CARE HOME ADULTS 18-65
Brickfields Cottage Hare Street Road Buntingford Hertfordshire SG9 OAB Lead Inspector
Alison Jessop Unannounced Inspection 3rd May 2006 10:00 Brickfields Cottage DS0000019297.V292962.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 Brickfields Cottage DS0000019297.V292962.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. Brickfields Cottage DS0000019297.V292962.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Brickfields Cottage Address Hare Street Road Buntingford Hertfordshire SG9 OAB 01763 289 230 01763 289 012 robin.brandon@turningpoint.co.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) Turning Point Southern Area Office Care Home 6 Category(ies) of Learning disability (6), Physical disability (1) registration, with number of places Brickfields Cottage DS0000019297.V292962.R01.S.doc Version 5.1 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). 27th February 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 two 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. Brickfields Cottage DS0000019297.V292962.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One Regulatory Inspector carried this unannounced inspection out over one day. Time was spent with service users, talking to staff and the acting manager. Most service users were out during the morning attending day care and out shopping with staff. The inspector ate lunch with service users and observed them enjoying a relaxed afternoon at home. On the day of the inspection a maintenance surveyor from Turning Point arrived to carry out an inspection on the property in preparation for future maintenance work which is planned to be completed. The financial administrator for Turning Point was also visiting the home during the afternoon. Feedback was also later obtained from the visiting community nurse, of which was very positive. What the service does well:
The atmosphere in the home was relaxed and service users appeared to be well cared for. Service users health care needs appear to be met and regular visits from other professionals were recorded. Service users bedrooms were attractively decorated providing a pleasant, relaxing private area. The home looked clean and although some maintenance and decoration is required in communal areas, the environment looks homely and comfortable. Some good examples of enabling service user choice were observed however this area could be developed if more resources were available. Feedback was gained from the visiting community nurse who said ‘the staff working at the home appear to be very committed and appear to be very fond of the service users. The fact that most of the staff are bank or agency does not appear to effect the service as there is a consistent approach. The staff are very open to suggestions and advice and the care is very good considering the complex needs of the service users. One service user who moved in a year ago has flourished and she has achieved great things that she would not have done before.’ Service users attend day care facilities and the staff organise regular outings and activities for service users. Staff try to ensure that service users remain in contact with relatives or friends although none of them are local or are closely involved. Brickfields Cottage DS0000019297.V292962.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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. Brickfields Cottage DS0000019297.V292962.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 Brickfields Cottage DS0000019297.V292962.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): 1, 2 & 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comprehensive assessment is carried out with prospective service users by a manager and in addition to information gained from other sources a decision is made to ensure suitability. EVIDENCE: Although the Service User Guide and Statement of Purpose have been reviewed, these are not in a format that are user friendly and no evidence was found to suggest that this has been explained to service users. Comprehensive needs assessments were observed on service users files along with referral forms from Adult Care Services. A decision is made by the manager about whether the persons needs can be met and prospective service users have the opportunity to visit on several occasions prior to moving into the home. Brickfields Cottage DS0000019297.V292962.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): 6, 7, 8 & 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. As care plans and risk assessments are not dated, it is difficult to establish if information contained is relevant. EVIDENCE: Although comprehensive information was available in service users care plans, due to these not being dated, it was difficult to establish if information was up to date. According to records, care plans had last been reviewed in May 2005. The home does not have a formal review process but is involved in CPA reviews. Minutes from CPA meetings were observed on file however actions agreed had not been recorded on the service users care plan. One service users file observed had no risk assessment, although according to the care plan some risks had been identified. Care plans are not available in accessible formats. Staff spoken to said that service users were unable to make choices about what food they would like to eat or how they would like their room decorated. The acting manager stated that other methods such as offering pictures has been tried however staff felt this was not effective due to service users
Brickfields Cottage DS0000019297.V292962.R01.S.doc Version 5.1 Page 10 abilities. A process of elimination is the method used to determine likes and dislikes. The community nurse said that the lack of resources such as speech and language therapy and specialist training available to staff does not enable them to implement better ways of consultation. One service user prefers to move around the home by pulling herself around on the floor, staff assisted her to sit in a chair at meal times and into a wheelchair to go to the bathroom. Another service users behaviour change was associated with changing into nightclothes, guidelines stated that the service user preferred to go to bed in the clothes she had worn in the day and changed into fresh clothes the following morning. This has reduced upset to the service user each evening and promoted choice. Brickfields Cottage DS0000019297.V292962.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff organise regular outings and activities that are appropriate to service users and ensure that service users are part of and integrate in the local community. EVIDENCE: On the day of the inspection some of the service users were attending day care services. The remaining service users were taken out to do food shopping. Due to the location of the home the staff rely upon their mini-bus to take service users out, as the home is not within walking distance of local facilities. Staff stated ‘service users usually go away on holiday once a year which they enjoy very much.’ Although none of the service users receive regular visits from family members, staff ensure that service users stay in touch with those who do not live nearby. Letters to family members were observed on one service users file. Another
Brickfields Cottage DS0000019297.V292962.R01.S.doc Version 5.1 Page 12 service user is taken on holiday in an area that is located near to her relatives which enables her to visit. The acting manager stated that there is a lack of advocacy services available to service users, a link had been made with an advocacy service but service users do not receive regular visits from a representative. Menus are developed in conjunction with a dietician and a process of elimination establishes choice. Service users appeared to enjoy the lunch, which was pork casserole. Brickfields Cottage DS0000019297.V292962.R01.S.doc Version 5.1 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 the following standard(s): 18, 19 & 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. During lunch one service user vomited at the dinner table, staff did not take the service user away from the table and the situation was not dealt with in a dignified manner. EVIDENCE: During lunch one of the service users vomited several times, staff did not deal with this in a dignified manner. The acting manager stated that although the service user has some behavioural issues, which are being monitored and are identified on the care plan, staff feel that the service user may physically unwell and is awaiting tests in order to establish if this is the case. Input from specialist services such as doctors, dentists, dieticians, psychologists and other services ensure that service users health care needs are maintained. Procedures relating to medication were generally satisfactory although some recommendations were made. The supplying pharmacist carries out an audit of medication at the home and a report is produced. It is recommended that stock balances are carried forward onto new Medication Administration Record,
Brickfields Cottage DS0000019297.V292962.R01.S.doc Version 5.1 Page 14 for auditing purposes. It is also recommended that a thermometer is available to monitor the temperature of the medication storage area. Brickfields Cottage DS0000019297.V292962.R01.S.doc Version 5.1 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 the following standard(s): 22 & 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The complaints procedure did not contain details of the Commission for Social Care Inspection, therefore complainants are unaware of where to go if they are dissatisfied with the response. EVIDENCE: The complaints procedure must be reviewed, as it does not contain the contact details of the Commission for Social Care Inspection. Although staff had received training on the Protection of Vulnerable Adults, they did not hold much confidence in the Whistle blowing procedure. Brickfields Cottage DS0000019297.V292962.R01.S.doc Version 5.1 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 the following standard(s): 24 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Many communal areas within the home look tired and in need of refurbishment, however service users bedrooms were attractively decorated and provide a pleasant, private environment to service users. EVIDENCE: On the day of the inspection a maintenance surveyor employed by Turning Point was carrying out an audit of the internal and external areas of the property. A leak from the roof has caused a large area of damp on the ceiling in the hallway at the top of the stairs. The communal hallway, lounge and dining area are in need of complete redecoration. The flooring in the hallway also requires replacing with non-slip flooring as an accident had occurred when a carer slipped over. In the garden the slabs on the path are uneven and require re-laying, a handrail is also required on the slope leading down the garden in order to protect service users safety. Brickfields Cottage DS0000019297.V292962.R01.S.doc Version 5.1 Page 17 All area of the home were clean and no malodours were detected. Paper towels must be made available and must be stored in an appropriate paper towel holder. Brickfields Cottage DS0000019297.V292962.R01.S.doc Version 5.1 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 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): 32, 34, 35 & 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the home currently has very few permanent staff, regular bank and agency staff provide a consistent approach. EVIDENCE: The acting manager stated that although the home has very few permanent staff at the moment, the use of regular bank and agency workers ensures that service users are cared for by familiar staff. A recruitment day was held and a number of new bank workers were recruited with a possibility of them becoming permanent full time. Records pertaining to training were minimal, and there was very little evidence that staff had attended mandatory training. A number of staff have completed NVQ training and others currently undertaking this. Although some staff were receiving regular supervision, others had not. Records pertaining to recruitment were unavailable for inspection on this occasion. Brickfields Cottage DS0000019297.V292962.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Due to service users inability to communicate verbally, have difficulty in gaining feedback from service users. The home must implement an appropriate quality assurance system in order to ensure that service users lives continue to be enhanced. EVIDENCE: The home does not currently have a registered manager and the permanent manager has not been working in the home for several weeks. An acting manager is currently managing the home and she is currently carrying out audits on training and other areas in order to be able to ensure that National Minimum Standards can be met. There is currently no system in place to assess quality assurance. There is little input from relatives, friends or advocates and therefore a system must be identified in order to be able to ensure that aims and objectives are achieved. Brickfields Cottage DS0000019297.V292962.R01.S.doc Version 5.1 Page 20 Records pertaining to Health and Safety in the home were satisfactorily maintained. A gas safety certificate was unavailable for inspection, a copy of this must be sent to CSCI. Brickfields Cottage DS0000019297.V292962.R01.S.doc Version 5.1 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 2 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 2 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 2 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 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 2 3 2 X 3 X 2 X 2 2 X Brickfields Cottage DS0000019297.V292962.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 YA1 Regulation 5(1)(c) Requirement The Service Users Guide is to be in a user friendly format or a record maintained that communication with the service user has been undertaken to explain their rights and its details (Outstanding since last inspection of 28/04/06) Service user care plans and risk assessments must be regularly reviewed. Service users dignity must be respected at all times. The complaints procedure must include the details of the Commission for Social Care Inspection. Hand drying facilities must be provided in the laundry room (Previous time scale of 21/11/04 & 28/04/06 not met). Timescale for action 31/07/06 2 3 4 YA6 YA18 YA22 15(2)(b) 12(4)(a) 22 (7)(a) 31/07/06 31/05/06 31/07/06 5 YA24 16(2)(j) 31/07/06 6 YA24 23(2)(b)(c) (d)&(h) A maintenance, renewal and 31/08/06 redecoration plan must be developed detailing all areas in the home that require works with time scales for action and
DS0000019297.V292962.R01.S.doc Version 5.1 Page 23 Brickfields Cottage works to be completed (Outstanding since last inspection of 05/04/05 & 28/04/06) 7 8 9 10 YA32 YA35 YA36 YA39 18 (1)(c) (i) 17 (3)(b) 18 (2) 24(1)(b) Staff working in the home must be suitably trained. Records pertaining to recruitment must be available for inspection at all times. The registered person must ensure that staff are appropriately supervised. The home must establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided and a copy of the report supplied to the Commission. All records of incidences and accidents within the home must be recorded on records that comply with the Data Protection Act 1998 (Outstanding from last inspection of 05/04/05) A copy of the gas safety certificate must be sent to CSCI. 31/07/06 31/08/06 31/07/06 31/07/06 11 YA41 17(1)(b) Sch3(3)(j) 31/07/06 12 YA42 13(4)(c) 31/07/06 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 3 Refer to Standard YA6 YA7 YA8 Good Practice Recommendations The service users care plan should be in a more accessible format. More appropriate methods of assisting service users to make decisions about their lives should be sought. Suitable ways to ensure that service users participate and contribute to the running of the home should be
DS0000019297.V292962.R01.S.doc Version 5.1 Page 24 Brickfields Cottage 4 5 YA20 YA20 implemented. Stock balances of medication should be carried forward onto new MAR sheets. The temperature of the medication storage area must be monitored and maintained within suitable levels. Brickfields Cottage DS0000019297.V292962.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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