for their rooms and can move small possessions in gradually in terms of giving a sense of ownership. The home has a policy stating that they do not offer emergency placements.Standard 5 (5.1 - 5.5) The registered manager develops and agrees with each prospective service user a written and costed contract/statement of terms and conditions between the home and the service user. 3 Key findings/Evidence Standard met? The service users receive a contract that covers all the required points in 5.2, it is now contained within the service users guide. One of the service users had an advocate who helped them understand and sign the contract. Families of other service users were part of their process. The contract is currently not available in any other format than written word, the inspector advise the service to review the use of other appropriate forms for the document. The home has guidance in place for the discharge, termination and discharge at short notice of placements.Bramshaw HousePage 14 Individual Needs and ChoicesThe intended outcomes for the following set of standards are: · · · · · 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.Standard 6 (6.1 ­ 6.10) The registered manager develops and agrees with each service user an individual Plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations and achieve goals. 3 Key findings/Evidence Standard met? The care plan are full and comprehensive covering all aspects of the service users lives, the plans are formulated from assessments and information given to the home by the professionals and families involved with the service user. The service users are also involved with the care plans. The plans identify any risk and the restrictions on choice and freedom in order to protect and keep the service users safe. The home has a key worker system in place, the key workers work with the service users to review and implement the care plans. The home has a policy in place for the Planning and Individual Work.Bramshaw HousePage 15 Standard 7 (7.1 ­ 7.7) Staff respect service users right to make decisions, and that right is limited only through the assessment process, involving the service user, and as recorded in the individual Service User Plan. 3 Key findings/Evidence Standard met? The assessment process and care plans identify any needed restrictions, these are explained to the service users and decisions taken are done so with full discussion. These plans are reviewed on a monthly basis. The service has identified local community services such as advocacy and a local social group. The home holds monthly meetings for the service users where decisions can be made about activities, menus and group issues. All finances are currently undertaken by the service users families, a person within the organisation would be appointed if it became necessary.Standard 8 (8.1 ­ 8.5) The registered manager ensures that service users are offered opportunities to participate in the day to day running of the home and to contribute to the development and review of policies, procedures and services. 3 Key findings/Evidence Standard met? The service users are consulted on issues such as the environment, menus and activities, these are discussed on an individual basis and at group meetings. The home to date has not implemented a quality assurance survey but a questionnaire is in place for the service users, this is due to the service only having been open for four months. The home is a new service, however it has already updated the Service Users Guide to contain the contract. Standard 9 (9.1 ­ 9.4) Staff enable service users to take responsible risks, ensuring they have good information on which to base decisions, within the context of the service users individual Plan and of the homes risk assessment and risk management strategies. 3 Key findings/Evidence Standard met? All the risk assessment are kept upon the service users files and identified in their care plans. Action is taken to minimize any risks identified in the plans. Independence training is undertaken in the home. The home has a policy on Risk Assessment and Management Procedure. There is also guidance in place on Health and Safety for the service. A policy with guidance is in place for procedures to take if a service user goes missing, incidents will be recorded when and where they happen.Bramshaw HousePage 16 Standard 10 (10.1 ­ 10.6). Staff respect information given by service users in confidence, and handle information about service users in accordance with the homes written policies and procedures and the Data Protection Act 1998, and in the best interests of the service user. 3 Key findings/Evidence Standard met? All staff receive training on confidentiality in their induction period. The home has policies on both record keeping, access to files, confidentiality and disclosure of information. The service users are spoken to about the issue of confidentiality, and also it is explained that maybe not all information can be kept on a one to one basis. There is a policy in place and agencies are verbally informed of this.Bramshaw HousePage 17 LifestyleThe intended outcomes for the following set of standards are: · · · · · · · 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.Standard 11 (11.1 ­ 11.4) Staff enable service users to have opportunities to maintain and develop social, emotional, communication and independent living skills. 3 Key findings/Evidence Standard met? The home offers the service users daily opportunities to undertake practical life skills, the service has an ethos of the service users being responsible for their own care to whatever extent that it is possible. None of the services users at the present time attend any religious meetings but if new service users wanted to the home would accommodate their wishes.Standard 12 (12.1 ­ 12.6) Staff help service users to find and keep appropriate jobs, continue their education or training, and / or take part in valued and fulfilling activities. 3 Key findings/Evidence Standard met? Service users are offered the opportunity to be referred for a work programme or college courses if applicable on an individual basis. The use of day centres will also be implemented, as would any courses if assessed to be appropriate for the service users. Both service users are supported with their money and benefits, each have an individual plan.Bramshaw HousePage 18 Standard 13 (13.1 ­ 13.5) Staff support service users to become part of, and participate in, the local community in accordance with assessed needs and the individual Plans. 3 Key findings/Evidence Standard met? The home will implement and use many of the local amenities. The home has already identified a local social group and gym. The home is well placed within the local community to access restaurants, pubs and cinemas. All staff are given a copy of the Disability Discrimination Act 1995. The home has two vehicles that are adapted for all of the service users needs. The service users have not undertaken their right to vote due to the service being new but this will be arranged in the future. The home has an equal opportunities policy for both staff and services users. Standard 14 (14.1 ­ 14.6) Staff ensure that service users have access to, and choose from a range of, appropriate leisure activities. 3 Key findings/Evidence Standard met? The service users are supported in their choice of activity. They have a regular choice of appropriate videos. Individual holidays will be organised for this year and are part of the fees paid to the home. Both group trips and individual trips are undertaken, mainly outside instructors are used for these but some of the staff can take activities.Standard 15 (15.1 ­ 15.5) Staff support service users to maintain family links and friendships inside and outside the home, subject to restrictions agreed in the individual Plan and Contract (subject to standards 2 and 6 if necessary). 3 Key findings/Evidence Standard met? Both service users have regular contact with their families, visits are arranged whenever required. Limitations on contact are made only when identified by the service users care manager. The home does have a policy in place for the visiting of family and friends. The service users at the moment are able to meet other people through activities. This will be increased as service users attend more regular activities such as college and day centres. A policy is in place for guidance in relation to sexuality and intimate relationships. Specialist support would be sort if required.Bramshaw HousePage 19 Standard 16 (16.1 ­ 16.11) The daily routines and house rules promote independence, individual choice and freedom of movement, subject to restrictions agreed in the individual Plan and Contract (subject to Standards 2 and 6 if necessary). 3 Key findings/Evidence Standard met? Daily routines are geared towards the needs of the service user. The residents do have tasks and undertake them with support. This is not in the service users guide as the approach is based on an individual basis. Privacy is respected within the appropriate bounds set by the service users needs. The service users are talked and listened to by the staff this was seen by the inspector and service users can choose to spend time alone but this is monitored due to some of the assessed behaviour displayed by the service users. The service users are able to keep small pets and there is a policy in place for guidance in relation to caring and any health and safety issues this may raise. A smoking/alcohol policy is in place for both staff and service users. Standard 17 (17.1 ­ 17.9) The registered person promotes service users health and wellbeing by ensuring the supply of nutritious, varied, balanced and attractively presented meals in a congenial setting and at flexible times. 3 Key findings/Evidence Standard met? The menus are based on a four- week rota that has been selected by the service users. The range of food does offer a wide range choice and are set to offer a healthy diet. Snacks and drinks are available all day. The staff prepare and provide all the meals and undergo training in order to offer a comprehensive service. The service users also cook in the kitchen and one of the service users has his food hygiene certificate, all activities in the kitchen are risked assessed. Any special diets would be provided and eating habits are monitored within the health care plans. The home has a policy on food safety and nutrition.Bramshaw HousePage 20 Personal and Healthcare SupportThe intended outcomes for the following set of standards are: · · · · 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 homes 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.Standard 18 (18.1 ­ 18.11) Staff provide sensitive and flexible personal support and nursing care to maximise service users privacy, dignity, independence and control over their lives. 3 Key findings/Evidence Standard met? There is clear guidance for each service users healthcare and any needs are included on the care plans. The home has a policy for the moving and handling of service users, also in place is guidance for the use of wheelchairs, frames and hoists. The training for staff including guidance for use of equipment is part of the induction process. Service users can have a choice of staff were possible including a same sex carer. Bedtimes and getting up times are variable according to the choice of the service user. This could change in the future with the routines of the service being altered for daily activities. Service users are encouraged to be as independent including choice of image and personal care products used. There are policies in place to cover all aspects of health for the service users. A key working system has recently been introduced into the unit this has been backed up by a policy that is in place for this individual home. Any specialist service required for the service users are referred for and supported by the home.Bramshaw HousePage 21 Standard 19 (19.1 ­ 19.5) The registered person ensures that the healthcare needs of service users are assessed and recognised and that procedures are in place to address them. No. of incidents where service users have been taken to Accident & Emergency during last 12 months No. of service users with pressure sores at the time of inspection (from information taken from care notes) 003 Key findings/Evidence Standard met? Both the service users are now registered with a local doctors surgery and have a general health check as part of this process. Health care information is kept within the service users files. A section of this tracks appointments and other services used. Service users are supported in their appointments by the staff. Appointments are undertaken at the local surgery.Standard 20 (20.1 ­ 20.14) The registered manager and staff encourage and support service users to retain, administer and control their own medication, within a risk management framework, and comply with the homes policy and procedure for the receipt, recording, storage, handling, administration and disposal of medicines. 2 Key findings/Evidence Standard met? The service users need full support with their medication. The medication given is recorded in the care file and on the daily sheets. The home uses the MARS recording system and the medication is distributed from the bliss packaging. Records are kept of all the medicines being taken into the home or out going are recorded on separate sheets in a medical file. The staff receive comprehensive training on all medical issues from the local chemist. A pharmacist offers advice to the service. The home does need to ensure that a risk assessment is undertaken if staff accompanying service users on trips with epilepsy who have been prescribed rectal diazepam. The service needs ensure that all staff does undertake such specific training. The medication is kept in the sleeping in room in a lockable cupboard. The service users have separate boxes for individual medicines. Any household medication used is also recorded. The home has fully comprehensive policies in place for its use of medication, these do not include guidance highlighting the procedure of what to do if someone dies and they are on medication.Bramshaw HousePage 22 Standard 21 (21.1 ­ 21.8) The registered manager and staff deal with the ageing, illness and death of a service user with sensitivity and respect. 3 Key findings/Evidence Standard met? The home has a full comprehensive policy on dying and ageing. The service users opinions on their wishes if they were to die are not recorded within the files; at the present time the service users are quite young. If in the event of a death in the home or within the service users families, carers and friends the home would seek help from the community team in terms of bereavement counselling and support groups.Bramshaw HousePage 23 Concerns, Complaints and ProtectionThe intended outcomes for the following set of standards are: · · Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm.Standard 22 (22.1 ­ 22.7) The registered person ensures that there is a clear and effective complaints procedure, which includes the stages of, and timescales for, the process and that service users know how and to whom to complain. No. of complaints made to the home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to CSCI Percentage of complaints responded to within 28 days 0 0 0 0 0 0 0 3 Key findings/Evidence Standard met? The home has a complete and full policy on complaints, the procedure for complaining is included in both the Statement of Purpose and the Service Users Guide. Service users are able to speak to all of the staff and the manager. The home was seen to have an open door policy on the day of the inspection. There are advocate services in place for the service users and families would be involved if required. There is a system in place to record and track any complaints that happen. The manager is monitoring a situation with one of the service users families as although they have not lodged a complaint there have been issues raised about the care of their son.Bramshaw HousePage 24 Standard 23 (23.1 ­ 23. 6) The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self-harm, or inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policy. The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the DOH Guidance No Secrets No of staff referred for inclusion on POCA/POVA lists YES03 Key findings/Evidence Standard met? The home has its own policies and procedures to be followed in any allegations of Adult Protection. The home also has a copy of the West Sussex Adult Protection Guidance. An incident file is in place for any recording of any incidents in conjunction with Adult Protection. The home does have a policy in place in regard to aggression towards staff, there is also guidance for the use of physical intervention this includes the use of sanctions. The home clearly states that physical restraint is not used within the home and guidance given says that the police would be used if a situation occurred where violent abuse could happen. Staff are trained for dealing with challenging behaviour. Policies are in place for the service users money and details are kept on the files. Service users have a box in the office for general money and recording system in place when money is entered or withdrawn.Bramshaw HousePage 25 EnvironmentThe intended outcomes for the following set of standards are: · · · · · · · 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.Standard 24 (24.1 ­ 24.13) The homes premises are suitable for its stated purpose; accessible, safe and well maintained; meet service users individual and collective needs in a comfortable and homely way; and have been designed with reference to relevant guidance. 3 Key findings/Evidence Standard met? The home is suitable for its stated purpose. The home has room for ten service users it is set in a residential area. The home has a good-sized enclosed garden at the rear of the house, it has a lawn and patio area it is accessible to all the service users. The home is clean, appropriately decorated and well furnished; it is accessible to all the service users. The service does accommodate people with physical disabilities and is appropriately designed and equipped for this purpose, the bedrooms upstairs are accessed by the lift that has been fully serviced. The home is central to the local amenities in Worthing. The home does not have or offers any short-term placements.Bramshaw HousePage 26 Standard 25 (25.1 ­ 25. 11) The registered person provides each service user with a bedroom, which has useable floor space sufficient to meet individual needs and lifestyles. Total no. of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing homes only (1st April 2003) ­ single bedrooms below 10 sq.m usable space or additional compensatory space Total no. of wheelchair users accommodated for in rooms at least 12 sq.m Total no. of wheelchair users accommodated for in rooms less than 12 sq.m Total no. of shared rooms at least 16 sq.m Total no. of shared rooms below 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total no. of single bedrooms Number of single bedrooms with en suite Total no. of double bedrooms Number of double rooms with en suite YES NO NO 10 10 0 0 3 0 010 10 0 0Key findings/Evidence Standard met? All the bedrooms meet the required standard, all of the rooms are en-suite. There are no shared bedrooms in the home.Bramshaw HousePage 27 Standard 26 (26.1 ­ 26.4) The registered person provides each service user with a bedroom that has furniture and fittings sufficient and suitable to meet individual needs and lifestyles. 3 Key findings/Evidence Standard met? The service users bedrooms are furnished to a high standard and meet the requirements of this standard. Some rooms have hospital beds in due to the assessed needs of the service users. The rooms are decorated in consultation with the service user before they move into the home. It was evident to the inspector that service users can bring their possessions to the home and they are provided with a lockable space. All of the bedrooms have locks and the service users are able to have keys. Standard 27 (27.1 ­ 27.6) The registered person provides service users with toilet and bathroom facilities which meet their assessed needs and offer sufficient personal privacy. 3 Key findings/Evidence Standard met? The home meets the requirement for this standard on its numbers of bathrooms and toilet facilities. The bathrooms and toilets are well decorated and in good order. The bathrooms are all appropriately adapted for the service users who have specific care needs due to their physical disabilities.Standard 28 (28.1 ­ 28.3) A range of comfortable, safe and fully accessible shared spaces is provided both for shared activities and for private use. 3 Key findings/Evidence Standard met? The garden is in proportion to the house and has both a lawn and paved area and is accessible to all the service users. The lounge and communal space are well furnished and decorated at the present time and are more than adequate to accommodate the service users, the service also has a large dinning room and a snoozelum that is a sensory room. The space put aside for the staff is adequate. The staff keep a majority of their possessions in the sleeping in room, that is a large space which can be used as a second office or for supervision. The staff have no separate bathing or toilet facilities but do not use any of the en-suite facilities. The office has space to store any valuables for the staff.Bramshaw HousePage 28 Standard 29 (29.1 ­ 29.8) The registered person ensures the provision of environmental adaptations and disability equipment necessary to meet the homes stated purpose and the individually assessed needs of all service users. 3 Key findings/Evidence Standard met? The home does cater for service users with physical disabilities who are wheelchair dependent. The unit has appropriate adaptations to meet the assessed needs of the current service users, the equipment has been checked and past and the home is awaiting the report. If a service user needs a specific service or assessment due to their physical disability the home will organise an appropriate referral.Standard 30 (30.1 ­ 30.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation, published professional guidance and the purpose of the home. 3 Key findings/Evidence Standard met? The house is cleaned daily by the staff and with support from the service users. The inspector saw that the house was clean and tidy. The laundry meets the required standard. This is inclusive of hand washing facilities and the correct washing machines that have a sluicing programme installed in the programme system. The home does have a clinical waste bin. Policies are in place for the hygiene procedures in the home. Maintenance records for the homes services and facilities comply with the Water Supply Regulations 1999.Bramshaw HousePage 29 StaffingThe intended outcomes for the following set of standards are: · · · · · · 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 homes 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.Standard 31 (31.1 ­ 31.7) The registered manager ensures that staff have clearly defined job descriptions and understand their own and others roles and responsibilities. 3 Key findings/Evidence Standard met? The staff have their job descriptions on their file, this is available for viewing if needed. The staff induction is undertaken over three months, as the home has only been open since January 04 this process is on going. The home had a warm open atmosphere and relationships are developing between staff and service users. A key-working system is in place within the service. There is guidance and support in place for the staff if they ever feel in need of support with a situation that is beyond their skill base. Standard 32 (32.1 ­ 32.6) Staff have the competencies and qualities required to meet service users needs and achieve Sector Skills Council workforce strategy targets within the required timescales. 3 Key findings/Evidence Standard met? The service has employed a wide range of staff with differing skills and qualifications. The home offers a thorough training programme to meet any skills the staff maybe needing to acquire or update. An induction period is given to all new staff and basic training is undertaken over this time. The inspector was at the home when staff had to deal with issues relating to the care needs of the service users. This was undertaken in a caring, supportive and professional manner. A third of the staff have the required NVQ training and training will be planned for the remaining members of the team. The rotas reflected that currently the amount of staff on duty is sufficient to meet the current needs of the service users at the home.Bramshaw HousePage 30 Standard 33 (33.1 ­ 33.11) The home has an effective staff team with sufficient numbers and complementary skills to support service users assessed needs at all times. Staff numbers/hours relating to the needs of service users are based on guidance recommended by the Department of Health. Personal Care No. service users High needs No. service users Medium needs No. service users Low needs Total no. of hours needed No. of staff with NVQ level 2 or above No. of Trainees registered on Sector Skills Council training programme X X X X 3 No. of full time equivalent Staff with nursing qualification (where applicable) No. staff hours allocated No. staff hours allocated No. staff hours allocated Total Hours Provided X X X X Nursing X X X003 Key findings/Evidence Standard met? The service users currently receive a one to one service, the hours and service users needs are assessed and their Local Authority will agree hours of care to be provided. However the levels of care needs are changing on a weekly/monthly basis, as the home is a new service and are slowly bringing new service users into the home. The home is currently recruiting staff, it did suffer the loss of one male member of staff that was employed but quickly decided it was not for them due to the commitment of the work. At the present time only two men are employed and seven women at the home so the team is not equally balanced. The service has implemented monthly staff meetings, the inspector viewed minutes from these sessions. The staff have various communication skills and are in tune with the required needs of the current service users.Bramshaw HousePage 31 Standard 34 (34.1 - 34. 8) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 2 Key findings/Evidence Standard met? The home recruitment process includes all the relevant checks, such as two references, CRB checks and identification. The inspector checked for these documents on the staff files and a majority were present apart from CRB checks although record of these being sent for were in place, the matter is being chased up. Staff are given a contract, terms of conditions and a staff handbook at the beginning of their employment. All staff receive a copy of the codes of conduct and practice set by the GSCC. Staff are invited to view the home before being employed and start work on a three-month induction period. Standard 35 (35.1 ­ 35.8) The registered person ensures that there is a staff training and development programme which meets the Sector Skills Council workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 3 Key findings/Evidence Standard met? The service offers a full training programme to its staff this includes appropriate guidance concerning the service users who are in the home. The home has an induction programme in place that offers basic training. The training records for the staff are available in the home this tracks the individual training needs. The home has a policy on Racial Harassment and Equal Opportunities. The staff will receive NVQ training instead of the Learning Disability Award Framework. Specific training in relation to learning disabilities is given by the service. Standard 36 (36.1 - 36.8) Staff receive the support and supervision they need to carry out their jobs. 3 Key findings/Evidence Standard met? Supervision for the staff is undertaken on a monthly basis the inspector saw records of this, an appraisal system will be introduced over the next six months once the service is more established. The supervision format meets the requirements in 36.4 of this standard. Information is passed through supervision, staff meetings and hand over meetings. The staff are given a pack at the beginning of their employment which contains all relevant information pertaining to the job including the disciplinary procedure. The home provides the staff with full and comprehensive guidance in dealing with physical aggression and potentially dangerous situations.Bramshaw HousePage 32 Conduct and Management of the HomeThe intended outcomes for the following set of standards are: · · · · · · · 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 homes policies and procedures. Service users rights and best interests are safeguarded by the homes 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.Standard 37 (37.1 ­ 37.4) The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Registered manager qualified to level 4 NVQ in Management and care [by 2005]. YES3 Key findings/Evidence Standard met? The registered manager has six years experience in working with people with learning disabilities and has managed another service. Rebecca Ward is currently undertaking her NVQ4 Registered Managers Award. The inspector did view the managers job description that was applicable to the role of manager. However within the case of this particular service the manager is also the registered provider and so has a dual role within the home. The manager is included in the annual training programme. Standard 38 (38.1 ­ 38.6) The management approach of the home creates an open, positive and inclusive atmosphere. 3 Key findings/Evidence Standard met? The home appears to be a very open environment with procedures in place to allow everyone in the home, staff or the service users to express their opinions. There is a comprehensive complaints system in place. The home has both an Equal Opportunities Policy and a Racial Harassment Policy both look at the services support and guidance to these issues.Bramshaw HousePage 33 Standard 39 (39.1 ­ 39.10) Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in achieving the aims, objectives and statement of purpose of the home. Key findings/Evidence Standard met? 2 The home is a new service that has only been open for four months so at the present time the service has not undertaken any quality assurance but this will happen over the next year. The company has systems in place to undertake this monitoring. The service has yet to put into place the Regulation 26 inspections, due to the confusion over who was to undertake this role, because the manager is also the registered provider and the home is an independent service. The service will resolve this by the silent partner in the home implementing the inspections. The home will develop a plan over the next year in order to look at future developments for the service. Policies and procedures are reviewed on an on-going basis with the home changing as new service users arrive. Standards 40 (40.1 ­ 40.6) The homes written policies and procedures comply with current legislation and recognised professional standards, covering the topics set out in Appendix 2 of the National Minimum Standards for Adults (18-65). 3 Key findings/Evidence Standard met? The home has the required policies in place as stated in appendix 3. The file containing the documents is kept in the office that can be accessed by all staff. The policies and procedures are not in any other format than written English so they may be not appropriate for all service users. The manager has signed all of the policies, the staff are required to read the policies and procedures file in their induction period. Discussions are held in the staff meetings to review the individual documents. Standard 41 (41.1 ­ 41.3) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 3 Key findings/Evidence Standard met? Individual and home records seen on this occasion were up to date and in good order. The records are kept secure and safe within the office. The files are maintained and kept in accordance with the Data Protection Act 1998. Service users and/or other representatives have access to their personal records.Bramshaw HousePage 34 Standard 42 (42.1 ­ 42.9) The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 3 Key findings/Evidence Standard met? Due consideration is given to the health, safety and welfare of all who live and work at Bramshaw House or visit, and the home does comply with relevant health and safety legislation. Risk assessments are undertaken and staff receive regular training to ensure safe working practices. The service keep on top of the fire drills and checking fire equipment the inspector saw evidence of this within the fire safety records. Staff are trained in first aid. All accidents, injuries, incidents of illness or communicable disease, or death of a service user all have a procedure for recording and reporting.Standard 43 (43.1 ­ 43.7) The overall management of the service (within or external to the home) ensures the effectiveness, financial viability and accountability of the home. 3 Key findings/Evidence Standard met? Service users benefit from competent and accountable management of the service. The service has supplied the Commission with a business plan that is fully comprehensive, all the financial plans are undertaken by the registered manager/provider and the silent partner. The homes insurance policy was in the office to view. Guidelines of accountability are given to all staff. In discussions with the staff they had clear ideas of the structures in place.Bramshaw HousePage 35 PART C(where applicable)COMPLIANCE WITH CONDITIONSCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceLead Inspector Second Inspector Regulation Manager DateGaynor MooreySignature Signature Signature11th May 2004Bramshaw HousePage 36 Public reports It should be noted that all CSCI inspection reports are public documents.Bramshaw HousePage 37 PART DD.1PROVIDERS RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTSRegistered Persons comments/confirmation relating to the content and accuracy of the report for the above inspection.We would welcome comments on the content of this report relating to the Inspection conducted on 26th April 2004 and any factual inaccuracies: Please limit your comments to one side of A4 if possible Overall the report is an accurate reflection of the inspection.Action taken by the CSCI in response to provider comments: Bramshaw House Page 38 Amendments to the report were necessaryNOComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection report Provider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The inspector believes the report to be factually accurateYESYESNote: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. D.2 Please provide the Commission with a written Action Plan by 1st June 2004 , which indicates how requirements are to be addressed and stating a clear timescale for completion. This will be kept on file and made available on request.You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. Status of the Providers Action Plan at time of publication of the final inspection report: Action plan was required YESAction plan was received at the point of publicationYESAction plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action planOther: enter details here Bramshaw HousePage 39 D.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.D.3.1 I Rebecca Ward of Bramshaw House confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date Or D.3.2 I of Bramshaw House am unable to confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) for the following reasons: Rebecca Ward Signed on 20/05/04 Provider/ Manager 20/05/2004Print Name Signature Designation Date Note: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable.Bramshaw HousePage 40 - 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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