Inspection on 29/10/07 for Bromhall Road

This inspection was carried out on 29th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bromhall Road 16/05/06

Bromhall Road 08/12/05

Bromhall Road 09/09/05

Bromhall Road 15/03/05

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Bromhall Road 110 Bromhall Road Dagenham RM9 4PH Lead Inspector Harbinder Ghir Unannounced Inspection 29 October 2007 09:55 th Bromhall Road DS0000060787.V349993.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 Bromhall Road DS0000060787.V349993.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. Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bromhall Road Address 110 Bromhall Road Dagenham RM9 4PH 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) 0208 592 7690 0208 592 7690 glebe.house@theavenuestrust.co.uk The Avenues Trust Ltd vacant post Care Home 8 Category(ies) of Learning disability (8), Physical disability (8), registration, with number Sensory impairment (8) of places Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th May 2006 Brief Description of the Service: 110-112 Bromhall Road are 2 bungalows linked via a corridor and are owned and run by the Avenues Trust. The home is situated in a residential area of Dagenham close to local shops and transport links. There are ample parking spaces to the front of the building and the garden to the rear of the property is laid to lawn and flower borders. The service currently has 8 residents, 4 residing in each bungalow, who have a varying degree of physical and learning disabilities and sensory impairment, between the age range of 18 - 64 years. As informed by the service manager at the time of the inspection, the fee currently charged by the service is £1.480.44 per week. Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken by Regulation Inspector Harbinder Ghir. The inspection took place on the 29th October 2007 between 9.55am and 3.45pm. The service manager of the home was available throughout the day of the inspection. During the inspection the inspector was unable to talk to residents residing at the home due to their profound communication needs. Staff on duty and the physiotherapist visiting the home during the day were spoken to and relatives were contacted via telephone. A community learning disabilities nurse was also spoken to; comments are included in the report. The London Borough of Barking and Dagenham, who is the host authority for the service was contacted, inviting their comments on the service they are commissioning. They did not provide any feedback to be included at this inspection. As part of the inspection the inspector toured the home, read records of people who use the service and examined documents in relation to the management of the home. At the end of the inspection the inspector was able to provide feedback to the service manager. The Commission received a completed Annual Quality Assurance Assessment by the manager at the time in post, prior to the inspection. The inspector would like to thank everyone involved in the inspection process. What the service does well: What has improved since the last inspection? At the last key inspection 15 requirements were made in the following areas; updating care plans; correct recording of residents’ finances; risk assessments; to increase the content of information on menus; medication practices; Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 6 reducing health and safety risks posed to residents; the availability of staff recruitment files; the storage of equipment in bathrooms; the manager to register with the Commission for Social Care Inspection and to improve quality assurance systems. At this inspection 14 of these requirements had been complied with. I was pleased to see that these requirements had been met at this 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. The summary of this inspection report can be made available in other formats on request. Bromhall Road DS0000060787.V349993.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 Bromhall Road DS0000060787.V349993.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): 2, 3, 4 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service completes comprehensive pre-admission assessments, to ensure they can fully meet the needs of prospective residents. Trial visits are offered to all prospective residents, to ensure residents have information on the services and facilities provided at the home. EVIDENCE: There have been no new admissions to the home and all eight residents have resided at the home since it was opened in May 2004. On examining care plans it was identified that admissions are not made to the home until a full needs assessment has been undertaken. Pre-admission assessments were completed comprehensively and care management assessments viewed were obtained from health and social care services. Assessments comprehensively covered the mental health needs of residents, their personal care needs, dietary preferences, communication needs, mobility, religious, cultural and social care needs. There is also an extensive pre-admission policy and procedure in place to be followed for any future admissions to the home. Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 9 New prospective residents are able to visit the home as many times as they like and have an opportunity to stay overnight. Due to the profound communication needs of residents the inspector was unable to verbally communicate to residents. However, staff were observed to interact positively with residents, showing warmth and understanding of their needs. On the interaction from staff, residents were observed to respond through smiles and hand gestures. Staff were very aware of how each individual resident liked to have their daily needs met. For example, where they preferred to sit in the lounge. One member of staff assisted a resident to sit in the lounge, as this is where he liked to have his tea, while other residents preferred to have their tea in the dining area. Staff were also seen asking residents whether they would like to go out for an outing during the day or stay at home, promoting their rights to choice and ensuring they delivered a service, which ensured individuality. Bromhall Road DS0000060787.V349993.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): 6, 7, 8, 9 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is a good care planning system in place, but the registered persons needs to ensure that care plans are updated with changing needs of residents. The right for residents to exercise choice and control is promoted by the service and they are actively consulted on, and participate in, all aspects of life in the home. Risk assessments are undertaken routinely, to ensure residents are supported to take risks as part of an independent lifestyle, and are always updated according to residents’ changing needs. Service users’ financial interests are safeguarded and records of residents’ outgoings and incomings of money are recorded promptly. Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 11 EVIDENCE: Three care plans were closely examined. Care plans were written in plain language, and were easy to understand and looked at all areas of the individual’s life. Each care plan included a very detailed life history of the resident giving a lot of detail on the identity of the individual. The service has also implemented person centred active support programmes aiming to support residents to achieve their aspirations and actively participate in the running of the home, by staff supporting residents to taking more of an active role in cooking, cleaning, activities within and outside the home. A photo folder compiled by staff of residents was seen, which included photos of residents hoovering, loading the dishwasher, making a cup of tea, going to restaurants and having parties, to ensure they participated in all aspects of life within the home and were supported to make decisions. Information in care plans was also found specific to the religious, cultural and social care needs of residents. The information provided in care plans was very detailed and individualised, and clearly recorded and described how residents wanted their needs met. For example one resident’s care plan described how he indicates that he is angry or upset. His care plan stated “When X is upset, angry or wanting his personal space he will indicate this by putting his right finger to his ear and turn his head away, he may wave his arms over his face and refuse to interact with others.” Another example of the detail in care plans included how a resident would like to be woken up in the morning, the care plan states “When staff come to my bedroom I like them to knock on the door before entering, this lets me know someone is coming. They should greet me by saying hello or good morning which I respond to by smiling, clapping my hands or by making vocal noises.” Care plans were written from the residents’ point of view and concentrated on promoting the independence and aspirations of residents. The documents also included information in picture formats, including information on their likes, dislikes, how they communicate and what they are able to do independently and tasks they require assistance with. A booklet summary of the care plan was also kept in each resident’s room, ensuring the plan was available to residents at all times. The service had named these booklets “Communication Passports” which were also to be transported with residents in an emergency to ensure any new individuals in contact with residents knew their needs and how they liked them to be met. The service must ensure that all information included in the plan, always accurately reflects the needs of the resident. On speaking to the physiotherapist who was visiting the home at the time of the inspection, highlighted that one resident at the home wears custom made boots to enable him to weight bear and encourage him to mobilise, who she has completed a lot of work with. She stated that she has informed staff that the resident must wear the boots at least twice a day. However, on viewing the resident’s care plan, it did not identify this as a need or how care staff were to monitor or Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 12 meet this need, even though on-going correspondence was found in regards to referrals made by healthcare professionals providing these boots. A requirement in relation to the above findings will be stated as Requirement 1. On viewing the daily case recording sheets, there was no recording to evidence whether the boots had been put on or whether the instructions by the physiotherapist had been followed. The detail of case recording in the daily notes was very variable. Whilst some entries were adequate others were very brief and generalised, which did not reflect the daily life of residents at the home. Staff must record daily notes in sufficient detail to evidence that they are following the care plan and reflect the daily life, feelings, moods and observations of residents to ensure they are meeting the needs of people who use the service. This will be stated as Requirement 2. Care plans were reviewed on a six monthly basis. Residents also have a meeting with their key worker to discuss any concerns they may have on a monthly basis and monthly progress reports were completed by key workers covering any new risks posed to residents in regards to their health care, communication needs, relationships, personal care and finances. Risk assessments were completed for residents and identified risk areas in care plans including, risks that may be presented by the building, mobility, falling and wandering, going out, showering and bathing, which were all presented in picture format. Risk assessments included clear guidelines for staff to follow in managing risks posed to people who use the service. Risk assessments were reviewed regularly and amended accordingly. The service does not organise resident meetings. Resident meetings would be an opportunity to encourage residents to express their views and feelings about the running of the home and any issues that they may have and changes they would like made. Therefore it is Recommendation 1 that residents meetings are considered to be provided. The service is responsible for the finances of residents. Two residents’ records of money held were checked with the money held in safekeeping, which was all in good working order and the correct amounts were counted against the balance recorded. Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 13 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): 11, 12, 13, 14, 15,16, 17 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are provided with support to maintain their independence and in areas of personal development according to their needs and wishes. Residents are engaged in community life, promoting their opportunities to be part of the local community. Daily routines respect the rights of residents ensuring their needs are met in the way they prefer. Residents are offered meals that promote their choices and respect their individual preferences. Residents are supported to maintain family links and relationships inside and outside the home. Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 14 EVIDENCE: The service does have a commitment to enabling people who use the service to develop their skills, including social, emotional, communication, and independent living skills. Residents are encouraged to go out for walks, to the local park, shopping, and bowling and eat out. One resident has been supported to go swimming by staff and staff with great perseverance have enabled the resident to use the adult pool. The service leases a people carrier van, which a limited number of staff are able to drive. Due to the limited number of drivers this can inhibit residents from going out, as they may have to wait for a member of staff who can drive the van to come on duty. The service manager informed that they are trying to recruit more staff who are drivers. Due to the profound needs of residents they are unable to pursue educational or employment opportunities. Two residents attend healthlands day centre where they actively participate in a range of activities. Residents were also observed to be given choice in relation to daily living. One resident liked to spend time alone in his bedroom and this was respected. An annual holiday has not yet been arranged for residents as staff are in dispute with the company over pay arrangements when they support residents on holiday away from the home. The service must ensure this situation is resolved as soon as possible to avoid any adverse impact on the quality of life for residents or restricting their opportunity of going on holiday this year. Daily routines promoted the rights and choices of residents. Care plans further reflected this, as daily case recording sheets identified residents going to bed at their preferred time and getting up when they liked. The service has involved itself in a campaign of staying up late, which ensures residents do not feel they have to go to bed because of staff shifts and service constraints. All residents had leaflets and information on staying up late in their rooms. The home provides meals, which are varied and nutritious and meet the dietary needs of residents. There is a four weekly menu, and residents are able to choose their meals from a folder of pictures of foods, meals and ingredients. Separate menus were also devised for individuals on a soft diet to ensure they were not placed at any risk of aspirating from foods, which may not be suitable for them. Staff support residents to choose meals from the menu. Residents also could refuse their choice of meal on the menu on the day and staff prepared alternative meals specified by the resident. Residents also go out shopping and devise a shopping list with the support of staff. Evidence was also seen of residents going out to local restaurants and being provided with take away meals of their choice. The daily nutritional intake for each resident was recorded, to ensure their nutritional intake is monitored. Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 15 Individuals living at the home have the opportunity to develop and maintain important personal and family relationships. Some service users visited their family household on a weekly basis while others had family visit them at their home. Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 16 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): 18, 19, 20, 21 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents receive personal support and care in the way they prefer and require. Medication practices always ensure the safety of people who use the service. The ageing, illness and death of service users are handled with respect and as the individual would wish. EVIDENCE: Each resident has a devised health profile and plan in place. The plan identified their daily routine including the type of support they need in relation to personal hygiene and according to their level of care needs; it gives a comprehensive overview of their health needs and acts as an indicator of change in health requirements. Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 17 All residents have a designated key worker to promote their privacy and dignity, and all personal care is provided in private. Attention is paid to personal preferences in relation to the provision of personal care, for example whether one prefers a shower or a bath. Personal support takes account of individual preferences and residents’ choice of dress and appearance is respected. Residents are supported by staff to attend appointments with healthcare professionals and their health is closely monitored and prompt referrals are made to multli-disciplinary healthcare professionals where required. Regular appointments are seen as important and systems are in place to ensure they are not missed. Professionals spoken to, spoke positively about the staff team, in regards to meeting the needs of residents. The community learning disabilities nurse was spoken to as part of the inspection who spoke positively about the care provided at the home. She stated, “Staff always follow my instructions, service users are very well cared for. Staff are very good at contacting me promptly and I have never had any concerns about the service.” The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication administration records (MAR) were closely examined. Medication records are fully completed, contained required entries, and are signed by appropriate staff. Regular checks are recorded to monitor compliance. An audit trail of two medications was checked against the medication administration record, which was found to be in order. The service is highly efficient when identifying the needs and wishes of residents in the event of death. The arrangements residents’ want are openly and sensitively discussed during the development of the care plan. These are clearly recorded, respected and known to the staff delivering care. One resident’s care plan had identified that they wanted to be buried, the type of flowers they wanted, the type of head stone they liked, that they would like the local vicar present and their preferred selection of music to be played at their funeral, which was all presented in picture format and was completed with the support of Mencap advocacy. There are also policies and procedures for staff to follow in the event of a death; to ensure the death of service user is handled with respect and as the individual would wish. The service is commended for the high level of detail the information provides and they way it is presented in pictorial format. Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 18 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): 22, 23 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users can be assured their views are listened to and acted on. However, the service needs to record all concerns to ensure any dissatisfaction with the service is recorded regardless of source. All staff have received up to date training in Safeguarding Adults, which ensures the protection of residents. EVIDENCE: People who use the service are supplied with a complaints procedure that is easy to understand and follow. The procedure is devised in picture format and was displayed in the front foyer of the home and in residents’ bedrooms. The procedure is also available on CD and cassette. A complaints logbook is kept by the home, which was viewed. No recent complaints had been received by the service. The Commission for Social Care Inspection has also not been informed of any complaints. The home has comprehensive policies and procedures in place to follow when investigating a complaint. However, evidence was not seen of verbal concerns recorded by the service or how they are actioned. It is Recommendation 2 that all concerns about the care of service users, regardless of source or how they are made, are recorded and responded to. Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 19 All staff had attended Safeguarding Adults training which is also covered in the induction programme. The service has comprehensive Safeguarding Adults procedures and protocols in place. The service has obtained Safeguarding Adult procedures devised by The London Borough of Barking and Dagenham. There was also comprehensive guidance for staff on how to record incidents of abuse and preserving evidence. On speaking to staff they were all able to demonstrate their knowledge on identifying abusive practices and the protocols they would follow in reporting the incidents. On viewing the complaints book, which also has a section for recording compliments, a number of compliments had been received by the service. One comment made by the mother of a resident stated “I am very happy for Y, he always seems contended. I can see he likes the staff at the home”. Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 20 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): 24, 25, 26, 27, 28, 29, 30 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable environment and décor is of a good standard and provides a homely and pleasant living environment enhancing residents’ comfort. But further environmental safety checks and prompt maintenance would improve the environment of the home. EVIDENCE: Bromhall Road consists of two bungalows linked via a corridor. Four residents live in each bungalow, which has its own kitchen area, dining room, lounge, laundry and rear garden. Residents from both bungalows can freely move around both bungalows as they wish and socialise with residents. The interior of the property is very well maintained, is pleasant and furnished to a very good standard. All bedrooms and communal rooms meet the National Minimum Standards or are larger; all residents’ bedrooms are also en-suite. Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 21 During a tour of the home, some residents’ bedrooms were viewed with their permission. Bedrooms were bright and personalised to the taste of each resident. Residents had furnished their rooms with TV’s, DVD players and music equipment. Sensory equipment was also provided to some residents. A few residents kept a key to their room and staff could override all room doors in an emergency. The well-maintained environment provided specialist aids and equipment throughout the home to meet the needs of people who use the service. It was disappointing to find during a tour of the building that household hazardous cleaning equipment, detergent salts were stored under an unlocked cupboard under the sink in both laundry rooms. On viewing residents’ risk assessments two residents were identified at risk of poisoning themselves through consuming shower jells or bathing products. They could also place themselves at risk of consuming cleaning products. On touring the kitchen areas, foods were not labelled with date of opening in the fridge and foods were also not stored in airtight containers. A further tour of the rear garden area identified that the area was generally tidy but stored an old bed frame and soiled cushion. All parts of the home to which residents have access to must be so far reasonably practicable made free from hazards to their safety and unnecessary risks to residents are identified and so far as possible eliminated. This will be stated as Requirement 3. Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 22 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): 32, 33, 34, 35, 36 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recruitment practices are robust and ensure residents are in safe hands at all times. Staff training is provided to all care staff, to ensure they are equipped with the skills and are competent to do their jobs. The service has a good skill mix of staff to meet the needs of residents, but the use of agency staff needs to be reviewed by the service, to ensure consistency of staff is provided to people who use the service. EVIDENCE: The service does not store staff recruitment files at the home, these are kept at the service’s head office. A data sheet was provided for each member of staff confirming their CRB number, number of reference checks, employment history, confirmation of identity checks and a list of previous training, which was examined for three members of staff at the inspection. Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 23 On viewing staff training files it was identified that there is a comprehensive training programme in place and all staff receive on-going training. Training provided to staff this year included training in person centred active support, care of the dying, safeguarding adults, food hygiene, first aid, health and safety. Some of the training attended by staff in the later half of last year included training in epilepsy, manual handling, de-escalation and diffusion, breakaway techniques, valuing diversity and shift leading. The organisation must be commended for the quantity of training it provides to its members of staff and placing a high level of importance on training. The service has a ratio of 50 of NVQ qualified staff. On viewing the staffing rotas, six members of staff are on duty throughout the day, with three members of staff on duty on each bungalow. Two waking members of staff are on duty a night. The service regularly uses agency staff to cover sickness; this does not provide consistency to residents. The community learning disabilities nurse was spoken to as part of the inspection who expressed concern at the high level of agency staff used at the home. She stated, “The home does use agency staff which is not good for service users.” It is Recommendation 3 that the service reviews its use of agency staff with an aim to reduce the amount used, to ensure a consistent service is provided to residents at all times. Staff meetings take place on a monthly basis to ensure staff have an opportunity express their views or any concerns they may have. Staff supervision also takes place every one to two months and supervision minutes evidenced that these sessions are an opportunity to discuss the role of the job and any training needs staff feel they have. Minutes were taken in detail and outcomes to be actioned by the supervisor were clearly recorded. On speaking to relatives and family they commented very positively regarding the care provided at the home. One relative spoken to stated “X always has a smile on his face when we visit. I am very happy with the care provided at the home and never have had any reason to complain. X has been admitted to hospital a couple of times, and the staff have always kept me informed. They are very friendly.” The physiotherapist visiting the home at the time of the inspection was also spoken to, who stated “The staff are very good, the home has really improved, and they are very co-operative.” Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 24 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): 37, 39, 42 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is not a manger in post and the service manager is overseeing the running of the home until a manager is employed. The systems for service user consultation are in place, to ensure the home is run in the best interests of residents. The welfare of staff and residents is promoted by the home’s policies and procedures. EVIDENCE: The home does not have a manager in post with the previous manager leaving in September 2007 due to ill health. The service manager is overseeing the running of the home until a manager is recruited. She informed that they have Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 25 short listed six candidates to be interviewed in the coming weeks. She also informed that they have also advertised internally for an acting deputy manager today. The service is trying very hard to recruit a manager to run the home as soon as possible. However, the service must employ a permanent registered manager as soon as possible, in accordance with Care Standards Act 2001. This will be stated as Requirement 4. The service manager has had a positive impact on the running of the home as staff spoken to stated that they feel supported and that they have felt no adverse effects on the running of the home by the previous manager leaving. One member of staff stated, “The service manager is very approachable, she is very good. She is always here to support us. We have pulled together as a team and we are managing.” Another member of staff stated, “We are doing very well at the home, and the service manager is very good.” A senior member of staff informed “It’s been ok since the manager leaving, the service manager is always around, she’s at the end of the phone if we need her.” The service has comprehensive policies and procedures in place, which the service manager and senior members of staff review and update, in line with current thinking and practice. Systems are in place to monitor staff adherence to policies and procedures during their practice by senior members of staff observing care staff and through regular supervision sessions. There is also a sign and date monitoring sheet that staff complete to demonstrate they have read and understood the guidance. Quality assurance systems are in place and surveys are given to relatives, family, representatives and stakeholders to complete. Evidence was seen of the results being compiled centrally, received by all respondents throughout the organisation and transferred into charts and a report, which was published and available to anyone on request. The service has also introduced opportunity sessions for residents, to establish how they feel about life within the home and what the service can do to improve where dissatisfaction has been expressed. The opportunity sessions consist of staff observing residents throughout their daily life, and looking at how they feel about the home they live in. Health and Safety records were inspected. All documentation was in order and appropriately completed. Fire drills were completed regularly. Monthly regulation 26 visit reports were available to view at the home, and the Commission for Social Care Inspection has also been sent copies of these reports. Visits have been completed on a monthly basis and provide sufficient information on the day-to-day operations of the home. Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 26 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 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 4 3 X 3 X X 3 x Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 27 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 (1) (2) (a) (b) (c) (d) Requirement The registered persons must ensure that care plans are amended according to the changing needs of residents. Repeated Requirement. Timescale of 31/05/07 not met The registered persons must ensure that staff must record daily notes in sufficient detail to evidence that they are following the care plan and reflect the daily life, feelings, moods and observations of residents to ensure they are meeting the needs of people who use the service. The registered persons must ensure that all parts of the home to which residents have access to must be so far reasonably practicable made free from hazards to their safety and unnecessary risks to residents are identified and so far as possible eliminated. The home needs to employ a permanent registered manager as soon as possible, in accordance with Care Standards Act 2001. DS0000060787.V349993.R01.S.doc Timescale for action 31/01/08 2 YA6 17 (3) Schedule 3 (m) 31/01/08 3 YA30 YA24 13 (4) (a) 31/01/08 4 YA37 8, 9,10 29/02/08 Bromhall Road Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA8 Good Practice Recommendations It is recommended that the service organise resident meetings, to allow residents with an opportunity to express their views and feelings about the running of the home and any issues that they may have and changes they would like made. It is recommended that all concerns about the care of service users, regardless of source or how they are made, are recorded and responded to. It is recommended that the service reviews its use of agency staff with an aim to reduce the amount used, to ensure a consistent service is provided to residents at all times. 2. 3 YA22 YA33 Bromhall Road DS0000060787.V349993.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Bromhall Road DS0000060787.V349993.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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