CARE HOME ADULTS 18-65
Bromhall Road 110 Bromhall Road Dagenham RM9 4PH Lead Inspector
Ms Rhona Crosse Unannounced Inspection 8th December 2005 09:55 Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 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) 020 8308 2900 020 8308 2999 The Avenues Trust Limited Care Home 8 Category(ies) of Learning disability (8), Physical disability (8), registration, with number Sensory impairment (8) of places Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th September 2005 Brief Description of the Service: Bromhall Road is situated in a residential area of Dagenham. Bromhall Road is a residential care home offering 24 hour care for 8 service users. Any nursing needs are met by input from the Community Nursing staff who visit the home as required. Bromhall Road numbers 110 – 112 are 2 purpose built bungalows connected by an internal corridor. Each bungalow has accommodation for 4 service users. All accommodation is in single occupancy rooms with an adjoining en-suite. There is ample parking space within the grounds. Staffing levels are set for each bungalow. Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection therefore the home did not know the inspector was coming. The inspector arrived at 09.55. The acting manager was at the home and the home was appropriately staffed. The inspector looked at care plans, activity sheets, risk assessments and daily records and spoke with service users as part of the inspection process. The premises were also inspected. At the last inspection in September 2005 the Commission has concerns about the operation of the home. A meeting was held with Avenues Trust and an agreement was reached that the home should be monitored on a weekly basis by Avenues Trust. This was to ensure that the changes that were required to bring the home up to the National Minimum Standards took place. The manager at the time of the inspection left the home and an acting manager (an area manager) has replaced the manager that left. Since then the home has improved and the Commission are pleased to report that the quality of life for service users has also improved. Although there are definite improvements that are measurable, the home has still some way to go to be considered to meet all the requirements set out in the last inspection. This unannounced inspection took place prior to some of the timescales set for achievement. This was to ensure that the home was taking appropriate steps to address the concerns of the last inspection in September 2005. What the service does well:
As part of the new care planning process the home have put together a document that identifies the needs and wishes of service user at the time of death. The document is in pictures and words and excellent work has been undertaken to gain information about the wishes of service users. This is a difficult task and has been dealt with skill. The home have scored 4 for this standard. Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 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. Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 This information was not available at the last inspection but was available at this inspection. The formatting into a document that could be used by service User’s is in the process of being addressed. EVIDENCE: The Statement of Purpose and the Service Uses Guide were to be updated and put into formats that are suitable for service users. Although they have been updated specific formatting for service users still needs to be addressed. Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 8, and 10 The dependency levels of service users are such that although their needs and wishes are taken into consideration in relation to daily life, it is not clear whether they would have any understanding of how information is handled that relates to their lives. Of the 8 men accommodated only 2 would possibly have a very basic incite. EVIDENCE: The staff at the home have got to know the needs and wishes of service users by information provided by care planning, social history information and from watching body language, when choices are made for the service users who have no speech. One service user has an advocate who acts on his behalf. Relatives also give important information to the home. Care plans have been updated, however it was observed that for one service user with mobility problems there was no care plan drawn up this must be put into place. For another service user there had been a change in the dosage of the mediation ‘Warfarin’, the care plan did not reflect this change as it still had the old dosage recorded. As service users needs change care plans must be updated to show these changes.
Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 Page 10 Goals and aspirations have not been documented this will form part of the ‘person centred planning’. The home must ensure that these documents are completed and in use by the end of February 2006. Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 The above standards were inspected and found to have been improved. However the home still has a long way to go until these standards are met. EVIDENCE: As stated in the previous section ‘person centred plans’ are to be drawn up. Once this is achieved the opportunities for personal development, rights and responsibilities as well as appropriate personal and sexual relationships will be addressed. Service users use local service in the community and are able to participate in appropriate activities with their peers. An activities plan has been drawn up and staff are now engaging more appropriately in activities with service users. There was a very different atmosphere within the home at the time of this inspection and staff appeared to get more satisfaction from participating in activities with service users. Service users were more active and involved. The home is looking to developing named staff to be responsible for the organisation of activities. This
Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 Page 12 should enhance the opportunities available once some research has taken place by the staff about what is available in the local community. Families written to as part of the inspection process stated that they were happy with the care provided by the home. Meals provided for service users who are at risk of choking and aspiration are now being provided. Menu’s and meal choices were inspected, these documents recorded the appropriate meals provided for service users. However the home must maintain this and take advice from specialist should any changes occur to the needs of service users. Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21 These standards have been improved but still have a long way to go before they are achieved. The home have compiled a document/care plan for service users at the time of death. This includes picture formats as well as words. Although not all are completed, excellent work has taken place in relation to the lay out of the documentation and the plans that have been completed. The home are to be congratulated on how they have achieved this and the in-depth information about wishes they have gained. The home have scored 4 (exceeded) for this standard. Standard 20 relates to medication practices. The CSCI pharmacy inspector carried out an inspection of the medicines held and the medication practice and requirements were made in a separate report. EVIDENCE: During the inspection it was observed that one service user had personal care attended to by a male carer. Other service users were said not to have any particular preference to same gender care. However this must form part of the information in the ‘person centred plans’ that are to be put into place. Current care plans do not identify this choice. Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The home has policies and procedures and systems in place for the protection of vulnerable adults. Staff have attended training in the detection and reporting of suspected abuse. The home meets this standard and is operating well in this area. EVIDENCE: As stated the home has policies and procedures for the protection of vulnerable adults. The homes ‘Whistle blowing’ policy has been used and appropriate action was taken by the management to deal with a situation that arose. The Commission were informed as required by legislation. The home have policies and procedures for dealing with any complaints they receive. There have been no complaints made to the home by relatives about the care provided. Questionnaires sent to relatives that were returned to the Commission after the last inspection praised the home for the care they provided. Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): At the last inspection there were areas that require attention these have been dealt with and closer monitoring is taking place. The home was clean and tidy at the time of inspection and this enhances service users lives. EVIDENCE: The home was decorated for Christmas and looked very homely at the time of the inspection. Decisions were being made about how Christmas was to be spent. The manager stated that all the service users would probably be together for Christmas dinner if they were not going out to relative’s homes. The home was clean and tidy. Only one area, an en-suite in 112 requires the flooring of the en-suite scrubbing to remove the smell of urine as a stain has built up on the non slip flooring. The grounds around the home were being weeded and changes are taking place to the gardens. This will benefit the service users when spring/summer arrive as they will now be able to use the garden that were observed to be overgrown and requiring attention at the last inspection. Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 Page 16 Specialist equipment is provided in en-suite and bathrooms for the needs of the service users. Specialist beds and hoists are also provided. Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35 & 36 A random selection of staff files were inspected and found to be in order. Training and supervision is being provided. This protects the vulnerable service users in their care. EVIDENCE: The recruitment and selection procedures of the home were inspected. Staff files held the appropriate information. All documentation is assessed by the Human Resource department of the company. All staff have to undertake an induction programme and cannot complete their probationary period until this has been achieved. Staff training is taking place. Some of the recent courses provided are: Diversity in the work place, Autism, infection control, Basic first aid, health and safety, person centred plans, adult protection, Alzheimer’s disease and Challenging behaviour Training booked for 2006 is Epilepsy and rectal diazepam (booked to take place on the 10/1/06 and 18/1/06 by a specialist nurse). Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 Page 18 Some staff supervision sessions have taken place since the acting manager took over in September 2005. Senior staff who have had supervision training will take over some supervision sessions. Three staff are undertaking NVQ level 2 and two others are to commence this training in January 2006. Four staff hold NVQ level 2 qualifications. Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 & 42 There is no registered manager at the home. The role of manager is being undertaken by an area manager until a new manager can be recruited. However the acting managers approach has had a beneficial affect on the management of the home and the quality of life for service users. EVIDENCE: The home has no registered manager. A manager has been interviewed and was to come back to the home for a second interview where time would be spent with service users to see if the person had the appropriate empathy and approach to become the new manager. The home must put forward a manager for registration, if the person has not been successful at the second interview then the area manager must put forward an application to register as manager in the interim period until a suitable replacement manager is recruited. Health and safety documentation was available and a fire drill has now taken place. The home are aware that 4 fire drills per year should take place.
Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 Page 20 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 2 2 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 x 32 3 33 x 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 2 12 3 13 3 14 3 15 2 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 X 4 x 2 x x 2 3 x Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 Page 21 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 YA1 Regulation 4&5 Requirement The Statement of Purpose and the Service Users Guide is to be put into a format suitable for service users. Care plans must be updated to include all the needs of service user at the time of any change. Work needs to continue to build on personal skills rights responsibilities and personal relationships . These must be documented in the new person centred plans. Care plans must identify service users preferences to how personal care is delivered (whether same gender are on no preference). The en-suite flooring in house 112 requires the urine staining to be removed. The company must put
DS0000060787.V274614.R01.S.doc Timescale for action 28/02/06 2 YA6 15(1) & (2) 28/02/06 3 YA11YA15 14(2)(a) & (b) 28/02/06 4 YA18 12(4)(a) 28/02/06 4 YA30 16(2)(k) 20/01/06 5 YA38 8&9 30/01/06
Page 22 Bromhall Road Version 5.1 6 YA41 forward a manager for registration. 17(1)(a)schedule3(k) The daily records must 30/01/06 be more informative and provide evidence of how the service users spent their day and record any health needs appropriately 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 YA41 Good Practice Recommendations The current daily recording sheet is a poor document and consideration should be given to improving this to enable staff to write information more appropriately. Bromhall Road DS0000060787.V274614.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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