Inspection on 19/11/07 for Breage House

This inspection was carried out on 19th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Breage House Breage House Breage Helston Cornwall TR13 9PW Lead Inspector Stephen Baber Unannounced Inspection 19th November 2007 10:00 Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Breage House Address Breage House Breage Helston Cornwall TR13 9PW 01543 414222 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) callerton@swallowcourt.com Swallowcourt Limited Mrs A. Reynolds Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection March 2007 Random Inspection. Brief Description of the Service: Breage House is one of seven care homes owned and managed by Swallowcourt Ltd. Breage House is registered with Commission For Social Care Inspection (CSCI) for 16 people with a learning disability whose ages range from 18 to 65 years of age. The home is ideally situated in the village of Breage and close to their church, post office and local pub, which is across the road from the home. The main bus route from Penzance to Helston/Camborne runs through the village, which makes getting to the home easy for parents and relatives. The home has two styles of architecture an older main house, which is linked to a large modern extension. Internally the premises provide extensive communal areas and ensuite rooms. The company have invested substantially in the home recently and provides a high standard of accommodation for the people that live there. The home has been adapted for wheelchair users with ramped areas, wide corridors and a wide variety of fixtures and fittings for the more physically dependent residents. There is a call bell system available for those people wishing to use it. There are two shaft lifts, which serve ground to first floor. There is parking to the front and side of the home and spacious grounds to the rear of the property. The home has its own vehicle which is used daily to access a full range of resources in the community in accordance with residents assessed needs and personal preferences. Each resident has a structured timetable of activities, many of which make use of community facilities. The home also arranges less formal activities, regular outings and trips to the shops daily. The residents living at Breage House have been placed by the department of Adult Social Care following a thorough assessment of their needs. Weekly charges range from £850 to £1050. Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) have made changes to the way we inspect services. Known as Inspecting for Better Lives (IBL). We are now more proportionate when reporting our findings, and more focused on the experience of people using services. This was the homes first inspection with residents living in the home. The purpose of the inspection was to ensure that resident’s needs are appropriately met, with good outcomes provided to them. This was a key inspection, which was unannounced. It took place on 19th and 21st November 2007 and lasted for approximately 16 hours. The purpose of the inspection was to ensure that residents’ needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that residents’ placements in the home result in good outcomes for them. The inspection included interviews, some held privately in residents’ rooms and some in the communal area of the home, with residents and visiting relatives. Several members of staff were interviewed and there were opportunities to directly observe aspects of residents’ daily lives in the home and staff interaction with them. Other activities included an inspection of the premises, examination of care, safety and employment records and discussion with the manager senior manager for the company and managing director who were present throughout the inspection. The principle method of inspection was “case tracking”. This involves interviews with a select number of residents; staff caring for them and/or their representatives, and examination of records relating to their care. This provides a useful impression of how the home is working overall. At this inspection three residents were case-tracked, with particular reference to their individual and diverse needs relating to their age, culture and ethnicity, religion, gender, sexual orientation and disabilities. Everyone working at the home was most welcoming, friendly and open. What the service does well: The manager has drawn up good care plans and supporting documentation, which give a really full picture of each persons preferences and particular Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 6 needs, and give clear guidance to staff on how these should be met. The staff I spoke with said how much they enjoy working at the home. There is a really good schedule of activities on offer. Each person has a wide range of one-to-one and small group activities and outings. Residents are given lots of opportunities to broaden their experience and enjoy their social and leisure time. The residents that were able to speak with me said they enjoy their lives at the home and that staff were very good to them. Observations we made throughout the visit showed that staff were very supportive to residents and there was lots of interaction taking place that was meaningful and caring. The manager is highly involved with the service and is supported by the senior manager and managing director. It was noted throughout the inspection that the manager goes out of her way to be readily accessible to the residents and staff. Breage House provides residential support to 10 adults at present who have complex needs. Staff work well to ensure that individuals are supported in an individualised manner with one to one support provided when required, good strategies are in place in order to direct and guide staff practice. The home is well organised and managed and residents fully participate in the day-to-day running of the home. Positive arrangements to consult with residents about the quality of the services and facilities and future plans are in place. This means that resident’s needs are well met; residents are provided with a range of stimulating and varied life styles and have regular opportunities to comment and influence how the care home is run. Residents are encouraged to make decisions and to help organise each day according to their commitments and choices. This helps residents to have control of their lives and improve decision-making and problem solving skills. Residents are supported to participate in a wide range of activities in the home and local community. The activities reflect their interests and ambitions and help provide a varied and stimulating experience. Health needs are positively dealt with and services are accessed promptly when required. Positive arrangements are in place to protect residents and respond to any concerns. The parents continue to play a major role in the care of their young people and one parent told me that she was very satisfied with the care her daughter receives and if she had any concerns she would discuss it with the manager. What has improved since the last inspection? This was the first key inspection of the home now that residents are living there. The manager’s and staff commitment to providing a high quality of care to residents that promotes choice, meets need and encourages independence is impressive. Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 8 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 Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2,3,4 and 5 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The statement of purpose and service users guides are well written and tell residents, prospective residents and representatives about the services and facilities provided but it would be helpful if suitable formats were put in place for those residents who cannot read. Positive arrangements are in place to assess prospective residents to make sure all of their needs and aspirations are taken account of and the home is able to provide the care and support required. Each resident should be provided with a written up to date contract, terms, and conditions of residency. The documents tell residents of their rights and responsibilities. EVIDENCE: There is a clear and informative Statement of Purpose and Service User Guide, which fully sets out the aims, objectives and philosophy of the home, its services and facilities and terms and conditions. Thorough pre-admission assessments are carried out on all prospective residents and the home confirms in writing that it is able to offer a service. Following admission, the manager compiles a care plan from the assessment, Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 10 which includes how the person s privacy, dignity, community presence and choice can be met by the home. Prospective residents are encouraged to visit as many times as they need to in order to make an informed decision about whether to come and stay at the home. This was happening on the days of the inspection when one person was deciding if she wanted to live at the home. At the time of the inspection no resident had been given a contract of residency. The manager explained that she was waiting for the contracts from The Department of Adult Social Care. The manager said that she would issue an individual written contract between the home and the resident or their representative when this has been done. The company have stated in the annual quality audit assessment (AQAA) that Our plans for improvement in the next 12 months “We will continue to build on our success so far and address any areas of concern that arise in a quick and efficient manner. To deal with issues that arise from inspections or other CSCI visits quickly and professionally”. Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7,8,9 and 10 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are well looked after in terms of their health and personal, emotional and social care needs. Residents are fully involved in the care and supports provided and review systems have been set up by the manager to ensure they are satisfied and that all their needs are met. Reliable arrangements have also been put in place by the manager to ensure each resident do not experience any unreasonable risks that could cause them harm. EVIDENCE: Each resident has a care plan that details their needs and provides staff with direction about the most appropriate ways to provide the care and support required. The care plans case tracked direct and inform staff in all areas. The care plans for the residents take account of the changing needs documented in the care plan records. Care plans also contain information about the residents’ Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 12 needs at night. Residents have a written profile about their preferred lifestyle and activities, and all three case tracked contained this information. The care plans are written in a manner that provides easy access for the staff but it would be helpful if the care plans were available in a format or language that residents can understand e.g. visual, graphic, video or simple printed English. This would make them user friendly and more easily understood by all residents. It would be good practice for staff to record that they had discussed and explained their care plan with residents, or for next of kin to sign the care plan where this was possible. This evidences that agreement has been reached on the care to be given. The manager said that she plans to implement regular planned reviews at least every six months, which will be recorded, dated and signed. Each review will summarise the areas considered and detail the action that is required to make sure the care plan is fully up to date. Residents are encouraged to take decisions about their lives and the manager and staff provides appropriate assistance where this is required. There was evidence in the records of residents being supported to make decisions. As an example, trips to the shops, pubs or choir singing at the local church. Residents reported that they were pleased with the arrangements and we observed this practice-taking place throughout the inspection. One resident talked about going on outings and enjoying having lunch out. The risk assessment and risk management arrangements in place provide staff with guidance about the support that is required where a resident may experience an unreasonable risk. Situations, which could compromise the health or welfare of a resident are, assessed. The assessments detail the action required by the staff to minimise the potential risk. However one situation did not identify the risk adequately or direct staff in detail as to how to minimise and control the risk E.g. two residents who wish to use the lift independently of the staff. Residents are encouraged and supported to make their own decisions about their lives and assistance and information are provided when this is required. In general the manager makes sure that any unreasonable risks are taken account of and support provided to make sure the resident’s health and welfare are not compromised. The company have stated in the annual quality audit assessment (AQAA) that Our plans for improvement in the next 12 months “Our evolving Quality Assurance audits will continue to enable us to meet our service users needs”. Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11,12,13,14,15,16 and 17 were assessed. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. An excellent range of activities is available, and residents get good support to maintain other relationships with staffing ratios on duty able to offer consistently the level of support residents need. Residents experience a range of activities in the home and local community that provide stimulation and reflect interests and ambitions. Arrangements in the home are flexible and residents play a lead role in how each day is organised. This helps residents to feel in control of their lives and allows them to make their own decisions in a setting that is not judgemental. EVIDENCE: Each person has their own timetable of regular activities, designed to suit their particular needs and interests. The home arranges plenty of group outings as well. The high staffing levels allow for a lot of one-to-one time to be spent with each resident. More able residents are encouraged and supported to arrange some of their own leisure time. Residents have varied activities within the care home and local community. The activities are chosen by the individual concerned and include education, hobbies and interests and shopping trips. Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 14 The parent of one resident said that she was more than happy with the opportunities available to her daughter and that her daughter was very happy in the home. The routines are flexible and the arrangements reflect the resident’s choice and commitments. The manager has had one resident meeting and is going to make them a regular feature of the home where residents can give their views and suggestions and contribute towards the running of the home. Residents will be encouraged to take responsibility for housekeeping tasks (cooking in the small kitchen which has low level units suitable for disabled residents). The chef said to me that he intends to give training cooking sessions to the residents. Daily records and activities records did reflect the level and frequency of activities described in residents timetables. We discussed days when residents would like a day at home and the manager explained that residents can often refuse to participate in the activities that are offered and spend the day at home doing what they wish to do. The home employ a fully trained chef and we noted throughout the two days that all residents had what they wanted to eat. Fresh produce is used at all times. There are two dining rooms, which are equipped and furnished to a high standard. We noted that meal times are relaxed, unrushed and flexible to suit resident’s activities and schedules. Resident’s nutritional needs are assessed and will be regularly reviewed including risk factors associated with low weight, obesity and eating and drinking disorders. The residents I spoke with said they enjoy their meals, which meet their dietary and cultural needs. The company have stated in the annual quality audit assessment (AQAA) that Our plans for improvement in the next 12 months “All staff are registered on the Learning Disability Qualification (formerly LDAF). This will equip staff to deal with every aspect of Learning Disability. We seek to provide quality that are able to give the service user every opportunity to achieve their goals and their lifestyle choices”. Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19,20 and 21 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Heath care needs are well met and closely monitored. This ensures that residents receive health services efficiently when required and promotes their quality of life. The support provided by the manager and staff is of a high quality and helps to maximise independence and minimise potential risks. Residents are fully consulted about the way support is provided and this means the resident has control over events. Positive arrangements are in place for the safe administration of medicines. While the home’s written guidance is exceptionally clear, some staff are lacking the necessary skills to translate this into practice. EVIDENCE: Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 16 There is a policy and procedure on the provision of personal care. The sensitive provision of care is included in induction training and the day to day mentoring of new staff. Personal support is always provided in private. The manager discussed the care of one resident who requires intensive assistance with personal care and the use of technical aids and equipment. We also discussed the extensive specialist support and guidance currently involved with this resident. The manager demonstrated how she would like all the staff to receive the necessary training to be able to meet the needs of the resident before she comes back from hospital. All residents have their own full ensiute facilities with impressive walk in showers. This means that all residents can receive personal assistance in the privacy of their own rooms. We were provided with positive feedback from some residents and relative about the sensitivity of staff in the provision of personal assistance. There is guidance for staff on intimate care and the management of incontinence. Residents choose their own clothes with some guidance as to weather conditions and proposed activities. Relatives stated that they were satisfied with the overall care provided when we spoke with them The senior manager said that he has arranged for a representative from People First to visit the home to discuss advocacy. All residents are registered with one of two GP practices. Community facilities will be accessed in the normal manner like we would do in our own homes. The manager is very skilled at working with all other professionals and these include the consultant Professor Brown, epilepsy nurse, specialist elder nurse, continence nurse, physiotherapy and occupational health. This ensures that residents receive good quality physical and mental health care. The staff keep detailed records of all contacts with healthcare professionals. Records document the attentiveness of staff in monitoring healthcare needs and referral to specialist workers. Care planning and documentation in respect of the healthcare needs of individual residents is well developed and detailed. There is a policy and procedure on the handling of medicines and guidance documents such as the Royal Pharmaceutical Society that inform and direct the staff. Medicines are stored in a locked cupboard and trolley. The Boots monitored dosage system is in use. There are photographs of residents in the medication administration records folder. The medication administration records were well maintained but there needs to be a consistency of approach by staff when referring to the medication sheet index. Staff were failing consistently to refer to the index and this meant that there were days when there were gaps in the recording sheets which would leave one wondering was the medication given or not. Also there seems to be two processes when administering medication. One senior staff was seen to take the trolley around and sign for medication and the other senior took medication from the trolley to the residents in pots with the MARS sheets left in the office. This places the residents at risk of being given the wrong medication and is secondary dispensing. Staff who administers medicines have completed a course in the safe handling of medicines. The company have stated in the annual quality audit assessment (AQAA) that Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 17 Our plans for improvement in the next 12 months “To maintain the high standards we are setting ourselves and to ensure we keep abreast of any changes in legislation or regulation Ensuring our internal audits are maintained”. Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are formal and informal systems in place to ensure that resident’s views are listened to and taken into account in the day-to-day running of the home. Robust procedures for responding to suspicion or evidence of abuse or neglect (including whistle blowing) ensure the safety and protection of residents. EVIDENCE: Residents and their relatives said they were very comfortable about raising concerns with the manager and are confident that any issues are dealt with in a positive manner. The company have corporate policies and procedures for dealing with complaints. This needs to include the contact details for Cornwall Department of Adult Social Care and their statutory complaints procedure. The home has a written policy and procedure for protecting residents against abuse and supplementary guidance on the nature of abuse. There needs to be a small amendment to the policy and that is the company should not investigate but allegations of abuse are reported to the statutory agencies who determine the action required. The manager has a copy of the Cornwall MultiAgency Code of Practice on the Protection of Vulnerable Adults from a training event that she completed. The core staff have received Adult Protection training from one of the company trainers. Evidence of training is recorded on the staff’s individual training portfolios.Staff knew their reporting responsibilities in relation to the protection of vulnerable adults The arrangements for protecting adult are suitable and the protection policy reflects the Department of Health Guidance ‘No Secrets’. Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 19 The home’s records demonstrate that staff are recruited on the basis that they are suitable and safe to work with vulnerable adults in a care setting and are provided with appropriate training. The company have stated in the annual quality audit assessment (AQAA) that Our plans for improvement in the next 12 months “To continue working in a positive way. To continue with training so staff are equipped to offer quality care. To continue to monitor our service delivery and to ensure our internal systems work effectivly with the audit processes we have in place. Ongoing assessments will be undertaken to ensure the policies abd proceedures are being met.” Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24,25,26,27,28 and 29 were assessed. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable environment that is well suited to their needs. Residents are provided with a comfortable high quality environment that is maintained and equipped to excellent standards. Respect for resident’s privacy is fundamentally important, including the freedom to come and go, and receive visitors as they wish. This enriches the quality of life for residents living at the home. EVIDENCE: The company have invested substantially in the home to provide excellent services and facilities for the residents who live there. Residents make full use of the facilities and throughout the two day visit utilised all parts of the home freely with oversight from the staff. In conversation with the residents we were told how much they enjoyed living at the home. Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 21 There is more than sufficient communal space for residents, including areas where residents can sit quietly to listen to music. The home is accessible to all residents accommodating wheelchair users; provide level access, and doorways into communal areas, resident’s rooms, bathing and toilet facilities and other spaces to which wheelchair users have a clear access. Residents are provided with specialist equipment to help them to maximise their independence including equipment to lift bath and mobilise them. There are two shaft lifts that serve ground and first floor. Two residents have asked to use the lift independently and the manager has respected this. The manager works well with and seeks input from a qualified occupational therapist to ensure that the new accommodation meets resident’s needs in the best ways possible. All of the residents have en suite bathrooms so that their personal care needs can be met in private. Some residents and relatives confirmed they are satisfied that their privacy is respected and this was confirmed in interviews with individual residents during the course of the inspection. All of the rooms are lockable from the inside and there are facilities for staff to over-ride locks in an emergency. The home was clean and tidy throughout at the time of the inspection. Staff are routinely provided with training in basic food hygiene and infection control from the training manager of the company. The home’s has its own sluice facilities sited away from areas in which food is cooked, prepared and eaten and there are stocks of dissolving sacks for heavily soiled laundry (red bags) and special sacks for clinical waste to ensure that infections are contained and not spread throughout the home. The company have also created a laundry area with its own washing machine and dryer for residents to gain greater skills according to their abilities. The home was very clean and hygienic throughout with hand washing facilities and paper towels available in the toilets and bathrooms. There are spacious grounds to the rear of the home and the company are planning to establish an open-air theatre for residents to use. The grounds are currently being landscaped. There is parking to the front of the home and over flow parking to the side of the property. The company have stated in the annual quality audit assessment (AQAA) that Our plans for improvement in the next 12 months “To continue to move the boundries in the provision of top class services and facilites for those with Learning Disability”. Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,32,33,34 and 35 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. High staffing ratios and positive arrangements are provided at the care home and residents find the staff to be supportive, helpful and provide assistance in a manner that does not compromise their individuality or independence. EVIDENCE: The company provide high staffing ratios to meet and support the residents. We noted that staff were accessible, approachable, good listeners, communicators, reliable, interested and motivated to carry out the tasks required of them. The staff group have considerable experience, skills and abilities about providing care. It is clearly evident that staff builds and maintains positive relationships with residents and have a good understanding of residents support needs. Most of the staff providing direct care to residents have undergone training to achieve qualification to at least NVQ level 2. New staff undergo structured induction training to Skills For Care specifications, with records kept. Staff members interviewed at the time of the inspection stated that they are well supported and encouraged to undertake formal training to update their knowledge and skills on a regular basis. They have good access to courses Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 23 both in and through the company and external training. The manager has created senior care assistants who accept some responsibility for the shift. It is recommended that they have a job description that reflects their roles and responsibilities. There is a demonstrable commitment to ongoing staff training. Each member of staff have a training portfolio to evidence the training completed and projected ongoing planning of staff training in a range of subjects to protect and enhance the lives of the residents in the home. The home’s recruitment policy is clear and detailed and ensures that staff are recruited on the basis of equal opportunities and that only people who are suitable to work with vulnerable adults in a care setting are employed there. This is backed up with thorough recruitment records relating to staff working in the home. The files case tracked contained the required information but three other files looked at did not contain some information such as missing reference, CRB and application form not signed and dated. The staff at the home said they were well supported by the manager and informal advice and guidance was readily available when this was required. The manager will establish regular opportunities for staff to be formally supervised about their work and each staff member will have an annual appraisal. The company have stated in the annual quality audit assessment (AQAA) that Our plans for improvement in the next 12 months To continue with our current training plan and look to training more staff trained to the LDQ”. The registered person is the principal provider of care. Three carers have been appointed to assist in care provision on an emergency basis. The individuals are well known to the residents and have regular contact with the home. Residents said they are very pleased and confidant about the support they receive. The staff concerned are suitably trained and experienced in social care. Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,38,40,41, 42 and 43 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager provides a safe environment with the health and safety policies and practices adequately reflecting the arrangements. Good standards of record keeping occur and the home is managed professionally, efficiently and in a manner that reflects the residents needs, wishes, aspirations and legal requirements. EVIDENCE: It is evident the home is well run and well managed. The Manager is a qualified nurse and has considerable experience of care and management. The Manager is appropriately qualified and has obtained the Registered Managers Award. Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 25 Staff, residents and relatives were positive about the manner in which the home is run, organised, and commented they found the Manager to be approachable and responsive to any concerns or suggestions they raise. The manager works alongside the staff offering them support, guidance and supervision. The senior manager and managing director for the company visit daily and offer support, which the manager is grateful for. All were present at the time of the inspection. We talked with the manager about her ethos and she clearly explained that her leadership style was approachable, open, positive and created an all-inclusive atmosphere. The manager communicates a clear sense of direction and leadership, which is appreciated by the residents and staff and meets the aims and purpose of the home. The company accountant provides input with financial matters and works alongside the manager to ensure that resident’s financial interests are protected. The parents or representatives manage the financial affairs of the residents. Full records are available in this respect, and are overseen by the home’s accountant The company maintains efficient and detailed records about the business and residents. Residents are consulted about their records and there are no barriers to them accessing their records. Positive safe working practices are provided and the procedure continues to be reviewed and developed. Equipment and services to the home are new and will be regularly monitored and maintained. Suitable policies and procedures are in place to promote safe working practices and provide a safe environment for residents and staff. Some residents, relative and staff said they were confident that every reasonable effort was made to provide a healthy and safe environment. There are no concerns regarding the financial viability of the home and an appropriate Insurance Policy is in place. The registration and Insurance certificates are publicly displayed in the front entrance. It was agreed with the company representatives that the monthly regulation 26 reports would be filed in the respective homes available for inspection. The company have stated in the annual quality audit assessment (AQAA) that Our plans for improvement in the next 12 months “To build on our expected success with this project”. “ Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 4 26 4 27 4 28 4 29 4 30 4 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 2 3 4 3 X 3 3 3 3 Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 27 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 YA5 Regulation 5 Requirement The registered person agrees and develops with each prospective resident a written contract/Statement of terms and conditions between the home and the resident The registered person must ensure at all times that all recruitment details are in place and on file to protect residents. Timescale for action 30/05/08 2 YA34 Reg 17(2) schedule 4 30/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations The registered person should compile information about the home e.g. Statement of Purpose and Service User Guide in suitable formats for people for whom the home is intended. The registered person should agree and involve residents and their families in the drawing up of the care plan . The registered person should complete a risk assessment in respect of the residents who wish to use the lift independently of the staff. DS0000068089.V347945.R01.S.doc Version 5.2 Page 28 2 3 YA6 YA9 Breage House 4 YA20 5 YA22 The registered person should ensure that residents are protected by the homes policy and procedures for the receipt, recording, storage and handling of residents medication and all staff should comply with them at all times. The registered person should provide contact details for Cornwall Department of Adult Social Care and its statutory complaints procedure. The registered person should amend the Adult Protection policy and procedure by There needs to be a small amendment to the policy and that is the company should not investigate but allegations of abuse are reported to the statutory agencies who determine the action required The registered person should give a job description to the senior staff that clearly reflects their roles and responsibilities. 6 YA23 7 YA31 Breage House DS0000068089.V347945.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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