CARE HOME ADULTS 18-65
Brickfields Cottage Hare Street Road Buntingford Hertfordshire SG9 0AB Lead Inspector
Alison Jessop Unannounced Inspection 2nd May 2007 10:00 Brickfields Cottage DS0000019297.V339054.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 Brickfields Cottage DS0000019297.V339054.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. Brickfields Cottage DS0000019297.V339054.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Brickfields Cottage Address Hare Street Road Buntingford Hertfordshire SG9 0AB 01763 289 230 01762 289 012 jane.harris@turning-point.co.uk www.turning-point.co.uk Turning Point Southern Area Office 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) Manager post vacant Care Home 5 Category(ies) of Learning disability (5), Physical disability (1) registration, with number of places Brickfields Cottage DS0000019297.V339054.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. This home may accommodate 5 people with learning disability. This home may accommodate up to 1 person with physical disability (when associated with learning disability). 25th October 2006 Date of last inspection Brief Description of the Service: Brickfields Cottage is a care home providing personal care and accommodation for 5 adults with a learning disability, one of whom may have associated physical disabilities. The house is owned by Hertfordshire County Council, however the service is managed by Turning Point. It is located two miles east of Buntingford and one mile from Hare Street village, which is in a rural area of Hertfordshire. The home uses its own transportation. The home is a large detached two-storey house. It has five single bedrooms, three on the ground floor and three on the first floor. There are adequate bathing and toilet facilities on each floor for service users. Communal space is provided on the ground floor and comprises of a large lounge, dining room and a well-equipped domestic style kitchen with separate laundry room. The home has a large landscaped rear garden. The grounds are secure with fenced boundaries and a driveway has been constructed to provide safer access from the main road to the car park. The weekly charges for care are £1481. There is also a weekly rent charge of £134.52. A copy of the Service User Guide and Statement of Purpose can be obtained from the office. Brickfields Cottage DS0000019297.V339054.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One Regulatory Inspector carried out this unannounced inspection over half a day. A short amount of time was spent with people who use the service as they were going out for the day. As there were no previous concerns about the care that residents receive and service users are unable to offer verbal feedback, the inspector made a proportionate decision not to return to the home on another occasion as part of this inspection. A meeting was held with the manager and her deputy and all policies, procedures and records required by legislation were inspected. The premises were also inspected. What the service does well: What has improved since the last inspection?
The Service User Guide and Statement of Purpose have been reviewed and each resident has a user-friendly copy in their bedrooms. The complaints procedure is also included in this pack.
Brickfields Cottage DS0000019297.V339054.R01.S.doc Version 5.2 Page 6 Care plans and risk assessments are in the process of being reviewed. Those that have been completed provide much clearer and comprehensive information about residents needs. The maintenance programme is complete and many areas of the home have been redecorated. The office has been redeveloped and staff have dedicated sleep-in facilities with an en-suite bathroom. A handrail has been provided in the garden to allow residents safer access to the garden. Records relating to recruitment are available for inspection at the home. 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. Brickfields Cottage DS0000019297.V339054.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 Brickfields Cottage DS0000019297.V339054.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): 1&2 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken. Admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. EVIDENCE: The Service User Guide and Statement of Purpose have been reviewed and are available in a user friendly, pictorial format. People living at the home have a copy of this in their bedroom. Admissions are made on the basis of detailed assessments of the individual’s needs and aspirations so that it is clear that the home can provide a suitable service. The home also has good arrangements to enable new residents to familiarise themselves with the home prior to moving in. Brickfields Cottage DS0000019297.V339054.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): 6, 7 & 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff ensures that the people who use the service get the opportunity to explore new experiences and they closely monitor their reaction ensuring they feel comfortable and happy. EVIDENCE: Staff have an in-depth knowledge of the needs of the people who use the service and care plans reflect this. Each aspect of their care is written in the plan and detail about how service users prefer to be cared for is included. Risk assessments are more detailed and people who use the service are now receiving an annual review of their care. Adult Care Services have been invited to attend the meetings. The manager stated that the service has difficulty obtaining support from independent advocacy services. It is recommended that this further explored
Brickfields Cottage DS0000019297.V339054.R01.S.doc Version 5.2 Page 10 as none of the service users are able to make informed decisions and those who have family are not regularly or closely involved. Brickfields Cottage DS0000019297.V339054.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 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Although the home is located in a rural position, staff ensure that the people who use the service are involved in the local community. EVIDENCE: The manager stated that more time would be spent doing one to one activities with the residents. She explained that this may not need to be something that costs a lot of money or requires two staff to assist. She gave examples of gardening, baking cakes, bingo and visiting the coffee shop. Two residents who enjoy music are being taken to a local disco and each resident goes on holiday once a year. Two members of staff had taken one resident bowling. The manager stated ‘we didn’t know if she would enjoy it as it was quite busy and noisy. However, she
Brickfields Cottage DS0000019297.V339054.R01.S.doc Version 5.2 Page 12 managed to achieve things that she may never have done before. It was really nice to see her having such a great time.’ Another resident will be taken on a holiday, which is located near to her family. This will give the resident the opportunity to spend some time with her family, whilst enjoying her holiday. People who use the service are offered a balanced diet and provision is made for one particular service user who has to follow a specialist diet. Staff are aware of individual preferences and encourage residents to choose their food by showing them the packaging. Brickfields Cottage DS0000019297.V339054.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 & 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Input from specialist services such as doctors, dentists, dieticians, psychologists and other services ensure that service users health care needs are maintained. EVIDENCE: Staff respect preferences and constantly add to their own expert knowledge about their individual personal needs when providing support including intimate care. Residents personal and healthcare needs are clearly set out in care plans. Very detailed instructions, which include preferences and safe ways of providing care is included. Procedures relating to medication are satisfactorily maintained in accordance with manufacturers instructions. Brickfields Cottage DS0000019297.V339054.R01.S.doc Version 5.2 Page 14 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 & 23 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The ethos of the home is that it welcomes complaints and suggestions about the service, uses these positively and learns from them. EVIDENCE: The manager stated that no complaints have been received since the previous inspection. She also stated that a recent internal inspection carried out by Turning Point was welcomed by staff, recommendations were welcomed in order to make further improvements to the service. Staff spoken to confirmed that they were aware of the whistle blowing procedure and that they receive training on Safeguarding Adults. Brickfields Cottage DS0000019297.V339054.R01.S.doc Version 5.2 Page 15 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 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The living environment is appropriate for the particular lifestyle and needs of the residents and is homely, clean, safe and comfortable and well maintained. EVIDENCE: Since the previous inspection a maintenance programme has been completed. Work has been carried out to the outside of the building and many of the internal communal areas have been redecorated. New carpet has also been fitted to the hallway, stairs and office. The lounge carpet has been ordered and will be replaced shortly. Staff now have private washing and sleeping facilities and the office has been extended. Brickfields Cottage DS0000019297.V339054.R01.S.doc Version 5.2 Page 16 A handrail has been erected in the garden allowing residents safer access to the large garden. The home is very clean and staff work in accordance with universal infection control procedures. Brickfields Cottage DS0000019297.V339054.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, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the people who use the service. EVIDENCE: The service has plentiful staff available at all times to support the needs, activities and aspirations of the people using the service in an individualised and person centred way. The manager has carried out an audit of staff training and has arranged for staff to attend updates on their mandatory training. Several of the staff are currently doing NVQ training. The manager is currently doing her Registered Managers Award and Deputy Manager will be undertaking NVQ 4 in management in the near future. Brickfields Cottage DS0000019297.V339054.R01.S.doc Version 5.2 Page 18 The service has rigorous recruitment procedures that clearly define the process to be followed. The service recognises the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Brickfields Cottage DS0000019297.V339054.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 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has a clear understanding of the key principles and focus of the service, based on organisational values and priorities. She works to continuously improve services. There is a strong ethos of being open and transparent in all areas of running of the home. EVIDENCE: The manager has submitted a criminal record application and is waiting for her manager’s application to be processed by the Commission for Social Care Inspection. Brickfields Cottage DS0000019297.V339054.R01.S.doc Version 5.2 Page 20 The home has a quality assurance process that includes service user reviews involving social services and family members. It is recommended that independent advocacy services be involved in the quality assurance processes. The manager wrote to all relatives informing them of the complaints procedure and about the Commission for Social Care Inspection. Staff team meetings are also held on a regular basis. Procedures relating to health & safety are satisfactorily maintained. Brickfields Cottage DS0000019297.V339054.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 4 2 4 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 4 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 4 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 3 X 2 X X 3 X Brickfields Cottage DS0000019297.V339054.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. Standard Regulation Requirement Timescale for action 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 YA7 YA39 Good Practice Recommendations It is recommended that independent advocacy services be involved with service users to assist them to make decisions about their lives. It is recommended that independent advocacy services be involved in the quality assurance processes within the home. Brickfields Cottage DS0000019297.V339054.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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
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