Inspection on 13/01/06 for Brighton Lodge

This inspection was carried out on 13th January 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brighton Lodge 15/04/08

Brighton Lodge 26/06/07

Brighton Lodge 24/05/06

Brighton Lodge 15/07/05

Brighton Lodge 05/01/05

Brighton Lodge 02/09/04

Brighton Lodge 27/04/04

Brighton Lodge 21/08/03

Brighton Lodge 01/10/02

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

CARE HOME ADULTS 18-65 Brighton Lodge 40 New Brighton Road Emsworth Hampshire PO10 7QA Lead Inspector John Vaughan 13 and 19 th th Unannounced Inspection January 2006 01:00 Brighton Lodge DS0000011716.V267704.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 Brighton Lodge DS0000011716.V267704.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. Brighton Lodge DS0000011716.V267704.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Brighton Lodge Address 40 New Brighton Road Emsworth Hampshire PO10 7QA 01243 373539 01243 373539 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) Mr. David Ernest Clarke Mrs. Ninfa Clarke Mrs Sarah-Jane Mouhsine Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Brighton Lodge DS0000011716.V267704.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th July 2005 Brief Description of the Service: Brighton Lodge is a residential service for twelve adults who have learning disabilities and whose needs are often complex. Brighton Lodge is a large period house set in a street of similar properties. Emsworth village centre is a short walk away. Service users are supported to use local amenities. The service is privately owned by Mr and Mrs Clarke, who also own Ormsby Lodge, a residential service in Southsea and a Day service also in Southsea. Brighton Lodge DS0000011716.V267704.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second inspection of the home in this inspection year and the visit took place over two days. A decision was made during the first day of the inspection to stop the visit and come back on a second day to allow staff to concentrate on meeting the high support needs of service users at the time. The inspectors met with the manager, the owner of the home, staff members and spoke to one service user. The inspectors examined records and documents held in the home. What the service does well: What has improved since the last inspection? What they could do better: The manager has be asked to look at the assessments they have in place to protect service users and make sure they are all up to date. Some need more information to make sure staff know what they should do to report concerns if incidents occur. The manager has been asked to take steps to report concerns raised about the conduct of some staff members to the local social service office to make sure these concerns are fully explored with care managers and the inspector of the home. Brighton Lodge DS0000011716.V267704.R01.S.doc Version 5.1 Page 6 Some work is needed to make sure records of medication received into the home are in place. The owner of the home has been asked to make a record of what he has looked at when they visit the home and send a copy of this to the inspector. 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. Brighton Lodge DS0000011716.V267704.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 Brighton Lodge DS0000011716.V267704.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 The improvements to accessible information about the home means that service users are more supported in making choices about where they wish to live. EVIDENCE: The inspectors spoke to the manager about the development of a service user’s guide. The manager provided a copy of the new guide, which has been completed since the last inspection of the home. The guide has information on the home’s environment and local amenities, comments from service users already living in the home, what to expect if you move into the home and a statement of the rights and responsibilities of service users. The manager needs to link this to the assessable complaints procedure that they have also put in place to ensure service users now how to raise concerns about the care and support they receive. Brighton Lodge DS0000011716.V267704.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): 9 The lack of detail in some risk assessments and absence of reviews of these assessments the mean that safety needs of service users are not fully met. EVIDENCE: The inspectors looked at a sampled of three service user’s risk assessment documentation during the visit to the home. At the last visit the inspector advised that further work was required to ensure the safety of service users. The inspectors saw evidence that risk assessments were in place to respond to ongoing concerns with service users. The documents seen indicated that regular reviewing and updating does not take place. There is no information to indicate if the intervention is successful and some assessments are still in pencil. One assessment describes the possible serious outcomes of a service users behaviour however there are no guidelines for what action should be taken if this actually happens. The inspector advised that the manager must ensure that they have a clear strategy in place to respond if the service user carries out this behaviour. Brighton Lodge DS0000011716.V267704.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): 16 and 17 The responses of the home demonstrate that service users rights and responsibilities are recognised. Service users benefit from a well balanced diet reflecting their likes and dislikes. EVIDENCE: The inspectors spoke to one service user who said that they have lived in the home for a long time and are very happy with the support they receive. This person told the inspectors that they have responsibilities within the home and work with the housekeeper. The recent work completed with most service users on person centred planning recognises each person’s different aspirations, dreams and wishes and the new more accessible service users guide makes statements about the practices in the home being based on underpinning values of choice, dignity and respect for service users. Brighton Lodge DS0000011716.V267704.R01.S.doc Version 5.1 Page 11 Four service users plans seen by the inspectors detailed areas that service users are responsible for including making their bed and keeping their home tidy, putting out their laundry to be washed and helping to prepare their own sandwiches for day services. The inspector met with two staff members and discussed how they work with service users. This confirmed that staff members are aware of how to support service users according to their assessed needs and wishes. Since the completion of the new shower room service users are no longer sharing en-suite facilities, which concerned the inspectors at previous visits. The manager stated that they are supporting one service user to use this communal facility now rather than another service user’s en-suite but it is taking time as they have used this facility for a long time. The home’s menu plan is developed with service users at regular house meetings. Flash cards and food pictures are housed in a folder that is used at meetings to support service users to make choices about meals and these are added to the menu plan. This plan had a wide variety of meals and appeared well balanced with the inclusion of vegetables, salads and vegetarian options. Previous comments from service users at the last inspection and in questionnaires completed and sent to the commission indicated that service users are happy with meals offered to them. A service user who spoke to the inspectors at this visit also said that they are happy with their meals and individual likes and dislikes are recorded within the person centred plans examined. Brighton Lodge DS0000011716.V267704.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, 19 and 20 The home provides appropriate support for service users to access health care professionals to meet their needs. Personal support is given in a way that respects the privacy and dignity of the individual. The medication administration practices protect service users however they would be enhanced by better recording practices. EVIDENCE: Service users personal care and heath needs are documented within care plans and intervention guidelines. From discussions with staff and the manager it was evident that service users privacy is maintained and they can lock their doors if they choose. Guidelines were seen in each of the four plans examined and these detailed daily routines for each person including specific personal care requirements. The inspectors found it difficult to ascertain how this information will be reviewed and updated and this was discussed with the manager. The manager recognised the need to have a means of documenting reviews and updates of care plans and would develop a system to record this within the plans. Brighton Lodge DS0000011716.V267704.R01.S.doc Version 5.1 Page 13 Information seen by the inspectors confirmed that service users are supported to visit GP’s and specialists if required. The medication administration practices and storage facilities were examined and found to be generally satisfactory. The home manager stated that none of the service users self-administer their medication. A record of medication administered to service users is maintained however details of medication coming into the home are not being recorded on the medication administration recording sheets. The manager was advised that the keep an accurate record of all medication received and stored in the home. Guidelines for the use of ‘when required’ medications are held within each service user’s plan and during discussions with the manager it was agreed that holding this information within the medication administration guidelines would be more helpful for staff as it would be more accessible. A new member of staff confirmed that they are currently watching staff administer medication before undertaking training and assessment of their competence to administer medication. Another member of staff confirmed that they have had training in medication administration and were only able to carry out this practice when they were assessed as competent and felt confident to do so. Brighton Lodge DS0000011716.V267704.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The home can demonstrate that service users have accessible information and support to raised concerns about the support they receive. The lack of action to report allegations of abuse means that the home cannot demonstrate that the homes systems for responding to concerns are effective. EVIDENCE: At the last inspection the manager was required to develop a complaints procedure that service users would find more accessible. The manager provided a copy of the new procedure that has been personalised for each service user. Two of these documents were seen on service user’s files and the manager stated that each service user has a copy of this document. The new complaints procedure uses symbols, pictures and plain English to explain what support is available to service users if the wish to raise concerns. Service users have also added people they want contacted if they are unhappy about their care and support. The inspectors arrived at the home and were informed that a disciplinary hearing was taking place in the home. On further enquiry the owner of the home made the inspectors aware of allegations of abuse of service users. Brighton Lodge DS0000011716.V267704.R01.S.doc Version 5.1 Page 15 The manager and owner confirmed that these allegations have not been reported to local social services office or the commission. The owner of the home outlined the sequence of events that have taken place since these concerns were raised. The inspectors were able to confirm that reasonable steps have been taken to safeguard service users once the manager was made aware of the allegations. The inspectors raised concerns about the lack of reporting of the allegations and required the manager and owner of the home to send details of the allegations made, a full explanation of the actions they have taken so far and a report under regulation 37. The manager was also asked to make contact with the local adult services department and report these allegations under the agreed Hampshire procedures for the Protection of Vulnerable Adults in order to establish what further steps should be taken to protect service users. The inspectors confirmed that the manager has a copy of the Protection of Vulnerable Adults procedures in the home however the manager was advised to obtain the more recent updated version of the policy. The inspector examined the practices for managing service users monies. The manager confirmed that neither they nor the owner act as appointee for service users and this has been passed to the family or local authority that purchase the placement. Three records examined confirmed that amounts of money are sent to the home by the appointee or family member. An accurate record of all transaction was available supported by receipts for each person. Brighton Lodge DS0000011716.V267704.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): These standards were not inspected. EVIDENCE: Brighton Lodge DS0000011716.V267704.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 36 An established training programme demonstrated that service users are supported by staff who are obtaining suitable qualifications. The practices of the home when recruiting new staff members protect service users. An appropriately supervised staff team supports service users. EVIDENCE: Through discussions with the manager, staff members and examining records the inspector was able to confirm that the home has not met the timescales for having 50 of the staff team with a NVQ award. However a programme of training is in place to ensure staff have the underpinning knowledge needed to obtain their NVQ award. Currently the home has one staff with an NVQ 2, three staff members working on their award and a further 3 staff members starting their NVQ award in September 2006. The home has ten staff. The manager told the inspector that three staff that were working on their NVQ 3 have left. At the last inspection concerns were raised about the provision of staff during the day should service users need or wish to return home from day services. Brighton Lodge DS0000011716.V267704.R01.S.doc Version 5.1 Page 18 The manager explained and provided evidence on the rota that staff are available should this happen. The inspector examined the recruitment records of two staff who have been employed since the last visit to the home. Both records had satisfactory information to demonstrate that appropriate checks are carried out on staff prior to then taking up their posts. The records included an application form, proof of identity, two written references and evidence of a Criminal records Bureau (CRB) check. One of these staff members started before the return of their CRB and an appropriate Protection of Vulnerable Adults List (Povafirst) check was completed. The inspector met with two staff members and found them to be knowledgeable and clear on their roles in supporting service users with their day-to-day routines. Both staff confirmed that they have had inductions to the service and one staff is undertaking the early stages of this programme at present and told the inspector that they are due to meet with the manager for supervision today to discuss their progress. At the last visit there was a concern that staff were not receiving regular supervision. The inspector confirmed that records of supervision are in place for staff and that regular supervision takes place. Brighton Lodge DS0000011716.V267704.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 and 42 Service users are supported by a generally well-managed service. The recent work undertaken by the home demonstrates that an established system is in place to develop the service with views from service users and their families included in this process. The home can demonstrate a well maintained and safe environment is provided for service users. EVIDENCE: The manager discussed their current actions to obtain recognised qualifications. The inspectors were told that the manager is three quarters of the way through their NVQ 4 in care. The manager stated that they have not undertaken the Registered Manager’s Award yet and they have recognised that this is due to time management however they intend to restart this at college. Brighton Lodge DS0000011716.V267704.R01.S.doc Version 5.1 Page 20 The home has established a wide-ranging review of the service. This has included an assessment of service users experiences based on a recognised assessment tool. The inspector was provided with a programme of action to confirm the approach of the home and prior to this visit the manager supplied a copy of the Life experience checklist carried out in July 2005. The inspectors saw evidence of consultation with family members and the staff team as part of this process. The manager is now meeting to collate all of the responses and stated that a full report and service development plan would be produced by the end of March. Regulation 26 visits are not being completed in the home. The owner of the home has a regular presence in the home however a report is not completed. The owner accepted that they have not fulfilled this requirement despite sending in a format and one report. The inspector reiterated the need for this process to take place and the owner said he would complete and send these reports to the commission. A selection of servicing and maintenance records examined by the inspectors confirmed that the home keeps electrical, heating and alarm systems maintained. The fire alarms system was last serviced in December 2005 along with the emergency lighting and fire extinguishers. A fire drill was undertaken on 17th November 2005 and fire training was up to date for all staff. The certificate for the servicing of the gas boiler has not been received by the home and the manager stated that they will obtain this and send a copy to the commission. Brighton Lodge DS0000011716.V267704.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 X 2 X 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 3 23 2 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X 2 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X Brighton Lodge DS0000011716.V267704.R01.S.doc Version 5.1 Page 22 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 YA9 Regulation 13 Requirement The registered person must ensure that risk assessments are fully reviewed and updated with clear strategies for managing assessed outcomes of the risks. Risk assessments written in pencil are reviewed and completed correctly. The registered person must ensure that all incidents detrimental to the well-being of service users are reported to the commission. Repeated requirement previous timescale 15/08/05 not met. The registered person must ensure that a record of all medication received in the home is in place and accurately maintained. The registered person must ensure that allegations are reported under the Protection of Vulnerable Adults procedures. The registered person must ensure that the regulation 26 visits are completed and a copy of this report is held in the DS0000011716.V267704.R01.S.doc Timescale for action 19/03/06 2. YA9 37 19/02/06 3. YA20 13 19/02/06 4. YA23 13 19/02/06 5. YA39 26 28/02/06 Brighton Lodge Version 5.1 Page 23 home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Brighton Lodge DS0000011716.V267704.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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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