Inspection on 25/09/07 for Brentside Cottages

This inspection was carried out on 25th September 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brentside Cottages 06/09/06

Brentside Cottages 04/01/06

Brentside Cottages 10/08/05

Brentside Cottages 22/02/05

Brentside Cottages 16/07/04

Brentside Cottages 30/10/03

Brentside Cottages 30/07/03

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Chatsworth Care - Dawson House

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Townley Road, 2-3

Chatsworth Care - Tudor Lodge

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

CARE HOME ADULTS 18-65 Brentside Cottages 80 Ruislip Road East Ealing London W13 0AL Lead Inspector Ms Jean Bovell Unannounced Inspection 25th September 2007 11:00 Brentside Cottages DS0000027724.V342852.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 Brentside Cottages DS0000027724.V342852.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. Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brentside Cottages Address 80 Ruislip Road East Ealing London W13 0AL 0208 991 9668 0208 991 9668 hm80ruislip@ealing.org.uk 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) Ealing Consortium Limited ****Post Vacant**** Care Home 3 Category(ies) of Learning disability (0), Mental disorder, registration, with number excluding learning disability or dementia (0) of places Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th September 2006 Brief Description of the Service: Brentside Cottages is a residential care home for three adult female service users with learning disabilities and/or mental health issues. It was first registered in 1994 as a small home, under the Registered Homes Act 1984 and 1991 Amendment Act. The Registered Providers are Support For Living. Acton Housing Association owns the property and is responsible for the maintenance. There is a Registered Manager and a team of support workers who provide care personal and practical support to the service users. The home is a detached property, which was converted from two cottages. It is situated on Ruislip Road East adjacent to the swimming pool. There are local shops nearby, and the shopping centres of Greenford and Ealing Broadway can be reached by public transport. The accommodation consists of three single bedrooms, one of which is on the ground floor. There is a lounge and a separate dining room. The office/sleeping in room is on the first floor. There is a shower and toilet, on the ground floor, and a bathroom and toilet on the first floor. The kitchen and the laundry are on the ground floor. There is a patio area with garden furniture and a good size garden to the rear and in front of the home. Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out between 11:00am and 4:30pm on 25th September 2006. During the course of the inspection the home’s policies, procedures, records and documents were viewed. A tour of the building was undertaken and observations were made. The Registered Manager, two Support Workers, three residents and a Service Manager were spoken with. The CSCI Annual Quality Assurance Assessment (self assessment) document was considered as part of the regulatory process. The requirements that were made at the last inspection and all Key Standards were examined. What the service does well: What has improved since the last inspection? What they could do better: Attention must be paid to having effective deployment of staff to ensure that people are supported in separate activities within the local community. Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 6 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. Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are being appropriately assessed prior to admission into the home. EVIDENCE: The current residents have lived at the home for between five and twelve years. Their personal records were viewed and reflected that they were referred to the home by social workers based in Community Teams for People with Learning Difficulties and that an initial written assessment was submitted at the point of referral. It was indicated that a needs led assessment was subsequently undertaken by the home. Relatives, social workers and relevant healthcare professionals were involved in the process of determining the suitability of the home to meet separate identified needs and aspirations. Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The changing needs of people are regularly assessed and related risk assessments have been undertaken. People are able to make decisions regarding their daily living routines. EVIDENCE: The care plans relating to three residents were inspected and reflected that their changing personal, healthcare and social needs were being assessed. Action plans and short term and long time goals were put in place. Risk assessments associated with activities identified within care plans such as moving and handling, entering the kitchen and choking, had been carried out. Care plans and risk assessments were regularly reviewed. Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 10 The Inspector was informed by a support worker that residents were able to make decisions regarding daily living routines including meals, activities, what they wore each day, make-up/hairstyles and personal purchases. People were observed moving freely around the house. They drew the Inspector’s attention to their chosen dress/colour co-ordination, cultural outfits and accessories/handbags. Individual choices and interests were also reflected in personalised bedrooms. Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported in activities within the local community and contact with relatives is encouraged and facilitated. Residents are able to undertake various housekeeping tasks whilst being supervised. Varied and nutritious meals are being provided to residents. Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 12 EVIDENCE: It was reflected on care plans that people attended Church Services with relatives and visited a Temple. The Inspector was informed by a support worker that the Local Authority had introduced a policy of denying younger people in residential care, access to day resources. As a consequence, day centre attendance had become unavailable or significantly reduced prior to eventual termination. This had impacted negatively on people due to loss of friendships, structured activities and sense of purpose they received. Although care staff ensured that people attended college courses in cooking and/or craft, places on courses during 2007/08 were not available. A support worker confirmed that people were supported in activities within the local community and included shopping trips, walks, meals out and the cinema. However, activities were often ‘rushed’ due to various other tasks that must be undertaken within the home. Apart from one person being taken to a drama and movement session, no organised activity occurred at the time of the inspection. People watched television and/or viewed magazines while sitting in the lounge. It was reported by a support worker that due to lack of resources, a day centre placement could not be found for a particular individual. He/she appeared un-stimulated and wandered aimlessly around communal areas or spent significant periods in bed. No meaningful interaction between the resident and support workers was observed. An open visiting policy was in place and the records indicated that people received regular visits from relatives, visited their homes and were taken on family holidays. A support worker confirmed that residents were supervised while assisting with housekeeping tasks such as clearing the dining room table, preparing vegetables and bringing down laundry. People were observed making tea and laying the dining table in preparation for lunch. The menus were reflective of varied and wholesome meals including cultural preferences being provided. An appealing and nutritious lunch was provided to residents at the time of the inspection. Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s personal and health care needs are being met appropriately. The home’s medication policy is in place and satisfactory. EVIDENCE: The personal care needs of people were identified within their separate care plans and indicated that all three residents required assistance or supervision with undertaking daily personal routines. A support worker reported that people’s privacy and dignity were respected and that they were able to choose what they wore each day. The records reflected that the changing health care needs of residents were being regularly assessed and received appropriate access to healthcare professionals including therapists. However, concerns regarding a young resident who appeared drowsy and spent significant periods in bed were Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 14 discussed with the Manager Designate. The Inspector was informed that the individual’s health had actually improved following medical intervention but prescribed medication was currently being monitored. The home’s medication policy was in place and the records indicated that staff training on medication had been delivered. Medicines held at the home were securely stored and administration sheets were accurately documented and signed. A support worker confirmed that none of the residents had capacity to self-administer their medication. Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 15 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): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is appropriately detailed and accessible. People are being satisfactorily protected from abuse. EVIDENCE: The Complaints procedure was clearly detailed and accessible to residents and their relatives. The complaints’ book was viewed and no complaints had been received at the home following the last inspection. The home’s policy and procedures on abuse and the London Borough of Ealing manual on Safeguarding Vulnerable Adults were in place. The records indicated care staff received training on the Protection of Vulnerable Adults. The Inspector was informed by a support worker that weekly benefit allowances were paid directly into bank accounts. Cash withdrawals were made of behalf of residents and signed by two managers and monies were kept securely at the home. Separate financial records were inspected but no discrepancies were identified. Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 16 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): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is well maintained and homely. EVIDENCE: The communal areas at the home are adequately spacious, comfortably furnished and suitable for shared and/or individual activity. The garden was in good order and accessible to residents. No issues were identified in relation to the laundry. The environment was clean, hygienic, well maintained and homely. Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 17 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): 32, 33, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Support workers are appropriately trained and qualified for meeting the needs of residents. The ratio of staff to residents is adequate. However, it was not evidenced that people were being regularly supported in separate activities within the community. The home’s recruitment policy and procedures are satisfactory. EVIDENCE: The Inspector was informed by the Manager Designate that two support workers had achieved Level 2 National Vocational Training in Health and Social Care one Support Worker had commenced NVQ training. Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 18 It was indicated on the rota that one support worker was on duty in the morning. Two support workers covered the middle shift and there was one sleep-in duty cover at night. Two support workers returned briefly to the home at the time of the inspection. One had supported a resident during a drama and movement session. The other attended a meeting. One support worker was on duty during the majority of the inspection and prior to the arrival of the Manager Designate who covered the evening/sleep-in night shift. Staff recruitment files were inspected at random and contained all required documents. A training programme was in place and reflected that staff training delivered included Moving and Handling, Food Hygiene, Health and Safety, Protection of Vulnerable Adults and Medication. The Manager Designate confirmed that new members of staff received induction training. Support workers who covered duty at the time of the inspection reported that insufficient time was allocated for appropriately supporting people in the community due to various other demands at the home. Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 19 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): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager Designate is appropriately experienced and the home is well run. It was evidenced on relevant documents that effective quality assurance had been undertaken. Health and safety records were satisfactory and indicated that the welfare of people were being protected. Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 20 EVIDENCE: The Manager Designate has been employed by the Organisation for nine years and occupied her current position for six months. She is currently receiving training for achieving level 3 National Vocational Qualification in Health and Social Care and A1 Assessors Award. Support workers that were spoken with reported that they would prefer a more open and approachable working relationship with their new Manager Designate but acknowledged that the adjustment period was still ongoing. It was reflected on documents viewed that effective quality assurance for reviewing the service had been undertaken and appropriately summarised. The Annual Quality Assurance Assessment had been satisfactorily completed and submitted to the CSCI. Health and safety records were up-to-date and included checks that had been carried out regarding fire safety, water temperature, portable appliances and gas maintenance. Fire drills were regularly undertaken and clearly recorded. Environmental risk assessments had been carried out but were in the process of being updated. Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 22 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 YA33 Regulation 18 (1)(a) Requirement The Registered Person must ensure effective deployment of staff to make sure that people’s needs are being met. Timescale for action 30/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brentside Cottages DS0000027724.V342852.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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