Inspection on 24/05/06 for Brighton Lodge

This inspection was carried out on 24th May 2006.

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 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 6 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 13/01/06

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 Liz Palmer Unannounced Inspection 24th May 2006 09:30 Brighton Lodge DS0000011716.V287769.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.V287769.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.V287769.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.V287769.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th January 2006 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 another residential service and a day service in Southsea. The fees for the home range from £120 to £140 per day. Brighton Lodge DS0000011716.V287769.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over eight hours and was unannounced. During the inspection documents were sampled, including care plans, daily records, policies and procedures. A tour of the premises was undertaken, three staff were spoken to, four service users and the manager. Observation of staff working with service users was also made. The views of relatives have been considered as part of a quality review undertaken by the home. What the service does well: What has improved since the last inspection? What they could do better: More detail needs to be added to one risk assessment to give staff clear guidelines to work to. Brighton Lodge DS0000011716.V287769.R01.S.doc Version 5.1 Page 6 All incidents detrimental to service users must be correctly recorded according to the home’s policies to ensure service users are not put at risk. Monthly, regulation 26 visit forms must be completed and a copy kept in the home. 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.V287769.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.V287769.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s assessment and care planning procedures demonstrate that service users’ needs can be met in home. EVIDENCE: There have been no new admissions to the home since the last inspection but the work recently undertaken on developing person centred plans has included the reassessment of each service user. The three plans sampled were detailed and included information such as their likes, dislikes, wishes and aspirations. Plans were individualised by drawings and photographs. Brighton Lodge DS0000011716.V287769.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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements for drawing up and reviewing care plans have improved. The lack of detail in some risk assessments means that their safety needs are not fully met. EVIDENCE: Three service user care plans were sampled. These were person centred plans that reflected the personal goals and aspirations of each individual. Service users keep their own plans with them when they attend day service for example. These plans have been drawn up in conjunction with service users, relatives and care managers. Staff referred to care plans when talking about service users and they had good knowledge of individuals’ needs and preferences. Brighton Lodge DS0000011716.V287769.R01.S.doc Version 5.1 Page 10 Risk assessments are in place to respond to ongoing concerns with individual service users. A requirement made at the last inspection for these to be fully reviewed and updated correctly has been met. A review sheet has been put in place and evidence of recent reviews were seen. Work on risk assessment for one service user is being done with the community learning disability team and their care manager. The requirement made at the last inspection for clear strategies for managing assessed outcomes of risks identified has not been fully met. More detail needs to be added to a risk assessment in respect of one service user so that staff and the service user concerned are clear about what is to happen if the identified risk behaviour actually takes place. This was discussed with the registered manager and an amended requirement has been made. Brighton Lodge DS0000011716.V287769.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 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home makes arrangements for opportunities for social activities, community access and support with relationships. Daily routines ensure service users’ rights are respected. EVIDENCE: On the day of inspection most of the service users were out attending their day service. On their return four were spoken to about their day. They said they liked the day centre and get to do a range of activities including crafts, shopping and trips out. Care plans reflect service users preferences and close links with the day centre are evident. Some of the regular activities service users are supported by the home to engage in include swimming, trips to the pub, bowling, picnics, trips to Portsmouth, discos and cinema. A list of activities on offer for the coming week were on the notice board in the dining room where service users could put their name down for the activities of their Brighton Lodge DS0000011716.V287769.R01.S.doc Version 5.1 Page 12 choice. Outings on offer included a trip to the Isle of Wight a day trip to Longleat and a cinema trip. Service users were looking forward to their chosen trips and also mentioned holidays that they had planned and they were looking forward to. Care plans and daily records showed evidence of regular weekend and evening activities. Comments from the majority of families who responded to the home’s questionnaire stated that they thought service users had a wide range of social activities and educational opportunities. Some people commented on the mini bus not being available to service users for recreational use. This is being addressed by the manager who is currently looking into the cost of hiring the mini bus from the home’s owner for service users to use for their leisure activities. Care managers and families will be involved in this and it will be monitored at future inspections. Service users are supported to use local transport as far as possible. Transport is provided by the home for service users to access their day services. Care plans and daily records show that service users are supported to maintain contact with their families and friends outside the home. Service users confirmed this and one service user said they had their own mobile telephone or could use the pay telephone to contact their family whenever they chose. The service user guide states that the home welcomes families and friends. Results of the home’s questionnaire showed that the majority of families who responded expressed satisfaction with the arrangements for maintaining contact and the support given to service users. Through discussion with staff it was evident that service users are supported and encouraged to make decisions about their daily lives. Routines reflect individual choices as stated in care plans, for example what time people like to get up and go to bed. Service users were observed moving freely around the home, assisting with household chores which they discussed and planned between themselves. Service users were also observed opting out of being with others and being supported in a positive and respectful way. Regular house meetings are held where service users are involved in planning the menu. Flash cards and pictures of food are used to enable service users to choose from a range of foods. Personal preferences in relation to food were recorded in individual’s care plans. One service user was observed assisting in the preparation of the evening meal. Another asked if they could have an alternative and this was agreed. Service users spoken to aid they enjoyed the food and enjoyed preparing and cooking the meals. All relatives who responded to the home’s questionnaire stated that they consider service users receive adequate support to follow a healthy balanced diet. Brighton Lodge DS0000011716.V287769.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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Person centred care plans enable service users to receive the support they need in the way they prefer. Improvements to the procedure for recording medication promotes the protection of service users. EVIDENCE: Care plans contained very detailed accounts of service users individual needs and preferences regarding personal care. A cross gender care policy is in place in the home. Records of service users general practitioners, any medication, medical conditions and other relevant health issues are recorded on individual files. One service user spoken to said they would tell staff if they felt unwell or unhappy. During the inspection a service user was unwell. Staff were observed supporting them in a caring manner and calling out a doctor so they could receive treatment. Details of this were handed over to the next shift so that continuity of care could be given. Relevant health professionals are involved in service users’ care as necessary. Evidence of involvement from the community learning disability team was Brighton Lodge DS0000011716.V287769.R01.S.doc Version 5.1 Page 14 seen. Transport is provided by the home for service users to attend medical appointments. Staff were observed supporting people in a positive and respectful manner. Some entries in the daily records were of concern as they were referring to a service user in a friendly way which could be have been interpreted as derogatory. This was discussed with the manager who had not audited these records but agreed the language was not acceptable and felt there were cultural reasons for the terminology. The manager stated she had no concerns about the member of staff. This has since been addressed and resolved. The home has clear and detailed policies and procedures in place for the storage and administration of medication. Guidelines for ‘when required’ medication were also seen to be clear and detailed. A requirement made at the last inspection for a record of medication coming into them home to be kept has been met. Only staff who have received training and an assessment of their competence are permitted to administer medication. Brighton Lodge DS0000011716.V287769.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 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made in following the procedures for reporting suspected abuse but procedures for reporting incidents of assault between service users must also be reported to ensure service users are not at risk. EVIDENCE: During this inspection three incidents of a service user assaulting another service user were found in the daily records that had not been reported to the commission. Staff had not filled in an incident report and the manager was unaware that the incidents had taken place. Therefore, no action was taken and the home’s procedures were not followed. Regulation 37 requires any event which adversely affects the well-being or safety of any service user to be reported to the commission. This is a matter of serious concern which the home must address to ensure that service users are fully protected. Staff spoken to said they had recently received Adult Protection training, comments such as ‘it really made you think’, ‘it was really useful’ and ‘very good’ were made. Staff also said they were happy with their responsibilities within the Hampshire Adult Protection Policy. At previous inspections it has been noted that the home has not always reported incidents under Adult Protection procedures. Improvements have been made in this area and the manager and staff spoken to appeared to be clear about the procedures that should be followed. Brighton Lodge DS0000011716.V287769.R01.S.doc Version 5.1 Page 16 Results of the relatives’ questionnaire showed that the majority of people who responded felt that enough steps are taken by the home to protect service users from abuse A pictorial complaints procedure is provided to all service users. The home’s questionnaire for relatives reflects that all those who responded felt comfortable discussing any concerns with the home. They felt they would be taken seriously and treated with respect. Service users spoken to said they would talk to staff about their concerns. However, the service users who were assaulted had not complained to anyone so it is not fully evident that all service users are fully able to make their concerns or complaints known. . Brighton Lodge DS0000011716.V287769.R01.S.doc Version 5.1 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 the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A clean, comfortable and safe environment is provided for service users. EVIDENCE: The inspector was shown parts of the home by one of the service users. The home was clean and tidy and is decorated to a good standard. Service users have freedom of movement around the communal areas and can access the laundry for example. There is a large rear garden, which is well maintained, and accessible to all the service users. Concerns over service users using ensuite bathrooms of other service users have been resolved. Service users who do not have ensuite facilities use the new downstairs shower or the upstairs bathroom. Two service users told the inspector they enjoy using the new shower facility. The results of the relatives’ questionnaire show that people are satisfied with the standard of accommodation provided to service users. One relative stated ‘Brighton Lodge is always beautifully presented – a very high standard.’ Brighton Lodge DS0000011716.V287769.R01.S.doc Version 5.1 Page 18 Brighton Lodge DS0000011716.V287769.R01.S.doc Version 5.1 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 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 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The practices for recruiting, training and supervising staff demonstrated that service users were supported by suitable, competent staff. EVIDENCE: No new staff have been employed at the home since the last inspection. Staff files of the most recent staff were seen at the last inspection and found to meet the standard. They included having an application form, two written references and evidence of suitable Criminal Records Bureau checks including a Protection of Vulnerable Adults check. An ongoing training programme is in place including opportunities for staff to achieve National Vocational Qualifications (NVQ). Of the nine staff employed, one has NVQ level 3, two have NVQ level 2 and two have nearly finished it. Staff said they had undertaken included a thorough induction programme and spoke highly of the ‘constant’ training provided to them by the home. Examples of training specific to individual service users was given. Staff said they were well supported by the manager who they respected. They said they received regular supervision and could ask for help and advice at any time. Brighton Lodge DS0000011716.V287769.R01.S.doc Version 5.1 Page 20 Staff were knowledgeable and confident about their roles. They talked about ‘team support’ and the importance of speaking openly. They were very positive about their jobs and said they really liked working at the home. Brighton Lodge DS0000011716.V287769.R01.S.doc Version 5.1 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 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, 38, 39, 40, 41 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements need to continue to be made to the running of the home to ensure procedures for recording and reviewing events which affect the health and welfare of service users are followed. EVIDENCE: Incidents detrimental to the well being of service users that were found in service users’ daily records had not been reported to the commission. The manager had not audited the records and staff had not followed the home’s procedure for reporting them, therefore the manager was unaware of the events. The manager stated that staff had received training on reporting incidents under regulation 37 during a staff meeting on the day of inspection. Staff and service users expressed confidence in the manager and spoke highly of how the home was run. Brighton Lodge DS0000011716.V287769.R01.S.doc Version 5.1 Page 22 The results of a questionnaire sent out to service users’ relatives has been analysed and the manager is now working on a service development plan. Service users, staff and relatives have been consulted as part of the review and all parties will receive copies of the findings. A requirement was made at the last inspection for regulation 26 visit forms to be completed and a copy kept in the home. One form for March 2006 was available for inspection but there was not one for April. The owner of the home regularly visits the home and engages with service users and staff. An unannounced monthly visit is required to take place and a record of this must be available for inspection. A repeat requirement has been made. All staff receive mandatory training in health and safety, first aid and manual handling, for example. Regular fire checks are undertaken and servicing of fire equipment, electrical equipment and the gas boiler are up to date. Brighton Lodge DS0000011716.V287769.R01.S.doc Version 5.1 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 Standard No Score 1 3 2 3 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 3 2 3 2 2 x Brighton Lodge DS0000011716.V287769.R01.S.doc Version 5.1 Page 24 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 YA9 Regulation 13 Requirement The registered person must ensure that risk assessments include clear strategies for managing assessed outcomes of the risks. This is an amended requirement from the inspection of 13/01/06 The registered person must ensure that all incidents detrimental to the well-being of service users are reported to the commission. This is a repeated requirement from 13/01/06 The manager, through effective leadership must ensure procedures are followed to promote and review the health and welfare of all service users, including those likely to be violent and those likely to be assaulted. The registered person must ensure that the regulation 26 visits are completed and a copy of this report is available for inspection. DS0000011716.V287769.R01.S.doc Timescale for action 10/08/06 2. YA23 37 10/08/06 3. YA39 12 (1) and (4) 30/08/06 4. YA39 26 30/08/06 Brighton Lodge Version 5.1 Page 25 5. YA40 17 (1) 6. YA41 18 (1) (a) This is a repeated requirement from 13/01/06 The manager must keep clear records of all incidents relating to individual service users including actions taken to reduce or eliminate events. The manager must ensure that staff are at all times competent to meet health and welfare needs of service users, including reporting events in a full and timely manner. 10/08/06 10/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Brighton Lodge DS0000011716.V287769.R01.S.doc Version 5.1 Page 26 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. Extracts may not be used or reproduced without the express permission of CSCI Brighton Lodge DS0000011716.V287769.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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