Inspection on 10/05/05 for Bromley Road (44)

This inspection was carried out on 10th May 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bromley Road (44) 01/04/09

Bromley Road (44) 07/04/08

Bromley Road (44) 23/04/07

Bromley Road (44) 16/05/06

Bromley Road (44) 04/10/05

Bromley Road (44) 13/01/05

Bromley Road (44) 26/07/04

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

CARE HOME ADULTS 18-65 44 Bromley Road 44 Bromley Road Beckenham Kent BR3 5JD Lead Inspector Wendy Owen Unannounced 10 May 2005 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. 44 Bromley Road G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 44 Bromley Road Address 44 Bromley Road, Beckenham, Kent BR3 5JD 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) 0208 658 7829 London Borough of Bromley Vacant Care Home 7 Category(ies) of Learning disability (6), Physical disability (3), registration, with number Sensory impairment (6). of places 44 Bromley Road G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18/01/05 Brief Description of the Service: 44, Bromley Rd is a purpose built care home owned by the London Borough of Bromley. The registered provider is the London Borough of Bromley Adult Division. The home is managed and staffed by employees of this service. It is located within a residential area of Beckenham and is close to transport links and Beckenham town centre, with its range of shops and leisure facilities. The home has recently been registered to provide respite care to a total of 7 adults. The home provides care to adults within the following groups; 6 with a learning disability; 6 with a sensory impairment and 3 with physical disabilities.Communal and private accommodation is set on three floors accessed by stairs. A newly appointed manager is now in post and has completed an application to be registered with the Commission. 44 Bromley Road G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one week day evening and one weekday morning. Two inspectors were involved on day one and one on day two. Two residents, two agency staff and the manager were all spoken to. The inspector received written feedback from three individuals. Medication procedures, care plans and other records were viewed during the course of the inspection. Since the publication of this report the Commission have met with the manager and provider to discuss the concerns and issues raised during this inspection. Immediate requirements were raised at this time and a response provided. What the service does well: What has improved since the last inspection? What they could do better: 44 Bromley Road G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.doc Version 1.30 Page 6 There are a number of areas requiring improvement, including the monitoring procedures. Medication and recruitment standards also had significant shortfall and there are also issues regarding the staffing mix and number of agency staff used. This provides a less than cohesive staff team and may reflect some of the poor systems found. The inspection also found concerns regarding servicing and monitoring of health and safety within the home. The Provider has still not developed individual agreements with residents to ensure residents are aware of any terms or conditions. This is an outstanding issue. The findings of the inspection, gives rise to concerns for how residents are being protected and the safety of residents being promoted. The findings show that there are a number of areas where residents may potentially be at risk. Further action may be required by the Commission to ensure the quality is improved in these areas. 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. 44 Bromley Road G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.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 44 Bromley Road G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.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 & 5 Residents are assessed to ensure care staff able to provide appropriate support and ensure needs are met. The home does not provide individual contracts which protect residents’ rights and ensure the care and support required. EVIDENCE: There is still no individual agreement between provider and service user. (See requirement 1) The home is registered for respite care with one bed allocated for a longer stay of six months. The objectives of the service, as detailed in the Service Level Agreement, is to provide planned respite care to service users. However, there are currently two residents who have been living in the home for approximately a year. This home has not been set up for such a service and will be discussed further with the provider. The home offers respite care on a regular basis to a number of service users. For “new” service users the manager attends an initial meeting with the learning disability team “panel” with a referral and assessment taking place involving the home and Care Management Team. 44 Bromley Road G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.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) 6,9,10 Care plans and risk assessments do not fully provide the information required to ensure residents’ needs are fully met. EVIDENCE: The last inspection detailed the need to improve care plans and to review these regularly. The manager has since this time reviewed a number of assessments and produced some good guidance in respect of each individual. There is still some work to be done to ensure the care plans identify all the individuals’ needs but also the interventions required by the home. (See requirement 2) Some general risk assessments have been developed but more specific ones are required in respect of individuals, such as residents going missing. (See requirement 3) Records are kept safe in the main office and on the ground floor. However, daily record books were kept in the lounge for anyone to access. (See recommendation 1) As resident only visit the home for periods of short term care, such as a week or weekend, the decision-making process and involvement of individuals in the 44 Bromley Road G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.doc Version 1.30 Page 10 home is quite limited. However, two residents spoken to felt that they had some control over how they spent their time during their stay. 44 Bromley Road G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.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) 11,12,13,14,17 The home maintains routines and activities, which promotes their continued well-being. Meals are provided to an adequate standard, ensuring residents’ continued health. EVIDENCE: During the stay residents are supported to maintain the usual routines and patterns of their lives, as far as possible. The home provides transport to and from two day- centres in the area, to enable service users to maintain their routine. One resident said that the home is very good in ensuring they are able to continue with their normal routine. The home does not provide transport to other educational, places, places of work or other day centres but will assist in finding alternative transport. One relative also spoke of the difficulties where ages and interests vary so much in the home. However, this reality is that this is the only option in the area. The Service Level Agreement also stated that it is expected the home support service users to participate in everyday activities, including household and 44 Bromley Road G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.doc Version 1.30 Page 12 cooking and social and leisure interests. There is some indication that residents assist in some simple domestic tasks. However, the information in care plans, relating to this, is limited. (See recommendation 2) Service users are able to visit a variety of social and leisure interests in the Beckenham area. Many service users attend the local Gateway Club, shop in the busy High Street and more often, at the weekend have a pub lunch in one of the local public houses. One resident spoke of how they attended various activities during their stay as well as the day centre and voluntary work. The residents who stay for a longer term receive regular visits or contact. For those staying for shorter periods the stay is to family and individual a break and therefore contact is limited. Residents spoken to said that the food offered was not great but “OK”. The lack of desserts offered appeared to be a concern for one resident and the printed menu showed no alternatives on offer. Many residents eat a full meal at lunch- time and therefore a lighter snack in the evening is reasonable. The home should consider recording where there is a reason for lack of desserts or offer lighter or low fat alternatives. 44 Bromley Road G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.doc Version 1.30 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 standard(s) 18, 19 & 20 The medication procedures are poor which place residents at risk. Healthcare support and promotion, for those staying in the home for longer periods, do not adequately ensure residents’ well-being EVIDENCE: The pre-admission checklist enables service users to detail their preferred routine and preferences, which the home tries to continue whilst the service users are in the home. These routines and assistance required must be recorded in the individual care plan. (See requirement 2) The home does not register residents with a local GP as they are already registered with one local to their home. There is an agreement with the local GP to provide emergency healthcare, if required, during their stay. This must be documented on the individual care plan. Those on long- term care must be registered with a local GP, if their current GP is not willing to visit outside the area. One resident refuses to visit a GP and therefore the home needs to ensure that there is a risk assessment and procedure where treatment may be required. (See requirement 4) An audit of the medication procedures showed little improvement since the last visit. The records were disorganised, confusing and in many cases, incomplete. Such a poor system gives rise to risks, especially in a service 44 Bromley Road G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.doc Version 1.30 Page 14 which has a number of residents throughout the week. Agency staff are often used in the home and act as seniors. All the agency staff spoken to, administer medication. Two agency staff spoken to confirmed that they received basic medication training through the agency and on the home’s procedures. (See requirement 5) 44 Bromley Road G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Residents feel their views and concerns are listened to and acted upon. EVIDENCE: There is a complaints procedure which now includes the Commissions details and there is a system for recording complaints. This is now more organised. The home also has a leaflet, which is in written and pictorial form. This is a simple and easy to read document. Residents spoken to said that they would have not problem in raising issues with the manager and that they are able to talk things through. Agency staff spoken to had an adequate knowledge and understanding of adult protection and the action they would take if they noted any incidents. They would benefit from a greater understanding of the various agency roles in respect of adult protection. (See recommendation 3) 44 Bromley Road G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.doc Version 1.30 Page 16 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) 0 EVIDENCE: These standards were not fully inspected on this occasion. 44 Bromley Road G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,34, & 35 Staffing levels and mix and recruitment procedures do not provide the level of care and support to protect residents. EVIDENCE: The home has a limited number of permanent staff in the home. There a number of vacancies and these are currently filled by agency staff. In the week of the inspection there were twenty-one shifts worked by agency staff and this is not unusual. There is no deputy manager and all staff work as the designated officer in charge on duty. Although there is consistency of the agency staff used and staff showed adequate understanding of core needs. These circumstances together with lack of a robust import from the management team does not provide an effective staff team. There is a lack of permanent staff, including senior members. This does not promote cohesive team working and can lead to inconsistent care. It may also be reflected in the poor medication procedures and documentation. Feedback from visitors and residents also identified the difference in care, when there is only agency staff on duty. (See requirement 7) The manager continues to be out of the home for two days per week and the roster did not identify any other working hours for the week or amount of time 44 Bromley Road G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.doc Version 1.30 Page 18 spent in the home. Respite care home needs sound management and administration practices. (See requirement 7) No permanent staff have undertaken the NVQ 2 in Care and none are registered. The management has done little to show that the package of qualifications and experience of staff are inline with NVQ 2. Whilst staff records show some core training, there is little other training or qualifications, which would show staff meeting this standard (See requirement 6) Recruitment procedures could not, once again, be inspected, as the recruitment records are not kept in the home. The manager has endeavoured to acquire some of the records, required to be kept, but there are gaps. The manager was not aware of the new POVA guidelines and up date Care Home Regulations Schedule 2 (July 04). This suggests that the current recruitment procedures are not robust enough. (See requirement 8) 44 Bromley Road G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.doc Version 1.30 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 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) 39,41, 42 The management and administrative practices, internal and external to the home, require significant improvement to ensure the home is being managed and residents fully protected. EVIDENCE: It is clear from the inspection findings and from a lack of records, that there is no internal or external monitoring of the quality of care in the home. The last inspection required the home to implement a quality assurance system and for the required monthly visits by the provider to take place. Neither have been implemented although the timescale for the quality assurance system has not yet expired. Previous standards have suggested that this service needs a more robust management and administration to ensure the quality of care and give residents the full protection they require. (See requirements 9 & 10) The health and safety file was well organised and, in many cases, records were up to date. The exception to this was the fixed wiring and fire alarm system 44 Bromley Road G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.doc Version 1.30 Page 20 checks. Unfortunately this would not have been addressed unless inspector had raised this. (See requirements 11 & 12) 44 Bromley Road G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.doc Version 1.30 Page 21 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 1 Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 2 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 3 2 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score x 2 2 1 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 44 Bromley Road Score 2 2 2 x Standard No 37 38 39 40 41 42 43 Score x x 1 x 2 2 x G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.doc Version 1.30 Page 22 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 5 Regulation 5 Requirement Residents must be provdided with individual terms and conditions of residency. This is an outstanding requirement from the last inspection. 1/05/05 Service users plans must reflect the assessed needs of the individual and include all areas of health, wlefare and social care. Risk assessments must be developed for all residents where there are potential risks. Residents must be provided with appropriate access to healthcare, including registration with a GP more local to the home. The medication administration records must be significantly improved. An immediate requirement was raised. This requirement was raised during the last inspection. Timescale: 1/03/05. The manager must ensure that staff used home are qualified to NVQ 2 or above or provide evidence to the Commission that staff have acquired the knowledge, skills and experience to this level. G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.doc Timescale for action 1/08/05 2. 6 15 1/08/05 3. 4. 9 19 13 13 1/08/05 1/07/05 5. 20 13 1/06/05 6. 32 18 1/08/05 44 Bromley Road Version 1.30 Page 23 7. 33 18 8. 34 17&19 9. 39 24 10. 39 26 11. 42 23 12. 42 23 This is a requirement from the last inspection. Timescale: 1/03/05 The home must be staffed with an appropriate mix, adequately trained and qualified staff. The number of agency staff must be reduced to provide consistent staffing levels in the home. The home must keep employee records in the home, as required by Schedule 4 of the Care Home Regulations 2001. This is an outstanding requirement from the last inspection. Timescale; 1/05/05 Recruitment procedures must be improved upon to reflect the POVA guidance and emendments to Regulation 18 of the Care Home Regulations 2001 (amended July 2004) A system for the monitoring of the procedures and care practices must be developed and implemented. The Provider must undertake the montlhy monitoring visits as required by Regulation 26. This is an outstanding requirement from the last inspection. Timescale:1.05.05 The inspection of the fixed wiring must be undertaken. An immediate requirement was raised. Monitoring of the fire alarm system must be undertaken weekly. An immediate requirement was raised. 1/08/05 1/08/05 1/07/05 1/08/05 1/06/05 1/06/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. 44 Bromley Road G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.doc Version 1.30 Page 24 No. 1. 2. 3. Refer to Standard 10 6 23 Good Practice Recommendations Records relating to residents must be kept secure within the home with access restricted to appropriate individuals. Care plans should include where residents are involved in undertaking domestic chores. Staff should be provide with more training or instruction on the role of the different agencies in relation to the protection of vulnerable adults. 44 Bromley Road G51-G01 S38244 Bromley Road V215261 10-0505 Stage4.doc Version 1.30 Page 25 Commission for Social Care Inspection Sidcup Area Office River House 1 Maidstone Road, Sidcup DA14 5RH 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. 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