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Inspection on 13/07/05 for Brimley

Also see our care home review for Brimley for more information

This inspection was carried out on 13th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Brimley provides a high standard of accommodation to less physically able residents with a learning disability. It is a one-storey building that residents say they like because `it is quiet` and `there are no stairs`. Residents went about their normal business during the inspection, some chose to change for bed, one was knitting, another watered the garden. When the inspector arrived residents had just had tea and had settled to watch television in the lounge. All were relaxed and were happy to speak with the inspector. Comments were `I like helping the staff` and `I love it`. One resident said that if she could anything she would have more outings and another said nothing should be changed. Each resident has been comprehensively assessed to ensure that Brimley can meet his or her needs. Each has a programme of activities which they have devised with staff and which they enjoy. These include computer work, arts and craft, attending the Doyle Centre, swimming and outings on the homes minibus. All activities take place during the day as there is only one member of staff on duty between 6pm and 8am. Residents said they had no complaints about the home but if they did they would discuss these with staff. The member of staff on duty demonstrated an excellent understanding of the ethos underpinning the complaints procedure and of the protection of vulnerable adults. This member of staff felt well supported by the staff team and by management. Although working alone, he said he could always call staff at the sister home or the person on call. Training for staff is comprehensive and appropriate.

What has improved since the last inspection?

Since the last inspection the garden has been improved with a lovely seating area and many pots and plants which many residents obviously enjoy. Thermostatic valves have been fitted to all sinks and baths to ensure that residents are not scalded.

What the care home could do better:

Each resident has a care plan but some do not contain a level of detail or the detail is not easily accessible to ensure that residents` needs are understood by all staff and are consistently met. Daily records are kept in a communal book which does not comply with the Data Protection Act. Medication records demonstrate poor practice in some areas. Hand written entries are not signed and not checked by a second person. Some prescriptions are crossed through without explanation or signature and no references to changes could be found in the care plan. Prescribed medication has not been given and there is no record of why. On one occasion one medication was not signed as being given. Whilst the staff member on duty demonstrated an excellent understanding of the types of abuse and the procedures to be followed if observed or alleged, some residents would benefit from further training in what to do if they observe abusive practices. Fire training records did not detail which residents have received training. The member of staff on duty had not had a fire drill at Brimley. Substances potentially dangerous to service users were not stored safely.

CARE HOME ADULTS 18-65 Brimley 1 Read Close Pound Lane Exmouth EX8 4NP Lead Inspector Teresa Anderson Unannounced 13 July 2005 17:30 hrs 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. Brimley D54 D06_s21893_brimley_v222845_130705 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Brimley Address 1 Read Close Pound Lane Exmouth EX8 4NP 01395 265775 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) Normanlea Society Limited. Miss Paula McConnell is the Responsible Person. Mrs Linda Williams Care Home 6 Category(ies) of LD Learning disability (6) registration, with number PD Physical disability (6) of places Brimley D54 D06_s21893_brimley_v222845_130705 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 04 February 2005 Brief Description of the Service: Brimley provides residential care for up to 6 people with learning disabilities who may have a physical disability.The property is a purpose-built detached bungalow located in a residential suburb of Exmouth, a short walk from the centre. There are six single bedrooms for residents, a lounge/dining room and a conservatory. There is a pleasant garden with seating areas. Car parking is ample. The home has the use of a mini bus which it shares with the sister home - 29 Albion Hill, also in Exmouth. Brimley D54 D06_s21893_brimley_v222845_130705 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place as part of the normal programme of inspection. It started at 5.30pm and finished at 8.30pm. The inspector saw all of the shared areas of the home and three bedrooms. All residents and the one member of staff on duty were spoken with. Records in relation to fire procedures, care planning and medications were seen. The member of staff on duty was helpful and was able to find all the information the inspector requested. In addition anything he did not know, he was able to find out. What the service does well: Brimley provides a high standard of accommodation to less physically able residents with a learning disability. It is a one-storey building that residents say they like because ‘it is quiet’ and ‘there are no stairs’. Residents went about their normal business during the inspection, some chose to change for bed, one was knitting, another watered the garden. When the inspector arrived residents had just had tea and had settled to watch television in the lounge. All were relaxed and were happy to speak with the inspector. Comments were ‘I like helping the staff’ and ‘I love it’. One resident said that if she could anything she would have more outings and another said nothing should be changed. Each resident has been comprehensively assessed to ensure that Brimley can meet his or her needs. Each has a programme of activities which they have devised with staff and which they enjoy. These include computer work, arts and craft, attending the Doyle Centre, swimming and outings on the homes minibus. All activities take place during the day as there is only one member of staff on duty between 6pm and 8am. Residents said they had no complaints about the home but if they did they would discuss these with staff. The member of staff on duty demonstrated an excellent understanding of the ethos underpinning the complaints procedure and of the protection of vulnerable adults. This member of staff felt well supported by the staff team and by management. Although working alone, he said he could always call staff at the sister home or the person on call. Training for staff is comprehensive and appropriate. Brimley D54 D06_s21893_brimley_v222845_130705 stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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. Brimley D54 D06_s21893_brimley_v222845_130705 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 Brimley D54 D06_s21893_brimley_v222845_130705 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) 2. Residents benefit from an assessment process that clearly identifies their individual needs. EVIDENCE: Care plans show that all the residents who live at Brimley have undergone comprehensive needs assessments. This forms the basis of each individuals care plan. Any restrictions are discussed with and agreed by the resident involved. Residents spoke with the inspector about their lives and what they like to do and how staff help them to achieve this. Residents also talked of the involvement of their families and friends. Brimley D54 D06_s21893_brimley_v222845_130705 stage 4.doc Version 1.30 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 standard(s) 6, 7, 9 and 10. The system for care planning does not provide staff with easily accessible information on how to meet residents needs. Residents records are not held according to the Data Protection Act. Residents benefit from an ethos which encourages autonomy and selfdetermination and which balances risk taking with protection. EVIDENCE: Each resident has a plan of care generated from an excellent and ongoing assessment. However, the level of detail in some care plans does not provide staff with sufficient and easily accessible information on residents needs and does not detail how these needs should be met. Any changes to residents’ conditions or information regarding the residents are recorded by care staff in a ‘communal’ house diary. This poses problems with confidentiality aswell as with continuity of record keeping. Risk assessments are comprehensive and balance the rights of residents to take risks against the needs for safety and protection. Brimley D54 D06_s21893_brimley_v222845_130705 stage 4.doc Version 1.30 Page 10 Residents talked of how they manage their daily lives and of the choices they make. These include the clothes they wear, what time they get up and go to bed, who they mix with and when and what they do. The member of staff on duty demonstrated an excellent understanding of the missing persons policy and was able to describe the actions which would be taken if someone did not come home as planned. Brimley D54 D06_s21893_brimley_v222845_130705 stage 4.doc Version 1.30 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 standard(s) 12, 13 and 15. Residents benefit from involvement in varied activities of their choosing and from involvement with family and friends. EVIDENCE: Residents spoke about the activities in which they partake. These include swimming, arts and craft, skittles and outings on the minibus. The residents visit local shops, restaurants and coffee shops and have links with their sister home which is also in Exmouth. All these activities are undertaken during the day, as there is only one member of staff on duty from 6pm until the following morning. Residents said, or gave the impression, that this was not problematic. However, it is something that the inspector will continue to monitor. Some residents visit with or are visited by friends and family. Brimley and 29 Albion Hill hold joint events to which family and friends are invited. Brimley D54 D06_s21893_brimley_v222845_130705 stage 4.doc Version 1.30 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20. Systems for managing medication do not fully protect service users. EVIDENCE: The procedures for managing medication were not fully inspected during this inspection. However, a number of areas for improvement were identified. Hand written entries are not signed and not checked by a second person. Some prescriptions are crossed through without explanation or signature and no references to changes could be found in the care plan. Prescribed medication has not been given and there is no record of why. On one occasion one medication was not signed as being given. Brimley D54 D06_s21893_brimley_v222845_130705 stage 4.doc Version 1.30 Page 13 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 and 23. Residents are well protected by the complaints policy and procedures but could be better protected from abuse. EVIDENCE: The residents have an easy and relaxed relationship with staff. They said that if they had any complaints they speak to the staff and that they have regular meetings where they are encouraged to speak up and air their views. The complaints policy is clear and understood by staff. The member of staff on duty demonstrated an excellent knowledge of the types of abuse and of the procedure to be followed if abuse were alleged or observed. However, one resident was unclear what to do, during the times when there is only one member of staff is on duty, if that member of staff were abusive. He was clear that if more than one member of staff were on duty he would speak out. Brimley D54 D06_s21893_brimley_v222845_130705 stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26 and 30. Residents benefit from homely and comfortable surroundings which are clean and hygienic throughout. EVIDENCE: Residents at Brimley are very proud of their home and garden which is clean and tidy throughout (although obviously well used). The six residents have their own bedrooms with shared washing and toileting facilities. Each bedroom is decorated and styled to the resident’s preference. Residents choose what electrical equipment and furniture to have in their bedrooms. This includes TV, video player, DVD player and music centre. Some residents have equipment that helps them to remain independent, such as a perching stool. Communal space is made up of a large lounge with dining room and a conservatory. Residents have ample comfortable seating and enjoy using this space to meet, relax and for such activities as watching TV and knitting. Brimley D54 D06_s21893_brimley_v222845_130705 stage 4.doc Version 1.30 Page 15 The garden is a clear favourite with many residents. There is a seating area and many pots and plants. One resident had been out watering the garden, a responsibility he clearly took seriously and enjoyed. Brimley D54 D06_s21893_brimley_v222845_130705 stage 4.doc Version 1.30 Page 16 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) Not inspected. EVIDENCE: Brimley D54 D06_s21893_brimley_v222845_130705 stage 4.doc Version 1.30 Page 17 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) 42. Residents would benefit from improved safety procedures. EVIDENCE: All staff receive induction and basic training such as moving and handling and food hygiene. Some resident have also received training in food hygiene. The member of staff on duty demonstrated an excellent understanding of fire procedures and practices. He has received fire training but the fire drill had been carried out in the sister home of Brimley (29 Albion Hill). The fire log book was in order. Residents were clear about what they should do in case of fire. However, accurate records have not been kept regarding which residents have attending fire drills. Brimley D54 D06_s21893_brimley_v222845_130705 stage 4.doc Version 1.30 Page 18 Substances hazardous to health were not stored safely. The door to the room and the cupboard in which these substances are kept were wide open placing residents at risk. Brimley D54 D06_s21893_brimley_v222845_130705 stage 4.doc Version 1.30 Page 19 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 x 3 x x x Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 3 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 x 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 x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Brimley Score x x 1 x Standard No 37 38 39 40 41 42 43 Score x x x x x 1 x D54 D06_s21893_brimley_v222845_130705 stage 4.doc Version 1.30 Page 20 No 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 20 Regulation 13 Requirement The registered person must make arrangements for the recording and handling of medication. The registered person must ensure that all parts of the care home to which service users have access are free from hazards to their safety. (This refers to the storing of substances which should be stored under COSHH regulations). The registered person must make adequate arrangements for all staff working at the care home and residents to receive suitable training and records kept. Timescale for action 31/08/05 2. 42 13 31/07/05 3. 42 23 31/07/05 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. Brimley Refer to Standard 6 Good Practice Recommendations The registered person should ensure that care plans detail the actions which need to be taken to meet needs and D54 D06_s21893_brimley_v222845_130705 stage 4.doc Version 1.30 Page 21 2. 3. 10 23 contain details of current and changing needs and aspirations and goals. The registered person should ensure that information regarding service users is kept in accordance with the Data Protection Act 1998. The registered person should ensure that service users understand what to do if they observe or allege abusive behaviour. Brimley D54 D06_s21893_brimley_v222845_130705 stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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 Brimley D54 D06_s21893_brimley_v222845_130705 stage 4.doc Version 1.30 Page 23 - 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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