Inspection on 12/05/05 for Briar House

This inspection was carried out on 12th May 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Briar House 26/11/08

Briar House 13/12/06

Briar House 21/12/05

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Briar House 89 Povey Cross Road Hookwood Surrey RH6 0AE Lead Inspector Penelope Calthrop Announced 12 May 2005 09:45am 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 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 Stationary 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. Briar House H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Briar House Address 89 Povey Cross Road, Hookwood, Surrey, RH6 0AE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01883 731547 01883 744721 Cavendish care Berry House, 58 High street, Bletchingly, Surrey, RH1 4PA Miss Tracey Lynne Spencer Care home only (PC) 6 Category(ies) of Learning disability (LD), 6 registration, with number of places Briar House H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 The age/age range of the persons to be accommodated will be: 18-45 YEARS. Date of last inspection None Brief Description of the Service: Briar House is a converted house that provides a care home for up to six service users who have a learning disability. The age range catered for is from 18 to 45 years of age. At the time of the inspection, four of the six beds were occupied. The home was registered and opened in December 2004 and is gradually increasing the numbers of service users who live there. The home consists of six fully ensuite bedrooms, some at ground floor level and some on the first floor. There is an additional communal bath/shower room. Other communal facilities consist of the fully fitted kitchen, dining room and lounge. Outside there is a large garden to the rear, with lawned area and swings. There is parking space for a number of cars to the front gravelled area of the home. The home has been refitted and refurbished prior to its opening and provides a good standard of accommodation for the service users who live there. The local towns of Hookwood and Salfords are within easy access. The property is owned by Gresham Care, who have experience of running four similar homes in the area. Briar House H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on one day, over a period of five hours. This was the first inspection of the home by The Commission for Social Care Inspection since the home’s registration last December. The manager was present for the visit. Two of the four service users were seen and were present during part of the inspection. Due to their needs their views could not be obtained and other means of assessing their wellbeing were used. Two members of staff were spoken with during the visit. A tour of the premises was made and records and documentation viewed. What the service does well: What has improved since the last inspection? This was the home’s first inspection. Briar House H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Briar House H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Briar House H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 & 5. There is sound assessment of clients needs before deciding whether to admit them to the home. Contracts are in place and need two minor additions to them. EVIDENCE: The manager explained the process of assessment gathering undertaken, before a decision was made about whether to admit an individual to the home or not. A sample of assessments gathered about one individual was viewed and the manager explained that she had undertaken several visits before deciding the home could meet their needs. Contracts are in place for each person living at the home. These are also available in pictorial format, although the manager advised that service users are unable to comprehend these, due to their needs. In order that this standard is fully met, the signature of service users next of kin or representative needs to be obtained on the contracts. The period of notice to be given by either party also needs to be included in this document. Briar House H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 9. Care plans were informative, with evidence of attention to the differing areas of service users lives. This included comprehensive assessments for areas of risk identified. EVIDENCE: The home is just commencing a new form of care plan, Person centred Planning and a sample of a partially complete one was viewed. The manager plans to set up a key worker system within the home at the same time, with an individual named staff member taking lead responsibility for a named service user. Information held by the home on care plans was detailed and ensures that staff have the information they need to meet service users needs. There was evidence of attention to differing areas of an individual’s life, examples being communication needs, likes and dislikes and behaviour issues and guidelines. Service users can make daily decisions about their lives. An example given was activities, where it can be difficult to explain a new activity to an individual and therefore whether they will enjoy it. The manager explained they would try things out with a service user and would then use different ways to ascertain whether they enjoyed it and would want to do the activity again. Briar House H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 Page 10 Assistance in more major decisions is given by staff, family or may be jointly made by those involved with the individual. Risk assessments were evident, both for individuals and in general. These covered many different areas of service users lives and potential risks around the home environment. Briar House H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 15, 16 & 17. The home showed attention to the individual lifestyles of service users. There are high levels of family involvement at this home. EVIDENCE: Two service users attend either college or day centre for part of the week. The home is supporting the individual at college by one to one staffing for them, in order they can access this. There was evidence of attention to addressing independent living skills on care plans. It was discussed with the manager ways to formalise this, with records of skills being worked on, when/how practised and evidence of progress made. Service users living at the home are younger adults and all have close involvement from their families. The manager reported that some go to their parents home most weekends. All see their family at least once a week and the home manager reported that she has frequent contact with parents. Service users may hold keys to their own bedroom door, for those who do not this is documented with the reason why. Staff respect service users own space, during this visit permission was sought by the home manager to enter a Briar House H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 Page 12 service user’s bedroom. When this was not clearly given, the matter was not pursued. Service users have unrestricted access to all communal areas of the home. Menus show a variety of foods being cooked. The main meal of the home is usually eaten together in the evening, although one individual chooses to eat alone at present. Some service users can participate in tasks associated with meal preparation, such as buttering bread and laying the table with encouragement. The manager reported the home tries to incorporate attention to healthy living in the menus it serves. Asking a dietician to assess the home’s menus was discussed with the home manager and recommended. Briar House H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20. All service users at this home require some help with meeting their personal care needs. Health needs are attended to and medication systems are safe. EVIDENCE: The home manager reported that service users will choose who they wish to assist them with their personal care, from staff on duty. Individuals will walk up to their chosen member of staff and take them by the hand. Service users choose their own clothes to wear, although guidance may be provided by staff in some circumstances. Times for getting up and going to bed are flexible, although may be dictated by activities individuals are due to attend, in the mornings. The home benefits from having a gender mix of staff, enabling service users to have support from individuals of the same gender much of the time. It was particularly encouraging that there were a number of male care staff working at the home, given that three of the four service users are male. The home ensures that health needs of service users are attended to. A health action plan has been completed for all four individuals at the home. Annual well man/woman checks take place at the GP surgery. One individual’s health indicates further tests are needed to confirm a suspected diagnosis. The service user concerned has refused this. Following discussion with the home manager, a requirement was made that the issue of capacity to consent is established and recorded for each individual in the home. This should be Briar House H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 Page 14 with the involvement of all relevant persons, such as medical staff, family and care manager. The home’s system of storing and administering medication was judged to be safe. None of the service users are capable of self-medicating. It was recommended that in case of future need, the GP documents consent to any homely remedies the home may use on any of the individuals at the home. This in case there are contra indications for some service users with their prescribed medications. Briar House H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 &23. The home has a robust complaints system in place. Staff are trained in the protection of vulnerable adults. EVIDENCE: The home has had no complaints in the six months it has been operational. There is a complaints book on site and the organisation’s complaints procedure is known to be thorough. Staff at the home are being trained in The Learning Disability Award Framework (LDAF). The home manager advised that a pre requisite of attending this, is that they must have attended training in the protection of vulnerable adults. Most staff at the home have done so, the manager reported that night staff at the home were due to attend vulnerable adults training in June ’05. Measures are in place regarding service users monies. Families oversee their relative’s finances, with the home having a system of rigorous checks in place for petty cash held on an individual’s behalf for day-to-day needs. The manager reported a plan for some service users to have their own account at a building society. The measures that need to be considered to safeguard both service users and staff were discussed. Briar House H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28 & 30. The environment benefits from recent total refurbishment prior to the home opening. Standards are high providing a good level of accommodation. EVIDENCE: As the home is newly refurbished and has only been open for a short period of time, the environment remains clean and fresh in appearance. Furnishings are of a good quality, including those in service users bedrooms. All bedrooms are en suite, with these facilities being new at the time of refurbishing the property. Decor is light and gives an airy feel to the premises. Outside, service users have the benefit of a large attractive garden to the rear. A swing has recently been purchased for service users to use. An area of the fencing dividing the home from the adjoining garden needs some attention. Potentially a service user could force their way through as it is, although there are some conifers which provide an additional barrier. It was recommended the manager consider this in light of the service users living there and the risk to them. One of the bedrooms had a malodour present. On discussion with the home manager and due to the needs of the individual concerned, it was agreed that an alternative floor covering should be sought. Briar House H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 Page 17 Briar House H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35 & 36. Staffing levels are good and staff benefit from regular appropriate training. The home needs to ensure all relevant checks are in place when recruiting staff. EVIDENCE: Staffing levels in this home are good, enabling service users to have a high level of support. There is a gender mix and the home manager observed that some of the male service users will monopolise male staff over female, if they are on duty. Sickness levels amongst staff is generally low, although some use of Gresham Care bank staff is currently being made. Staff meetings are held every six weeks with records kept. There was evidence that some staff are enrolling for NVQ training. This was discussed with the home manager as in order for the minimum training requirements to be met, at least one additional member of staff needs to consider this training. There was evidence of attention to training needs in the home with both general and individual training plans held. The manager has a system in place to highlight when updates for staff are needed. The week following the inspection vulnerable adults, food hygiene, moving and handling and infection control were booked for some staff. A sample of recruitment records held by the home were viewed. One individual is awaiting their CRB clearance and the manager reported did not Briar House H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 Page 19 work unsupervised in the home. The issue of staff rights to employment in this country was raised with the home manager and advice provided. It was reported that staff supervision is carried out by the deputy at the home, records were reported to be kept but could not be located by the manager during the visit. These will be checked on the next inspection. The home manager carries out annual appraisals of staff. Briar House H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 40, 41, 42 & 43. The management of this home is competent and works towards ensuring service users rights and welfare remain paramount. EVIDENCE: The home manager is trained to NVQ level 4 and will be commencing her registered managers award. Prior to her current post, she managed another of Gresham Cares’ homes. There was evidence of a well organised home, with documentation such as records, policies and procedures in place and well ordered. Due to missing recruitment records, the home is currently not quite meeting the standard in this area. A recommendation was also made regarding expanding the policy on aggressive behaviour and linking this to the homes policy on restraint. The organisation has a system of quality auditing in place, which includes this home. The homeowner carries out unannounced formal monthly visits and sends the report to CSCI. Annual questionnaires are distributed to families, neighbours and any professional who has contact with the home. Responses Briar House H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 Page 21 were seen following a survey earlier this year and were all positive. A follow up meeting by management after the survey results are reviewed takes place, in order to address any issues raised and how the home might work to improve. Obtaining the views of service users is difficult in this home due to their needs, so the home is particularly reliant on the views of others involved with them. Both the home and the organisation have development plans in place. The financial viability of the organisation that owns the home was established at the time of registration late last year. Relevant insurance is in place. There was evidence of attention to the health, safety and welfare of both service users and staff in this home. Fire officer and environmental health reports are in place and recommendations made have been acted upon. The home manager is a fully qualified first aider, with the remainder of the staff attending some first aid training. Briar House H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x 2 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 x 2 Standard No 11 12 13 14 15 16 17 3 3 x x 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Briar House Score 3 2 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 2 3 3 H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 Page 23 NA 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 5 Regulation 5(1)(c) Requirement Timescale for action 12/8/05 2. 19 12(2) 3. 4. 33 34 17(2)sche dule 4 19 That the home fully complies with those specifications made under The National Minimum Standards for Adults Standard 5 as detailed in the body of this report. That the matter of consent to 12/8/05 medical treatments be considered, established and recorded for each service user. Staff roles must be identified and 12/6/05 recorded on the staff rota. Appropriate checks must be 19/5/05 carried out on all staff recruited to work at the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 6/11 17 20 Good Practice Recommendations To identify independent living skills on care plans and a method of recording on going progress made. That a dietician reviews a sample of the homes menus to ensure a healthy and balanced diet. The GP is consulted about the use of homely remedies and written consent obtained for each individual in case of H58 S62117 Briar House V217173 120505 Stage 4.doc Version 1.30 Page 24 Briar House 4. 5. 24 40 contra indications. That consideration is made regarding the improvement to the fencing between the home and adjoining garden close to the house. The policy on aggressive behaviour needs to be expanded and a link made to the policy on restraint. 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