CARE HOME ADULTS 18-65 Brickfields Cottage Hare Street Road Buntingford Herts SG9 0AB
Lead Inspector Louise Bushell Unannounced 05 April 2005 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. Brickfields Cottage Version 1.10 Page 3 SERVICE INFORMATION
Name of service Brickfields Cottage Address Hare Street Road Buntingford Herts SG9 0AB 01763 289230 01763 289 012 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) Turning Point Paul Matthews Care Home 6 Category(ies) of LD 6 registration, with number PD 1 of places Brickfields Cottage Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: This home may accommodate 6 people with learning disability This home may accommodate up to 1 person with physical disability (when associated with learning disability. Date of last inspection 07 October 2005 Brief Description of the Service: Brickfields Cottage is a care home providing personal care and accommodation for 6 adults with a learning disability, three of whom may have associated physical disabilities. It is owned by Turning Point. The home is located two miles east of Buntingford and one mile to Hare Street village, which is in a rural area of Hertfordshire. The home has its own means of transportation. The home is a large detached two-storey house. It has six single bedrooms, three on each floor. The three ground floor bedrooms accommodate service users with physical disabilities. There are adequate bathing and toilet facilities on each floor. Communal space is provided on the ground floor and comprises of a large lounge, dining room and an activity room in addition to a well-equipped domestic style kitchen and a separate laundry room. The home has a large landscaped rear garden. The gate to access the home is mechanically controlled. 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 Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the first unannounced of this year. It took place late morning to mid afternoon. The inspector spent time talking to all staff on duty, and one service user who was at home during the inspection. Time was spent with the acting manager discussing progress and plans for the future, looking through records and care plans. Time was also spent touring the building and the grounds. This was a positive inspection in terms of the needs of the service user being met. What the service does well:
One service user was present throughout the inspection and although unable to communicate verbally with the inspector, clear indications were given that she was happy and relaxed within her environment. The home has a high ratio of staff to service users ensuring that individual and complex needs can be met. Currently the staff team is reasonably stable and the home tries to ensure that regular bank staff work to promote continuity of care for the service users. The atmosphere throughout the inspection was calm and friendly, promoting a good relationship between staff and service users. Staff spoken with during the inspection were very complimentary of the management style within the home and the ethos of working open, honestly and with a transparent approach appears to be effective. All service user bedrooms are individually decorated reflecting their individual personalities and preferences. Staff should be commended for their efforts. The staff approach within the home ensures that service users are empowered to make choices and encourages user self-determination. The home has clear policies and procedures that are well organised and maintained, and accessible to all. The acting manager in post is currently reviewing all care plans in place and is adapting and developing them to introduce person centred planning within the home. Ensuring that the service can be user led rather than resource led. Brickfields Cottage Version 1.10 Page 6 What has improved since the last inspection? What they could do better:
Accident and incident records must be maintained within the home in compliance with the Data Protection Act 1998. Information was provided to the manager on what company may supply these. All COSHH items must be locked away and COSHH data sheets required reviewing in order to ensure the safety of all within the home. Following discussion with the manager a detailed redecoration and renewal plan is to be completed and forwarded to the CSCI. This plan must highlight all area’s as discussed within the inspection. Due to the volume of maintenance works required within the building and the nature of the continued work that consideration should be given to the employment of a part time maintenance person. Care plans must be completed and reviewed periodically to ensure a constant approach is always offered to the service users. Current development work on implementing new care plans must continue in order to provide the service user group with a holistic care plan package. All information pertaining to the service users must be locked away and secured. Due to the complex needs of the service user group and the category of registration that the home provides it is vital that core documents are user friendly. The Statement of Purpose and the Service User Guide must be user friendly for existing service users and potential new referrals. The details of the CSCI required updating on the Statement of Purpose. A system to inform the service users of activities and meal options should be introduced into the home to empower and enable them to have choice and self-determination. Brickfields Cottage Version 1.10 Page 7 Hand drying facilities are required to be erected once received. Risk assessments should be signed and dated once completed to ensure that for auditing and reviewing purposes the document remains current and effective within the home. Due to the acting manager’s secondment opportunities to post, she should undertake a formally recognised management qualification. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brickfields Cottage Version 1.10 Page 8 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 Brickfields Cottage Version 1.10 Page 9 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) 1, 2, 3, 4, 5. Prospective service users individual aspirations and needs are assessed and reviewed, enabling the service user and the home to continuously review the individuals care package provided. Information provided to the service user about the home and its terms and conditions is not user friendly and therefore may not empower and enable the service user to make an informed choice about where to live. EVIDENCE: A comprehensive Statement of Purpose is held within the home and all current and prospective service users are provided with a copy. This contains information for the service user to make an informed choice about where to live. However, the content is not in a user-friendly format. The Statement of Purpose does not include the corect contact details of the Commission. Therefore readers of the document would not be able to easily contact the Commission if required. A requirement was made for this to be addressed in the last inspection report but it remains unmet. Full assessments of each service users needs and aspiration are made before the service user moves into the home. The home is currently completing all service users new assessments to ensure that the home is meeting all individual need and working towards a person centred approach. Brickfields Cottage Version 1.10 Page 10 The admissions procedure to the home includes trial visits for the service users to make an informed choice about where to live. A contract is then drawn between the home and the service user. The contract includes the terms and conditions within the home and the rights of the service user. Due to the complex needs of the service users the contract and Statement of Purpose are needed to be in user-friendly formats and signed by the manager of the home and the service user / representative. Brickfields Cottage Version 1.10 Page 11 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, 10 Individual needs and choices within the home are being promoted to encourage and empower user self-determination. Service users individual records were not secure and did not meet with the homes own confidentiality policy, which is in breach of the rights of the service users. EVIDENCE: All service users have an individual care plan and an allocated key worker to support them in the home. The care plans in place currently are being reviewed and a detailed reassessment completed with each service user to ensure all needs, aspirations and goals are being achieved. Once completed this will ensure that the methods of the planning are person centred and involve the service user at each stage. Individual daily notes and guidelines for the service users were not securely held. The main care plan and files are held in a locked office. An external advocacy agency works with a number of the service users to support them in making decisions in their lives. Risk assessments are completed within the home for necessary actions. Activities and outings
Brickfields Cottage Version 1.10 Page 12 enjoyed by the service users indicated that service users are supported to take risks as part of an independent life style. Brickfields Cottage Version 1.10 Page 13 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) 12, 13, 14, 15, 17 An opportunity for engagement in activities and meal choices within the home occurs. The methods used needs reviewing to ensure service users can be encouraged and empowered, as far as practically possible, to make individual choices. The home encourages inclusion into the local community thus enabling integration into community life. EVIDENCE: Service users are supported appropriately to take part in activities within the home. Individual needs, choices and preferences are always considered. A record of activities is maintained. Service users access the local community services frequently and visit the local area, enjoying going out for lunch and shopping. Activity options were not displayed within the home in a method or format appropriate to the service user group, to encourage and empower individual choice. The home provides a four-week rolling seasonal menu, which is developed through service user choice and preference with specialist dietary advice. A
Brickfields Cottage Version 1.10 Page 14 record is maintained of foods eaten. Meal options are not displayed within the home in a method or format appropriate to the service user group, to encourage and empower individual choice. Brickfields Cottage Version 1.10 Page 15 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 personal and health care support is well maintained within the home ensuring individual needs, choices and preferences are met at all times. EVIDENCE: All care provided is individual and tailored to each person, with service users needs, choices and preferences being promoted. New assessments are currently being completed to ensure that the approach adopted by the home is person centred and holistic to each service users needs. Service users are supported with all aspects of their physical and emotional health and receive adequate, appropriate input from specialists such as community nurses, consultants, GP, dentists, opticians and dieticians. Information and advice is provided to all services users regarding general health issues. The home has a robust policy and procedure in place to support the safe administration, storage and receipt of medicines. All staff receive training prior to being recognized as competent to administer medication. Records are well maintained of all medication received, stored and administered within the home. Brickfields Cottage Version 1.10 Page 16 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 complaints procedure within the home is sufficient and adequate in order for the service users to feel that their individual views are listened too. Robust policies, procedures and training is in place to ensure service users are protected and safe. EVIDENCE: The home has a comprehensive complaints procedure in place, which details that all complaints are responded to within 28 days. A record is maintained within the home of complaints made detailing actions and outcomes as necessary. All services users have been informed about the complaints procedure. Robust procedures are in place to ensure that service users are protected from abuse and harm. Staff receive suitable and adequate Protection of Vulnerable Adults (POVA) training, which is currently occurring within the home. Staff employed within the home are all subject to enhanced Criminal Records Bureau (CRB) checks. Records were well maintained. Brickfields Cottage Version 1.10 Page 17 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, 29, 30 Each service users individual space within the home is extremely well decorated and maintained, reflecting individual choices and preferences. Communal and shared space within the home is not so well maintained with many areas requiring maintenance work, this dos not promote a safe, well maintained comfortable, homely feel for the service users. EVIDENCE: The staff within the home have tried to ensure that the environment is homely and welcoming for all service users. Due to the volume of maintenance work required within the home many areas are looking worn and tired, including walls, skirting boards, ceilings, doors and flooring. The upstairs bathroom is very dated and appliances are worn so not promoting an area of relaxation and a homely feel for the service users. The kitchen is in need of replacing. This is currently being costed for works to commence. A renewal and redecoration plan is currently being implemented by the manager and the company, focusing on all area’s as mentioned above. Each individual service user has a bedroom that meets their individual needs and preferences. These are extremely individual and all service users have
Brickfields Cottage Version 1.10 Page 18 been involved in the choice of decoration of their rooms. The staff have worked extremely hard to ensure this individual space for the service users is maintained and should be commended. They are brightly coloured and reflect each service users personality and preferences. Lockable space is also provided so ensuring security and privacy. Aids and equipment within the home are provided as required and are currently suitable for needs. A separate laundry facility is available within the home, hand drying facilities are being erected in the laundry room and are currently on order. The washing machine had suitable programmes to comply with infection control requirements. Brickfields Cottage Version 1.10 Page 19 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) 31, 32, 33, 35, 36 Service users are supported in the home by a competent, qualified staff team. Effective systems are in place to ensure sound recruitment practices. EVIDENCE: Each member of staff has a clear and well-defined role; this is supported by clear and concise job descriptions and person specifications. Staff are familiar with the General Social Care Council (GSCC) Code Of Conduct and have received this booklet during their induction programme. Training is in place within the home and is offered on a regular basis. All training required by law is attended by staff. Training records are maintained. One member of staff has completed their NVQ II in care with a further four staff members due to complete by June 2005. The staff team has recently undergone some internal changes with the secondment of the registered manager for a period of six months. A project worker is acting up in their absence. Following discussions with the staff team this current structure appears to be working and the acting manager is being adequately supported within her role. The home has sufficient staff working in the home and the use of agency is minimal with a focus on using regular bank staff for a consistent approach. Staff meetings occur within the home and supervision is provided every two months with records maintained.
Brickfields Cottage Version 1.10 Page 20 Brickfields Cottage Version 1.10 Page 21 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, 40, 41, 42. The home is running reasonably smoothly and this ensures that all aspects of the service users needs can be met. Systems for effective health and safety management are in place but require further work to ensure the safety of everyone is maintained within the home. EVIDENCE: The staff team has recently undergone some internal changes with the secondment of the registered manager for a period of six months. A project worker is acting up in his absence. The acting manager has over 25 years experience in the learning disability field, a degree in psychology and is currently completing the NVQ Assessors award. To further support the role it would be beneficial for her to complete the Registered Manager Award as a recognised qualification. Following discussions with five members of the team the approach and the management of the home is reported as effective, open and transparent. Brickfields Cottage Version 1.10 Page 22 The home has a vast range of policies and procedural guidelines in place. Staff are requested to read and sign risk assessments and polices. The home has many risk assessments in place. COSHH data sheets had been produced by the home were in need of reviewing and signing along with other risk assessments completed. Some COSHH items were not locked away in an area where service users freely access. All records required by regulation were available and maintained. Individual service user records were not being stored to protect their individual confidentiality as per the homes policy. All accident and incidences within the home were recorded, however not in the required format under the Data Protection Act 1998. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 3 3 3 2 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6
Brickfields Cottage Score 2 Standard No 24 25 26 27 28
Version 1.10 Score 2 3 3 x 3
Page 23 7 8 9 10
LIFESTYLES 3 x 3 2
Score 29 30
STAFFING 3 2 Standard No 11 12 13 14 15 16 17 x 2 3 3 3 x 2 Standard No 31 32 33 34 35 36 Score 3 3 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 2 2 x Brickfields Cottage Version 1.10 Page 24 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 1 Regulation 6 (a) Requirement The Registered Manager must ensure that the Statement of Purpose is reviewed and updated to contain the correct details for the Commission for Social Care Inspection (Previous time scale of 15/11/04 not met). The Service Users Guide is to be in a user friendly format or a record maintained that communication with the service user has to explain their rights and its details. Care plans and assessments must be completed to meet individual needs, kept under review and revised to ensure a holistic package of care is provided. Hand drying facilities must be provided in the laundry room (Previous time scale of 21/11/04 not met). The Registered Manager must ensure that all COSHH substances are managed in accordance with the Health and Safety At Work Act 1974. COSHH substances must be removed from the activities room and the kitchen and placed in
Version 1.10 Timescale for action 15Th May 2005 2. 5 5 (1)(c) 31st May 2005 3. 6 14 (2) (a) (b) 15th June 2005 4. 30, 24 16 (2) (j) 15th May 2005 1st May 2005 5. 42 13 (4)(a) Brickfields Cottage Page 25 6. 7. 10, 41 24 17 (1) (b) 23 (2) (b), (c), (d) & (h) 8. 42 12 (1) (a) 13 (4) (c) 9. 41 17 (1) (b) Schedule 3 (3) (j) suitabley locked facilities (Previous time scale of 15/11/04 not met). All records must be kept securely in the home. A maintenance, renewal and redecoration plan must be developed detailing all areas in the home that require works with time scales for action and works to be completed. COSHH data sheets must be reviewed to ensure health and safety practices within the home are maintained. All records of incidences and accidents within the home must be recorded on records that comply with the Data Protection Act 1998. 1st may 2005 31st May 2005 31st May 2005 31st may 2005 10. 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. Refer to Standard 12 Good Practice Recommendations It is recommended that the home implements a system to inform service users of activities and options available to empower and enable them to have user selfdetermination. It is recommended that the home implements a system to inform service users of meals choices and options available to empower and enable them to have user selfdetermination. It is recommended that the acting manager commence a management qualification to support her in the role. That risk assessments are signed and dated once complete so accurate reviewing of them can take place. That consideration be given to the employment of a part time maintenence person. 2. 17 3. 4. 5. 37 40 24 Brickfields Cottage Version 1.10 Page 26 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Herts AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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