Inspection on 07/01/08 for Brighton Road (851)

This inspection was carried out on 7th January 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brighton Road (851) 19/06/08

Brighton Road (851) 01/08/06

Brighton Road (851) 12/07/05

Brighton Road (851) 07/12/04

Brighton Road (851) 20/05/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOME ADULTS 18-65 Brighton Road (851) 851 Brighton Road Purley Surrey CR8 2BL Lead Inspector Michael Williams Key Unannounced Inspection 7th January 2008 10:30 Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 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 Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 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 Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brighton Road (851) Address 851 Brighton Road Purley Surrey CR8 2BL 020 8763 0062 NONE 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) Ms Alice Manteaw-Dankyi Iris Naa A Asiedu-Addo Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8) of places Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st August 2006 Brief Description of the Service: 851 Brighton Road is registered with the Commission as a care home for adults 18 to 65 years of age. The registration category is for up to 8 people with past or present mental health problems. The home is situated on the Brighton Road (Purley) and is therefore on bus routes and within walking distance of shops and other local community resources. The premises comprise six single and one double bedroom (currently used as a single). The home has a lounge, dining room and several conservatories plus the usual facilities comprising kitchen, laundry, toilets, bathroom and a small office. There is limited off-street parking to the front of the home and a small, landscaped garden to the rear. Fees are from £525 per week with any additional charges by negotiation with the purchasing authority. Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection included a visit to the home on 7th January 2008. In addition to this visit, which latest approximately 6 hours, a number of questionnaires were distributed to interested parties including residents, relatives/friends, professional visitors and to staff working in the home. In compiling this inspection report the Commission also noted information we receive and this can include details of any complaints, untoward incidents and general correspondence. During the course of the inspection visit most residents and staff met with the inspector. In order to cross-check information we toured premises and checked documentation, including records such as case files, staff records, fire safety records plus the money and complaints records. What the service does well: What has improved since the last inspection? This home is in a period of transition. The provider, Mrs Dankyi intends opening a similar service adjacent to 851 Brighton Road and some residents will move to the new care service if the commission registers it as suitable and fit for its intended purpose. It is perhaps for this reason that some areas of the home have not been maintained; we are advised that as part of this development No. 851 will be thoroughly refurbished. Only five requirements were made in the last inspection and these have been addressed to a greater or lesser extent. For example, residents’ case files now make clearer whether or not the provisions of the Mental Health Act apply. The medication charts Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 Page 6 have been revised and improved so that no anomalies were identified on this occasion. The manager assures the Commission that proper hand-washing facilities are being maintained in toilets but paper towels ran out over the weekend and the door lock was also broke within previous 48 hours. Residents have been given information about how to make their concerns known and this was confirmed in feedback we received in our questionnaires. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 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 Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 2 and 5: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Assessments are in place for each service user and form the basis of the initial care plan and risk assessments. So this ensures the care needs, including mental health care needs, of service users is made clear from the outset and that those service know their needs have been identified and will be met. However, not all residents have a contract or the information required by regulation nor a formal notification of changes to the contract and fees payable. EVIDENCE: Each service has a case file, samples of which were examined during the inspection; we also interviewed residents and spoke to the manager about the admission process. The service users confirmed that they have contributed to the compilation of these documents and usually sign their care plans. In previous inspections the home’s manager was not clear about the legal status of some service – particularly when they had been subject to the provisions of the Mental Health Act. Some staff have since had training in mental health law and are much clearer about these technical issues. This is especially important because it does affect the decision to admit and will certainly inform the staff as the services rights and any restrictions that may apply at the time of admission. Information about legal status was of particular important to a new resident. Whilst her legal status was clear it would appear, from what the manager advised us, that the hospital had not been at all clear about her discharge plans and this caused the resident some distress. The home will be following up this issue. Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 Page 9 Another problem requiring attention was the information supplied to resident; there was not contract or agreement to provide information about fees payable, how they would be paid and changes to the original agreements for example a resident that moved from one home to another (within the Alice group of homes) and nor were changes to the level of support and charges made clear to the resident in the form of revised contracts or addenda. As some residents wish to move into the new service being developed next door so we had the opportunity to discuss with residents what preparations had been made for this and they told us that they had been consulted as to whether or not they might move and which bedroom might be allocated to them. Areas of strength include the collation of information prior to admission and in general the information available to most residents including the opportunity for visits and a trial stay. Matters requiring improvement include the need to provide information about contracts and fees without delay and to keep contracts updated when there are changes. This section, about choice, is assessed as adequate Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 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. Residents confirmed that they do know their needs and personal goals are set out in individual plans and are reviewed periodically, but additional needs have not been made clear in at least one case. During the process of assessment and review, and in the drawing up of care plans, service users are involved in making decisions about their own lives and lifestyle. Responsible risk taking is an integral part of the care and care planning in this home. So this enables service users to develop independence and confidence. EVIDENCE: This care home recognises the right of individuals to take control of their lives and to make their own decisions and choices and there is some evidence that individuals are involved in some decision making about the home, such as day to day living and social activities. However, areas where individuals can affect change are limited because management decisions are centralised; decisions are often made by the proprietor rather than the local, on site manager. Each individual has a care plan but practice of involving residents the service in the development and review of the plan is variable, so for example where a resident required additional support beyond what is provided by the basic fees, Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 Page 11 the care plans did not reflect the changing, reduced level of support needed. The plan includes basic information necessary to deliver the resident’s care but is not detailed as to how additional, one-to-one, support was to be given and recorded as given. Phrases such as ‘prompt resident to attend to person hygiene’ which is part of basic care and not a specialist service. Care plans are reviewed and updated as required by the NMS and the manager advised us that this was an ongoing process to keep the care plans alive and relevant for residents. The homes procedures describe the arrangements for providing Key Workers to support individual residents. These staff have a very limited role in practice because staffing levels are very limited, there was just one care worker (plus the manager) on duty when we inspected, so on each shift the carer is responsible for supporting all the residents with little opportunity to develop a ‘key-worker’ relationship with any nominated key resident and in no position to offer one–to-one support as indicated in a residents’ funding agreement. As one resident did not have a good grasp of English a translation and advocacy service is recommended. Meanwhile we are advised that the family of this person has been located and has given advice about background, language and cultural needs. The family should not however been relied upon as the sole form of interpretation of the resident’s needs, independent translation and support is indicated here. Risk assessments are completed, these are basic and mainly focus on keeping residents safe. Where limitations are in place, there is some evidence that decisions are agreed with the individual, for example when leaving the premises with or without staff support. There is basic information available to inform individuals of their rights for example in respect of mental health ‘sections’ as they might apply, most commonly ‘after care’. The manager advised us that they have supported residents in using advocacy services of agencies such as MIND (a specialist mental health voluntary agency). The home consults with residents on their satisfaction with the service they are receiving, usually during the course of residents’ meetings such as the one held in December, which the residents told us about. Areas of strength include the general care-planning process and consultation and discussion with residents which is acceptable but matters requiring improvement include the need to ensure that if residents have special needs, such as one-to-one support for certain number of hours each day, then this is reflected in their care plans and proper arrangements are in place to meet those needs including adequate staffing numbers and evidence that the care plans are being adhered to and are not just written ‘plans’ for care without the care being delivered. This section, about need and choices, is assessed as adequate. Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 11, 12, 13, 15, 16 and 17: Quality in this outcome area adequate. This judgement has been made using available evidence including a visit to this service. Personal development is offered but there are limits to this aspect of the service; residents are able to engage in community activities and maintain personal contacts and relationships but more support is needed where residents do not have English as their first language. The service aims to support residents’ rights and provides a good catering service. EVIDENCE: Generally staff are aware of the need to support residents to develop their skills, including social, emotional, communication, and independent living skills. Some residents are consulted or listened to regarding the choice of daily activity, but this process could be improved. The home is generally able to provide the facilities for some personal development but the laundry is very small indeed and inhibits staff working together with residents; the kitchen is of an adequate, domestic size in layout and equipment but in general staff cook for the whole group of residents whilst a resident is in attendance. As food is bought centrally (by the proprietor) the scope for personal development in catering is somewhat limited to helping peel vegetable and washing-up plus Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 Page 13 some shopping but this does not amount to the best form preparation for independent living and taking part in ‘life in the community’ as standards 11, 13 and 16 indicate. It is nevertheless acknowledged that staff try to develop residents’ self sufficiency by cleaning rooms with resident not for them and by having a resident in the kitchen when they are cooking, at least observing if not participating, but this is not always the case as we noted during our visit. As an example of our concern, the midday snack was beans on toast and yet it was the staff who cooked this simple meal – it might be expected that at least one resident could prepare such a snack. People using the service are given the opportunity to take part in a variety of activities both within the home and in the community. Where possible staff gathers information on community based events and try to make individual arrangements for people to attend. Educational, and where appropriate employment opportunities are explored and encouraged, residents are supported to lead a lifestyle that enables them to become part of the local community but progress is very slow; this maybe because staffing levels are very low so that one member of staff is expected to ‘support’ residents in cooking cleaning and laundry tasks each day. With this poor staffing arrangement there is little time or scope for individualised training for each resident – not even those that pay for one-to-one support each day. So, where appropriate some residents could be more involved in preparation for independent living or support at a lower level. We are advised that the proprietor plans to develop two residential units next to each other in Brighton Road and this one, at No. 851, will provide a higher level of skills and independence training. Greater emphasis on individual work with residents will be needed to achieve that aim – requiring a higher staff ratio not a lower one. Residents enjoy shopping in the local High Street and some have plans to take up further (adult) education. Residents told us that they keeping touch with family and friends and if residents have young children the home support residents to keeping touch where this is appropriate. Residents have commended the home for the meals and one comment summarises the general opinion of residents, “The food is excellent”. Whilst it is appreciated that residents enjoy the cooking skills of staff this tends to suggest residents are treating catering as part of the service the pay for rather than meal-preparation is a skill they might learn. The manager confirmed this point. Most meals are prepared communally and residents are on roster to assist. They confirmed in discussion they do help, for example “I help peel potatoes”. However, few meals are prepared with one-to-one support so residents can become more self-sufficient. As indicated earlier in this section, the purchase of food and other supplies by the proprietor tends to hinder local initiatives and independence and undermines the home’s manager’s role. Opportunities are available for residents to be involved in food shopping, the preparation of meals and menu planning, although the service might focus on the more able individuals and not always recognise the maximum potential of all people using the service. Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 Page 14 Areas of strength include the residents’ appreciation of the support given by staff, and the good meals. Whilst there is atmosphere of independence and choice in fact progress towards residents playing a full part in community life is very slow. Improvements include the need have enough staff to support residents to be independent; to move from communal activity to individualised support and to move away from centralised purchasing to home-based shopping so residents have greater opportunity to learn life skills. This section, about lifestyle, is assessed as adequate. Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 18, 19 and 20: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In most instances residents can be assured that their identified needs will be met although this is not always the case. Physical and emotional support will be provided. At present no residents retain and control their own medication. EVIDENCE: Residents have access to health care services both within the home and in the local community. The residents are able to choose their GP and attend local dentists, opticians and other community services from local options available to them. Health needs are monitored and appropriate action and intervention taken, for example if a resident’s mental health deteriorates then the manager consults the appropriate mental health team. There is evidence in the Care Plan of health care treatment and intervention, and a record of general health care information. There are some gaps in information, for example the staff duty roster does not indicate when one-toone care is being provided by additional staff hours and paid for purchasing authority for extra care. There is a care plan that outlines the care required including support for personal hygiene and support to undertake daily activities but in practice all residents received much the same support and ‘prompting’ and with only one carer on duty it was impossible for that member of staff to Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 Page 16 offer one-to-one support and supervision as required and at the same time provide support to the other residents. This meant the resident in question was wandering around the service rather aimlessly. Staff encourage individuals to be independent and to take responsibility for their own personal hygiene and this was confirmed by residents who responded to our questionnaire by telling us, “You are encouraged to live independently”. The views of residents are sought in the way personal care is delivered, this is reflected in the way that the care plan is drafted with reference to this specific point, and in most instances person care is delivered in a private and dignified manner but the missing door lock to one of the toilets will compromise privacy and dignity until it is fixed. The home has a medication policy which is accessible to staff, medication records were on this occasion up to date for each resident and medicines received, administered and disposed of are recorded. A new medication administration chart is in use to avoid the problems (failing to sign for medication given) identified in previous inspections. There is no evidence of any residents administering their own medication safely at present and it is surprising that none of the residents is being supported to do so in a unit offering rehabilitation – some level of self-mediation might be expected even if only on a daily basis. Residents are happy with the way that staff deliver their care and respect their dignity and have commended the staff for their “considerate and compassionate support”. Areas of strength include the residents’ appreciation of the support given by staff, and the good meals. Whilst there is atmosphere of independence and choice in fact progress towards residents playing a full part in community life is very slow. Improvements include the need have enough staff to support residents to be independent, to move from communal activity to individual. This section, about lifestyle, is assessed as adequate. Areas of strength include the support given to residents to maintain their mental health and to keep in touch with their metal health teams; they are supported in maintaining their medication regime and are encouraged to lead an active life and not to linger endlessly in the lounge smoking or watching television. Matters requiring improvement include the need to deliver the care contracted for including one-to-one support. This section, about personal care and health, is assessed as adequate. Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 22 and 23: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a clear and simple procedure for dealing with complaints so service users’ are confident their concerns will be dealt with promptly and effectively but not all service have copy of the procedures as required. To ensure vulnerable service users are safeguarded from abuse the home has written policies and procedures about the protection of service users and their property; this includes procedures for passing on concerns to the relevant authorities including the local authority care management team and the Commission. EVIDENCE: The record of complaints remains empty and no new complaints have been recorded for several years. However the home has taken up the suggestion of comments and concerns book which is now readily accessible to all residents and their visitors in the lounge – this too is empty. It is also noted that staff hold resident meetings from time to time, and of course staff meet with residents regularly both informally throughout the day and more formally for individual support sessions. This contact enables residents to make known their concerns without using the formalised compliant procedures. Nevertheless they must be given a written copy of the procedures as required by regulation and the manager is planning to do so by including it in a ‘welcome pack’ and the manager confirmed that this is happening. The Commission will continue to monitor the complaints procedures to ensure the home is demonstrating in a tangible way that it will listen to service users’ views without reprisal or recrimination. The residents themselves made no complaints about the service, on the contrary they commended the home and staff. Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 Page 18 The manager is familiar with both the complaints and the safeguarding procedures and has confirmed her understanding that these procedures must be referred to, and followed, if allegations of abuse in any form arise. No such allegations arose during the course of this inspection. Areas of strength are the positive way in which residents are supported to make known their concerns and the procedures that are in place to safeguard residents from abuse; whilst a matter still requiring improvement is for each resident to have a written copy of the complaint procedures. Despite this shortcoming this section, about complaints and protection, remains assessed as good. Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 24 and 30: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a safe, well-maintained and comfortable environment. This care home is an adapted family home and therefore very homely. It is well maintained. It was clean and tidy on the day of inspection but on a very hot day some areas such as the conservatories can be a little too hot and winter a little too cool, but otherwise service users are assured they will live in a safe and comfortable setting. EVIDENCE: Communal areas are pleasantly decorated and individual rooms are reasonably spacious and comfortably furnished. No bedrooms (except the one in the annexe) have ensuite facilities but each bedroom has a wash hand basin and each has a range of suitable bedroom furniture and fittings. Some areas of damage were noted such as broken unit in the kitchen, damage kitchen foodpreparation surface; broken/missing door lock to a toilet and lack of paper or linen hand-towels in both ground floor toilets and the kitchen’s wash hand basin. Cabinets in the kitchen and work surfaces are damaged and need repair or replacement. The Commission is confident these are matters that will be addressed by the manager or owner but a requirement is made to deal with Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 Page 20 them without further delay. Staff should be reminded to take some initiative and report matters needing attention and then follow up by making sure such items are fixed without promptly. The garden is very attractive and makes a pleasant location for service users to relax and meet visitors. As usual, the care staff were busy cleaning the house while the inspector was present and so the home was clean and tidy and free of unpleasant odour. However the lack of suitable hand-washing facilities in the ground floor toilet is a lapse in hygiene standards particularly as the toilet near the kitchen will be used by staff and residents preparing food. A requirement is made to address this point. Areas of strength are the very comfortable surroundings in which residents live and the good standards of hygiene maintained in the home. Matters requiring improvement are need to ensure hand-washing facilities are available in all toilets at all times and also the need to repair or replace broken equipment in the kitchen which are both important hygiene matters. This section, about the environment, is assessed as adequate. Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 32, 33, 34 and 35: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The number of staff employed and their skill mix is not entirely appropriate to the assessed needs of the current service users in this home – so this will not completely reassure residents that their needs are being fully met. The required procedures are now in place to ensure recruitment of staff protects residents but some deficiencies are again identified. The home has a staff induction, support and supervision regime in place but some staff have yet to receive suitable training in mental health; so service users can only be conditionally assured, with some reservation, that staff are competent in their jobs. EVIDENCE: Recruitment practices were found to be not safe when the home was inspected in 2005 in so far as two staff were being employed and neither the person in charge nor the proprietor could confirm that all necessary checks have been completed prior to their appointment. In 2006 this matter had been resolved and suitable recruitment procedures were put in place. From the checks wee made and judged by the statement made by the manager no staff are being employed with suitable safety checks including the police [CRB] checks taking place before employment starts. Nevertheless some of the older staff files inevitably have poor documentation such as a work history that is incomplete Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 Page 22 and is not a ‘full history of employment’ as required by regulation. It is strongly advised that such gaps in the documentation are either dealt with by further enquiry, by inserting a suitable photograph or an explanation from the manager is kept in the file as to the circumstances of the member of staff’s employment – for example why there is not a second written reference. As identified in 2005 and 2006, the staff team is a well established and loyal team of carers; they do reflect the gender of the resident group, that is, all resident are female and so are the staff but the staff team does not reflect the racial and cultural mix of residents, so the staff team reflects the background of the Africo/Caribbean proprietor not the predominantly White, English or European resident group. As to numbers of staff on duty each day, there is no longer any specified formula for staffing numbers; it is for the registered person, having regard to the size and layout of the home, the number of residents and their needs, to demonstrate that enough staff are on duty to meet residents’ needs. The home did not provide evidence that it could meet the identified needs of residents with just one carer and the manager on duty when we visited. The carer was responsible for cooking, cleaning and laundry - with residents either actively or passively involved as their condition allowed or they chose to assist. In addition to these daily routine tasks the carer has to provide personal support that is planned-for such as support in bathing and further support must be given for daily activities such preparation for shopping expeditions and visits to day centre. The carer must also respond to residents who need direct support or supervision as the need arose – for example when resident wanted advice or reassurance. It was not surprising that residents frequently entered the manager’s office looking for support. In our report dated 20th May 2004 we outlined an example of staffing levels that might meet the residents thus: The home is providing care for up to 8 service users including service users who are periodically removed to hospital under the provisions of the Mental Health Act and then discharged back to the home on leave. In these circumstances the CSCI requires that, unless the home can demonstrate that the safety and care needs of service users can be met, then there must be a minimum of two staff must be on duty for the safety and protection of staff and service users and to ensure the care needs of service users are fully met. The manager must also ensure that she has sufficient hours to provide supervision, training, administration and management duties in addition to any direct care she may provide. 20 Hours management time for the manager each week is advised. In addition to the minimum staffing levels indicated here, if a resident requires and is specifically funded for one-to-one care and supervision, as was the case when we visited in January 2008, then extra staff will need to be employed to meet the resident’s assessed needs. Areas of strength includes some improvement to staff recruitment practices and the support and supervision provided for staff but some staff need training in mental health care. More staff need to be employed to meet the needs of residents so this section about staffing is assessed as adequate. Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 37, 39, 41, 42: Quality in this outcome area adequate: This judgement has been made using available evidence including a visit to this service. This is a reasonably well run home and there is little doubt that the home’s aims and objectives benefit the service users in most aspects but the home was not being entirely safely run when we visited. Residents can be assured that, subject to observations made in other sections of this report, their best interests are being safeguarded but not at all times. EVIDENCE: The manager is qualified and has the necessary experience to run the Home and she is aware of and works to the basic processes set out in the National Minimum Standards. 851 Brighton Road is one of a small number of care homes owned by Mrs Dankyi. She has been advised by the commission in the past, for example in 2004 to develop are clearer managerial structure for her organisation and to that end she now employs an area manager who oversees the running of the care homes. However despite this clearer structure Mrs Dankyi still does not delegate clear lines of responsibility – so for example each Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 Page 24 manager has only a very small petty cash budget and even that has severe restrictions we are told so that when this home ran out of paper towels the manager did not feel free to buy extra locally. This centralised control is compromising both hygiene and residents’ personal development. The manager is aware of the need to keep up to date with practice and continuously develop management skills and uses here initiative to keep up to date with changes in the law - for example the new Mental Capacity Act and PACE (Police and Criminal Evidence Act, Code of Practice) as it applies to care homes. The manager trains and develops staff who are generally competent and knowledgeable to care for the residents the service, but not all staff have had training in mental health and this is particularly important for staff who have no previous experience of mental illnesses, as was the case when we visited the service. The service is planned to be user focused, to take account of equality and diversity issues, and generally works in partnership with families of residents the service and professionals. A good example of this is the admission of residents who first language is not English, the home has sought out family members who can supply information about the residents. However, the home still does not employ any staff that reflect the racial and cultural background of the majority of residents who are white, English or European. The home has a Statement of Purpose that sets out the aims and objectives of the service. The proprietor is improving and developing systems that monitor practice and compliance with the care plans, policies and procedures of the home by employing an area manager who will monitor and supervise the care homes under his authority. The manager is aware of the need to promote safeguarding and has developed a health and safety policy that generally meets health and safety requirements and legislation. The proprietor is in control if the staff budget and has limited staffing to one carer and the manager. This is not acceptable. Staffing levels have been outlined under the staffing section of this report. In addition to the minimum staffing levels the proprietor has contracted to provide one-to-one care for a specified resident and this is not being provided. Checks show that records are generally up to date although some gaps are found in recording and entries are not always clear. For example the staff records are not tidily presented and it was difficult to see if all the required documentation was in place and in some instances I was not. Other records such as the complaints record are in place and so was the record fire safety checks and drills. Residents case files were acceptable but would benefit by clearer subdivision. No health and safety matters arose other than the need to replace hand-towels and this was done during the course of the inspection. Kitchen units still need to be repaired or replaced to maintain hygiene standards in this area. In view of the staffing problems and the lack of adequate delegation of roles this section about management is assessed as adequate. Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 Page 25 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 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 2 32 2 33 1 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 2 12 3 13 2 14 X 15 3 16 2 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 2 X 3 X 2 3 X Brighton Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation 1 YA1 5(1)b; 5A(2); 5B Requirement Information: Not all residents have a contract or the information required by regulation nor a formal notification of changes to the contract and fees payable. This information is required so residents know what they are paying and was it intended for. Care plans: We identified a care plan that did not provide enough detail about how staff were to give one-to-one support specified by the placing authority. It must be made clear to the resident which member of staff is providing their one-toone care and that member of staff must be free of other duties so the resident will know they are getting the support they require. Personal development: It is required that the service move from communal activity towards individualised support and to move away from centralised purchasing to home-based shopping so residents have greater opportunity to learn life skills. Personal support: Residents must receive the supported the home has agreed to provide, and is paid to provide, and what the residents need. This is so the residents get the support they require for DS0000028529.V357219.R01.S.doc Version 5.2 Timescale for action 28/02/08 2 YA6 15(2)b c and d 28/02/08 3 YA11 YA16 YA13 12(1)b 28/02/08 4 YA18 YA19 12(1)a and b 28/02/08 Brighton Road (851) Page 27 5 YA30 16(2)j their own and others’ emotional and physical wellbeing. Hygiene: Evidence suggests this standard 28/02/08 had been previously met but the service ran out of paper towels and did not replace promptly enough on the day of our visit. The registered person must ensure that there are suitable handwashing facilities in toilets including towels at all times and without delay. This will ensure staff and residents can maintain hygiene standards at all times. Hygiene: The kitchen including work surfaces and cabinets must be maintained in good condition so as to reduce the likelihood of contamination and spread of infection. Staffing skills: Not all staff have received training in mental health and must be suitably trained so residents know they have the skills to understand and support them. Staff numbers: There were not enough staff on duty to meet all the residents’ individual needs and so in order meet those needs the home must employ adequate numbers of staff. Nor were staff roles defined in respect of residents with special needs. As a minimum there must be no less than two carers, whose roles are clearly defined, for each day shift and one carer as minimum at night. If the manager is to provide personal care and support she must be, as minimum, supernumerary to these levels at least 50 of her working week, that is 20 hours per week as manager not carer. Where one to one care is to be provided this must be in addition to these staffing levels. This is so residents will know their needs can be met by adequate staffing numbers. Staff recruitment: Prospective staff must be required to complete all sections of the home’s application form in sufficient detail to meet regulations including a full work history. The home must ensure it DS0000028529.V357219.R01.S.doc Version 5.2 6 YA30 16(2)j 30/03/08 7 YA32 YA35 18(1)a 30/03/08 8 YA33 YA31 18(1)a 28/02/08 9 YA34 YA41 19(1) to (11) 30/03/08 Brighton Road (851) Page 28 10 YA37 8(1)biii has been provided with all the information about staff listed in Schedules 2 and 4. Wherever possible gaps in this detail for existing staff must be explained and recorded in staff files. This is to safeguard residents by thorough recruitment practices. Management: The owner does not intend 28/02/08 to be in day to day charge of the home but the appointed manager is not being given overall responsibility for the day to day running of the home. The manager must be given overall responsibility to ensure the home meets its aims and objectives. This is so residents’ personal development is not compromised. 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 Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Road (851) DS0000028529.V357219.R01.S.doc Version 5.2 Page 30 - 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. 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