Inspection on 04/02/08 for Brook House

This inspection was carried out on 4th February 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 5 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 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 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 1XN Lead Inspector Sue Davies Unannounced Inspection 4th February 2008 10:45 Brook House and 58 Ash Grove DS0000065900.V358861.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 and 58 Ash Grove DS0000065900.V358861.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 and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 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 1XN 01386 765551 01386 429380 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 vacant post 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.V358861.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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. An electrical installation report in respect of 58 Ash Grove will be obtained from an accredited electrical contractor and any recommended remedial work undertaken within one month of registration. Remedial work to the electrical installations at Brook House, as recommended in the electrical contractor`s report of 17 August 2005, will be undertaken within one month of registration. Fire risk assessments of both properties will be available for inspection by 8 November 2005. Any remedial work recommended by the Fire Safety Officer in his report of 2 June 2004, that is identified as outstanding during the inspection on 8 November 2005, will be undertaken within a timescale agreed with CSCI and the Fire Authority. The current Statement of Purpose, Service User Guide and Service User Agreement for the home will be reviewed and produced in the MacIntyre Care format within three months of registration. 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 May 2007 4. 5. 6. 7. 8. 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 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 and 58 Ash Grove is owned by Evesham and Pershore Housing Association. The stated purpose of the organisation is, ‘to be recommended and respected Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 5 as the best provider of services for people with learning disabilities throughout the United Kingdom.’ The Responsible Individual is Mr William Mumford. There is no registered manager at present. Current fees for this service are £567.00 Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 6 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. This was an unannounced key inspection that took place during the days of 4th and 14th February 2008. The purpose of the inspection was to look at progress made on the improvement plan set out after the last key inspection. Time was spent preparing for the inspection by reading documentation, including previous inspection reports, history of contact with the commission, and the provider’s monthly visit reports. A first visit was made during the morning and the second during afternoon and early evening to spend time observing patterns of care and talking with the service users at home, meeting with the acting manager and staff. The acting manager was present throughout and the deputy on the first day of the inspection, and we also talked to several staff members and spoke at length with 3 service users’ and their key workers, toured the building and looked at a range of documents and records including personal care records. Some time was spent looking at changes to the service since the last inspection and meeting with eight of 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, four and at times five staff on duty who were supporting service users at home or accompanying them out. The time and assistance given by service users and staff during the inspection were helpful and much appreciated. What the service does well: The house is welcoming and well cared for. Service users have chosen new colours ornaments and pictures for redecorating their home, and there are lots of photographs around the home showing the things they’ve all been doing. Things for service users to do at home include craft and sensory activities, television, video and DVDs, listening to music, games and puzzles, garden activities. Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 7 There are notice boards and information with symbols and pictures to tell people who live here about how their service works. Staff are learning different ways of communicating so everyone understands each other better. Service users are supported to have good contact with their families. Service users are working together with their key workers on their own support plans, so all staff will be able to understand what is important to them. There is good information in the plans about how they deal with day to day risks, so they can plan more activities with staff. This means some of the plans could be about learning more daily living skills so they can do more for themselves. Everyone had a good holiday by the sea last summer. What has improved since the last inspection? There is a skilled and experienced acting manager in charge of this service now. He has worked extremely hard and made a lot of important changes in a very short time, so service users can begin to see their service getting better. He is committed to resolving the difficulties in this service, and keeping management stable. There is a stable group of staff here now. Staff have had a lot of changes, with several different managers, in recent years. Although it is taking time for some people to adjust to more changes, the acting manager has good support from other staff for the positive improvements he needs to make. Staff have had a lot of meetings with training so they know about the sound values and practice they need to support service users really well. They are starting to put this into practice. Some are doing especially well so service users can enjoy a good quality of life. Service users tell us this means their lives are starting to feel much better. Staff have had training in safeguarding people. They know the right way to support people and know treating service users disrespectfully will not be tolerated. Staff have been shown how to keep better records. Each service user’s personal and private information is being recorded properly in their service user plan and personal records. Staff have been working on writing service users plans with them and from their own point of view. This is called person centred planning. There will be more training so staff know how to help service users make plans and decisions about their lives. Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 8 The acting manager has been working alongside staff and meeting them individually to see how they work. This has helped him understand the guidance and support they need to do their job well. A lot of hard work has been done to update information about how service users understand and manage risks in everyday situations. This means staff will know better how to support them to face new challenges while keeping themselves safe. It would help staff to have more training so they know how to help service users do this and lead a fulfilling life. Nearly all staff now have up to date training in safe working practices so they can keep service users and themselves safe. What they could do better: An application must be made to register a manager for this service so everyone knows who is in charge, and can be confident the manager is going to stay so they know what to expect. Service users need the acting manager to use his management skills to restore their service to a good standard. This means he must free enough time to do this by not working on shift. This is so he can focus on putting right the problems the service has been facing. One very important job he must concentrate on is leading and supervising the staff team so they have the support and skills to do a really good job. Staff need to make good use of their time too. It may be useful to have some staff who do more domestic work, and some clerical support to help the manager with organising records about running the service. It is essential for service users that their community care assessments are up to date. This is so everyone can understand, agree and plan with them the right resources for their support including specialist resources. More staff with the right specialist skills and experience are needed so the team is well balanced and the manager has enough skilled senior support. This is so that all service users have the staff time, skills and well planned support they need to live their lives and follow their own interests in the way that suits them. Records about how staff are recruited must show all the right checks are made before they start work, so service users can be sure staff are fit to work with them. More time and attention must be given to getting training plans up to date to make sure staff have the training and support they need. Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 9 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 and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 10 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.V358861.R01.S.doc Version 5.2 Page 11 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. There have been no new service users for some time. There are community care assessments on service users care records but these are now dated. It is intended the service aims and objectives will be reviewed and a new statement of purpose drawn up before any consideration is given to offering any new placements. EVIDENCE: Nobody new has moved into this home for a number of years. When they first moved in the service wasn’t very clear about the needs it could meet so people have very varied needs that are sometimes not compatible. These needs have changed further over the years through age and illness. Service users had community care assessments before they moved in, but the placing body has not updated these to make sure the service is still right for them. The last key inspection in May 2007 found the purpose of this service had become clouded. It was unclear about the needs it was seeking to meet and the resources required. Staffing levels and skills did not match the current level of need. The facilities were unsuited to the needs of people with physical disabilities. Some people here had difficulties living in a large group, which diminished quality of life for everyone living here. Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 12 Priority needed to be given to evaluating current service provision and determining its future direction. Following that inspection the service formally asked Worcestershire Adult and Community Services in June 2007 for up to date community care assessments. This had not been achieved by the time of the present inspection but a meeting between the providers and placing authority has now reached agreement on the need for collaboration to determine current support needs and the right service to meet them. Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 13 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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ personal information is being recorded more effectively. Considerable work has now been done to update and complete service user plans, with evidence of real progress in person centred planning since the previous inspection. All risk assessments are now up to date. This means staff now have the information to plan service users skills development with them, to support them better in making their own decisions and taking more responsibility for themselves. EVIDENCE: We looked at three service users plans. One service user showed his own plan and explained with his key worker how they put this together. His plan is written in a person centred way, and includes an Essential Life Plan with photographs and images he can use easily. Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 14 He talked about the things that are important to him and it is clear his plan is about these things. It shows his needs and interests and his dreams for the future. It shows how his life has changed as a result of illness. It explains how staff are listening to how he wants to live in the future and are helping him take steps towards this. He talked enthusiastically about some of the changes he has already been able to make, and felt staff are helping him in the right way so that he is happy making new friends and enjoying life. Plans are now arranged so service users’ experiences are used to help them plan what they do and any support they might need, and to make decisions for themselves. For example a section called a ‘learning log’ records new things the service user has tried and what he or she thinks about them. The service user builds on this information with staff help, to plan activities. This approach should help service users be more confident that staff understand what is important to them. The way information is shared is much better. It was reassuring to see service users’ personal information being treated in confidence in a way that respects their dignity. The daily communication book and appointments diary are now being used in the right way to tell staff there is more detailed information in personal records. Each service user plan shows personal and health care needs in a way that helps better understand how these affect the whole person. This should mean service users can be more confident staff will have the information they need to support them in a consistent way, so it is very important all staff use these records carefully. The acting manager explained how he supports and encourages staff to develop a person centred focus. He provides practice guidance at staff meetings on person centred working, as well as working alongside staff and meeting them individually. There is evidence from observation, in discussion with staff and in records that some good practice is developing, and those staff are to be commended for their work. However progress needs to continue as not all staff are as yet working to these guidelines. For example, the acting manager showed a record chart he had given staff to help everyone monitor particular difficulties between two service users. The chart was designed to help everyone understand, safeguard and achieve the right outcome for these two people. It had not been filled in at all although it is known there are usually such incidents every day. Staff had been shown how to complete the chart, so it is disappointing they have ignored it. It suggests that in some important areas staff are still failing to take their responsibilities seriously. Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 15 Staff have started training on better communication skills. Each service user now has a full communication needs assessment and profile on their service user plan. The providers have a specialist worker responsible for improving communication techniques, including Makaton. This means that service users here who have this skill can start using this to communicate better with staff. This inspection showed much more animated and meaningful communication between some service users and staff. Service user Essential Life Plans and documents such as the complaints procedure are being written in a way service users can understand better. Staff and service users showed how information about day-to-day life in the home such as staff on duty, activities and meals is being displayed on an accessible notice board. Photos and objects of reference are now being used so service users can make their own choices and decisions. Staff are enthusiastic about how having more information is helping service users make more real decisions of their own. Service users need staff to understand and support them to manage risks well. This is so they can learn through overcoming difficulties and become as independent as possible. A sound system is now in place for assessing risk and keeping these assessments up to date. Risk assessments have all been updated in September 2007, and are being reviewed regularly and whenever there are significant changes. Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 16 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): 11, 12,13,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have things to do at home and out in the community that they enjoy. It is clear from service user plans that more careful planning goes into this now involving service users themselves. Staffing levels and deployment have improved allowing for more one to one time, but there is scope for further improvement and especially to develop more community links and a wider range of more fulfilling activities and interests. Family contact is supported and encouraged. The manager continues to hold meetings, build stronger links with families. Much has been done to improve meals and mealtimes making sure they are person centred and reflect service users choices about what where and when they eat. EVIDENCE: Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 17 As staffing has improved service users have benefited from more individual staff time to look at activities they wish to follow in and outside the home. An activities notice board shows different pursuits. Service users said they enjoyed going out for walks, shopping, coffee, to the pub and meals out, swimming and bowling. On the day of inspection some were looking forward to going to their regular music club. There is considerable scope to extend the range of activities and interests available to service users, so they have the chance to try new experiences and build a more individual and fulfilling lifestyle. Staff and service users have also been looking at opportunities for new activities as part of developing person centred planning, and explained how they are getting out more into the local community. One older service user talked happily about leaving his day centre and joining community activities organised for older people in the community, while another service user was very enthusiastic about her work at a charity shop. Photos of service users following personal pursuits, this summer’s holiday by the sea and Christmas partying are displayed around the house, showing staff and service users enjoying happy times together. At home service users have equipment for games, puzzles, music, art and craft, watching videos, and a variety of sensory equipment and materials such as special lighting and a bubble machine. However during the inspection it was clear some service users still had less planned activity than they would like, and were finding this frustrating. Service users have a lot of contact with and support from their families. One service user who had lost contact with family, has been supported to trace her relatives who are now keeping in touch. The acting manager held meetings with families soon after he was appointed, to hear their views of the service and any improvements they would like to see. These meetings are continuing, to keep families involved with service development, and it is intended that in due course they will contribute to the quality assurance process once this is in place. As service users came home from their day activities they went into the kitchen to talk to staff, helping themselves to drinks and snacks and talking about the preparations for the evening meal. A notice board displays meal options with photos and objects of reference for service users to make their own choices. Service users and staff demonstrated enthusiastically how they used it – for example one service user was keen to ‘order’ sausages every day! A complete record of food provided showed a varied appetising and nourishing range of meals and snacks is available reflecting individual choices, while personal records show details of any special diets provided. Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 18 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 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Personal and health care records are now better designed and up to date. Staff practice has benefited from more consistent guidance and support. This means service users can now be more confident that their needs will be met in the way they prefer, because staff are beginning to understand better how to do this well. Service users needs assessments are very dated. The placing body has not been carrying out regular care reviews, and in-house review practice has been erratic although recently resumed. The placing body has therefore been asked to carry out further assessments in preparation for a joint review of the support services needed, and the capacity of this service to provide them. EVIDENCE: Most service users have lived at Brook House and 58 Ash Grove for many years. Their needs and living arrangements have changed a lot in that time, and so has the service. Community care assessments carried out before moving in are out of date and the placing body Worcestershire Adult and Community Services (WACS) has not kept up to date with care reviews. This means service users do not have a proper agreement about the support they Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 19 now need, so they cannot be confident the arrangement their placing body has made is still the right service for them. WACS was formally asked for up to date assessments following the inspection in May 2007 but a response is still awaited. This has been discussed with WACS senior management, as service users have a right to expect that the service and placing body work together to agree on the right support package for each person living here and arrangements for achieving them. Up to date person centred needs assessments are an essential first step. Despite this, there has been commendable action to improve the quality of support service users are currently receiving for personal and health care. Records are now better designed and kept up to date, and staff are being given consistent guidance and support to understand what is expected of them and improve practice. Service users can start to be more confident that they will be supported in the way they prefer. This is because staff are beginning to understand better how to work with service users to plan how they live their lives, and support them as they wish. Their recorded information is now clearer and easier for service users to understand, relevant and up to date. Plans seen had been reviewed within the last year. In particular, plans are becoming person centred with the person they are about at their heart. Staff need to keep up the good progress, as there is more to do so records include full details about each person’s special needs, the way they want to live their lives and the support they need to do so. Previously missing health information has been sought and as far as possible brought up to date for each person. Everyone now has a health action plan, and takes them to health appointments to help everyone keep up to date about their health care. Some plans seen had information about diagnosed health conditions. For example, one person has diabetes and the plan shows how this is to be managed including dietary needs and medication, progress and possible complications. Another plan shows how a degenerative condition is progressing and the implications for the service user’s health and quality of life. However other service users’ plans need more work to show a full picture of their health and well being and what they need to manage these well. The information needs to work with their health action plan to make sure they get timely, appropriate attention from health services to stay in the best of health. To help service users get the right help in a planned and integrated way, staff need training including on health action planning. This is to give them a better understanding of service users’ general health needs through life, what Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 20 particular support is required for special needs and how to use records to make this clear and plan with service users for good health. Service users are being supported to be as independent as possible in managing their care. Their records help staff do this while making sure service users themselves stay at the heart of planning. For example, one service user has had to make changes to daily living following recent illness. He told us what this has meant to him, and how his key worker has supported him to make real changes that have made a big difference to his quality of life. He has retired from his day centre and joined a day service for people his own age, and is enjoying a full social life. This is all recorded in his up to date service user’s plan that is written in a way he can follow easily with many photos. His plan also shows how staff help him to manage any risky situations. This means he can now be sure of the right staff support to help safely manage the new challenges to keep as independent as possible. The plan records his hopes for the future including moving to accommodation where he will be able to get around more easily, and shows how this service is helping him towards this. Service users’ communication needs have all been assessed and each person now has a full communication profile. Staff have begun communication skills training, and are supported by the providers’ specialist communications advisor. A number of service users here use signing and other non-verbal communication so this process is ongoing to improve communication practice and support service users to gain more control over their life. For example there is now information about aspects of daily life such as staff on duty, meals and activities in easy read or symbolised form, that service users can use themselves to make choices known. Service users need to be confident they will always be treated well and supported sensitively, so they also need to know that poor practice will not be tolerated. Staff need to have confidence in management systems for monitoring the quality of their work and supervising their development, and to know that managers will identify and respond robustly to poor practice. Some older people use this service. Training has yet to be provided so staff are well prepared for the extra help people need as they get older, relating to conditions such as diabetes, stroke and dementia, and the need for good practice in mobility support, continence management, skin care and tissue viability. Service users for whom this is relevant are being referred for assessment for early onset of dementia. The manager recognises how well-trained staff can offer early support and comfort from the outset for what can be an anxious time, so training is proposed in understanding and caring for someone with dementia. Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 21 Service users need to be sure staff know and understand their medication needs and that their medication is stored and handled appropriately for their safety. The pharmacy inspector made a random inspection that showed medication was generally being managed in accordance with Royal Pharmaceutical Society guidance but that some practice in relation to storage and handling of medication needed attention. This inspection showed service users are safeguarded by the careful approach now being taken to all aspects of medication management. A new medication cabinet is located in the staff room at Brook House, and records sampled were in order. No service user currently takes responsibility for their own medication. Files seen contained a signed consent to treatment form, although further assessment may show some more able service users could have capacity to progress towards this with support. Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 22 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 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improved procedures are now in place and staff have had training, so service users can be more confident their views and any concerns will be listened and responded to, and their well being safeguarded. But there is a history of lack of trust and it will take time for everyone to be confident about new ways of doing things. EVIDENCE: The complaints procedure has now been provided to service users in an alternative visual format and a video is also planned, that they can understand and use more easily. The acting manager is alert to service users concerns, and the need to encourage use of the complaints procedure to make sure these are brought to attention and responded to effectively. Staff have all received training in safeguarding people and further training is planned. However the acting manager is aware that the difficult history of this service means both staff and service users all need to gain confidence in these procedures, so that it will take time before new practices are in place and fully effective. It was reassuring to meet staff during the inspection who are clearly aware of sound practice and treating service users with care, dignity and respect. The Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 23 atmosphere in the home at the time of inspection was calm and relaxed, and service users seemed at ease with staff. However, there is evidence that despite training in safeguarding people, some aspects of practice still show the need for further reflection on values and responsibilities. Following concerns raised by one of two service users sharing accommodation, records had recently been introduced for monitoring incidents between them. This was to determine any incompatibility and need for safeguarding arrangements for the two people concerned. The acting manager gave staff clear guidance on why and how to use them. But the inspection found these records were not being completed. The acting manager treated the concerns as a complaint and responded accordingly. He has alerted the service users’ placing body to these concerns, and they are receiving careful attention. Pending a solution satisfactory to both people, a move to the larger house has been agreed with one service user. However, failures in staff practice could have left service users at risk so it is essential the reasons for this are examined and addressed with them. Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The accommodation is well maintained, safe and comfortable. It is kept in good order, clean and fresh. EVIDENCE: The two houses are generally suited to their purpose, but not necessarily appropriate to the needs of people living here now and the long-term aims of the service are to be reviewed. Two people have decreasing mobility, so stairs are likely to become a problem for them but there are no ground floor bedrooms. The accommodation is well located for access to community facilities. It is clean and fresh and maintained in good order throughout. Outstanding safety and maintenance aspects have received attention. There are ongoing day to day issues with blocked drainage due to specific behaviours of some service users but these are attended to promptly and effectively. Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 25 Communal areas are simply decorated and furnished in a pleasing modern style. There is one large lounge dining room with an extremely large dining table at Brook House so limited scope for service users to pursue different activities, but a comfortable small conservatory provides for some private space. 58 Ash Grove is also well maintained. It is arranged with two sitting rooms to accommodate the very different needs of the two people who live there at present. Service users bedrooms have been personalised, although two long landings and upstairs bathrooms at Brook House have an institutional air. The empty bedroom at Brook House is undersized. It is still included in the registration but it is not intended to offer it to new service users, so this therefore needs to be reflected in the registration. At present one service user from no. 58 has asked to use it pending a review of living arrangements there, but this is intended to be temporary only. The room’s limitations have been made clear to him but he especially wants this room and it is accepted as his choice. Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels and training have improved but not enough to make sure service users have all the personal support they need to lead a fulfilling life. Staffing levels have improved and they are deployed better, but are still stretched to cover both domestic and support tasks in the two houses. There is reported evidence staff have attended essential training, but up to date individual training assessments and profiles are yet to be established, together with a training plan for the staff team linked to service users’ assessed needs. Maintenance of adequate staffing levels each day relies inappropriately on a substantial contribution from the acting manager to complete the numbers on shift. This significantly reduces time available for management tasks, including staff supervision, training and development, limiting the attention that can be paid to these essential responsibilities. New experienced staff are being recruited. There is recorded evidence that robust checks are made so service users know they will be supported by people who are fit to work with them, but this is not sufficiently detailed to confirm all the required checks and procedures are followed. Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 27 EVIDENCE: While some people using this service are quite independent, others need substantial and increasing support from staff. The extent of these needs is becoming clearer as their personal and health care records are improved and brought up to date. Information from their available records about their health, capabilities, daily routines and patterns of activity suggests each service user needs more staff support than they get at present, to help them develop individual and fulfilling lifestyles. If good progress in person centred planning is to be sustained and meaningful, service users need enough staff to support them with their plans. Up to date needs assessments are essential. A request has been made to the placing body, Worcestershire Adult and Community Services (WACS), to update community care assessments so that agreement can be reached on the right individual and overall staffing levels for people using this service. A random inspection in September 2007 found the number of staff and the way they are deployed had much improved. This improvement has been maintained, but service users still need more staff support to develop lifestyles that are meaningful to them individually. Recruitment has brought more trained and experienced staff with much needed skills to the team. The rota shows redeployment is making best use of existing staff resources. Each shift now has a balanced mix of skill and experience with an identified senior responsible for decisions on that shift. Few agency staff are used, and with ongoing recruitment it is expected there will soon be a full staff team so that agency use is no longer necessary. This provides a minimum of three staff on duty throughout the waking day, increasing to four and five at times to reflect specific needs and activities, with three or four staff on duty in the evenings over the two houses. This does allow for supporting some individual activity, but has primarily meant service users have more staff available at times of day when they need most support with personal care, such as mealtimes, getting up and going to bed. At key times when all service users are at home, they need more staff so they can plan and choose different things to do in the evenings and at weekends. Service users who do not have regular day care activities need more staff to help them with meaningful ways to spend their days. It was notable on both inspection days that although some service users were out at day activities, staff were attending to domestic duties rather than supporting planned activities with service users who were at home. Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 28 For example, service users spent much of their time on these days on activity that seemed unsatisfying, solitary and unfocused for example wandering from room to room, sitting doing nothing, or sitting in front of the television without following the programme. It was apparent that this was partly because the acting manager’s time was occupied with the inspection, but this served to emphasise concerns that the much of his time is spent on shift so that he does not have enough time for managerial responsibilities. Of the three, later four staff on duty at the time of inspection this did include the acting manager. Service users able to respond to the question when asked felt they now have more time and personal support from staff. Staff spoken to feel they can support service users better. However service users who were less able to comment were the ones who seemed to have less staff time, and less meaningful activity. Support staff are also responsible for all the domestic chores and household duties needed to keep the home functioning in good order. With two houses this is a considerable call on their time and compromises time available to support service users’ activities. The acting manager described suitably robust procedures followed during recruitment of all new staff, but some checks are carried out within the wider organisation and are not recorded in records kept in the home. The home’s records do show details of Criminal Record Bureau and POVA checks but need to include evidence that all required checks are made, including written references obtained and work history fully explored. The acting manager explained that written references are always sought by head office, and work history is fully explored at interview. Service users need the assurance of written evidence that these procedures are always followed to safeguard their interests. The Criminal Record Bureau area of the Commission’s website shows the information required with a suggested form of recording. The area manager has been directed to this. It is clear the acting manager understands the difficulties staff have had with several previous changes of manager. One difficulty for staff has been poor communication so he makes sure they are well informed about service objectives and the expectations of their own role, and given identified responsibilities so that they can actively contribute to service quality. For example, one staff member was delegated responsibility for reviewing the fire safety risk assessment and fire safety measures, and has made a very effective job of updating this to improve safety for everyone. The acting manager supervises all staff himself, pending training for the senior staff to share this responsibility. As staff needed to gain confidence in formal supervision he met them individually at first to get to know their strengths and development needs. This has built confidence in the new direction and Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 29 leadership, but now needs to progress to regular supervision. One barrier to this has been lack of management time as staffing levels mean he is almost fully occupied supporting service users. This must be addressed so staff have a reliable opportunity to discuss their work and any practice issues, obtain personal support and guidance, plan their development and have their progress recorded. Some but not all staff have relevant training. The acting manager has identified the need for individual and team training needs assessments before a full programme can be established, but has lacked the time to carry out full assessments yet. He is successfully recruiting new staff with relevant training. He uses staff meetings to provide all staff with core values and good practice guidance, and refresh existing knowledge and skills. Core health and safety training needs have been reviewed and most staff now have up to date training, or are booked to attend. A training record needs to be maintained. Specialist training relating to specific service user needs is being identified, for example, training in autistic spectrum disorder, ageing and dementia are planned. Other training needs include strokes and managing health at different life stages. It is intended that in due course all staff will have knowledge and skills to the level of the Learning Disability Award Framework, complete National Vocational Qualification level 2 programmes and have opportunities to progress further, but a structured programme of staff development is not yet in place. There is now a pressing need for an up to date assessment and record of staff training, to establish individual staff training profiles and a full and ongoing training and development programme as soon as possible. Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 30 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is still work to be done to restore an acceptable standard of service, but the appointment of an experienced and skilled acting manager has enabled a good start to be made. He has worked extremely hard since his appointment to successfully address urgent safety and staffing matters, and begin to restore the service to a more acceptable standard. The office has been refurbished and better equipped, and sound management and administrative systems and records have been established. All the requirements from the last key inspection have now been addressed in a timely way. Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 31 The acting manager is encouraging a much more open and inclusive approach for everyone who lives and works here. This is improving morale and staff spoken to say they appreciate the support and guidance they are now receiving. Regular planned supervision would provide more structured support and oversight of their work, and this needs to be established together with a full training programme so that all staff continue to develop sound values and good practice. This service needs to be confident about management continuity. An application needs to be made as soon as possible to register a manager for this service. A significant change for the better has been the providers’ recent agreement to extra staffing so that the manager’s time is supernumerary. This needs to be effected as soon as possible. This will free him from direct support for service users and enable him to focus his attention on service development, although it must await the successful recruitment of extra staff. Service users say they are getting more staff support, and some feel the service is getting better although not everyone is quite happy with the way the service works for them. Significant steps have been taken to improve communication and help service users take decisions for themselves within the home, and they are responding enthusiastically. The service does need to seek their views in a planned way as part of a quality assurance programme, and show them how it plans to incorporate these into plans for service development. Health and safety arrangements are now in good order and up to date, to make sure people live and work in a safe environment. Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 32 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 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 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 2 33 2 34 2 35 2 36 2 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 2 12 2 13 2 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 3 X 2 X X 3 X Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 33 no 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 YA34 Regulation 19(1)(b) Requirement Timescale for action 07/03/08 2. YA33 18(1)(a) , YA36 18(2)(a) Records must be kept in the home to show that all required procedures have been carried out verifying the fitness of a prospective employee before taking up employment. This is to enable confirmation that robust procedures are always followed to ensure prospective employees are fit to work with vulnerable people, before appointment is confirmed. 30/04/08 There must at all times be enough support staff on duty to meet the needs of service users in both houses, without inclusion of the manager on shift. This is to make sure the manager’s time is protected, so as to ensure he is able to give his full attention to management tasks and responsibilities necessary to restore the service to a good standard. Staff must receive regular 30/04/08 structured and planned supervision and support. This is to ensure they work effectively individually and as a team for the benefit of service DS0000065900.V358861.R01.S.doc Version 5.2 Brook House and 58 Ash Grove Page 34 4. YA35 18(1)(c) 5. YA37 8 users, are encouraged to build on good practice and have the help they need to identify and address any barriers to this The home must establish a 30/05/08 training and development plan for the staff team, with individual staff training assessments and profiles. This is to ensure staff have the necessary knowledge and skills to support service users and meet their assessed needs An application must be made to 30/05/08 register a manager for this service 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 YA9 Good Practice Recommendations Consideration should be given to providing staff with risk assessment, and risk management training 2. YA11 Consideration should be given to more ways of helping service users 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. Consideration should be given to providing staff with health care training Consideration should be given to the future use of the smallest bedroom, and the Commission advised. Details of room size and facilities should be made clear to any prospective service users who may be offered this undersized bedroom. Consideration should be given to appointing ancillary staff DS0000065900.V358861.R01.S.doc Version 5.2 Page 35 3. 4. YA19 YA24 5. YA33 Brook House and 58 Ash Grove 6. 7. YA34 YA39 to share some responsibility for domestic, clerical and administrative tasks, so support staff time can be focused on supporting service users. Consideration should be given to supporting service users’ involvement in staff selection A system should be developed for consulting service users and their representatives about the quality of care provided by the service, as part of planning for future development. A report on the outcome should be provided to service users with a copy to the Commission. Brook House and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 and 58 Ash Grove DS0000065900.V358861.R01.S.doc Version 5.2 Page 37 - 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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