Inspection on 03/05/06 for Brook House

This inspection was carried out on 3rd May 2006.

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

Brook House 01/12/08

Brook House 04/02/08

Brook House 08/05/07

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 08/07/2008.

CARE HOME ADULTS 18-65 Brook House and 58 Ash Grove Brook House and 58 Ash Grove Four Pools Evesham Worcs WR11 6XN Lead Inspector S Davies Unannounced Inspection 3 , 4th and 10th May 2006 16:30 rd Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Brook House and 58 Ash Grove Address Brook House and 58 Ash Grove Four Pools Evesham Worcs WR11 6XN 01386 765551 01386 765551 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) www.macintyrecharity.org MacIntyre Care Mrs Juliet Marie O`Connor Care Home 10 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (2) of places Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. The lease in respect of Brook House and the Service Level Agreement in respect of 58 Ash Grove (both between Evesham and Pershore Housing Association and MacIntyre Care) will be amended as advised by the CSCI within one month of registration. 8th November 2005 The care home is primarily for people with a learning disability but may also accommodate people with an additional physical disability. No more than eight residents will be accommodated at Brook House and no more than two at 58 Ash Grove. Date of last inspection Brief Description of the Service: Brook House and 58 Ash Grove provide residential care for up to ten adults with learning disabilities. There is accommodation for up to eight service users in Brook House and for two service users at 58 Ash Grove (next door) where service users are able to live more independently. Brook House and 58 Ash Grove are now operated by MacIntyre Care who were registered on 1st November 2005 in respect of this service. Evesham, Pershore and District Mencap Society continue to own Brook House and 58 Ash Grove is owned by Evesham and Pershore Housing Association. 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 Mrs Margaret Jukes and the registered manager is Mrs Julie O’Connor. Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place during the days of 3rd, 4th and 10th May 2006. The home is an established service, having been open since 1981. This inspector had not visited this home previously, and spent time preparing for the inspection by reading documentation, including previous inspection reports, notifications and the pre inspection questionnaire, familiarising herself with the service history and completing the new inspection record documents, followed by 12 hours at the home. The service now accommodates nine service users but it is intended for the tenth place to be filled, and a prospective service user is currently being introduced. A first visit was made during the early evening to introduce the inspector and spend time with the nine service users at home, the inspection continuing the following day and concluding the following week. The manager and deputy were present throughout the second day of the inspection, and the inspector also met with 5 staff members and 2 agency staff, continued to meet with service users, toured the building and looked at a range of documents and records. Some time was spent getting to know the service and meeting with the nine service users, who were all at home from late afternoon onwards and some for part of the daytime. The service users were at their day centres or college, or having a relaxing time either at home or going out locally following chosen activities. On the days of the visit there were three staff on duty who were supporting service users at home or accompanying them out. The service users were well, settled and those spoken to talked positively about living at the home. They liked the changes the new providers had made to the accommodation including new furniture and décor, and related comfortably to staff. Comment cards were given out and 5 service users responded. All needed help to complete their responses, and replied that they were satisfied with the service provided although one service user would like more varied food and activities. Comment cards were also sent to the home for distribution to service user’s relatives and general practitioners, but no replies had yet been received by the time of writing this report. The home has had a challenging year with a new manager and largely new staff team, followed by a change of provider and the introduction of significant changes to the service. The permanent staff team needs to be completed as soon as possible, so that service users have the consistency and support they need for the service to stabilize and develop. Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? All aspects of the service continue to improve. The atmosphere in the home is friendly and relaxed with service users and staff engaging well with each other. The service users are gaining more selfconfidence, have been enabled to have more say about their own individual lifestyles and the running of the home, and readily talked about themselves and their day-to-day lives with the inspector. Most service users now have keyworkers, and are being supported with their personal development. New staff have been appointed and a stable staff team is being established although final vacancies have yet to be filled. Most outstanding conditions of registration and previous requirements have now been met. Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 7 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. Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 8 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 and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are community care assessments on record for all current service users, although it is unclear what information was provided to help service users at the time they considered moving in. It is intended MacIntyre’s full procedures will be used to ensure suitable placements in future. A room significantly smaller than new build standards is to be offered to a prospective service user. Full information about the room size and its limitations must therefore be provided and personal space needs assessed, so that a realistic decision can be made about suitability. EVIDENCE: The nine service users already living in the home have been there many years, and there is no clear information about the approach used at the time of their admission. However the manager confirmed that new documents and procedures introduced by the new providers are to be used for the prospective new service user if present discussions result in a placement being considered. The room to be used as a tenth bedroom is much smaller than current standards for new accommodation and does not have the space for all the furniture likely to be needed, so the providers have been advised to consider whether to continue using it, and if so how to make best use of the space available. So that they can take this into account at an early stage and reach Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 10 a realistic decision about the suitability of the service offered, the prospective service user and representative(s) need to be given clear information about the room size and facilities offered, and a full needs assessment should be carried out which includes personal space requirements. Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service user plans and risk assessments need further development and regular planned reviews, to make sure these reflect and promote the evident philosophy that service users are involved, supported and enabled to take part in making decisions about their own lives. EVIDENCE: A sample of four service user plans was viewed. The plans have been compiled from 2005 onwards following police seizure of previous records, although some background information, including community care assessments, was available. Contributions from one service users family gives valuable background and insights from birth onwards, which highlights the difficulties in building an understanding of someone where no such information exists. These plans do contain useful information about each service user but this is not yet well coordinated which makes it difficult to track health care needs and personal development. This could mean it is difficult for staff to make sure they support service users consistently in the way they prefer. Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 12 A good start has been made in putting together essential life plans, risk assessments have been carried out and there are details of the service users’ day placements and some activities. However the information needs to be restructured from a person centred viewpoint and gaps need to be completed, so that service user plans provide an integrated picture of the whole person, their background, likes, dislikes, communication, support and health needs with preferred routines, how they like to spend their time, special people, hopes and plans. These will need regular and consistent updating to make sure they continue to show the real picture. There is a checklist to guide staff through the process of risk assessment, this needs to be used consistently to complete full individual profiles. These service users have been unused to taking responsibility for themselves, so they are likely to need plenty of time and support to gain confidence in developing new skills which could improve their overall self confidence, and perhaps in time achieve more independence in some areas of their lives. Risk assessment offers a key to show where service users may be able to develop their skills. This needs to be linked to action plans providing a realistic pathway for personal development according to individual needs and abilities. For example, service users spoke of holidays and outings, and many special interests such as expanding horizons by use of public transport, enthusiasm for cooking, gardening, taking care of their home, interests in birds and wildlife, which need to be reflected more fully in their plans showing strategies for helping them develop their skills and interests. Care plans and risk assessments need to be signed and dated, identify any action agreed with timescales and who is responsible for this, include the date of the next review, and be kept up to date. Service users need a bigger part in putting together their plans, which should be in a suitable format for them. The key worker system should support this, although continuing staff vacancies mean this is not fully in place yet. Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16, and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Service users regular lifestyles have been maintained during the period of change, and staff are now helping them to broaden their interests and activities. EVIDENCE: The manager recognises service users need for stability and continuity at a time of major staff and service changes, and has therefore aimed to build on service users established, daily routines while expanding opportunities and gradually introducing new challenges. During this inspection all the service users spent some time out on day activities such as day centre and college, at home or out in pairs or individually with staff for walks, to the local shops and to fetch a daily paper, for meals or coffee. Other planned activities included a regular club and the providers’ Leadership group, while there was enthusiastic discussion of trips out and holidays. At home, service users were watching television or a DVD, playing Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 14 music, reading the paper, doing household chores, helping prepare meals, doing jigsaws and enjoying the good weather sitting in the garden. Some service users enjoyed craft activities and work was proudly displayed around the house, while an array of photos showed great fun being had at many shared social activities and holidays. Although service users enjoy using community facilities such as the leisure centre and going to local football matches there is scope to develop more social links within the local community. The home has an unmarked mini bus and outings are arranged on a regular basis including attending the Gateway Club. Service users spoke of visiting family members and inviting them to their home. One service user was getting ready to go out for a birthday meal with mother, and it was evident from discussion that regular contact with friends and family was supported and encouraged. Staff were helping another service user re-establish contact with long lost family. Discussion with the manager and staff showed much thought and effort is also being given to supporting families through the recent changes, acknowledging their uncertainties and need for support in their own right. One service user had moved next door and the two older service users now living at no. 58 had adjusted well to this although there remains an active link between the two households. Some meals are still prepared at Brook House but in due course all meals could be prepared in their own home. Meals at Brook House are prepared in the large kitchen and service users are supported to help. The menus show healthy eating is encouraged, these need to show all meals and identify alternative choices. Main meals are served at a very large table in the combined sitting/dining room with space for all staff, service users and any visitors to eat together, but this is quite formal for everyday, and consideration might be given to dining furniture which can provide more versatile arrangements and allow flexible use of the room. Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,21 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The service users were all relaxed and well on the day of inspection, and being supported by staff with their personal and healthcare needs. To make sure consistent care is provided by all the staff team, relief and agency staff, records need to provide a full, clear, up to date and integrated account of service users personal and health care needs, showing personal care preferences and any action needed to promote good health and well being. There are older service users at this home, with different needs associated with ageing to be taken into account. Staff training needs to include an understanding of the ageing process and older service users’ support needs. EVIDENCE: Service user plans show the daily care and support individuals need from staff. However these could be more detailed to make sure all staff understand clearly how service users prefer to be helped. Most of the service users are able to manage their own personal care with some encouragement and support. Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 16 Staff changes have altered the gender mix so that a member of staff of the same gender is not always available to assist the four male service users. This needs to be taken into account in the recruitment and deployment of new staff. It is evident from the service user plans that healthcare professionals are involved to give guidance to both service users and staff on specific problems. Staff had received training in introducing Health Action Plans and there was a Plan for each service user in the home, introduced a year ago. The service user plans would benefit from rationalising so that they contain only information which is accessible clear and easy to understand, relevant and up to date. At present it is difficult to be confident staff can find all the details they need to make sure every service user receives timely, appropriate attention from health services to maintain optimum health. For example, there is no summary of each individual’s health needs, showing intervention, monitoring and progress, and integrating information about healthcare and personal support needs. Records track routine access to NHS services such as well person check ups, dentist, optician, audiologist, physiotherapist and chiropodist, these need to be completed consistently to show outcomes and plans for monitoring/follow up/future contact. Where there is a reason why services are not used, this needs to be stated and any alternatives recorded. All entries need to be signed and dated. Some service users have specific health conditions. Information about the condition and the individual’s personal needs should be kept up to date and presented in a way which helps staff coordinate any action needed. for example one service user with scoliosis, a serious and deteriorating condition, had received no specialist input until a physiotherapist recently identified the need for this and also provided exercise guidance. However it is difficult to discern from the records what is to happen next. The service user has complex needs for which all care and support will need to be well coordinated to ensure optimum benefit. Clear, well-constructed records are essential to support an integrated approach ensuring the best quality of life for as long as possible. There are some older people using this service and staff need further training to understand the additional needs associated with ageing. No service user currently takes responsibility for their own medication, but neither this nor their ability to give informed consent for staff to administer their medication has been assessed and recorded. Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 17 The medication system was not viewed on this occasion but is due to be inspected soon by the pharmacist inspector. Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Service users are being encouraged to contribute their views and wishes, but continue to need much support and encouragement to do so. Monthly service user meetings are held in house, and MacIntyre runs a Leadership Group which most service users enjoy attending. Action is being taken by MacIntyre to guide and support staff and service users throughout the forthcoming court hearing, when anxieties are likely to be heightened and there may be intrusions on privacy. Most staff do not yet have training in adult protection and the management of challenging behaviour, although this is essential knowledge and would further aid staff understanding of service users experiences in recent years. EVIDENCE: Service users are being encouraged to contribute their views and wishes, but continue to need much support and encouragement to do so. Monthly service user meetings are held in house, and MacIntyre runs a Leadership Group which most service users enjoy attending The new providers’ complaints procedure is now in place and a copy has been provided to service users and their families. There have been no complaints since the last inspection. The manager and staff meet with families, and use this time to discuss issues of concern to them. The manager is aware that some families have found the changes over recent months unsettling, and that there have been anxieties about whether the nature and pace of these changes is right for the service users. She Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 19 understands their own need for support and reassurance, and hopes to improve confidence in the new staff team so that in time families will feel able to support the more enabling approach the service aims for. Communication needs assessments have been sought so that service users can receive the support they need to communicate their views and wishes effectively. The manager is keen to encourage service users to express themselves better so they can take a bigger part in making choices and decisions about things that affect them. However she recognises this approach will be unfamiliar and that they will need much time and support to gain the confidence to do so, and that this may not be fully achievable for everyone. From discussion and observation during the inspection, it was clear new members of staff supported and promoted this approach with patience and respect for service users, but that some long standing staff unfamiliar with this still had reservations and would continue to need support to put the changes into practice. Police enquiries about previous adult protection matters are to be brought to a formal hearing. The providers have taken steps to ensure suitable guidance and support is provided for staff and service users in the event that any media or other interest may intrude on their everyday lives. However, only one staff member has training on adult protection awareness and aspects of managing challenging behaviour, and one on elder abuse, although these must be a particular priority for all staff, and especially to help staff at Brook House and 58 Ash Grove understand and address the recent history of this service and the service users’ experiences. Service users’ finances are carefully managed. Service users are supported to carry out some transactions themselves although none are currently deemed able to take responsibility for their own finances. An assessment showing this needs to be recorded in each service user plan, including whether and how service users might be supported to develop suitable skills. Detailed records are kept of all transactions with service users’ finances, although confidentiality is an issue as these are stored collectively not on individual service user plans. Although staff are expected to double sign entries this is not always done and care must be taken to do so. It would be good practice to include with the financial records a copy of the policy and procedure to be followed in handling service users’ money, and for the manager or a senior to periodically check and sign these records to verify they are in order. A check showed every account was in order on the final day of inspection, with personal monies and records tallied. Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Both houses are suited to their purpose, homely, clean and comfortable with service users having single, personalized bedrooms, spacious kitchen, washing and communal areas with good facilities and well tended gardens. Upgrading work has been carried out and bedroom redecorating has started. There are currently no ensuite facilities, although two service users would specifically benefit from this. EVIDENCE: The houses are situated at the end of a cul-de-sac on a residential estate, near a bus route and an out of town retail park. Brook House, a detached, extended family house for eight service users and 58 Ash Grove a semi detached house for two service users, are adjacent. Brook House (no 56) is owned by Evesham and Pershore District Mencap and Evesham and Pershore Housing Association own 58 Ash Grove. Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 21 The houses are in process of refurbishment and redecoration, comfortably furnished and equipped, homely, clean, warm and bright with pictures and the service users’ craftwork displayed, and there were many photographs showing service users and staff enjoying outings, holidays and social occasions. There is generally sound attention to health and safety measures to ensure the home is a safe place to live and work. A fire safety risk assessment has been completed and approved by the fire officer. One outstanding requirement for a standard height washbasin in the utility room has yet to be met. A sluice cycle washing machine has now been installed. Eight of the single bedrooms are of an adequate size but the ninth is small and the tenth is undersized. The service user who used this room previously had moved next door to no. 58. The tenth room at 9.3 square metres is much smaller than current standards for new accommodation (which is 12 square metres plus en-suite facility) and does not have the space for all the furniture likely to be needed. The previous providers had informed the Commission they did not intend to re-let this room in view of its small size, however the new providers have offered it to a prospective service user who is now being introduced. They need to be mindful of good practice in deciding on the use of this room, paying careful attention to space needed, so as not to disadvantage any occupant. A prospective service user and representative(s) need clear information about the room size and facilities offered, and assessment of personal space and equipment requirements, so that they can take this into account early on and reach a realistic decision about the suitability of the service offered. There are sufficient bathrooms for the number of service users in each house but those in Brook House appear stark and would benefit from some refurbishment to give them a more homely feel. There are no en-suite facilities although the personal habits of one and care needs of a second service user mean it would be preferable not to have to share washing and toilet facilities, and future consideration needs to be given to how this might be achieved. There is suitable and comfortably furnished communal space in both houses which all the service users share - in Brook House a large lounge/dining room and a conservatory, and in 58 Ash Grove a lounge/diner. A single very big dining table in Brook House enables all service users, staff and visitors to eat together if they so wish but as this might not be very often, and its size could be daunting for a smaller group, an extendable table might be more appropriate and allow for flexible use of this room. One service user’s physiotherapist has identified the need for a special supportive seat, but this has not yet been provided. Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 22 For staff use there is an office in Brook House and a sleeping-in room in each house. Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There is a suitable staff group to support the service users, with a training programme in place to provide them with appropriate knowledge and skills to care for people with learning disabilities. This programme needs to be extended to all staff and to incorporate specialist training needs. There is continuing reliance on a team of agency staff, and permanent staff still need to be recruited to remaining vacancies. EVIDENCE: There is now an established core staff team of 7 including the manager, plus 3 relief staff but there is continuing reliance on a team of agency staff, partly due to long term sickness of one full time staff member. Although the agency team is consistent so staff and service users are familiar with each other, permanent staff need to be recruited to remaining vacancies as soon as possible so that a full team is in place and team building can begin. Rotas have been submitted which indicate that a suitable core number of staff are on duty during the daytime, and at night a member of staff sleeps in at each house. However, as service users gain more self confidence and are ready to explore new personal opportunities, they will need more individual Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 24 one-to–one support to do so which needs to be taken into account in planning staffing levels and deployment. The rotas need to identify the senior, or designated senior, on every shift. It is not clear from the information provided if any handover time is allowed for at change of shift, and this needs to be clarified with sufficient time allowed for key information to be shared. The recruitment process for new staff was discussed with the manager. Staff recruitment records are kept at head office and although it was stated summary records of the recruitment process are kept in the home, these were not available. However evidence was seen confirming CRB checks had been made and received for all staff. In accordance with robust recruitment practice, the most recent staff member started work only once the check was obtained. The Commission has issued new guidance on storage, inspection access to and use of summary records in relation to confidential staff records. This has been discussed with the area manager, specific storage and access arrangements need to be confirmed in writing. MacIntyre offer a variety of training opportunities and a programme of induction and vocational training for new staff. In the last six months some staff have attended training for medication administration and first aid, and all have had fire safety training which now needs quarterly updating. One new member of staff is a Care Apprenticeship trainee and was enjoying her work and her studies. Information provided shows further training in safe working practices is still needed, the majority of staff still await training in food hygiene, general health and safety, and infection control. Training has only been provided to one person each on adult protection awareness, elder abuse and aspects of managing challenging behaviour, although the need to understand the recent history of the service and the service users experiences should make them a particular priority. There is a need for some more specialist training in response to specific health and other needs associated with this service user group, such as total communication techniques, diabetes, scoliosis, autism and ageing. Individual staff training needs assessments now need to be completed and individual staff training profile established, so that a training plan is in place for every staff member. Currently 29 of the staff have an NVQ in care and it is recommended that a minimum of 50 of staff have this. Staff spoken to were enthusiastic about working with service users, showed compassion understanding and empathy for them and their individual needs, and were committed to training and service development. Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been some good progress in developing the service, and 5 service users responding to a survey were generally satisfied with the support received. Although it was made clear not all staff share this view, staff spoken to welcome the positive changes which have taken place and were clear about the benefits for service users. Care needs to be taken to sustain the good progress made by ensuring the continuing development of sound records, completion of outstanding training on safe working practices which should include management level training for the manager, and pursuit of a full care practice training programme. Further progress will be achieved with the building of a strong, stable and well trained staff team. EVIDENCE: Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 26 The temporary manager initially appointed prior to change of ownership has been registered six months as manager. She has considerable experience in working with service users who have a learning disability and has completed NVQ level 4 in management. She needs to commence the Registered Manager’s Award and to complete updating of her training to management level in safe working practices. The manager has made positive changes to the service, in particular with regard to introducing a person centred approach and empowering the service users, and she has made good progress in recruiting a new staff team although this is still developing. Records required to be kept in a care home have been substantially improved, although discipline is now needed to sustain this progress and ensure staff contribute to and use the records effectively. In particular the records relating to service users’ care need to be restructured if they are to serve service users well. It would be advisable to accompany this with suitable staff training in record keeping. As yet MacIntyre’s full quality assurance system is not yet established. Service users are not familiar with their views being sought, and will need much support if they are to respond confidently. Advocacy support is likely to benefit service users in due course and consideration needs to be given to how this might be introduced. The Macintyre manual of policies and procedures and health and safety manual and policy have been introduced, although staff said they had to find time to familiarise themselves with its contents so progress could be slow. It would be good practice for staff to sign and date to show they have seen and understood each procedure, to facilitate monitoring and help encourage steady progress. Staff training in safe working practice topics is still ongoing and this must now be completed for all staff as a matter of priority. The manager has not yet undertaken training in the management of health and safety and needs to do so as soon as possible. Records showed most safe working practices and fire safety checks and procedures were now being observed, but several month’s gaps in fridge and freezer temperature checks (latest fridge check 27.12.2005, latest freezer check 19.8.2005) need addressing while two parallel COSHH systems need rationalising and bringing up to date. A full height handwashing sink in the laundry must be installed to meet a previous requirement. Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 27 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 2 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 2 26 X 27 2 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 X 2 2 X 1 X X 2 x Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 28 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 12,15 Requirement The service user plans must be completed with the service users, cover all aspects outlined in NMS 2.3, 6-21 and be structured in a way which is clear and easy to use.(timescale of 30/06/05 and 28/02/06 nearly met) Individual risk assessments must be fully completed and underpin action plans for service users personal skills development The low sink in the laundry must be replaced with a wash hand basin. (requirement of 31/03/06 partly met with installation of washing machine) Arrangements must be made to obtain a specialist support chair and any other equipment in due course identified as necessary for a service user with special needs Staff records must be available to show robust recruitment procedures have been followed, with 2 references and CRB and POVA checks made, prior to DS0000065900.V290801.R01.S.doc Timescale for action 08/09/06 2 YA9 13 08/08/06 3 YA28 23,13 10/07/06 4 YA29 16 08/08/06 5 YA34 19 08/09/06 Brook House and 58 Ash Grove Version 5.1 Page 29 commencing work in the home. 6 YA35 18 Individual staff training needs must be assessed and individual training profiles must be established A training programme for staff must be maintained which includes training in safe working practices, LDAF induction and NVQ qualifications, and specialist topics to meet service users’ identified needs. 50 of the staff must obtain an NVQ level 2 in care (timescale not yet met) 08/09/06 7 YA35 18,13 08/09/06 8 YA35 18,13 08/09/06 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 2 3 4 5 6 Refer to Standard YA2 YA6 YA17 YA23 YA23 YA40 Good Practice Recommendations Details of room size and facilities should be made clear to any prospective service users who may be offered the smallest bedroom Communication needs assessments should be used as the basis for establishing a communications strategy for the service A record of food provided for the service users should be kept, with sufficient detail to show individual choice and nutritional balance. Two signatures should be obtained for all financial transactions of service users money. Promote service users looking after their own monies, with support. Macintyre policies and procedures should be introduced to the staff with staff signing and dating that they have read and understood them. Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brook House and 58 Ash Grove DS0000065900.V290801.R01.S.doc Version 5.1 Page 31 - 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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