Inspection on 23/04/08 for Brook Lodge

This inspection was carried out on 23rd April 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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brook Lodge 27/06/07

Brook Lodge 09/10/06

Brook Lodge 02/11/05

Brook Lodge 25/04/05

Brook Lodge 17/12/04

Brook Lodge 28/06/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Brook Lodge Latchen Longhope Glos GL17 0QA Lead Inspector Ms Lynne Bennett Key Unannounced Inspection 23 and 24th April 2008 14:30 rd Brook Lodge DS0000044223.V359841.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 Lodge DS0000044223.V359841.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 Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brook Lodge Address Latchen Longhope Glos GL17 0QA 01452 830614 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) sherwoodj3@aol.com Voyagecare.com Voyage Ltd Mrs Jeanie Elizabeth Sherwood Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 11 27th June 2007 Date of last inspection Brief Description of the Service: Brook House consists of two semi-detached cottages, which have been joined to form one care home. The property was completely refurbished in 2005. The care home is one of several residential homes in the area managed by Voyage Homes. Brook House is in a rural location in the village of Longhope in the Forest of Dean. People living at the home have an identified learning disability and may present with challenges to the service. People have en suite accommodation and access to a range of comfortable and homely spaces. They also have the use of an allotment next to the home where they can grow vegetables. An additional self-contained flat is attached to the property, which has its own entrance and this provides accommodation for the eleventh resident. Each person has a copy of a service user guide and a statement of terms and conditions. A copy of the Statement of Purpose and last inspection report is available in the entrance hall. The fee levels for the home range from £793 to £2,200 per week. Some people contribute 50 of their mobility allowance to Voyage for costs for transport. Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place in April 2008 and included two visits to the home by one inspector. One visit took place in the afternoon and early evening and the other started the next morning until late afternoon. Most of the people living at the home were spoken with and time was spent observing the care they receive. Five staff were spoken with about the care they provide. Surveys were returned from eight people living at the home, ten relatives and two healthcare professionals. Since the last inspection, the house had been completely refurbished due to floods experienced in the area. During the refurbishment we agreed that people could live in a home in Gloucester. A walk around the house was conducted with one of the people living there. The registered manager was present throughout the visits. The group manager arrived on the second day to conduct a monthly check on the home complying with Regulation 26 of the Care Homes Regulations. The registered manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing information about the service and plans for further improvement. A range of documents was examined which included care plans, staff files, health and safety records and medication systems. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Each person has a care plan which is regularly reviewed. People said that they have a key worker and that they have reviews with healthcare professionals and parents. People said that they enjoyed their holidays last year and were busy planning trips away this year. People enjoy helping to prepare meals and enjoy the range of food provided. Each person has an en suite bedroom and access to comfortable and homely accommodation that they have been involved in redecorating. People said they enjoy going swimming and bowling and were observed helping to prepare their allotment to grow vegetables. Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4 and 5. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have access to the information they need enabling them to make a decision about whether they wish to live at the home. There is a failure to make sure that they have information about the fee levels and any additional costs to them. EVIDENCE: The Statement of Purpose and Service User Guide had been amended to reflect changes needed at the time of the last inspection. The Guide was available for people in a format appropriate to their needs using text and symbol. The AQAA indicated that the manager intends to produce the Statement of Purpose in a format that would be more appropriate to the needs of people living at the home. Since the last inspection each person has had a statement of terms and conditions put in place although sections relating to the fees had not been completed. The registered manager stated that a person had been for several visits to the home with a view to moving in. Admissions to the home were processed centrally and so she had not seen any pre-admission information or assessments. Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 9 A meeting had taken place with the placing authority. Admission information for the last person to move into the home was assessed as satisfactory at the last inspection. The previous three admissions to the home have settled in well, this was confirmed through observation of them during the visit, comments made in the AQAA and by staff. Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Improvements made in the care planning process need to be sustained to make sure that people’s changing needs are identified in their individual plans. The introduction of person centred plans will provide the opportunity to further develop the involvement of people in this process. Risks are being managed safeguarding them from possible harm. EVIDENCE: The care of three people living at the home was case tracked. This involved reading their care plans and other associated records, talking to them about the care they receive, observing them during the visits and talking to staff about the care they provide. Each person had a pen picture in place including background information about themselves and their family. Each person had an individual assessment in place that directed the reader to care plans and risk assessments. Care plans clearly indicated where a risk assessment or behaviour strategy had been developed. Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 11 Some care plans had been signed by staff and the person but this was not consistent practice. All records showed evidence of regular review by key workers and there was evidence that some people were having annual reviews with their family and placing authorities. People who have a Community Psychiatric Nurse were having regular access to them with evidence of regular reviews. The language used by staff in the care plans and daily notes was inconsistent. The terminology in some care plans implied the use of punitive measures. Staff and the registered manager confirmed that this was not the case and that care plans would be amended. On the whole the quality of care plans and risk assessments had significantly improved. The registered manager stated that a new person centred plan had been adopted by Voyage and was being introduced for people in the home. There was evidence in the current plans that people were being involved in the care planning and review process. The group manager was examining financial records as part of the Regulation 26 visit. She found these to be satisfactory. Individual records were in place for each person with evidence of receipts being obtained and cross referenced with the record. Separate records were being kept for holiday expenditure that again could be cross- referenced with the record. Where people need support with their finances this was clearly recorded in their care plan. Any restrictions or limitations to freedom or choice were recorded in care plans and the rationale for this noted. For instance the front gate has a keypad that restricts people’s access out of the grounds. The registered manager commented that this had been in place due to concerns about the wellbeing and safety of one person and that they were reviewing whether it still needed to be used. Any restrictions must be reviewed in light of the Mental Capacity Act 2005 and the appropriate documentation put in place in agreement with the placing authority. Risk assessments were in place for a range of hazards with evidence of regular review. Where appropriate these referred to physical intervention or medication protocols. Risk assessments had been put in place as a result of incidents or changes in need. Staff confirmed their understanding of hazards and what they should do to minimise them. Each file contained missing person information with a current photograph. Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 12 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. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staffing levels impact on the availability of appropriate activities for people living at the home reducing opportunities to engage in social, recreational and therapeutic activities. People may not have access to a nutritional and healthy diet due to budget restrictions. EVIDENCE: Each person had a schedule of activities for the week and each day a notice board in the dining room was being completed indicating what people were doing for the day and allocating staff to them. Staff spoken with during the visits indicated that at times the levels of staff could impact on whether activities had been carried out. Daily diaries also indicated that over a two-week period sampled in April there had been one occasion noted that an activity had not been carried out due to lack of staff. Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 13 Rotas for this same period showed that on two occasions in the evening there were four staff on duty and on another evening there were three staff. Otherwise there were between five and seven staff on shift. (See also Standard 33) Comments from parents and relatives expressed concern about staffing levels and the impact on activities. One stated “more staff are probably needed to lay on different types of activities at the same time as residents needs are varied” and “there needs to be varied outings and more variety of in- house activities”. One person said “ the home keeps residents happy, they take them out quite a lot”. Surveys from people living at the home indicated that they were able to do what they wanted. The AQAA stated under improvements for the next year that they would seek out an even wider range of activities both inside and outside the home.” Daily diaries provided a record of what each person had done during the day and where people had refused the opportunity to participate in an activity this was being recorded in some instances. People were observed going to day centres and a farm, going out with staff around the village, to the local shop and into Gloucester. One person talked about going swimming and had been rock climbing supported by a member of their family. Another person was planning for an evening at the pub and others choosing a video to watch together. People were encouraged to help at the allotment where they hope to grow vegetables for the home and to cook a dessert for tea. One person’s care plan indicated they would like to go horse riding and to church on a regular basis. Over the two-week period they went horse riding once but did not go to church. Previous records had indicated that they had walked around with others to the local church, but had not been to a service and had been supported to go to Gloucester Cathedral to light a candle. However these did not appear to be identified as part of their weekly schedule. People said they had enjoyed their holidays last year and staff were busy supporting them to plan this years holidays to Cornwall and Wales. Two people had a booklet providing a photographic record of their holidays with text. People said that they keep in regular contact with families and friends either by visiting them or inviting them to the home. They also keep in touch by telephone and letter. There was a mixed response from relatives in their surveys, with 50 saying the home ‘always’ helps their relative to keep in touch and 50 indicating that it does this ‘sometimes’. A number of relatives said that the home provides transport for visits either to them or the home. One relative said that they had not visited the home because they were unable to get there. Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 14 Staff were observed discussing with people how they would like to spend their day and offering them a range of activities either inside the home or outside the home. People were observed choosing what to do whether staying in communal areas or going to their rooms or the garden. Two people said that they were being supported to cook in the kitchen and also to learn how to iron their clothes. They said they help to clean their rooms and the garden. One person was receiving payment for cleaning the home’s buses. There were minutes of the two house meetings held this year. People had been discussing using public transport to go to Gloucester and were looking forward to this. People had also expressed several concerns at these meetings that were logged in the minutes. (See Standard 22) Although all bedroom doors in the home have keys, people were not observed locking their doors and said that they only usually lock them when they go away on holiday. Care plans did not make reference to access to keys. The home employed a cook to plan and prepare meals. She stated that people living at the home were involved in this process. Menus were set up for a fourweek period but there was some flexibility in this. Individual meal records were being kept for each person. Charts were in place for people whose diet or fluid intake needed monitoring. Staff were heard discussing with the cook the diet of a person with diabetes. Some staff had received training in diabetes. Comments from 20 of relatives voiced concerns about the lack of fresh vegetables or fresh meat. During the visits fresh salad and some fresh vegetables were provided with meals and fresh fruit was available for snacks. Staff expressed concerns about the budgets for provisions that provide £31 per person per week in line with Voyage’s allowances for all homes. The registered manager indicated that this had been discussed with the group manager at a recent management meeting and that she was monitoring this. Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Providing robust records will ensure that the personal care needs, health and wellbeing of people living at the home are being met. There are some improvements in the administration of medication that need to be implemented to safeguard people from the risk of error or possible harm. EVIDENCE: Care plans provide clear guidance about how people would like to be supported with their personal care. An assessment from a placing authority for one person indicated that they should have one male staff or two female staff to support them with their personal care despite their preference being for a particular female member of staff. This document noted the reasons for this being due to inappropriate conduct with female staff placing them at risk. This had not been identified in their care plan although it stated that staff were delegated on each shift to provide care. The care plan needs to state the reasons for this clearly. Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 16 Generally care plans need to identify people’s preferences for the gender of carer providing personal care. If, as in this case, this cannot be respected then the reasons must be clearly recorded. Staff spoken with had a good understanding of the needs of the people they support and were able to describe their responsibilities. Staff observed during the visit treated people with sensitivity and respectfully. The home had a calm and happy atmosphere quite different from previous inspections. The registered manager agreed that she had noted this also over recent months. The AQAA also stated “the home has a more relaxed atmosphere.” People were having access to a range of healthcare professionals although the records for these appointments could be more robust. A record of most appointments was being kept with an outcome of the appointment logged. It was not clear from these records whether a person with diabetes was having the necessary regular checks with a chiropodist, identified in their care plan. Financial records for the person confirmed that these were taking place. Health action plans have not been put in place for people. Systems for the administration of medication were examined and found to be mostly satisfactory. Staff confirmed that they had received one day training with a pharmacy and that refresher training was being provided by Voyage as part of their Electronic-Learning package for staff. Medication was being stored in a cupboard. The temperature was being monitored each day showing that medication was stored below 25°C. Each person has a medication profile including photograph. Most of the medication is dispensed in blister packs. The stock levels of medication provided in boxes was being recorded and monitored each week. Handwritten entries on the medication administration record had been countersigned for some drugs but not for all. A signature list had been provided for all staff administering medication. Creams and liquids were marked with the date of opening. Creams should be kept in a sealed container so that there is no contamination of internal medicines. There was no evidence that people had given their consent to have medication administered by staff although this had previously been in place. Protocols for the use of “as necessary” medication were in place providing clear guidelines to staff about the frequency of their use, the maximum dosage and when to refer to the Doctor for advice. Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 17 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): People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Reviewing the systems for dealing with concerns expressed by people during house meetings will make the complaints process more robust within the home. Arrangements are in place to help to protect people from harm and abuse. EVIDENCE: The home has a complaints policy and procedure which is produced in a format appropriate to people living at the home. All people indicated in their surveys that they knew how to make a complaint. Of the relatives 80 said that they knew how to complain and comments included “we talk about issues as they arise”, “I do now after recently making a complaint”. 20 of relatives said that they did not know how to make a complaint. The AQAA stated, “all service users and their families are provided with a version of letting us know what you think policy and service users are each provided with help cards. Since the last inspection we (The Commission) have received one complaint which we forwarded to the provider to investigate. An initial investigation was conducted in the absence of the registered manager and the outcome fed back to the complainants. The registered manager decided to complete a second investigation upon her return. This process was still ongoing at the time of the inspection. Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 18 The registered manager confirmed that they had met with the complainants on one occasion and that another meeting had been arranged with them as well as a healthcare professional. Records relating to this complaint were being kept at Head office. Considerable concerns were expressed in surveys from relatives involved in this process and their confidence in the home to deal with the complaint and safeguard their relative. Relatives of other people living at the home commented, “ I know he is well looked after and is safe” and “the home has acted appropriately to all concerns and suggestions we have mentioned in the past.” At recent house meetings people living at the home had expressed concerns about noise from the laundry and fixtures and fittings but there did not appear to be any system in place to action these and record the outcome. The registered manager acknowledged that this had not been done and that she would deal with the concerns raised. Staff confirmed that they had completed training in the safeguarding of adults through the Electronic-Learning package provided by Voyage. Discussions with staff confirmed their understanding of the process in place and the action they would take should they have concerns about the wellbeing and safety of people living in the home. The registered manager confirmed that she had provided a copy of the local procedure for people although no one at the home had attended training with the local team. Staff had previously trained in CALM (Crisis and Anger Limitation Management) but were now attending NCI (Non crisis intervention) training which promotes a low arousal approach to supporting people who may be presenting with challenging behaviour. Until all staff had received this latter training they confirmed that they were continuing to use the approaches advocated by CALM. Records were being kept for any incidents that cross referenced with monitoring charts such as ABC records, body maps and daily notes. For the people case tracked there was a significant reduction in the use of physical intervention, with no use being recorded between March and April. The same was noted for the use of “as necessary” medication. Staff spoken with confirmed this. They commented on increasing confidence in the use of verbal de-escalation. Some daily notes indicated that people were “assisted to their room” or “taken out”. The registered manager confirmed that this did not mean physically escorting a person using a physical intervention but providing support to them when needed by them. Staff said that they may offer an arm but had not used physical intervention for some time. The registered manager confirmed that she had been through the whistle blowing policy and procedure with staff. Copies of this with a signature list were displayed in the office. Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 19 Staff spoken with were aware of this procedure and said that they had confidence that the registered manager would challenge and deal appropriately with poor practice. Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is well maintained and reflects their lifestyles and interests. Brook Lodge provides a clean, comfortable and homely environment for people. EVIDENCE: The ground floor of the home had been refurbished after flooding in the area last summer. The registered manager stated that flood defences had been reviewed around the area and the home had received a supply of sandbags. The annex was not inspected on this occasion. Communal areas were clean and tidy and in good decorative order throughout. People were observed making good use of the dining room, lounge, craft room and conservatory. 20 of relative surveys expressed concern about the layout of communal rooms, which tend to lend themselves to being “through rooms” or “like a corridor”. Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 21 The registered manager said that staff had tried to be creative with fixtures and fittings to promote a homely atmosphere to stop rooms being used in this way. The layout of these rooms had been changed since the last inspection and people said they were happy with this. All areas had been fitted out with good quality furnishings. One chair in the lounge had a Kylie cover on the seat (to protect it) during the first visit, this was removed when questioned why it was there. The grounds around the home were in good order although the cook said that there had been problems with refuse collection. A large number of bags were waiting to be collected. The group manager dealt with this during the visits. On the tour of the home several rooms were shown to us that had been decorated to reflect the lifestyles and interests of people living at the home. One person had a room that had been developed into a sensory environment. A relative who visits the home frequently commented in a survey that the “quality, decoration and cleanliness of the home is good.” People said that they help with the cleaning of their rooms and their home. They were observed being supported by staff. Rooms that had a distinct odour at the last inspection were observed to smell fresh and clean. The laundry was on the first floor and despite having a special floor to minimise vibrations and noise was disturbing some people at night. (See Standard 22). Personal protective equipment was provided for staff use. Liquid soap and paper towels were provided for use in communal hand washbasins. Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33, 34, 35 and 36. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Improvements in recruitment and selection procedures will ensure that people are being safeguarded from possible harm. Staff need to have access to a robust training programme which will equip them to meet the needs of people using the service. EVIDENCE: The AQAA stated “New staff complete an induction programme equivalent to Skills for Care specifications. Over 60 of staff have a minimum of NVQ 2. One person is working towards an NVQ and five are registered to begin their NVQ.” Staff confirmed the NVQ programme was in place and one person confirmed that they had completed their award. Copies of induction programmes were in place. One new member of staff was shadowing staff during the visits. Feedback from healthcare professionals was positive about the staff group saying, “a satisfactory level of care is provided for a difficult group of people” and “challenging environment at times, staff cope very well”. Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 23 Comments from 80 of relatives indicated they were concerned about staffing levels, long-term staff leaving and the skills and qualifications of new staff. One commented, “I hope that new staff will have the right skills and experience”. Staff said that morale within the team was good and that they were working well together. There have been significant changes to the staff team since the last inspection with a number of staff moving on and new staff joining the team. There was one full time day staff vacancy and vacancies for night staff. The existing staff team were covering these vacancies. The rota confirmed that at least five staff including the senior on duty were being scheduled for each shift. This occasionally rose to a maximum of seven and sometimes fell to three per shift. Under Regulation 37 where there are staff shortages these must be reported to us. Staff files for two recently employed staff were examined. We had agreed that the majority of records for staff could be kept centrally. The registered manager was provided with a front sheet for the file to verify which documents had been received and when. Copies of an application form were available for inspection. This front sheet confirmed that: • • • • A current Criminal Records Bureau check (CRB) had been obtained Where people were employed with a POVA first check this was confirmed Two written references had been obtained prior to employment Any gaps in employment history had been verified with the applicant and recorded The files also contained a current photograph and evidence of identity. The registered manager said that she does not see references unless there was something that needed further clarification so she was unable to verify the reason why people had left their former employment. Therefore this section on the front sheet had not been completed. There was also no evidence that a risk assessment had been put in place for people working without a CRB check. The registered manager described the process in place and this was satisfactory. The home has a training matrix in place that was being monitored by Voyage and indicates when refresher training was needed. The AQAA identified a need for “further specialist training available for whole staff team.” Staff use an Electronic Learning package (El box) for mandatory training and certificates confirmed completion of fire, food hygiene and moving and handling. Staff said they had completed first aid with an external trainer and some had completed diabetes, autism and mental health training. Infection control and medication training were due to be delivered via the EL box. Staff do not have access to the Learning Disability Qualification (LDQ). Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 24 Supervision schedules had been put in place with evidence that 50 of staff had received their supervisions in January and another 50 had theirs in February. Copies of minutes were on their files. Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41 and 42. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Effective quality assurance systems are in place involving people who live there. The health, safety and welfare of people are being put at risk by unsafe practices in the monitoring of fire and electrical systems. EVIDENCE: The registered manager has the Registered Managers Award at Level 4 and considerable experience in the field of learning disability. All of the twelve requirements issued at the last inspection had been complied with. There had been a significant improvement in the quality of paperwork including care plans and risk assessments. There were some concerns about maintaining staffing levels and making sure that staff have the appropriate specialist training they require to meet the needs of people living at the home. Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 26 The AQAA was satisfactorily completed and submitted to us on time. The registered manager has liaised with us over notifications and complaints investigations. Staff spoke positively about her saying she was approachable and supportive. They said that the relationship between the staff team and management had improved with staff having confidence that management would challenge poor practice. Milbury/Voyage have a robust system in place for quality assurance that involves people living at the home. An annual quality assurance audit was conducted in 2007 and a report produced. People living at the home had last been surveyed in 2007. They were also being involved in the monthly visits to the home. A report was being produced each month detailing actions to be completed within a set timescale. Confidential information was observed to be stored safely and the office was kept locked when not in use. This is a significant improvement. Systems for the monitoring of health and safety are delegated to staff, who confirmed they have access to the relevant training. Records indicated regular monitoring of fire systems, fridge and freezer and hot food temperatures and water temperatures. Items in fridges that had been opened were labelled with the date of opening or preparation. Portable appliance testing was overdue. Fire records had not been completed on a regular basis showing that emergency lighting and fire tests were not being done at the required intervals. A fire risk assessment was in place. Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 2 36 3 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 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 3 X 3 X X 2 X Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 28 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 YA5 Regulation Requirement Timescale for action 30/06/08 2. YA7 3. YA11 4. YA14 5. YA17 17(2) The statement of terms and Sch4,8,5(1)b conditions for each service user must be reviewed to reflect current fees and costs of extras. 17(1)(a) Sch Any restrictions that are in 3.2(q) place must be recorded in line with requirements of the Mental Capacity Act. This is to safeguard people’s freedom of choice and liberty. 16(3) Where people have identified that they wish to go to attend a religious service of their choice, they must be supported to do this. This will make sure that the home is recognising and respecting the diversity and individuality of people living in the home. 18(1)(a) Staffing levels must be appropriate to the needs of people living at the home in order to support them to access social, educational and leisure activities. 16(2)(i) People must be provided food that sustains a nutritional and healthy diet. 30/05/08 30/05/08 30/05/08 30/05/08 Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 29 6. YA20 13(2) 7. YA22 22(1) 8. YA24 12(4)(a) 9. YA33 37 10. YA34 19(1)(b) Sch 2.4 11. YA35 18(1)(c) 12. 13. YA42 YA42 23(2)(c) 23(4A)(b) A record that people have given their consent to have their medication administered by staff must be in place. A system must be put in place for dealing with concerns and complaints raised by people living at the home during house meetings. This is to make sure that people can be confident that any concerns will be listened to and action taken as a result. Incontinence issues must be dealt with sensitively and ways found to discreetly protect furniture that respects the dignity of people living at the home. Where there are shortages of staff (below 4) the Commission must be informed. This is so that we can monitor the health and wellbeing of people living at the home. Where staff have previously worked with vulnerable people the written reason why they left this employ must be obtained. This is to safeguard people from possible harm. Staff working in the home must have specialist knowledge to support people with autism, learning disability and mental health needs. Also to understand the needs of people with diabetes. Electrical equipment must be tested each year to make sure that it is safe to use. The home must make sure that it complies with the Regulatory Reform (Fire Safety) Order 2005 and check fire equipment and systems at regular intervals as stated in their fire risk assessment. DS0000044223.V359841.R01.S.doc 30/05/08 30/05/08 30/05/08 30/04/08 30/04/08 30/07/08 23/05/08 23/05/08 Brook Lodge Version 5.2 Page 30 This will make sure that systems are in good working order to protect people from the risk of fire. 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 YA6 Good Practice Recommendations People should sign care plans where appropriate and countersigned by staff. Care should be taken with the language used in daily notes and care plans. 2. 3. 4. 5. YA16 YA18 YA19 YA20 Where people choose not to have keys to their rooms, this should be recorded in their care plan. Peoples’ preferences for the gender of staff providing personal care should be identified in care plans. Health action plans should be put in place for people living at the home. Handwritten entries on the medication administration record should be countersigned. Creams should be kept in a separate sealed container. Staff should attend the “Alerters Guide” training and the manager “The enhanced training in the protection of vulnerable adults” with the local adult protection team. The use of the room upstairs as a laundry should be reviewed – in terms of whether this is still an appropriate position or whether the hours of use could be restricted. A risk assessment must be put in place when staff, with a POVA first check and not a CRB are working in the home. Explore opportunities for staff to complete the LDQ. 6. 7. 8. 9. YA23 YA30 YA34 YA35 Brook Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Lodge DS0000044223.V359841.R01.S.doc Version 5.2 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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