Inspection on 15/07/05 for Brighton Lodge

This inspection was carried out on 15th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Brighton Lodge 15/04/08

Brighton Lodge 26/06/07

Brighton Lodge 24/05/06

Brighton Lodge 13/01/06

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 Unannounced 15 July 2005, 13:00 th 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. Brighton Lodge H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Brighton Lodge Address 40 New Brighton Road, Emsworth, Hampshire, PO10 7QA 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) 01243 373539 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 H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th January 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 H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first inspection of the home in this inspection year and the visit took place in the afternoon over six hours. The manager was present at the start however they had to leave due to another appointment and the inspectors had a brief discussion with the owner of the home. The inspectors spoke to service users, a family member and a care manager visiting the home. The home was toured with the help of service users and some records and documents were sampled. What the service does well: What has improved since the last inspection? What they could do better: The manager has been asked to do some more work on risk assessments to keep service users safe from assaults from other service users. Some documentation providing information to service users needs to be reviewed and made more accessible, this includes the Service Users Guide and the complaints procedure. Brighton Lodge H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 Page 6 The manager needs to make sure all incidents are reported to the inspector so that he can decide if he needs to take any action to support the service users or home. The inspector asked that the manager look at how they support service users during the day and clearly document what they would do if someone wanted to stay at home or return home early from activities as there are no staff available in the home during the day unless prearranged meetings are going on. The manager needs to make sure all staff are supervised regularly to ensure the best possible support is being provided to service users. The manager and provider have also been asked to show how they are looking at the quality of the service and involving the service users and their families and care managers in this review. 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 H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Brighton Lodge H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 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 standard(s) 1 and 2 The lack of accessible information about the home means that service users are limited in making choices. Improvements to the home’s approach to assessment and care planning demonstrate that service users needs are acknowledged and responded to. EVIDENCE: The inspector looked at records held in the home and requested to see the service users guide. Staff were initially unable to locate this document and they were told that it is not in an accessible format at present. The manager was advised that they must produce an accessible document which can be used to aid service users understanding of the services offered to them in the home. Although there have been no new admissions to the home in some time the work being undertaken on developing new person centred plans has involved the reassessment of each service users needs. The inspectors were able to see new plans and read these with service users. These documents are diverse and include information about the whole person the likes, wishes and aspirations. Brighton Lodge H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 Page 9 Pictures, drawings, collages and written statements are used to make this information meaningful to the individual. Brighton Lodge H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 Page 10 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 and 9 Excellent improvements to the care planning approach of the home means that service users needs and wishes are documented and acknowledged in a more holistic way. The lack of detail in some risk assessments mean that safety needs of service users are not fully met. EVIDENCE: The inspectors sampled four service users plans during the inspection and talked through three of these plans with the service users. These documents have been worked on with the service users supported by key-workers, family members and care managers. The manager informed the inspector that only one service user does not have a plan in this new format. It is taking time to work with the individual to move this forward and this was confirmed with the care manager who was present in the home on the day of the inspection. They are currently working on circles of friends and support with the individual. Brighton Lodge H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 Page 11 One service user has determined who they want to be at their reviews and these decisions have been respected by the home. A smaller group of people now attend this persons review. Comments from a care manager indicated that the home has made really good progress with care planning and risk assessment practices which have made for a more inclusive approach to supporting the service user and information is more assessable. Service users told the inspectors that they enjoyed completing their new plans and they talked the inspectors through the different parts of the folder which included likes and dislikes, the activities and places they like to do and go. The inspector noted the hard work of the manager and staff team to get to this point, which has had positive outcomes already for service users. Risk assessments continue to develop and a wide range of activities have now been assessed. Recent incidents regarding inappropriate behaviour of a service user have been responded to by reviews of guidance and risk assessments for the service users involved however the inspectors noted that other incidents have taken place that need to be taken into account. These have not been reported to the commission. The manager was advised that they must ensure any incidents detrimental to the health and wellbeing of service users are reported to the commission. Referrals for support have been made to provide additional input for the service user however this has not happened yet. The risk assessment for the individual who has been at the centre of these incidents needs further work to identify specific people who are vulnerable and the level of supervision and support this person needs to minimise these risks. Brighton Lodge H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 Page 12 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 and 15 Service users benefit from a well-organised activity programme and support to maintain contact with families and friends. EVIDENCE: The inspectors spent time talking to service users about their activities and day-to-day lives. The person centred plans clearly identified the interests, wishes and goals of service users and they told the inspectors about their recent activities. One service user told the inspector that they have been trampolining today and another favourite activity that they go to regularly is swimming. The service user said they were also going out to a club in the evening. Another service user had spent the morning at the seaside. The inspector was shown a script the service user is learning for their part in a musical at the Day centre. The inspectors met with a parent who was attending their son’s review in the home. They spoke very positively about the staff and manager and stated that they have regular contact with the service. Brighton Lodge H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 Page 13 Other service users confirmed that they have regular contact with their families and friends outside of the home. Two service users who spoke to the inspectors told them that they go for days out a stay with family members. One person keeps in regular contact with their family by mobile phone. Issues regarding two service users sharing were raised as concerns at the last visit. The inspector has received communication from the manager after this visit detailing plans to resolve these difficulties. These issues have not been resolved fully and the service users continue to share. The inspectors were not able to discuss this with the manager on the day and will need to address this with the manager and provider at a later date. Brighton Lodge H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 Page 14 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) NA These standards were not assessed at this visit. EVIDENCE: Brighton Lodge H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 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 standard(s) 22 The homes practices demonstrate that concerns of service users and their families would be responded to however this would be enhanced by rewording and development of a more accessible format. EVIDENCE: The inspector spoke to service users about raising concerns if they were unhappy with anything that happened in the home. The service users who spoke to the inspector said that they felt able to talk to staff or the manager if they were unhappy. A parent confirmed that if the felt concerned about anything they could speak to the manager and they found the home to be helpful and responsive when they have raised anything in the past. A complaints procedure is in place and a record of complaints is maintained. The inspectors noted that no complaints have been made since the last visit to the home. The manager is advised that they need to look at the wording of the complaints procedure as it refers to the other home owned by Mr and Mrs Clarke and not Brighton Lodge. The format is not assessable to service users and the manager needs to look at developing a different format to meet the needs of service users. At the last inspection registered person was required to provide the commission with details of the intended arrangements for managing service users monies related to the use of transport. Brighton Lodge H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 Page 16 Correspondence received from Mr Clarke confirmed that he is no longer an appointee and does not manage service users monies for transport. A care manager confirmed that contact and negotiation now takes place before and transport is paid for. This will need to be evaluated further a future visits to the home as neither of the registered persons were available to discuss this subject. Brighton Lodge H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 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, 26, 27 and 30 A comfortable, well-decorated and accessible environment is provided for service users. Improvements to the toilet and bathroom facilities mean that service users needs are being met. EVIDENCE: The inspectors toured the premises with the assistance of service users. The home was clean and tidy and is decorated to a good standard. Service users were observed moving freely around the home. The home has a large rear garden, which is well maintained, and service users told the inspectors that they enjoy sitting out in the garden when it is sunny. Concerns were raised at the last visit regarding the ongoing issues with service users sharing the en-suite facilities of other service users. The provider has installed a new shower facility downstairs. Service users told the inspector that they like this new facility and use it regularly and they now have a choice between a shower or bath. Brighton Lodge H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 Page 18 The inspectors viewed two service users bedrooms with their help and these were found to be laid out to meet the service users wishes and reflected their interests. Personal belongings, furnishings and equipment were observed in each of the individuals’ rooms and they were very happy with their personal spaces. The laundry was clean and tidy and free from any unpleasant odours. Brighton Lodge H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 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) 33, 35 and 36 Service users are supported by well-trained staff however the home cannot demonstrate that staff are appropriately supervised. The home cannot demonstrate how service users are supported effectively throughout the day. EVIDENCE: The inspectors sampled staff rotas and raised concerns about the practice of staff cover when service users are out of the home at day services. The provider who was present during this part of the inspection confirmed that unless specific meetings are scheduled in the home the service will not have staff on duty while all service users are at day services. The inspector asked about the contingency plans if a service user returned to the home or refused to attend day services. Mr Clarke was clear that staff would be made available if a service user decided to return. Mr Clarke indicated that the manager would have a better understanding of how this is managed on a day-to-day basis. The inspector advised that a clear rationale for supporting service users if they wish return or stay at home including the procedure for ensuring staff are available is to be established and documented in the home. Brighton Lodge H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 Page 20 The inspectors sampled staff records and were able to confirm that the staff team are receiving training to cover food hygiene, First Aid, health and safety and an induction programme is undertaken for all new staff. The inspectors spoke to staff on duty and discussed the training and support needs with one member of staff. They were able to confirm that they have received regular training and they have completed their NVQ 3 recently. The records seen confirmed that staff have had training in physical intervention. The inspectors noted that the provider is now registered as a trainer for SCIPP r UK. Records examined confirmed that a training session has been provided on challenging behaviour as part of a Learning Disability Awards Framework (LDAF) induction however there is no indication of how this is being developed as a induction and foundation approach and will need to be examined further with the manager. This is also relevant to the completion of a NVQ programme, which will need to be addressed with the manager at a future inspection. Records indicated that staff receive supervision and support sessions from the manager however they are not happening regularly and discussed with staff raised concerns that issues discussed in these sessions have not been addressed satisfactorily. The manager must ensure that staff receive regular supervision and that these sessions have outcomes which are monitored and responded to effectively. Brighton Lodge H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 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) 39 The lack of a structured quality assurance programme means that the home cannot demonstrate that service users views are being acknowledged. EVIDENCE: The inspector required the registered persons to ensure regulation 26 visits are carried out on a monthly basis. He commission now receives these reports. The provider was also required to develop an annual development plan based on the outcomes of a quality assurance reviews. Correspondence received from the provider outlined a programme of policy and document development, revision of the training programme and addressing communication within the organisation. Brighton Lodge H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 Page 22 The inspectors were unable to talk to the manager regarding the impact of this programme and how service users and their representatives have been involved in this programme. This correspondence gives no information on how quality assurance reviews have taken place and service user views on the service provided have been taken up and how these views are influencing the development programme. The home must introduce a quality audit system where by it seeks the views of all residents, residents’ representatives and other professionals and it can develop its annual development plan. Brighton Lodge H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 Page 23 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x x x Standard No 22 23 ENVIRONMENT Score 2 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 3 3 x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x x Standard No 31 32 33 34 35 36 Score x x 2 x 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Brighton Lodge Score x x x x Standard No 37 38 39 40 41 42 43 Score x x 2 x x x x H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 Page 24 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 5 Requirement The registered person must ensure that an assessible service users guided is made available to each service user in the home. The registered person must ensure that risk assessments are fully developed to address service users supervision needs to minimise the risk of assaulting other vulnerable adults. Strategies identified to provide this level of support and minimise risk are fully implimented by the home.. The registered persons must ensure that all incidents detrimental to the well-being of service users are reported to the commission. The registered persons must ensure that the complaint procedure correctly reflects the service it is intended for and is provided in an assessible format for service users. The registered person must ensure there is a clear documented strategy for enabling service users to return H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Timescale for action 15th October 2005 15th September 2005 2. 9 13 3. 9 37 15th August 2005 4. 22 20 15th October 2005 5. 33 18 15th September 2005 Page 25 Brighton Lodge Version 1.30 to their home during the day if the wish to do so. This must demonstrate how staff are made available at these time. The registered person must ensure that staff receive regular support and supervision sessions. The registered person must ensure that a review of the quality of Care is developed and a copy of this report is sent to the commission. 6. 36 18 15th September 2005 15th October 2005 7. 39 24 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 Good Practice Recommendations Brighton Lodge H54 S11716 Brighton Lodge V225040 150705 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 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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