Inspection on 07/04/08 for Bromley Road (44)

This inspection was carried out on 7th April 2008.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bromley Road (44) 01/04/09

Bromley Road (44) 23/04/07

Bromley Road (44) 16/05/06

Bromley Road (44) 04/10/05

Bromley Road (44) 10/05/05

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 Bromley Road (44) 44 Bromley Road Beckenham Kent BR3 5JD Lead Inspector Wendy Owen Key Unannounced Inspection 7th April 2008 14: 00 Bromley Road (44) DS0000038244.V361814.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 Bromley Road (44) DS0000038244.V361814.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. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bromley Road (44) Address 44 Bromley Road Beckenham Kent BR3 5JD 0208 658 7829 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) maxine.shaw@bromley.gov.uk London Borough Bromley Mrs Maxine Shaw Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 7 23rd April 2007 Date of last inspection Brief Description of the Service: 44, Bromley Rd is a purpose built care home owned by Broomleigh Housing Association. The Registered Provider is the London Borough of Bromley Adult Division and the home is managed and staffed by their employees. 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. One of the beds remains open for any emergency situation within the borough and there is one placement for residents in receipt of intermediate care for up to a period of six months. Communal and private accommodation is set on three floors accessed by stairs. The lounge/dining room and kitchen are located on the ground floor as are three of the bedrooms, one bathroom and one shower room. The home has a registered Manager and support staff working during parts of the day and all night. No ancillary staff are employed. The fees for respite care are £8.82 per night. The Service Level Agreement details that accommodation, staffing to the agreed level and food is included in the fees charged. Residents are expected to pay for all toiletries; magazines Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 5 and activities. In some cases, transport to day centres, is included in the service level agreement. Full information is available on referral and the inspection report can be provided by the home on request. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 1 star. This means the people who use this service experience adequate. This unannounced visit took place over the course of one afternoon/early evening and a few hours in a morning to ensure we were able to talk to residents and staff. The inspection included gathering information from viewing the recently completed annual assessment (AQAA) and other information held by the Commission, sending surveys to those using the service and their families and contacting the Local Authority Care managers responsible for the placements. During the visit we observed the daily routines; spoke to the manager, a member of staff and a resident, as well as undertaking a tour of the building and viewing records held by the home. None of the care managers responded to our request for feedback. We wish to thank the residents, staff and manager for their support and during this inspection. What the service does well: 44 Bromley Rd provides a safe, relaxed, warm and friendly environment where people are treated “ as a person rather than a disabled one” wrote one relative. Another person wrote, “ I enjoy my weekends at Bromley Rd.” Staff have the information they need to ensure they are able to provide the care and support according to individuals’ wishes and ensure their health needs are met. One person spoken to told the inspector that, staff “give me the help I need” and “take me to places I want to go”. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 7 Staff generally understand the individuals’ preferences and have the knowledge and good approach to understand and support people and include them in decision making, wherever possible, as well as encouraging independence. One relative wrote “they involve him in all relevant activities.” People using the service and their relatives believe that the service is well managed and that “ Maxine Shaw is a good manager.” We find that she tries to implement the improvements identified by us, and the people using the service, and responds positively to the inspection process. What has improved since the last inspection? What they could do better: Activities for people must be improved to ensure they meet the needs of the wide age range of people now being cared for. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 8 There are still some areas of medication practices that need to be improved and risk assessments must be improved to ensure any health and safety risks to people using the service are reduced. There is also a need to ensure people are protected from risks of abuse by developing safeguarding and recruitment procedures and ensuring that recruitment practices ensure people are protected. A separate urgent letter was sent to highlight the continued shortfalls in the recruitment practices. Further enforcement action may be taken if these issues are not addressed. An action plan must be developed to redecorate and, where necessary, refurbish parts of the home to provide people with a warm, comfortable and well-maintained environment where risks of cross infection are minimised. A separate urgent letter was sent to ensure fridge/freezer temperatures are working within the required temperatures to minimise the risk of infections to people. Whilst we received good feedback about how the home is being managed and that people can approach the manager to ensure the service is meeting their needs, there are areas that affect the health, safety and well-being of people that must be improved. This includes improving the systems for monitoring the health and safety and the quality of care provided. Staff training also needs to be more organised to ensure staff receive regular and timely updates in core training. 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. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 9 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 Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 10 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): 1,2,4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people using the service have the information they need to help them make a decision on whether the home is able to meet their needs. There are systems in place for ensuring staff have the information they need to provide individuals with the care and support they require. EVIDENCE: Information is available on what the home has to offer and what it provides. This is done in a words and pictorial format and given to individuals or their relatives during the meeting which discuss the assessment and pre-admission arrangements. The manager expressed her desire to produce the information in a more userfriendly format for people with various disabilities eg in a dvd/video format. This would be beneficial for a number of the residents. We noted that there are now a more younger age-group being provided with a respite service due to transition from the children’s services to adult. This makes the age group very wide ranging and with differing needs to the older age group previously catered for. The manager acknowledged that there is a need to review the service because of this. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 11 There are comprehensive procedures for the referral, assessment and admission of new and continuing respite residents. There is evidence from the three files viewed that referral and assessment processes are ensuring the home is able to meet individual needs with the care manager’s assessment in all three. Although in one case this was quite old ie 2006 for a resident admitted in 2008. There is evidence of the manager undertaking assessments prior to agreeing the service is appropriate as well as evidence of people visiting the service to decide if it is right for them. This includes tea visits, overnight stays and shorter visits. In one case a service user was admitted under Court order as they were subject of safeguarding adults and were placed there for their safety. The home did obtain all information from the PCT respite placement but the format for these made it difficult to determine all the risks and needs. One individual was spoken to about the pre-admission procedures and visits to the home told us that had looked at the home before they came to live there and that they had met the manager prior to the visit so they had a good idea as to what to expect. Some of the written feedback showed that prospective residents have little actual choice about where the respite is to take place as there is only this home and a PCT funded respite service available for adults and a decision on which one would be right for the individual is dependent on the assessment. This is out of the home’s control and more a matter for Commissioning. There is evidence of people receiving short-term respite contracts. However one resident who has been in the home since June 2007 has not received any form of contract or terms and conditions yet and this was confirmed through viewing individual records. The manager stated the parents are not able to sign, the individual who has only mild to moderate learning disability and could sign their agreement or an advocate could be sought. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 12 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 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff understand the individual needs of those people living there and encourage them to made basic choices and decisions during their stay to ensure they have a say in what goes on. EVIDENCE: Three individuals who are currently receiving a service were case tracked, including one who is a long-term placement. The admissions information, assessment and care/support plans were viewed in each case and one resident spoken to about their care. Two of the residents were observed with staff during the course of the visit as they had communication difficulties together with other residents. All showed signs of well-being and appeared to be content and relaxed with staff. They were able to move about freely about the home and able to choose what they wanted to do. They all looked reasonably well presented and groomed and written feedback showed that people are generally happy with the care and support received. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 13 “They treat X as a person rather than a disabled one. They involve him in all activities.” Care plans viewed were varied with two containing guidelines on how to care for and support the individual in health, personal, social, cultural care needs. One of these required updating. The third one had the information transferred from the PCT placement and, whilst there was a lot of information on the file relating to the safeguarding issues and a pathways completed by the previous respite manager, this had not been signed or dated. There was a lot of information but it was not presented in a structured or organised way and whilst it may have provided all the information on health, social, personal care needs this was not easy to find. The manager stated that she was in the process of producing this in the same format as the others which would make it clearer and easier for staff to view. She was reminded of the need to ensure that these are developed within reasonable timescale from the date of admission. Discussions with the manager showed that staff write the care plans and supporting information but they involve residents as much as they can in finding out their needs and how best they can be supported. Speaking to one member of staff, listening to others and observing what goes on in the home it is clear that staff are generally aware of individuals needs and individuals are actively encouraged to become more involved in day to day activities and go out into the community balancing these risks with promoting independence. General risk assessments are developed that identify possible risks. There were risk assessments in place for some ie moving and handling, falls and epilepsy (as required in health and personal care) This needs to be more specific for some, including going out of the home and involvement in daily living tasks which should balance risks with independence. For some this is identified in the daily living skills with appropriate interventions but for others it is not so clear. Risk assessments should clearly state the interventions required to minimise risks to individuals. In the case of one, risk assessments around the safeguarding of an individual were in place for a number of areas. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 14 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): 12,13, 14,15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff encourage residents to be involved in daily living tasks, continuing day centres and community activities to ensure active participation. However, activities should be more reflective of age groups and not be dependent on changes on staffing levels. Meals are varied with residents given choice on what is on the menu and involved in the preparation and cooking of the meals. EVIDENCE: Routines of the day vary from weekday to weekend with weekday routines revolving around trying to get residents ready for the day. With only two staff and seven people requiring different support it is not always possible to enable residents to get up and receive the support they require at the time of their choosing. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 15 Respite users of this service generally attend their usual day centres during the course of the stay. However, some residents do not have regular day centres to attend, including those younger adults who in the transition from children’s services to adult social care services. For these the visits are generally made during the time when there would be school holidays. During this visit there were three youngsters receiving respite care, including one emergency placement. For these, and one older adult on longer-term placement, arrangements had been made for one to one care during the day. During the first visit two residents had gone bowling and one resident had gone out to the local shops. During the evenings and weekends there are two carers and activities revolve around preparing meals and watching TV etc. Some feedback suggests that the younger residents need more and different activities to the older adults and that due to the staffing levels at weekends there is not always the staff to ensure varied activities take place. There is not “always enough staff to provide activities for certain clients” said one relative. “If there are staff shortages residents cannot go out” said another. Some weekends they enjoy cycling at the Croydon arena where cycles are available for all, including those with physical disabilities and this is enjoyed very much by residents of all ages. However, it would be beneficial to have equipment such as computer and game stations that are appropriate to the younger age groups now being admitted. “I find my weekends at Bromley Rd very enjoyable. However it can be very boring watching TV all day. I would like to go out sometimes during my stay.” For some grooming is important for example for one person they enjoy having their hair and nails done regularly and staff are supportive and assist with this. It is positive that the staff support individuals with daily activity tasks and they are encouraged to undertake domestic tasks, shop for, prepare and cook meals. For some this is not what they are used to but from observations they appear to enjoy the involvement and sense of achievement. Lowered kitchen worktops make it easier for those with disabilities, especially for wheelchair users to join in the preparation of meals. One resident spoken with said they enjoyed going out to shop at various towns as well as the cycling on Saturdays and the lunch out afterwards. Accessing community activities is made easier by the home being located close to the bus, train and tram links as well as being close to Beckenham High Street and its shops, bars, restaurants and park. We looked at the quality of the food provided. In general residents take breakfast in the home and those that attend the day centres either take a packed lunch or they pay for a meal at the centre. For those in the home they Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 16 have a snack at lunch-time, or if they wish, they can eat out at their own expense. Staff have meals paid for at residents’ expense in certain circumstances. During the evening residents eat together except where they express a desire not to. Previously menus have been arranged in advance the week previously. However, this means that those residents are often determining the meals for others, except where there are long stay residents. Now the process involves those that are living there making a decision about what they want to eat which means this is often made at a later stage. The home also have the information about residents likes and dislikes which enables them to have a good idea what choices to offer. One admission sheet clearly stated that the individual was not to be given any “junk food” and was to given a healthy diet. Records showed that staff were complying with this request. On the day of the inspection during the early evening the deputy manager was observed talking to residents about what they wanted to eat. Fish was on the menu and they were able to say if this is what they wanted and what they wanted with it. eg chips or mashed potatoes etc. At the last inspection there were some issues about individuals cultural needs, especially in respect of diet. There have been improvements in this area with records showing individual needs and staff having a knowledge and understanding of these. People are also able to attend church if they wish and, whilst the manager stated that staff would escort them in this the staffing levels and feedback may not support this statement. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff understand the individual support required by those using the service and ensure their health needs are being met. Medication practices are satisfactory and if improvements are made the people using the service would be less at risk of any potential harm EVIDENCE: Support plans and risk assessment detail the main health needs of individuals and also detail the personal support required although there were gaps in risks such as moving and handling and falls. There are specialist aids and adaptations for those with physical disabilities along with rooms on the ground floor. A number of residents have epilepsy and there are risk assessments and guidelines in place for how these are to be managed and action to be taken. Staff are aware of these. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 18 It is clear that residents are encouraged to undertake personal care tasks as much as they are able and therefore the support provided to each individual varies greatly. One resident spoken to stated their routine and how they are able to do some personal care themselves but need support from staff for some things. This works well for her. Another resident needs full support and their care plan shows that, support is undertaken by female staff only. For those residents on respite, healthcare is the responsibility of the relatives. For those on longer stays the home needs to register with a local GP and ensure appropriate appointments maintained. We viewed the file of one long stay resident and saw appointments for dentist, GP, nurse and, where the resident suffered a fall, referral to the hospital. For the other longer stay resident there were records of appointments for the GP and hospital appointments. The manager must remember to ensure other health checks, including optician and chiropody are readily accessed. There is clear evidence of the staff adhering to the epilepsy guidelines for one resident and that the home are notifying the Commission of any events required under Regulation 37. It is also positive to note the home’s purchase of a sensor pad to alert staff to possible seizures during the night and are looking to improve this through purchasing one that links to the alarm system. It would be beneficial that staff are made aware of the guidance on this aspect of the requirements of the Commission. We found that records of individuals’ weights were not taken for any residents. Whilst this is not so important for those short stays it is for those on longer stays. Residents bring in their prescribed medication with them and the procedures for this are clearly laid out for relatives to adhere to. Medication entering the home is recorded on the admissions sheet and then recorded on to the specific medication chart and form developed for auditing processes. Medication is recorded by hand onto the medication administration record (MAR) with two staff signing to ensure the accuracy of the hand transcriptions. Each MAR had been filled in and there were photos attached with records of allergies recorded or “none known” where appropriate. Medication had been recorded in and out of the home in most cases, although we found bottles of prescribed medication in respect of one resident left behind. Viewing the records showed that staff had not looked at what came in, what had been used and what should be returned. Three bottles remained, four booked in and one and a half returned. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 19 The manager was also made aware of the need to provide more guidance for the use of “as required” diazepam and the use of an anti sickness medication. Where medication such as eye drops has an end date after opening, the date of opening had not been recorded on one bottle viewed but had on others. This raises the risk of infection as staff may use the medication after its “use by” date. There are records of medication being administered by staff and appropriate reasons why they are not administered. There are also records of medication being returned home with residents. Records also show medication being carried forward from one period to another and checks being made on the amounts in stock to the records. There is a little evidence of staff receiving medication training but none regarding accredited training and assessment of staff. Staff must be provided with clear training covering all aspects of medication and a system for assessment. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home feel safe and are listened to if they raise concerns or issues about the care they are receiving. Specific safeguarding procedures must be produced to ensure management and staff have current guidance on their role in protecting people who are living in the home. EVIDENCE: The home has a copy of the Bromley-Inter-agency guidelines that have DH POVA guidelines included as an appendix. These were dated in 2004 and should be updated (accessible from the internet) to take into consideration changes made in practice since this time. There are currently no adult protection procedures relating directly to this home as the manager states they use the inter-agency guidelines and DH POVA guidance. This guidance is quite old 2004 for POVA and prior to that for the inter-agency guidelines. These guidelines would not give the staff the information they need about their role in safeguarding adults and what the process is in the home where allegations have been made. This should include referral to the POVA register where allegations have been substantiated. The manager showed us the recruitment procedures in respect of Bromley Social Services recruitment. However, once again these are too generic and do not give the information and guidance that is pertinent to services Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 21 registered with the Commission (ie schedule 2 of the Care Homes Regulations). Procedures must be develop that clearly show the checks required of new staff as well as good recruitment ie equal opportunities, applications and interviews. The manager is very aware of the need to refer any allegations to the relevant authorities including the adult protection officer, police and CSCI. There are out of hours telephone numbers for any allegations issues made whilst the manager is not available and this was put into operation recently when an agency member of staff appeared to have consumed alcohol whilst supporting a resident outside of the home. The on-call manager was contacted and visited the home immediately and took appropriate action immediately to ensure the safety of residents. Between the agency and the home this was dealt with effectively and relevant agencies informed. A resident in the home is also subject to safeguarding protocols and resides at the home under court order. There are clear guidelines in place for staff to adhere to including contact and personal care. One member of staff spoken to had a good knowledge of what constituted abuse and that they would have no hesitation in referring this on even if it were the manager. They had some idea of other agencies involvement but were not aware of the adult protection team within social services or that people who were found guilty of abuse would be referred to the POVA register and the potential consequences of this. A resident spoken to said they felt safe within the home and that they would raise any concerns with staff. They felt confident of this and at the same time ensured the inspector that they did feel quite safe here. Written feedback supported this view. There is evidence of staff receiving safeguarding adults training, although records on this were variable. Complaints procedures are also in place (Bromley social services complaints procedures) and are in a simplified format with words, signs and symbols. The AQAA shows there to have been 2 complaints since the last inspection and the manager has taken on board the need to ensure they are fully recorded with an audit trail showing the investigation, outcome and any action to be taken as a result of the complaint. There is a system for logging the complaints and although other information is held by the home the recording sheets were not, as they were sent to the Head Office. It is recommended that copies of these be held in the home’s complaints register. An audit of two individuals’ personal monies were made and found to be satisfactory. The amounts reconciled with the records and there were receipts in place for individuals’ expenditure. We would recommend that, staff Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 22 responsible for the expenditure on residents’ behalf be signed by that staff member. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 23 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): 24,27,28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a clean and comfortable environment for people living there although work is required to ensure standards are maintained. EVIDENCE: Bromley Rd is a purpose built home with communal areas and bedrooms on the ground floor and bedrooms on the first floor along with a sleep in room; bathrooms, WC, office and quiet lounge. It allows access for those with mobility issues and has lowered work surfaces in the kitchen to enable wheelchair users to be able to undertake daily living tasks. The home could make further improvements by providing a fridge freezer that was also accessible to all. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 24 The home is in need of redecoration in a number of areas, including the bedrooms and communal areas that look tired. One resident told us that the decoration throughout the home was “all the same”, “boring” and that the armchairs and sofas were quite uncomfortable to sit in. They said that their room is comfortable, although they would like to see it decorated a little nicer. As this person is currently in long stay this should be considered. One other written feedback said that the “facilities are good” Some of the bathrooms/wcs also are in need of refurbishment with the tiles in one bathroom missing and coming away as well as being quite dirty. The flooring also needs a deep clean or replacement. The bathrooms in particular are quite basic and require a more homely touch. Toilet roll holders are missing off the walls with marks where they should be still in place. We suggested freestanding holders might be useful. We tested the hot water in one bathroom on the first floor which was satisfactory. The laundry room is still without hand-washing facilities ie paper towels or liquid soap. This must be addressed immediately to ensure risk of cross infection is restricted. Environmental health has undertaken an inspection and required the home to change the front units in the kitchen. This has been completed, although the counter tops now need to be replaced as the overhanging area has the laminate coming away and presenting a risk of cross infection. Some of the bedrooms are without lamps or mirrors and, whilst there may be lockable containers available, there needs to be lockable drawer space to ensure medication is kept safe eg creams. The rooms are quite impersonal, mainly due to it being a respite service and people staying there for a short time only. However, the longer term resident had made their room very much to their liking with their personal possessions and belongings. Overall there is a need for the house to be redecorated and in some areas refurbished. It is positive to note that Bromley undertake health and safety inspections each year and require action to be taken where there are issues. These have been addressed by the manager. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 25 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): 32,34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff recruitment procedures do not ensure the safety of the people living there. Staff are trained and competent to provide the care to individual according to ensure their specific needs are met although there is a need to ensure core training is updated to ensure the continued safety of individuals. EVIDENCE: The staffing level within the home varies and is determined by the needs of the residents in the home at the time. Some residents attend day centre whilst others stay within the home and therefore have 1:1 during parts of the day. During the evening, night and weekend there are two members of staff. The feedback received shows that there are issues about the staffing levels at the weekend where activities are limited because there are only two members of staff and six or seven residents often with learning and/or physical disabilities. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 26 Comments have been made in previous sections regarding the lack of specific recruitment procedures. The previous inspection identified shortfalls in the recruitment of new staff where the required checks had not been completed. Since the last inspection there has been one member of staff only employed as a casual bank worker. They were previously employed by the London Borough of Bromley (LBB) as a bank worker with a day centre and casually at Bromley Rd. The individual has been employed without checks as their work continues within the LBB. However, the manager was made aware that the Regulations for care homes are specific to services registered with the Commission and checks are required under Schedule 2 and include bank workers. The file viewed showed no Criminal Records Bureau, POVA, references or proof of identity. There was no proof of interview as she had been employed by the borough in a previous position, although not in a care home setting or other registered service. An immediate requirement letter was sent prior to the inspection report being sent to ensure compliance with the Regulations. Failure to comply with the Regulations may lead to further enforcement action being taken by us. Discussion with this member of staff confirmed the lack of interview process and checks as she had been employed by LBB in the social care side. She told the inspector of the induction process that has taken place since she became a permanent bank worker. They are also currently undertaking the LDAF foundation qualification to support their NVQ in promoting independence. The individual was knowledgeable about the service provided and what to do in the event of emergencies, accidents and incidents. Observations during the visits to the home showed that staff had good relationships and approaches with residents. They communicated well and tried to involve them in discussions. Training is provided in a number of ways. LBB, the Primary Care Trust and Bromley Autistic Trust have joined forces to provide LDAF training and courses. LBB have mandatory course for individuals to attend, including moving and handling, H & S, food hygiene and first aid. Viewing of training records showed that some of these need to be updated in line with health and safety. For example a number of staff have not received moving and handling training since 2006. Fire training is also over a year to eighteen months behind for some staff. It is evident that not all staff have up to date first aid certificates. However, there is evidence of the manager organising this training over the next few months in these areas. There is also a lack of any formal accredited medication training. The manager states that not all training records are up to date and that some certificates are not in place. She must review individual training records and ensure these are up to date and where there are further gaps identified training is arranged. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 27 There is some evidence of training taking place that is specific to the service. For example autism and learning disability to ensure staff are provided with the knowledge and understanding of individuals’ needs. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 28 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): 37,38,39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager of the home is experienced and qualified and provides an open and inclusive environment for people living and staff working in the home. There is a need to ensure procedures and practices are monitored more effectively as there is a potential for risks to individuals. EVIDENCE: The manager has the qualification and experience to manage the service and there is evidence that people using the service are receiving a reasonable standard of care and support. However, there are some management issues such as undertaking of Regulation 26 visits and completion of reports, health and safety (fridge an freezer temperatures and action taken) recruitment of staff and ensuring the training records are up to date. These shortfalls mean Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 29 that people using the service are potentially placed at risk and must be improved. With these improvements, together with the requirements needed in adult protection, it may mean a change in the rating from adequate to good in future inspections. Regular residents’ meetings take place monthly. This was confirmed by a resident, viewing of the minutes of meetings and by a staff member. There are also meetings with relatives with the last one taking place in November 2007. People also find that the manager is approachable and open to other people’s views on how the service could be improved. One relative wrote “Maxine Shaw is a good manager.” We would advise that the manager and provider view the key lines of regulatory assessment (KLORA) produced by the Commission to give guidance on how we rate services. This would help to highlight the improvements they need to make for the different ratings. The manager has also undertaken a survey involving relatives where out of 40 sent only 13 were returned. The responses were positive but also gave some ways in which the service could be improved. No report has been produced on the outcome of the survey and therefore there is no clear action plan. This should be produced to complete the review process. A sample of service contracts were viewed and found to be satisfactory, except for the servicing of the fire alarm and fridge/freezer checks. The records for recent servicing could not be found on the days of the inspection as they are maintained by Broomleigh Housing association. The contractors did come into the home to service the fire alarm on the second day and the day after the second visit the manager sent information that the alarm had been serviced in November 2007. The manager was made aware of the importance of ensuring information relating to the health and safety of the home is kept up to date and within the home to ensure updates etc can be monitored. Servicing of the hoists and fixed wiring are all in date. There are regular fire drills in place and a fire risk assessment has also been developed and the fire equipment serviced annually. There are issues with the fridge and freezer temperatures with the upstairs freezer running below 18 degrees regularly and the fridge in the kitchen running above 8 degrees regularly. This must be resolved without delay and action should be taken when the readings are noted rather than waiting for this to be pointed out by others. A letter under separate cover was sent to ensure this issue is addressed without delay. Accident and incidents are reported to the Commission as required under Regulation 37 and whilst the manager is aware of the requirements of the commission it may be beneficial for staff to have some understanding of what Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 30 is required and the implications for staff in some cases. This may help improve certain aspects of the care. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 31 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 3 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 3 28 2 29 3 30 2 STAFFING Standard No Score 31 x 32 3 33 x 34 1 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 x LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 2 3 2 2 x 2 x Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 32 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 YA9 Regulation 13 Requirement Risk assessments must be produced to identify possible risks to individuals and how they can be minimised to ensure they are safe. Medication practices must be improved by ensuring there are records in place for medication being carried forward each month and that there are guidelines in place for the administering of “as required” medication. Staff must also be provided with accredited medication training to ensure they protect individuals from risks to health. Activities and access to age resources must be provided for people using the service to ensure they reflect their age and abilities. Adult protection and recruitment procedures must be developed specifically to give guidance to staff in the home on how to recognise abuse and their role in ensuring people are protected from abuse. There must be a plan for the DS0000038244.V361814.R01.S.doc Timescale for action 01/06/08 2 YA20 13 01/05/08 3 YA14 12 01/07/08 4 YA23 13 01/07/08 5 YA24 23 01/07/08 Page 33 Bromley Road (44) Version 5.2 6 YA30 23 7 YA35 18 8 YA39 26 maintenance and redecoration of the home to ensure it is safe, well maintained and homely for people living there. An action plan must be provided for the areas identified in the report including replacement of worktops in the kitchen; refurbishment of the bathroom areas; redecoration of the communal and private areas. Please provide an action plan by the date recorded. Hand-washing facilities must be 01/06/08 provided in areas where risk of infection is identified. This includes the laundry, kitchen and bathrooms/wcs Staff training must be monitored 01/07/08 and recorded for all staff working in the home. Staff must received regular updates in core training to ensure they are competent and keep individuals safe. Please provide us with an action plan for training planned for all staff by the date recorded. There must be regular 01/06/08 monitoring visits made to the service by the providers to ensure the quality of care is monitored. 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 YA17 Good Practice Recommendations The home should make records of the food provided to individuals. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 34 2. 3 YA34 YA39 Criminal Records Bureau checks should be made on staff every three years. There should be a system for monitoring the practices within the home with action taken to ensure compliance with procedures. Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bromley Road (44) DS0000038244.V361814.R01.S.doc Version 5.2 Page 36 - 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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