Inspection on 13/02/06 for Briarfield

This inspection was carried out on 13th February 2006.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Briarfield 10/05/07

Briarfield 04/07/05

Briarfield 14/03/05

Briarfield 14/07/04

Similar services:

Ruskin Lodge

Clover House

Dystlegh Grange

The Good Companions

Springfield Cottage

Cuerden Grange Rest Home

Parkside

Park Lodge

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

CARE HOME ADULTS 18-65 Briarfield 42 Stainburn Road Workington Cumbria CA14 1SN Lead Inspector Gordon Chivers Unannounced Inspection 13th February 2006 10:00 Briarfield DS0000022538.V280074.R01.S.doc Version 5.1 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 Briarfield DS0000022538.V280074.R01.S.doc Version 5.1 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. Briarfield DS0000022538.V280074.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Briarfield Address 42 Stainburn Road Workington Cumbria CA14 1SN 01900 66733 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) West House Miss Beverley J Steele Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places Briarfield DS0000022538.V280074.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 6 service users to include: up to 6 service users in the category of PD (Adults with physical disabilities) up to 6 service users in the category of LD (Adults with learning disabilities) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 4th July 2005 2. Date of last inspection Brief Description of the Service: Briarfied is a residential care home providing accommodation for six people who have a learning disability. West House who have a number of similar homes operates the home. The home is large detached bungalow, situated in a residential area on the outskirts of Workington. There is ramped access to the front and rear of the building. Garden areas are to the front and rear. There is also a large patio area to the rear of the home. Service users have access to a wide range of both in-house and community based activities. Briarfield DS0000022538.V280074.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five and a half hours between 10.00 and 15.30 hours. The inspection took place in the presence of Leanne Fowler, support worker, and Alison Stephenson, Assistant Service Manager, for some of the time. The inspection focused on those standards against which a requirement or recommendation had been made by the last inspection, and the key standards which were not assessed during the last inspection. Four of the service users were in the home throughout most of the inspection. A tour of the home was undertaken, and a sample of case files and a range of other documentation was examined. The inspector would like to thank the service users and staff for their welcome and cooperation throughout the inspection. What the service does well: What has improved since the last inspection? Efforts have been made to arrange for independent advocates and friendship schemes for those service users who do not have active family support. Staff have received training in the prevention of abuse and neglect. The home has produced a forward-looking annual development plan. Briarfield DS0000022538.V280074.R01.S.doc Version 5.1 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. Briarfield DS0000022538.V280074.R01.S.doc Version 5.1 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 Briarfield DS0000022538.V280074.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,4 The service users needs are fully assessed and regularly reviewed and updated. The admissions procedure requires the home to enable prospective service users to have several introductory visits at their own pace. EVIDENCE: The case files examined all had assessments of need, risk assessments, care plans and person centred plans. All of these documents have records of the service users’ needs, likes and dislikes. They are reviewed on a six monthly basis so that changes over time are recorded. Staff and others who have known and worked with them for a long time can only infer the aspirations of the present service users. The last admission to Briarfield was more than ten years ago. The home has a copy of Westhouse admissions policy and procedure. This states that admissions must be planned and undertaken at a suitable pace for all concerned. Visits to the home should be arranged for the prospective service user to be introduced and become familiar with the home and the other service users and staff. Everybody should be able to comment on the proposed placement on the grounds of suitability and compatibility. The key people in the prospective service user’s life should be involved in the admissions process Briarfield DS0000022538.V280074.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 Staff try to arrange things on the basis of the known likes and dislikes of the service users. The staff consult with families and advocates who are involved with the service users and the home. EVIDENCE: All of the service users have very limited decision-making skills. It is very difficult for them to make choices. Staff have to interpret their gestures, willingness or not to do things and vocal sounds, based upon experience and observation of their likes and dislikes. Consultation is also difficult because of poor communication skills. Again, staff arrange things in accordance with the known preferences of the service users. Staff consult with family members and advocates, and encourage them to be involved in the lives of the service users and contribute to their support and well being. Briarfield DS0000022538.V280074.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,15 Service users are given opportunities to develop personally, but the records in the case files are not clear. The service users have plenty of opportunities to undertake a range of different activities and to go out into the local community. Service users are supported in having contact with their families, and families are encouraged to be involved in the home as much as they can be. EVIDENCE: The person-centred and care plans contain references to personal development goals and how these might be achieved. Westhouse is in the process of developing and improving its person-centred planning processes and has produced guidance for staff on how to link needs to action to outcomes. However, the case files examined do not yet have clear links between personal goals, care plans, activities intended to meet those goals, and the outcome for the service user. Staff on duty were unable to identify examples of this from the case files. The requirement from the last inspection has not been met. Briarfield DS0000022538.V280074.R01.S.doc Version 5.1 Page 11 All of the service users have weekly plans detailing what activities they would be undertaking. All of them go out at different times of the week and weekend. Between them they are able to access a very wide range of activities and interests, both inside and outside the home. The home employs a full-time activities organiser who also works every other Sunday so that certain service users can go out then. Examples of the activities intended to stimulate and or calm the service users include horse riding, yoga, drama and music, physiotherapy, drumming, reiki, swimming, and use of the sensory room in the home. All of the service users are given opportunities to go out and about in the local community, such as shopping trips, pub lunches, shows and holidays in hotels and Oasis. Five of the service users have families who are involved to varying degrees. Two of the families are very involved with the home and the service user. Two of the service users have advocates from a local branch of Mencap. One advocate recently managed to arrange contact between a service user and an aunt in Carlisle whom she had never met. The home attempted to find a friend for the service user who has no family through a ‘buddy scheme’ but unfortunately this has so far been unsuccessful. None of the service users have personal friends but do have acquaintances through day services and other social situations. Briarfield DS0000022538.V280074.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,20 The daily living skills assessments record clearly how the service users prefer to receive support with their personal care. Medication is being stored and administered by the home, but the staff have yet to have accredited training. EVIDENCE: The case files contain daily living skills assessments which record in detail how the service users prefer to receive support and assistance in their personal care and other areas of daily living. The service users are unable to manage their own medication. Most of the medication is kept in an appropriate metal cabinet in a locked cupboard in the utility room. However, some surplus medication is kept in a wooden cabinet in that same locked cupboard. Whilst this surplus medication is sufficiently secure, its storage in a wooden cupboard doesn’t meet the actual regulation. The administration of medication is recorded appropriately on MAR sheets by the staff, as is the receipt of medication from the pharmacist. The staff have not had accredited training in the administration of medication. Westhouse has arranged for the staff to receive this training from ‘Stancliffe’ via an eightweek distance-learning course followed by an assessment on the job. Briarfield DS0000022538.V280074.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 It is difficult to know exactly what the views and wishes of the service users are, but the staff and others do their best to understand them and respond to them. EVIDENCE: All of the service users have great difficulty expressing themselves and making their views known. Staff have learnt through experience what people like and how to interpret their signals. Staff make every effort to meet their wishes as understood. Staff also involve families and advocates as independent supporters of the service users to represent their interests as best they can. Briarfield DS0000022538.V280074.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,27,30 Brairfield is very homely, comfortable, clean and safe. It is very well provided for and well equipped. The toilets and bath/shower rooms are big enough and well equipped to meet the needs of the service users. EVIDENCE: Briarfield has a very homely atmosphere. All the rooms are well decorated and have nice, comfortable furnishings. Each bedroom is different and individualised. The kitchen and communal lounge are spacious and well provided for. The home also has a well-equipped sensory room, very large patio and garden areas. There are fire alarms and extinguishers, smoke detectors, radiator guards and emergency lighting. Transparent perspex panels are being attached to the lower walls in the corridor to protect them from damage from wheelchairs. The home has a large bathroom and a large shower room, each with a toilet. Both are well decorated and have hoist chairs and non-slip flooring. All the service users require support with washing and toileting. There is also a third toilet in a separate room. The framed safety procedures on a wall of the bathroom and shower room were placed there following an incident when one of the service users was scalded in the shower in 1999. Neither the Westhouse Briarfield DS0000022538.V280074.R01.S.doc Version 5.1 Page 15 Health and Safety Management System, nor the internal Westhouse report or the report by Allerdale Environmental Health Department into this incident, made any explicit requirement or recommendation that the procedures should be displayed in the bathroom. Both reports focussed on staff being aware of the procedures and risk assessments through training, supervision and team meetings. The Environmental Health report recommended that Westhouse investigate ‘whether other showers are available which can have the temperature thermostatically controlled’ in the same way as the bath water. Unfortunately, Westhouse have not been able to find such a shower. The existing shower isnt thermostatically controlled as the water comes from the cold water tank and so doesnt have a thermostat. The risk assessment clearly states where the dial should be positioned when using the shower and a staff members hand is always in the flow of water between the shower and the service user and there is a thermometer in the bathroom to check the temperature. Briarfield is kept very clean and hygienic. There are no unpleasant odours in the home despite all of the service users having continence problems. All the cleaning materials are kept in a locked cupboard off the utility room. There is a set rota for the cleaning of all the rooms. Briarfield DS0000022538.V280074.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35,36 Staff are well trained and supported by the manager. Staff have formal supervision and an annual appraisal. EVIDENCE: Seven members of staff have attained NVQ level 2 in care and another is currently doing the course. All staff undertake refresher training in a range of health and safety issues each year. Other individual training needs are identified in supervision and the manager refers this on to the Westhouse training organiser. The service manager and her assistant collate and review competencies and training across the organisation. The manager keeps record of the training that staff have undertaken through the year. All staff have recently undertaken training in the prevention of abuse and neglect. Staff are provided with formal supervision, and those staff who have worked in the home consistently over the last twelve months have been supervised six times. Staff have an annual appraisal. Staff have an individual supervision file which is well organised and recorded. Briarfield DS0000022538.V280074.R01.S.doc Version 5.1 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 The home is well managed by a competent and qualified manager who has the respect of the staff. The home has produced a forward-looking annual development plan. The manager checks and arranges for the maintenance of all parts of the home in order to ensure the health and safety of the service users. EVIDENCE: The manager, Ms. Beverley Steele, has many years experience working with people with learning disabilities. She has a NVQ level 4 in care and the Registered Managers Award. She was the Senior Support Worker in the home for ten years before becoming the manager. The staff interviewed described her style as approachable, inclusive and fair, that she sets good standards and that staff morale is good. The manager has produced an Annual Service Development Plan for the home. It has been developed on the basis of feedback from families, advocates, staff and others. This focuses on 5 areas of work; person centred planning, staff Briarfield DS0000022538.V280074.R01.S.doc Version 5.1 Page 18 training, changing needs, community activities and relationships. Each of these key areas has an objective to be met and a stated process of monitoring progress. The plan is to be reviewed by the manager on a monthly basis. The staff in the home carry out regular checks on the water temperature, fire alarm and equipment, and undertake fire drills. The home also retains all records of inspections by the district council environmental health and fire service. Records and schedules of maintenance checks and servicing to key equipment such as bathroom hoists are kept. An environmental risk assessment by Westhouse is overdue as the last recorded environmental risk assessment was in 2004. Briarfield DS0000022538.V280074.R01.S.doc Version 5.1 Page 19 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 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 3 X X LIFESTYLES Standard No Score 11 2 12 3 13 3 14 X 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X 2 X 3 X 3 X X 2 X Briarfield DS0000022538.V280074.R01.S.doc Version 5.1 Page 20 Yes 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 YA11 Regulation 14,15 Requirement Activities must be clearly linked to the care plan and their effectiveness in meeting the objectives reviewed (Previous timescale of 04/0705 not met). The registered person must ensure that all staff who administer medication receive the accredited training. Timescale for action 01/05/06 2 YA20 12,18 30/06/06 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 Refer to Standard YA20 YA27 Good Practice Recommendations The manager should ensure that all medication is stored in metal cabinet. The home should not need to hang the procedures on the bathroom wall in order to ensure that service users are not scalded or endangered in any other way. The registered person should continue to look for a thermostatically controlled shower unit which can be installed in both bathrooms. DS0000022538.V280074.R01.S.doc Version 5.1 Page 21 3 YA27 Briarfield 4 YA42 The registered should ensure that an environmental risk analysis is undertaken at least once a year. Briarfield DS0000022538.V280074.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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