Inspection on 26/03/07 for Brook House Residential Care Home

This inspection was carried out on 26th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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

Similar services:

Flint House

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

The Cotswold Home

Fairways

Treloar College

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

CARE HOME ADULTS 18-65 Brook House Residential Care Home 19 Ockley Brook Didcot Oxon OX11 7DR Lead Inspector Mike Murphy Announced Inspection 26 March 2007 10:00 Brook House Residential Care Home DS0000066262.V322227.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 Residential Care Home DS0000066262.V322227.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 Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brook House Residential Care Home Address 19 Ockley Brook Didcot Oxon OX11 7DR 01235 818926 01235 818926 brookhouse@beeb.net Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Brook House Residential Care Home Ltd Abigail Reynolds Care Home 4 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (4), Physical disability (4) of places Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of service users to be accommodated at any one time must not exceed 4. This was the first inspection of this service Date of last inspection Brief Description of the Service: Brook House is a residential care home for four adults aged 18 or over with a mental illness or learning disability. The home is situated in a residential area within walking distance of Didcot Parkway station and local shops. Didcot town centre is less than one mile away. The accommodation is over two floors. The ground floor comprises the entrance hall, office, one bedroom, dining room, kitchen, lounge, small laundry room, cloakroom and conservatory. The first floor accommodates three bedrooms, bathroom, staff sleep-in room and storeroom, shower and WCs. The home has a small garden to the rear of the building and parking for two cars on the front drive. The home does not have a lift and does not facilitate wheelchair access. The service aims to support service users in a community based setting with a view towards moving on to independent living in time. The service achieves this through developing individual independent living skills and supporting service users to establish contact with a network of other services in the wider community. Fees at the time of this inspection ranged between £750 and £1250 per week. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of this new service in Didcot. The inspection was carried out by one inspector on a weekday in March 2007. The inspection methodology included discussion with the registered provider, other staff and service users, observation of practice, examination of documents supplied both in advance by the registered manager and on the day, examination of care plans, a tour of the building and consideration of a written response by a service user. A first inspection of any service is likely to lead to a number of requirements and recommendations and this home is no exception. The service had been operational for less than six months at the time of the inspection. The home is located in a pleasant detached house in a residential area, less than one mile from Didcot town centre and within walking distance of local shops, a pub and public transport. It can accommodate up to four service users with a mental disorder, learning disability or physical disability. The accommodation is over two floors and comprises four single bedrooms, bathrooms, shower, WCs, staff room, office, kitchen, dining room, lounge and conservatory. There is a small garden with seating to the rear. The home has good systems for assessing the needs of prospective service users and, together with the person concerned, of deciding whether it is likely to be able to meet those needs. It liaises closely with referring agencies, at the time of this inspection mental health services and social services. Home staff work closely with service users in formulating a plan of care aimed at meeting those needs. The home aims to support service users to move on to independent living and in preparing for this requires service users to accept some structure to their day and week. Within that framework service users participate in a range of activities, in the home and in the wider community. This should enable service users to establish their own support networks which is a key element of success in independent living. Service users and staff seemed to have a good relationship and service users gave positive reports of their experience of the home. The inspection makes a number of requirements and recommendations aimed at ensuring closer conformance to the standards in the service it provides to service users. These include the need for action on some aspects of the home’s arrangements for medicines, some health and safety matters, clarifying matters which appear unclear in the home’s documents and some staff matters. These, however, should not detract from the positive elements of the home and the quality of personal support it currently provides to service users. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Review documentation in the light of experience so that service users are quite clear about what the service provides and on some of its key policies. Review the complaints procedure so that it is available in a form which is appropriate for the needs of all service users. Ensure that health and safety concerns around the temperature of hot water storage, the temperature at hot water outlets, and that of radiator surfaces in order that the environment is safe for all service users. Address some aspects of its medicines procedures in order to minimise the risk of errors in administration. Draw up a training plan for staff to ensure that service users are supported by staff with the appropriate knowledge and skills. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 7 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 Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 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 Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, and 5 Quality in this outcome area is adequate. Prospective service users are given information to help them make an informed choice about the service. The home has an assessment procedure to ensure that prospective service users’ needs are assessed and that the home can meet those needs. The wording of some aspects of the statement of purpose and the contract signed by service users would benefit from review in order to provide a more accurate view of the service to prospective and current users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A statement of purpose and service user guide are in place. The statement of purpose provides details of the registered provider and registered manager including details of their qualifications and experience. It provides the staffing structure, information about the service on offer, and details of the complaints procedure. The document states that it should be read in conjunction with the service users’ guide. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 10 The service users’ guide includes reference to the statement of purpose, a summary of the service, details of the registered provider and the registered manager as in the statement of purpose, the staff structure, a summary of the home’s approach to quality assurance, the complaints procedure, a summary of the ‘terms, conditions and fees’, a summary of the ‘Contract of Residence’, visiting times and confidentiality. Both documents are to be reviewed after one year of operation. This is set for January 2008 but this review might usefully be brought forward. The statement of purpose states that the home provides for ‘Respite/Short Stay’ (p5), ‘medium length stays and longer-term placements depending on the referral needs of the individual’. It states that it provides ‘…a multidisciplinary treatment for adult mentally ill and disordered individuals who require conditions between those of being in general and psychiatric wards or secure units/special hospitals to total independent living. Brook House also accommodates service users who suffer with minor physical disability through brain injury, learning disability and dual diagnosis’. The terms ‘dual diagnosis’ and ‘multi-disciplinary treatment’ are not defined. The home is not registered to provide nursing care. This is a broad range of diagnostic categories, potential needs, prospective lengths of stay, and sources of referral, each of which will have an effect on the culture of the home, its systems for meeting the needs of its service users and its working relationships with a range of services in the community. The document includes a range of people for whom it is not suitable. The accommodation is described but room sizes are not given, therefore the document does not fully conform to paragraph 16 of Schedule 1. It is noted that on page 5 the document states, ‘All visitors should inform the home of their visit at least 24 hours before they arrive, so as to ascertain the availability of their relative or friend’ (p5). This seems an unnecessary condition in this kind of service. The requirement appears to be modified in the ‘contract of residence’ in which it is stated, ‘Visitors are encouraged to visit outside of activity times and must telephone the home before visiting’. The service users’ guide does not include reference to inspection reports. An assessment of needs is carried out before admission. All places were occupied at the time of this inspection in March 2007. The first service user was admitted in November 2006. Examination of service user records confirmed that the home has established a referral process with local health and social services. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 11 A referral form is completed at an early stage. This gathers information on the prospective service user’s mental health, current mental health state, physical health, medication, ‘social conduct’, personal care and other matters. Completion of a ‘combined assessment pack’ provides further assessment information, assessment of risk and plans to manage risk. This provides the registered provider and registered manager with sufficient information to decide whether the home is likely to be able to meet the referred person’s needs. It was noted that in one file that there appeared to be gaps in some key sections and the background to this was discussed with the registered provider. Given the range of referral sources, it is recommended that all gaps be explored as far as practicable at the referral stage. The registered provider said that the home may also accept emergency admissions. There does not appear to be a reference to that category of admission in the statement of purpose. Emergency admission may also carry greater risk and it would be advisable to develop a policy governing that process. This should include the arrangements for managing risk. Where a referral is progressed, a series of introductory visits are agreed. This provides the prospective service user, the home and the referring professional to decide whether the home is likely to be able to meet the prospective user’s needs. Admission is then agreed. The ‘Service Users Contracts’ states that the first four weeks of residence is regarded as a trial period. This can be extended if desired. There are two contracts. A contract to be agreed and signed by the purchasher of the service which is written in a formal written style and a ‘Service Users Contracts’ (sub headed ‘General Terms and Conditions Applicable to Service Users’) which is formal in the style in which it is written. The comments in this report are limited to the latter document. The contract is a five page document which sets out the terms and conditions of occupancy. It is to be signed by the service user, the home manager and a representative of the referring agency or CMHT. It is noted that on page two this includes a reference to payment of fees and expenses incurred in the event of the death of a service user. This is an unusual clause in such a document and its inclusion should be reconsidered. The document is incorrect in locating its reference to ‘assured tenancy’ in the context of the Care Standards Act 2000 and the Care Home Regulations 2001. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 12 The document does not fully conform to standard 5 in not specifying (i) the room to be occupied, (ii) fees charged and by whom paid, (iii) the Service User Care Plan (other than by reference to ‘maintain as a minimum the standards of care required by the Care Standards Act 2000….)’, (iv) the arrangements for reviewing needs and updating the Service User Care Plan, or, (v) any reference to the Care Management Plan (the Care Programme Approach (CPA) in mental health services). Brook House Residential Care Home DS0000066262.V322227.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): 6,7,8,9 and 10 Quality in this outcome area is good. A comprehensive care plan is in place for each service user. Care plans include assessment of needs, plans to provide support where required, and evidence of liaison with health and social care agencies in the community. These aim to ensure that service users’ needs are met and that they are supported in maintaining their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records of all four service users were examined. A care plan was in place for each service user. Care plans were generally of a high standard. Care plans include a photograph of the service user, a ‘comprehensive assessment plan’ (assessment of needs and assessment of risk), a record of the assessment by the manager, service user contract, notes of CPA review and risk management meetings, crisis plan, records of medication, notes of medical and dental contacts, activity diaries, individual menus and correspondence. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 14 Care plans included noting the importance of conforming to prescribed medication, support in personal care, following a healthy diet, conforming to the current multi-agency CPA plan of care, creating structure around the day and week and the action to be taken in the event of crisis. Care plans were signed by service users. Daily notes were detailed and of a very good standard. The care plan forms the basis of the contract between the home and the service user; it is based on an assessment of need, states how the home will support the service user and what is expected of the service user. Service users are supported in participating in home life and in making decisions. This is achieved through activity plans, participating in the cleaning rota, participating in the fortnightly community meeting and in joint activities, and menu planning. Service users are provided with contact details of seven advocacy services in the Oxford area. Risk assessment and management is carried out through the completion of individual risk profiles, information shared between the CMHT and the service, individual crisis plans and through the employment of a community psychiatric nurse (CPN) out of hours. Good risk management is a key element of such a service and the effectiveness of the current arrangements, in particular of good communication between agencies, should be periodically reviewed by the registered provider, registered manager and the appropriate managers in local mental health services. Arrangements for managing confidential information appear satisfactory. The provider said that there is a policy for staff to clear their desks on completion of work, for files to be locked when not in use and for separate computers for staff and service user use. The service user guide includes a confidentiality statement. It is noted that this includes reference to the Data Protection Act 1984. This was repealed by the Data Protection Act 1998 which took effect on 1 March 2000. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 15 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, 14, 15, 16 and 17 Quality in this outcome area is good. Service users participate in a variety of social, therapeutic and recreational activities which aim to meet individual needs, improve service users’ well-being and establish positive networks of support in the wider community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s statement of purpose states ‘….that service users will have the opportunity and will be encouraged to pursue outside activities and courses…’. Evidence of the application of this in practice occurred on the day of the unannounced visit of this inspection when all service users and staff were out of the house mid morning. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 16 Service users preferences and wishes are recorded in their care plans. The home stresses the importance of structure to each person’s day and week, a matter which is of particular importance in a service where there is an expectation that in time service users will move on to more independent accommodation. An activity diary is drawn up with each service user. Activities in the diaries examined included menu planning and shopping, sessions at social, support and rehabilitation groups, working in a shop one day a week, working at a work project in Didcot, participating in personal and communal domestic tasks, cooking, trips out to local shops and pubs, swimming and table tennis. It is noted that the service user guide includes reference to a ‘national holiday at least once a year’ and to ‘short weekend breaks’ – in each case ‘accompanied by staff’. The paragraph includes the sentence, ‘The above is exclusive of Scotland’. The financing and practicalities of this in a short to medium stay service are not elaborated on and the inclusion of the reference to Scotland is unclear. This mix of activities provides some structure to service users lives in the home, supports participation in communal activities, establishes and maintains links with a network of support services in the community and supports integration with the local community. The home had been open for less than six months at the time of this inspection and had not yet discussed the matter of inclusion on the electoral registration with service users. All four service users were in contact with their families. The nature and extent of the contact varied. Service users had established friendships before admission and the provider said that the home would support them in maintaining these. Visiting is allowed in communal areas. As mentioned above, the home’s policy on visiting would benefit from review and clarification, particularly in the light of experience since opening in November 2006. The office on the ground floor would be made available to service users who wish to have a private conversation with a visitor. The daily routine is structured and service users are expected to be up for breakfast and to have plans for their day. At the time of this inspection service users with morning commitments were ready to leave the home around 9:30am. Three service users were out at various activities and one was at home for the day. Service users make their own arrangements for lunch. Mid to late afternoon is a time when service users have free time. Cooking for the evening meal starts around 4:30pm. Staff and service users’ responsibilities for domestic cleaning of communal areas are clearly set out in the ‘Cleaning Rota’. Rules on smoking are set out in the service users’ guide. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 17 Meals are planned with service users. Each service user receives £25.00 per week for their food. Communal evening meals take place on Wednesdays and Sundays. A roast is always available for Sunday lunch. On other days each service user makes their own evening meal with support from staff as required. Breakfast is self-service – usually cereals, toast, fruit and beverages. Lunch may be taken at another service where that forms part of a service user’s programme or in the home. One service user makes lunch in the home every day. Selections for the evening meal from menus supplied for this inspection included, ‘Fish, Chips and Peas’, ‘Burgers, New Potatoes and Salad’, ‘Lasagne and Garlic Bread’, ‘Chicken Curry’, ‘Beef Stew and Dumplings’ and ‘Tuna Pasta Bake’. The opportunity to encourage service users to develop a healthy and balanced approach to their diet whilst resident in the home was discussed with the provider. It is noted that reference to a healthy diet was also made in care plans. It is acknowledged that achieving this with every service user will not be possible because individual preferences will need to be taken into account Brook House Residential Care Home DS0000066262.V322227.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, 20 and 21 Quality in this outcome area is adequate. Guidance and support is provided to service users when required. Arrangements for service users to maintain contact with healthcare services appear satisfactory and support service user well being. However, a number of aspects of the arrangements for the storage and control of medicines would benefit from attention in order to minimise the risk of error in administration. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose states, ‘…each service user will have an individual package of care aimed at addressing their needs, keeping themselves and others safe and moving them on as safely as possible to independent living. Service users will be encouraged to be active participants in their care’. The provider said that staff are aware of the need to respect service users’ needs. Staff appeared to have a supportive and positive relationship with service users. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 19 The approach to care for each service user needs to reflect the aims of the admission, the aims and philosophy of the home, the needs and aspirations of the individual service user and the needs of other service users resident at the same time. Staff and service users appeared to be obtaining a good fit between these different elements on the day of the inspection visit. The service user at home that day received guidance and support from staff as required. Another service user was out for the morning but returned around lunch time and interacted with staff as needed. Two service users returned from day time commitments elsewhere in the afternoon and spent time either in the lounge or in preparing to go out in the early evening. The statement of purpose states that the home ‘….will respect the personal preferences and identity in respect of race, gender, age, sexual orientation, ability, culture, language and religion’. The staff and service user groups comprised both male and female and people of different ages. The staff group includes staff of ‘white UK’ and other ethnic groups. There is not a great need for physical aids in a home such as this but the provider said that they would be installed as required. A shower seat, cooking aids and additional banisters had been installed to support service users who would benefit from such equipment. Each service user is registered with a GP. Individual service users were in contact with CHMTs in Reading, Didcot and Oxford and with Social Services in Abingdon. Access to opticians, chiropodist and a dentist is arranged locally as required. Rivermead Hospital in Abingdon offers rehabilitation services to service users with a physical disability. A nurse who is a specialist in the management of diabetes provides advice if needed. Specialist mental health services are accessed through the relevant CMHT and other NHS services via the service user’s GP. The home has a policy governing the administration of medicines. The manager has attended training provided by Boots Chemists. Other staff have received in-house training from the manager. Details of training on medicine administration are to be obtained by the manager. Competence is currently assessed through supervised practice. Medicines, with the exception of Clozapine, are prescribed by the resident’s GP and are usually dispensed by Boots Chemists. A copy of the prescription is retained in the home. Clozapine is dispensed by the hospital pharmacy following blood monitoring, usually on a monthly basis. Staff transcribe the medicines prescribed on to a medicine administration record (‘MAR’ sheet). It is recommended that the dispensing chemist write this on the MAR wherever possible. Handwritten entries should preferably be signed by two staff. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 20 Medicines are stored in a lockable cupboard in the staff room. It was noted that the cupboard was not securely fixed to the wall on the day of the inspection visit. No medicines required cool storage but the provider said that the home would use a lockable box if required and store it in the refrigerator. It was noted that creams for external use had not been labelled when opened. Two service users were administering their own medicines using dosset boxes which they fill weekly. Minor differences were noted in the agreements signed by service users to manage their own medicines. There is a lockable drawer in bedrooms if required. Depot injections are given either at the GP’s surgery or by CPNs in the service user’s bedroom if required. Medicines are reviewed at CPA review meetings or by the service user’s GP. The home has a policy to guide staff action in relation to the care of a dying person or in the event of a service user’s death. The provider said that the home would liaise with relevant healthcare services in the community. It is noted that the contract signed by the service user includes a reference to the death of a service user. This is entirely concerned with the financial consequences of such an event and its inclusion may be considered insensitive. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 21 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. The home has a policy governing its response to complaints. However, this requires a service user to submit their complaint in writing if not satisfied with the initial staff response, a process which may discourage or discriminate against some service users. The home’s policy on the protection of vulnerable adults is satisfactory and arrangements are in place for staff to receive training on the subject. This increases the protection of service users from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is outlined in the service users’ guide. The procedure states that a service user who has reason to complain should speak to the staff on duty in the first instance. It then states that, ‘If the service user feels that the complaint has not been resolved to their satisfaction, they can make a written complaint…..’ to the registered manager. If the problem remains unresolved then it says that it is passed to the registered provider. The procedure does not include timescales. The procedure correctly states that a complainant may contact CSCI at any stage – although this need not be in writing as stated in the document. Finally it says that if the matter remains unresolved the ‘next step’ is to write to ‘The Local Ombudsman’ at an address in Coventry. It is assumed that the latter is a reference to The Local Government Ombudsman. This would apply only to complaints about local authorities and the address may in fact vary according to the local authority concerned. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 22 The distinction between oral and written complaints in a service of this size seems unnecessary. Requiring a service user to put their complaint in writing may unintentionally discriminate against some service users. Whilst a service user, or someone on their behalf, should not be discouraged from making a written complaint if they wish, they should not be required to do so. The home’s systems for recording complaints should be sufficient to provide a reliable basis on which to investigate a complaint. The document does not include reference to advocacy – although the home provides information on a number of advocacy organisations in the Oxford area. Where a service user is funded by a local authority the care manager may have a role in resolving complaints and this too is not mentioned in the document. The document does not include reference to interpreters if required. In practice the home appears to deal promptly and effectively with complaints. Since its first admission in November 2006 it has had three complaints. The CSCI has not received any complaints about this service. The home has a policy governing the protection of vulnerable adults (POVA). The home states that it will conform to the Oxfordshire Multi-Agency Codes of Practice with regard to the investigation of suspected abuse. It has a copy of the Oxfordshire policy on this subject dated 2002. The provider was advised to contact the relevant lead officer in Oxfordshire Social Services to check if that was the policy currently in force. Staff are on a waiting list to attend local authority organised POVA training which is due to be held in a training centre in Kidlington. It is expected that this will take place in the near future. Staff were aware of issues surrounding POVA and expressed confidence in the manager and provider to investigate reports of such conduct. The home had a copy of the Department of Health guidance ‘No Secrets’. The home did not have a policy on whistle blowing. Staff training in dealing with aggression had yet to take place. The staff spoken to on this inspection visit were experienced in the care of vulnerable people (adults and children) and had a mature and appropriate attitude to the subject. However, given the nature of this service, this experience will need to be supported by formal training and management support. The home has facilities for managing service users’ money if required. Small amounts of cash may be held on behalf of a service user in secure conditions. All transactions are recorded. Two cash boxes were checked and the balance of cash corresponded with the relevant records. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30 Quality in this outcome area is good. The home is located in a quiet residential area, within reach of local shops, walking distance of Didcot town centre and of public transport. The home is an ordinary domestic house, which is conveniently located, well furnished and provides a comfortable environment which suits the needs of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is located in a quiet residential area about 15 to 20 minutes walk from Didcot Parkway station. The town centre is just under a mile away. Regular buses run between Didcot, Abingdon, Cowley and Oxford. There is limited parking to the front of the house. Alternative parking is available on nearby roads. There are local shops and a pub a short walk away and a larger shopping centre in Didcot. The entrance hall leads to the office, ground floor bedroom, cloakroom, kitchen, dining room, small laundry room, lounge and conservatory. There is a small garden with seating to the rear of the property. The conservatory is the only area in which smoking is permitted. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 24 Stairs lead to the first floor accommodation which comprises a landing, staffroom, three bedrooms, bathroom, shower and WC. Bedrooms vary in size. According to information provided by the registered manager one bedroom is under 12 square metres in size. None of the bedrooms have en-suite accommodation. Some additional support in the form of an extral banister, shower seat and cooking aid have been installed after consultation with an occupational therapist. The home provides a pleasant, comfortably furnished and well-maintained building. However, it is not suitable for a person with a significant problem with mobility or who requires a wheelchair. The kitchen is domestic in scale. It is equipped with wall and floor mounted storage cupboards, work surfaces, cooker, refrigerator, freezer, dishwashing facilities and small electrical items such as a kettle and toaster. Space is provided in the kitchen for service users to store their food. Some drawers are labelled. The kitchen facilities were tidy and in good order on the day of this inspection visit and are considered sufficient for their current use. There is a small laundry room which is equipped with a domestic washing machine and dryer, which again is considered sufficient for current use. The lounge is comfortably furnished and is sufficient in size for current use. The conservatory is a useful additional room which provides communal space separate from the lounge and from the distraction of the television. While most of the building is suitable for its current use, some points of concern were noted. Radiators are not covered and do not have cool touch surfaces. The temperature of the hot water outlets in areas to which service users have access is not regulated. Together, these could pose a hazard to vulnerable service users. The temperature of the hot water stored was not known. This should be above 60 degrees Celsius to avoid the development of Legionella. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36 Quality in this outcome area is adequate. Staffing levels appear satisfactory in this small home and systems of staff supervision are good. These ensure that there are sufficient numbers of supported staff to meet service users’ needs. However, potential weaknesses in staff recruitment and potential gaps in staff knowledge need to be addressed to ensure that service users are supported by appropriately trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Job descriptions are in place for all staff. The job description for ‘senior care/care worker’ was examined. This briefly outlines the key tasks of the post. The job description appears to be based on a health services professional post in a larger organisation and would benefit from review and revision in the context of the aims and objectives of this small social care service. For example, the document includes such references as ‘Lead a clinical team…’, ‘..manage own caseload…’, ‘…extending standards of care for patients…’, and ensuring adherence to ‘district policies’ and ‘departmental safety procedures’. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 26 The home’s recruitment, induction, training and supervision procedures aim to ensure that staff have the necessary qualities and skills for the job. Staff interviewed during the course of this inspection had acquired experience in a care or related setting before taking up post and had a mature and positive view of their jobs. They enjoyed their work with service users and reflected a positive view of the manager and provider. The provider reports that all care staff are registered to undertake the NVQ2. Staff with experience indicated a wish to progress to NVQ3 soon after achieving NVQ2. As a new service it is currently not achieving the standard that 50 of staff have acquired NVQ2. It expects to have achieved this by March 2008. All staff are provided with a copy of the General Social Care Council (GSCC) codes of practice on appointment. Current staffing of six full-time care staff (excluding the provider) and six bank staff provides two staff in the morning, two in the afternoon and evening and one waking and one sleep-in care staff at night. The home employs a community psychiatric nurse (CPN) to be on-call during the night. This provides additional ‘out of hours’ support to the home. The provider is available at all times. Applicants for posts in the home are required to complete an application form, provide two referees, have an enhanced Criminal Records Bureau (CBR) check, provide information in relation to their medical fitness for the job and attend an interview. Service users meet candidates for interview but are not otherwise involved in the formal process of staff selection. Two files were examined. Both files had a recent photograph of the staff member, completed application form, letter confirming appointment and a contract of appointment. One file fully met the standard. However, one file did not have references or evidence of a ‘POVA first’ check having being carried out before appointment. A search revealed that a ‘POVA first’ had been carried out and the results emailed to the home but a paper copy of the email had not been filed as evidence of conformance to this requirement. This is a new service which is still developing its approach to staff training and development. New staff follow the ‘Skills for Care’ induction programme. The home is establishing links with a range of training providers including local social services authorities, commercial providers (fire safety), Oxford and Cherwell College, courses supported by the Learning and Skills Council and others. Some staff had attended training in food hygiene, first aid, infection control, health and safety, medicines administration, POVA, challenging behaviour, moving and handling and introduction to working in mental health services. The home has a clear view on how it wishes to move forward with NVQ Level 2 training. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 27 Having been in operation for six months the home is now in a good position to carry out an audit of training needs, draw up a training plan for the next year or 18 months, agree training providers, agree how the programme is to be resourced and integrate the programme with its arrangements for staff induction, supervision, appraisal and development. A policy is in place with regard to staff supervision. A contract for supervison is agreed, sessions are planned and notes retained. All staff have one-to-one supervision every two months The home is aiming to increase this to monthly over the course of this year. A sample of supervision records were examined. This standard is fully met. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42 and 43 Quality in this outcome area is adequate. This is a new and generally well managed service which is providing a valued service in preparing service users for more independent living. However, potential weaknesses in health and safety procedures could compromise the safety of some service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager was on leave at the time of this inspection. The provider reports that the manager has acquired the NVQ4 and Registered Managers Award (RMA), has over six years’ experience working in mental health services and prior to that worked in other sectors in the care field. The manager was appointed in May 2006. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 29 The home aims to meet a range of needs and to support service users in moving on to more independent living. The provider feels that current staffing levels allow staff sufficient time, whether in the home or in the community, to provide support to service users as required. Staff seen expressed a positive view of managers and the provider said that service users and staff are encouraged to be involved in the development of the home through fortnightly house meetings and monthly staff meetings. The notes of recent meetings were seen. As stated earlier, the service had been operational for just under six months at the time of this inspection. It was, therefore, too early to assess the effectiveness of any systematic quality assurance processes. The provider said that she is on site every day, can observe how things are going and deal with any problems at an early stage. Regulation 26 reports are completed monthly. Day to day interactions and the fortnightly and monthly meetings with staff and residents provide ongoing feedback on life in the home. The provider thought that the CSCI inspection reports would be a useful indicator of the quality of the service. A stakeholder survey using questionnaires was being considered. The provider said that feedback from care managers involved in referring to the service had been positive to date. The contracts with social services included indicators of the quality of service expected. Ultimately, the provider felt that the best indicators of quality were the outcomes for service users and it was too early to assess those at the time of this inspection. The CSCI received one completed questionnaire from a service user in advance of this inspection visit. The respondent stated that sufficient information was provided before moving in to the home, that he or she ‘usually’ makes decisions about what to do each day and knows who to complain to if unhappy, the home is reported to be ‘always’ fresh and clean, staff are reported to ‘always’ listen, act on what is said and ‘always’ treat the respondent well. On the day of the inspection visit all four service users were seen. The relationship between staff and service users appeared good. One service user was particularly positive in his opinion of the home and felt that he was gaining benefit from his stay there. Others appeared well supported as they pursued their activities – whether preparing a meal, watching TV, relaxing in the conservatory, returning from a trip out or preparing to go out. The home has a policy manual and a list of policies was provided by the manager in the pre-inspection questionnaire. Policies are dated and some were being reviewed since the first admission in November 2006. It is noted that the list did not include a policy on moving and handling, this being considered ‘not applicable’ to this service. It is essential to have a policy to guide management and staff practice since moving and handling issues arise in all types of care services. Policies are readily available to staff and service users in the ground floor office. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 30 Arrangements for the maintenance and security of records appear satisfactory. Paper records are locked away when not in use and separate computers are used by staff and service users. The home has a policy of clearing desks when work is finished. Documents include reference to the Data Protection Act 1984. These need to be amended and the home to ensure that all staff are familiar with and conform to current data protection legislation. Arrangements for maintaining a safe environment and promoting the health and welfare of service users are generally satisfactory, but a number of matters require attention. A health and safety policy is in place. The home aims to provide care to service users with a wide range of needs and its health and safety procedures should take account of the needs of its most vulnerable service users. The statement of purpose states that ‘The home will be regularly checked and assessed by the local fire officer…..’. This statement may need to be reviewed in the context of fire safety legislation which came into force in October 2006. Contracts for the maintenance of fire equipment are in place. The emergency lighting is tested in the home weekly. There is a designated area for smoking within the home. A fire drill involving staff and service users had taken place a week before this inspection visit. There is a designated fire assembly point to the front of the house. Fire safety training was being arranged with ‘Red Box’. The manager should seek the advice of the fire service with regard to a safe method (such as the installation of a fire door retainer) of retaining the kitchen and office doors in the open position when required. COSHH materials are stored in a locked cupboard and the relevant data sheets are available in a health and safety file in the office. Systems are in place for recording accidents. Shower heads are cleaned and disinfected monthly. Information was not available on the temperature of the stored hot water. The temperature of the hot water outlets in areas to which service users have access is not regulated. Radiators are not covered and do not have safe touch surfaces. Arrangements for ensuring the safety of gas and electric appliances appear satisfactory. The provider said that there is a business and financial plan for the service and that relevant insurance cover is in place. Lines of accountability are clear and an organisation chart is included in the home’s statement of purpose. Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 2 32 2 33 3 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 2 3 3 3 2 2 2 3 Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? This is the first inspection of this home 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 YA1 Regulation Schedule 1 Requirement The registered manager is required to ensure that the statement of purpose includes all of the information required in this Schedule. This should include that required under paragraph 8 on emergency admissions and paragraph 16 on room sizes. The registered manager is required to review the present arrangements for the storage, control and administration of medicines. This must include securely fixing the medicine cabinet to a wall. The registered manager is required to review the complaints procedure to ensure that it is appropriate for the needs of all service users The registered manager is required to draw up a policy (‘whistle blowing’) to enable staff to communicate matters which may have an adverse effect on service users Timescale for action 30/06/07 2 YA20 13(2) 30/04/07 3 YA22 22(2) 30/06/07 4 YA23 21(2) 30/06/07 Brook House Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 33 5 YA24 13(4) The registered manager is 31/07/07 required to ensure that all areas of the home to which service users have access are free from hazards to their safety. This must include the temperature of hot water storage and that at hot water outlets. 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 Refer to Standard YA1 YA5 Good Practice Recommendations It is recommended that references to the home’s arrangements for visitors are consistent in all documents. It is recommended that home’s contract with service users be amended to include the information specified in standard 5.2 and that it reconsider the reference to the death of a service user on page two of the document. It is recommended that references to data protection legislation be amended to ensure that the correct legislation is referred to. It is recommended that the reference to holidays and weekend breaks in the service users’ guide be clarified It is recommended that the home clarify its policy on visitors and that this is accurately reflected across all documentation. It is recommended that the registered manager obtain the advice of a pharmacist on means of reducing to a minimum the number of handwritten copies of prescriptions on medicine administration records. It is recommended that the registered manager ensure that prescribed creams for external use are labelled when opened and used within the recommended time. It is recommended that the registered manager review staff job descriptions, making amendments where necessary so that job descriptions fit with the work staff carry out in the home. It is recommended that the registered manager carry out a training needs analysis and draw up a plan of staff training to March 2008 DS0000066262.V322227.R01.S.doc Version 5.2 Page 34 3 4 5 6 YA10 YA14 YA15 YA20 7 8 YA20 YA31 9 YA35 Brook House Residential Care Home Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Residential Care Home DS0000066262.V322227.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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