Inspection on 01/12/08 for Brook House

This inspection was carried out on 1st December 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brook House 04/02/08

Brook House 08/05/07

Brook House 03/05/06

Brook House 08/11/05

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

CARE HOME ADULTS 18-65 Brook House Brook House 56 Ash Grove Four Pools Evesham Worcestershire WR11 1XN Lead Inspector Emily White Key Unannounced Inspection 1st December 2008 09:00 Brook House DS0000065900.V373315.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 Brook House DS0000065900.V373315.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. Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brook House Address 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) Brook House 56 Ash Grove Four Pools Evesham Worcestershire WR11 1XN 01386 765551 01386 429380 www.macintyrecharity.org MacIntyre Care David Joseph Bunn Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 8 The maximum number of service users to be accommodated 8 2. Date of last inspection 4th February 2008 Brief Description of the Service: Brook House provides residential care for up to eight adults with learning disabilities. Brook House is operated by MacIntyre Care who were registered on 1st November 2005 in respect of this service. Evesham, Pershore and District Mencap Society own Brook House. The stated purpose of the organisation is, ‘to be recommended and respected as the best provider of services for people with learning disabilities throughout the United Kingdom.’ The Responsible Individual is Mr William Mumford. The registered manager id David Bunn. Current fees for this service are £567.00 Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The manager sent information about the house to us before we visited. This is called the Annual Quality Assurance Assessment. We visited on a week day, and the manager was on duty and helped us. We met people who showed us around their home and we met the staff. We looked at some records such as care plans and medication and looked at how the house is run. An expert by experience also visited the service with us. This is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Experts by experience do not need to have experienced an identical service but they know what it is like to need a service. We have used their opinions to help us write this report. What the service does well: What has improved since the last inspection? The manager is now registered as manager. He has some dedicated management time to focus on improving the service. A domestic staff member is to be employed which will allow support staff to spend more time with people using the service. Peoples personal support plans are up to date. Records show all the right checks are made about staff before they start work, so people are sure staff are fit to work with them. Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 6 Training plans are up to date which means staff have the training and support they need. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information about the service has been reviewed. The service supports people with a variety of needs who may be better suited to alternative arrangements to meet their care needs. EVIDENCE: The last inspection identified that the service may not be suitable to meet peoples long term needs particularly due to peoples different ages and individual needs. The expert by experience who worked with us agreed with this. This is an extract from the report from the expert by experience: One person with support said he does not get on with a person in the house. I don’t think people should live with people they don’t get on with, just because someone lives in a care home does not mean they have to put up with people they don’t like- its very wrong and unfair. From what I saw and heard the men in the home like a quiet life but the ladies like to go out dancing and singing. The home has too many people with different personalities and not the staff capacity for people to lead person centered lives. Following the last inspection, the providers MacIntyre and the placing authority reached agreement on the need for collaboration to look at peoples support Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 9 needs and the right service to meet them. At the time of this inspection the placing authority had not carried out further assessments of need, but had let us know of its intention to look at this during the coming year. We were not able to see the assessments used for the people currently living at Brook House who have all lived there for some time. The manager tells us their last review by the placing authority was 2002. However the manager continues to look into the suitability of the house for all of the residents. For example one person is being supported to look into and apply for sheltered housing according to his wish. The service tells us that they are working towards a different model of care for the people living at Brook House. The Annual Quality Assurance Assessment tells us that they intend to involve Macintyres My Way co-ordinator to liaise with families and to help the people understand their choices and options for the future. The service intends to use communication aids and guides, and clearly document all the results from these meetings. As part of this process the service has reviewed and updated the statement of purpose, the guide, the service summary and all agreements. It is not the intention for anyone new to move in to the service, however all assessment procedures are in place should this be needed. Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Peoples independence is supported by a detailed plan for their care. The ways people are supported to make decisions and take risks are not consistently recorded. EVIDENCE: The last inspection identified communication with people using the service and recording in care files as areas for improvement. The Annual Quality Assurance Assessment tells us that the service has improved staff training by accessing internal person centred planning training, communication training, and by supplying manuals in person centred planning, healthy lifestyles and challenging behaviour to staff. In spite of having extra training, we found that there are still gaps in the way staff record and the opportunities people have for communicating their wishes and making decisions. It was difficult for us to speak to people using the service about how they make decisions about their daily lives, so we observed life in the house and looked at peoples care records. People have key workers who are named Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 11 members of staff who make sure the person has everything they need and works with them regularly. Peoples key workers are not identified in care plans. Reviews of peoples support are held every six months, one with the persons key worker and one with their day service. We looked at peoples support records which did not show a record of these meetings and who was present, and did not record the contribution from the person using the service. They also do not show whether peoples families or representatives have been involved. Staff keep a daily diary for each person which describes what they do during the day but does not provide good examples of how people are supported to make decisions. Some examples of good practice where people are supported to make choices are their holidays, a recruitment wish list for new staff, a listen to me checklist, and one person is being supported to attend different day services and look for alternative accommodation. The records of the house meetings are detailed, and show use of a communication mat and printed with pictures and words. However this good practice is not always consistent. The last meeting took place in October this year. We also saw that some peoples hopes dreams and wishes had not been recorded in their plans, and one persons listen to me records had not been completed. The Annual Quality Assurance Assessment tells us that risk assessments are used to help the person to take controlled risks while keeping them safe. We looked at the risk assessments for two people which were based mainly around their personal care and physical needs, for example incontinence, medication, exploitation (relationships and finance), safety away from home, walking, and transport. One person had a risk assessment for incontinence at night, but their care plan did not identify this as a care need for assistance to get clean during the night or in the morning. The Annual Quality Assurance Assessment tells us that the service intends to review peoples care plans to include a picture format daily living needs plan. Each person using the service will be involved in this and keep a plan in their room. We looked at some peoples care plans. The information in the plans is very detailed about peoples care needs. There is a summary which has a picture of the person and information about their communication, mobility, medication, likes, dislikes and family and important people. People also have a more detailed communication profile and eating and drinking guidelines. People also have an Essential lifestyle plan which covers, for example, peoples life at the moment, hopes and dreams, talents, interests, things they do and don’t enjoy, how they like being supported, personal care, and top ten tips how to support me well. People also have a My Life person centred plan, which has been put together with the person. Most are in a scrap book style with photos and show how people like to live their lives. Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 12 Some of these records have not been updated, for example one persons daily timetable had not been completed and their Essential lifestyle plan did not appear to have been reviewed with their personal care plan. The Annual Quality Assurance Assessment tells us that all staff including relief staff receive training as part of their induction on confidentiality, and the storing of personal information. We observed that staff respected peoples confidentiality during interactions with other staff and people using the service and all records are stored appropriately. In spite of the improvements made to staffing which we mention later in this report, the service has further improvements to make, to ensure people have enough staff support to make choices and have an independent lifestyle. The expert by experience observed that: I am also concerned about the staff levels here, as they do not have enough staff on to support people to lead individual lives. With people’s different wants and needs they have to have more staff on to support them to go out, especially in the evenings. People do not always want to go out in groups and they should not have to, people need to be supported to lead person centred lives and do what they want to do and not be dictated by staff levels. Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been improvements in the way staff are able to spend time with individuals one to one. People should be supported to find appropriate stimulation outside of day services both within and outside of the house. EVIDENCE: The last inspection identified that the service should help people explore opportunities for stimulating activities in and outside the home, so they can try new things, build skills and have the chance to develop a more fulfilling lifestyle. We asked the expert by experience who worked with us to look at the lifestyles of people using the service. The Annual Quality Assurance Assessment tells us that new and different activities have been sought. The service now tries to take people out at weekends, for example to local places of interest. We looked at the daily diaries that are filed out by staff. Activities recorded include watching staff Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 14 cook, going out for drives, craft at the day centre, trips to the bank, music club, shopping and cafés, out for drinks, puzzles, singing with staff. It appears that some people get most of their entertainment from their day centre and that within the house there is little opportunity for stimulation. For example, we were told that one person was wrapping Christmas presents when we arrived. We saw the staff member wrapping the persons presents for her. Another person who was in the house all day had no stimulation except to accompany the manager to the shop to get a paper. The expert by experience also commented on the occupation available for people in the house: I was shown a cupboard where the home keeps its arts and crafts and board games. Although the cupboard was full with different things I did notice some of the board games were for children, which is not age appropriate for people living in this home. When I asked if people use them often staff said they don’t, is this because they are childrens games? During my visit one lady kept repeated asking the question what is for dinner. I could not help thinking this lady may have kept asking the question as she was bored, not being stimulated and the next thing to happen in her life was going to be dinner. The service has improved some peoples access to the local community. One person works in a local shop twice a week. Another person attends a day centre at his request which is for older people, and some of the younger people attend regular discos and social clubs. The Annual Quality Assurance Assessment tells us that they have access to Macintyres your money fund and staff council award fund which they may consider should anyone need extra funding for an activity. During our visit one person returned from a shopping trip on their own with their key worker, which s good practice. The expert by experience observed some good practice and areas for improvement for access to the community: People visit their own banks to withdraw their own money - this was good to hear people visiting their local bank and being part of the community. As I noticed lots of photographs of holidays I asked where people had been this year and who with. The staff said they organized three holidays this year depending on where people wanted to go and who with. Two holidays were to the seaside and another to the Yorkshire dales, either two or three people went on each. I was pleased people had separate holidays and didn’t go in one group and they had a choice in where to go. I asked how people got out and about in the area, staff said they have a minibus or people can have taxis. I asked if people have a bus pass and staff said some do, they have a bus stop not far away. I think that everyone should be encouraged to have a bus pass and encouraged to use public transport as it helps people to gain independence and be part of the local community. Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 15 We saw from daily records that people have a lot of contact with and support from their families. One person who has less contact with her family and friends is supported to write a newsletter to keep in touch. We saw one that had been written in April this year. It would be good practice for the service to record any formal involvement from families such as review meetings. The Annual Quality Assurance Assessment tells us that the staff team enable people to do as much as possible for themselves and take a full part in daily living activities, such as menu planning. One person told us they always do their washing and clean their room. We also observed one other person being assisted to keep their room clean. People also have jobs to do to help with mealtimes. The expert by experience observed some good practice and areas for improvement for people managing their daily routines: In the kitchen it had a rota on the wall showing people what household tasks they were doing each evening around dinnertime. I was pleased to see people being involved in the daily tasks and the jobs being shared out. I did notice that people do not cook their own foods, although they do help prepare food. I asked why this was and staff said it was down to health and safety as the cooker is too dangerous for people. But staff had previously said people could make their own hot drinks with the kettle. I don’t really see if people can handle boiling water why they can’t be supported to use the cooker and make their own dinners. People need to be supported to be as independent as possible and not to be cared for. This includes doing all their household tasks and shopping. The Annual Quality Assurance Assessment tells us that the service has improved nutrition and menus and involves people by the use of clear pictures and by following new menu planning guidance. We observed a lunch time which was relaxed and people seemed comfortable chatting to staff. However before lunch one person repeatedly asked for a sandwich and was told to wait until the others had returned from shopping. Staff should support people to eat their meals at a time to suit them and to assist them to make meals themselves. The expert by experience observed that: The kitchen was a good size and I was pleased to see pictures on the wall as to what was for dinner each evening, which the people in the home choose weekly. I did think the board could be a little clearer as it only had one meal a day on it which made me think whether people have alternative choices and what happens at breakfast and lunchtime. Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples health and personal care needs are being met. This could be improved by consistent recording through all the systems used, to make sure staff are aware of all aspects of peoples care needs. EVIDENCE: The service has improved the way it helps people with their personal care. The Annual Quality Assurance Assessment tells us that recruitment has ensured a more balanced and diverse staff team. All the people living in the home have a detailed and up to date personal care plan which identifies the support that they need and how this should be provided. We looked in detail at two peoples care files. People have a Support plan which are up to date - we saw that peoples personal care ad been reviewed this year. The support plans have a summary which shows what works, what does not work, keeping safe and well, and future plans. Peoples detailed plans cover all their personal care needs. Both files we looked at made a reference to the behaviour support plan, but neither of these people have a behaviour support plan. One persons information about support for the morning is contradictory, saying they need full support, constant supervision and can do most things for himself. Although it appears that this person is getting the care that he needs, staff Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 17 must be careful to record peoples needs in a way that is meaningful for staff who may not know the person, to ensure that their needs are met. The Annual Quality Assurance Assessment also tells us that people have health action plans which detail the physical health checks that people need, and how often these should happen. They also give details of any other medical support or appointments that are needed to help people stay healthy. Staff monitor peoples physical and emotional health on an on-going basis, seek further help and advice if required, and discuss any areas of concern at staff meetings, so the team as a whole knows what is happening and what is expected of them. Other professionals and health specialists are involved as necessary. We looked at peoples health action plans which are up to date and show people have had the support they need, for example physiotherapy reviews, hospital appointments, and other appointments with health professionals as needed. The expert by experience told us that: I also noticed a guide for healthy living for people with learning disabilities. This booklet was not in an easy read format and looked like it was for the staff. I felt this booklet should be in easy read for the people that live here and people need to be supported and encouraged to lead healthy lifestyles. If they choose not to that’s fine but people should have an understanding of what a healthy lifestyle is. It would be good practice for some people using the service to be supported to be more involved in their own healthcare. This might include managing their own medications with support. The Annual Quality Assurance Assessment tells us that there are plans to look into this. The Annual Quality Assurance Assessment also tells us that there have been far fewer medication errors over the last twelve months, the service has implemented a new medication policy and the manager has completed two workbooks designed to enable him to train new staff in the preparation and administration of medication. We observed that medications practice including storage and recording is satisfactory. The manager carries out a medications audit every month to make sure this is consistent. The manager of Brook House recognises the issues of ageing for people using the service and acknowledges the different ages of people living there. The Annual Quality Assurance Assessment tells us that the service is aware of the ageing issues around one person they support and are actively involving older peoples social workers, local day centres and the GP to ensure health needs are monitored and changes acted upon. Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Due to inconsistent recording, the service is unable to show fully how it manages peoples complaints or protects people. EVIDENCE: People using the service have recently been affected by a number of incidents which have been reported to us and led to police involvement. The service has shown through this that it is able to respond appropriately when the safety of people using the service is put at risk. The service has shown understanding of acting in the best interests of people using the service, and awareness of mental capacity issues and safeguarding. However following these incidents we found some areas where the service has not followed up to ensure the well being of people using the service. We observed that the incidents mentioned above have been recorded appropriately using incident forms. The incidents particularly affected one person using the service, and it would be helpful if a copy of these records is kept in that persons care file. We spoke to a staff member who is the key worker of this person. The service has engaged an advocate and contacted the police to support this person, non e of which has been recorded in any of the files we saw. The visitors book confirms that the police have visited the house. When the service is taking action to ensure the safety and protection of a person using the service, it must ensure that this action is recorded to demonstrate the service is acting appropriately. Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 19 In one persons care file we saw two complaints had been made on their behalf by members of staff, one relating to the persons property and one relating to the incidents at the home in previous weeks. While it is good to see that staff are able to complain on behalf of people using the service, we did not see any response to these complaints in the care file or in the complaints file. The manager tells us that the issues have been resolved but there is no recording of this process. Another person using the service had also made a complaint which had been recorded in his file. The response to this was not enough to explain the action that had been taken by staff. The service should ensure that records have better details about incidents to show that staff are responding appropriately to issues that are important to people using the service. During our visit we observed some good practice. We observed that peoples money is kept in the home. We looked at files for money which are up to date and in order with receipts. Staff do an evening check to make sure all financial information is correct. WE observed staff recording this after a day trip shopping. The Annual Quality Assurance Assessment tells us that staff are being booked onto external protection of vulnerable adults training as this becomes available. Training is also being booked for staff around Macintyre’s specific procedures for complaints and protection. The expert by experience told us: In the dining area staff showed me a complaints book that was a talking book- I was pleased to see this booklet and also to hear the words, as not everyone reads. The Annual Quality Assurance Assessment tells us that the service recognises that some of the people who live in the home have difficulty making complaints for themselves. All staff are aware of the need to look out for changes in people that indicates there may be a problem. The service also liaises with families and day centres and asks them to tell them of any concerns that they may have. It is important that any action taken by the service to protect people is recorded appropriately. Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made to the home to make it more homely. However it is not necessarily appropriate to the needs of people living there now and the long-term aims of the service. EVIDENCE: The last inspection identified that the house is not necessarily appropriate to the needs of people living there now and the long-term aims of the service. Two people have decreasing mobility, so stairs are likely to become a problem for them without ground floor bedrooms. The service has tried to make improvements to the house. Improvements identified in the Annual Quality Assurance Assessment include displays of photographs, artwork, communication aids such as a pictorial rota and menu board to show what staff are working, and what is for dinner. The conservatory and garden have been improved. Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 21 The expert by experience made some observations on good practice and areas for improvement, which agree with the observations made by the inspector during the visit: On arriving at the home today I was pleased to see the home set in a nice residential area. The home looked similar to other homes on the street and did not stick out as a care home, which made it feel homely. My first thoughts were the home was cold and quite large. I used the toilet, which I found incredibly cold and even sat in the lounge I was cold and did not take my coat off during the visit at all. I found it quite worrying a home was this cold and feel it needs to be addressed and not accepted. A staff member showed me around the home, the lounge was open planned with the dining area with a conservatory off the lounge. Although the size was good having one big room for all the people that live here does not give them an opportunity to have space away from others. The conservatory room I felt was very cold, dirty and quite messy, not a room I would like to spend any time in. I was pleased to see plenty of photographs on the walls of people that live here doing different things. I did feel uncomfortable with some of the artwork on the walls of people’s hands being dipped in paint and put on paper. I didn’t feel this was very age appropriate, as I would expect to see this in a children’s room. Adults should be engaged in art that’s appropriate for their age. I was shown one ladys bedroom. I thought the room was very personal to her and really pleased with the tasteful way the room was decorated. Overall I thought this home was not up to a good standard - it does not feel homely, it was cold and too big with the upstairs having so many doors and corridors, I felt lost at times. During a random inspection carried out on the 20th September 2008 staff told us they spent too much time on domestic tasks which took them away from spending time with people using the service. During our visit the manager informed us that a domestic staff member has been employed to start soon for 16 hours per week which will free up the staff. We observed that all bathrooms, toilets and the kitchen are kept clean, and the conservatory was the only room that was not kept in a pleasant state. We checked staff files which show that all staff have up to date infection control training. Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have been made to staffing so that peoples quality of life has improved and they are supported by staff who understand their needs. The manager recognises that there is further need for improvement in this area. EVIDENCE: On 29th September 2008 we visited the service to carry out a random inspection which focused on staff only. This was to check whether requirements from the last inspection had been met. We found that all the requirements had been met. We looked at staff files which showed us that staff have relevant background experience and have taken training relevant to their role. Staff we spoke to during the random inspection showed good understanding of working in a personalised way and of respecting people’s dignity and confidentiality. Staff we met during our second visit showed a varied understanding of these issues, as observed by the expert by experience: The staff member who showed us around the home I found very friendly and seemed to have excellent values and was very respectful about the people who Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 23 live in the home. Another staff member who came on shift during my visit was very different from the other staff member and I found her to be very patronising. The staff member seemed to shout at the people when talking to them, which I found very disrespectful. I felt she was treating people like they were children, although the one member of staff seemed very good I do think it would be a good idea for the staff team to have some value base training. Changes to the service mean that there are now three staff available at busy times of the day, and a more stable staff team. The manager is included in the rota; however he has allocated management time and has the support of the senior staff member who is taking on some management tasks. The manager and staff confirm that the use of agency staff has reduced since January 2008. Agency staff are used to cover sickness and holidays. Staff files and the rota confirm that there is not a high level of sickness and that the use of agency staff is only high during holidays. People using the service are protected and supported by the recruitment practices of the service. We looked at four staff files which showed us that required procedures have been carried out checking the fitness of staff before they start work. Staff have a recruitment checklist in their files. No new staff had been recruited between our visits. The service has developed a training matrix which covers all training needs. Staff also have an individual learning and development plan in their files. Five of the staff have had training in challenging behaviour in 2008 and three have had protection of vulnerable adults training since 2007. The manager and staff also confirm that induction takes place in the form of shadowing and training, however the induction portfolio of a new member of staff was unavailable for inspection on both of our visits. The manager has identified several areas to focus on in training in the coming year, for example, protection of vulnerable adults, food hygiene and infection control. Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager has made improvements to the quality of the service so that people now receive the care they need in a safe and supportive place. The manager also recognises there are significant areas for improvement. EVIDENCE: The manager has an NVQ4 and Registered Managers Award, and is now registered as the manger for Brook House which meets a requirement from the last inspection. During our visit we met the manager who told us about some of his plans for improvement. He recognises that there are areas where the service can improve and where there are issues that are harder to resolve. Some areas for improvement identified by the manager include: • Training for staff in autism awareness and mental health Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 25 • • • • • • Training for staff in nutrition and the healthy lifestyles and menu planning guidance. Improving makaton signing for all staff and using it consistently with people using the service Using the new care plan template which can be personalised and will collate all information into one accessible file Working closely with the local authority, the local housing association and Macintyres My Way adviser to look at the future of Brook House Actively encouraging a re-assessment of peoples needs as they get older Meeting with all families on a regular basis The manager has improved ways that the service gets information about how well they are doing. They send out surveys annually for relatives and friends, and which are used as part of the annual development plan for the service. The manager wants to update the surveys to include one in picture format. There is a monthly management visit which checks areas such as training, medication, finances, and support plans. People using the service who do not have verbal communication can use signing or the talking mat which uses pictures and symbols to illustrate likes and dislikes and what is working and not working. This is used at house meetings and the service intends to use it as part of review meetings, which should be recorded as mentioned earlier in this report. The manager tells us he has been encouraging the staff to take ownership of the paperwork and recording, which is good practice. However he must ensure that all paperwork relating to peoples care, decision making and complaints and protection is up to date and meaningful so the service can demonstrate it is meeting peoples needs. The service sends notifications to us as it is required to do when incidents happen that affect the well being of people using the service. The health and safety and policies and procedures up to date, and the safe working practices risk assessments have been reviewed this year. We looked at records which Show that all the fire checks are done regularly. Health and safety equipment tests are up to date and there are morning and evening checklists for fridge temperatures, medications, monies, cleaning, ironing, and diaries. Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 x 3 x LIFESTYLES Standard No Score 11 x 12 2 13 3 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 YA35 Regulation 17 (2) Schedule 4 (6) (g) Requirement The service must be able to demonstrate through staff records that new members of staff receive structured induction training. This is so that staff know how to meet the needs of people using the service. Timescale for action 01/01/09 2. YA22 22 (4) (8) Where complaints are made by 01/01/09 or on behalf of people using the service, details of any investigation, action taken and outcome must be recorded. All complaints must be responded to within 28 days. 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 YA7 Good Practice Recommendations People using the service should have regular opportunity DS0000065900.V373315.R01.S.doc Version 5.2 Page 28 Brook House to make decisions about their care through regular reviews in whatever way suits their communication needs. This contribution should be recorded. 2. YA16 YA12 People using the service should be given the opportunity for greater stimulation within the home, through greater involvement in household tasks or other age appropriate activities which increase their independence. Staff should make sure that the information in personal support records is consistent so that people using the service get the support they need. People using the service should be supported to be more involved in their own health care and taking their own medications where possible. Action taken to protect people using the service must be recorded so that the service can demonstrate how it is acting in peoples best interests. Some members of the staff team may benefit from training in how to support people in a way that encourages their independence. 3. YA18 4. YA20 5. YA23 6. YA35 Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Brook House DS0000065900.V373315.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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