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Inspection on 11/05/06 for Brooke House Care Home

Also see our care home review for Brooke House Care Home for more information

This inspection was carried out on 11th May 2006.

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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service users were found to be very positive about the quality of service being provided. There is an emphasis on empowerment and facilitation of service users at the home, with a committed manager and staff team. The home is beginning to develop as a service that will provide a valuable resource to stakeholders who place clients at Brooke House for assessment and life skills training. The service is sensitive to the needs of service users, and adopts a person centred approach to care planning with each individual resident. There is a clear commitment to consultation with service users and to enabling residents to gain new skills and life experiences. The environment is clean and bright and service users participate in the running of Brooke House and the wider community, where needed with staff support.

What has improved since the last inspection?

Risk assessments had been developed and linked to care plans and resident`s goals. These assessments still need further work to ensure they are specific, provide adequate guides to staff and relevant others and remain relevant to peoples changing needs, abilities and wishes. Action had been taken to provide staff with appropriate support and supervision, as well as induction and ongoing training and development. Craigmore had recently carried an audit of the service, and quality assurance systems continue to develop, with a commitment to consultation and participation from residents. The manager monitors health and safety throughout the service, and takes action as needed to safeguard service users and staff. There is an application to register a manager for the service.

What the care home could do better:

The service needs to ensure that risk assessments record specific information that can enable staff to provide appropriate levels of support based on issues of risk, service users needs and wishes. Wider issues of risk in the community also need to be clearly identified and where necessary addressed. Given the history of the service prior to the change of name, there is a need to raise the profile of the service locally, in order to regain the trust of local commissioners / purchasers. There were some routines and practices evident at the time of the visit that could be described as institutional. The kitchen area was locked, and while more able residents had a key some less able residents were unable to access their kitchen without staff support/permission. This was due to the behaviour and dietary needs of one service user who was not in at the time of the inspection. However, the kitchen was still locked even though the sign on the door stated only to be locked over night. The arrangements for managing medications at the home appeared to do little to support the home`s aims and objectives of promoting greater control and independence by residents. Staff members were holding the tobacco of one service user, which may be leading to the resident concerned learning dependency rather than independence? Such routines need to be reviewed in light of the outcomes for service users and the aims of the service. There is a need to review the care plan goals of one service user, as these had clearly changed. This will need to happen in consultation with the resident and their social worker and specialist nurse who are working with this client with regard to future permanent living arrangements. There is also a need to monitor and review the needs of one service users bedroom facilities, given their particular needs. This resident needs greater support and access to a WC to overcome problems of maintaining reasonable hygiene and continence in the bedroom. The provision of an en suite orlocation of a bedroom nearer to a WC may be needed, as well as potentially an assessment by a continence nurse. The organisation Craegmore act as appointee and manage some service users personal allowances and benefits. The organisation need to review these arrangements and if there are absolutely no other solutions, then Craigmore must declare who they act for and why to the CSCI and the Benefits Agency.

CARE HOME ADULTS 18-65 Brooke House Care Home 123 Millbrook Road East Freemantle Southampton Hampshire SO15 1HQ Lead Inspector Mr Richard Slimm Unannounced Inspection 11th May 2006 10:00 Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Brooke House Care Home Address 123 Millbrook Road East Freemantle Southampton Hampshire SO15 1HQ 023 8023 5221 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) heron.house@craegmoor.co,.uk Park Care Homes (No 2) Ltd Care Home 10 Category(ies) of Learning disability (10), Mental disorder, registration, with number excluding learning disability or dementia (10) of places Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th December 2005 Brief Description of the Service: Brooke House provides what Craegmore describe as a transition service within a hostel style service catering for adults who have a learning disability and/or mental health problems and who may also have a diagnosis of Autism and/or Asperger’s Syndrome. The aim of the service is to support service users in developing life skills to live more independently in supported accommodation, or need assessment prior to moving on into longer-term accommodation, as Brooke house does not intend to provide permanent housing. Brooke House is located close to the city centre of Southampton and is within easy access to all main amenities, transport links and local shops. Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit took place as part of a statutory key inspection carried out by the CSCI. The visit took place on the 11/5/06 between the hours of 10 am and 5 pm. Information was gathered from a variety of sources prior to the visit to the home. The aim of the visit was to validate outcomes for service users, and gather evidence to form judgements about the service, that could not be gained elsewhere. Prior to the visit the inspector spoke to a variety of professionals and commissioners of the service, including case workers such as social workers and care managers from local Authorities, consultants and doctors and other health based professionals working with people accommodated at the home. Other information was gathered from reports that the organisation sends to the CSCI on a monthly basis regarding the conduct of the home and notifications of events. Other regulatory activity also informs the inspection process such as registration. Given that this service was run under a different name by the same organisation, the commission have considered aspects of the homes history prior to the change of name. During the visit the inspector met three of the five service users accommodated, spoke to three staff members and the manager, as well as a brief conversation with a senior manager from Craigmore with regard to whistle blowing procedures. Two service users were case tracked, and a selection of care related documentation was seen. Other documentation and quality assurance recording was also inspected. This inspection identified evidence of a service that can be described as improving. However, there are still a number of areas of the service that need further development in order to ensure that the needs and wishes of service users are fully met and that the national minimum standards are fully complied with. What the service does well: The service users were found to be very positive about the quality of service being provided. There is an emphasis on empowerment and facilitation of service users at the home, with a committed manager and staff team. The home is beginning to develop as a service that will provide a valuable resource to stakeholders who place clients at Brooke House for assessment and life skills training. The service is sensitive to the needs of service users, and adopts a person centred approach to care planning with each individual resident. There is a clear commitment to consultation with service users and to enabling residents to gain new skills and life experiences. The environment is clean and bright and service users participate in the running of Brooke House and the wider community, where needed with staff support. Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: The service needs to ensure that risk assessments record specific information that can enable staff to provide appropriate levels of support based on issues of risk, service users needs and wishes. Wider issues of risk in the community also need to be clearly identified and where necessary addressed. Given the history of the service prior to the change of name, there is a need to raise the profile of the service locally, in order to regain the trust of local commissioners / purchasers. There were some routines and practices evident at the time of the visit that could be described as institutional. The kitchen area was locked, and while more able residents had a key some less able residents were unable to access their kitchen without staff support/permission. This was due to the behaviour and dietary needs of one service user who was not in at the time of the inspection. However, the kitchen was still locked even though the sign on the door stated only to be locked over night. The arrangements for managing medications at the home appeared to do little to support the home’s aims and objectives of promoting greater control and independence by residents. Staff members were holding the tobacco of one service user, which may be leading to the resident concerned learning dependency rather than independence? Such routines need to be reviewed in light of the outcomes for service users and the aims of the service. There is a need to review the care plan goals of one service user, as these had clearly changed. This will need to happen in consultation with the resident and their social worker and specialist nurse who are working with this client with regard to future permanent living arrangements. There is also a need to monitor and review the needs of one service users bedroom facilities, given their particular needs. This resident needs greater support and access to a WC to overcome problems of maintaining reasonable hygiene and continence in the bedroom. The provision of an en suite or Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 7 location of a bedroom nearer to a WC may be needed, as well as potentially an assessment by a continence nurse. The organisation Craegmore act as appointee and manage some service users personal allowances and benefits. The organisation need to review these arrangements and if there are absolutely no other solutions, then Craigmore must declare who they act for and why to the CSCI and the Benefits Agency. 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. Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1-2-4 There was evidence that the service is an improving one. Systems of assessment continue to develop and improve. Residents’ are enabled to make informed choices when moving into the service, are enabled to visit and “test drive” the home. Care is taken to ensure residents’ needs and wishes/aspirations are assessed. Quality for this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provision may benefit from a review of it’s statement of purpose, and service user guide. The service has only been operational for 6 months, and such a review may be useful to assess what the service is doing well and what needs to improve from the perspective of the service user group, and new admissions. There was evidence that the five service users had been admitted within the conditions and categories of registration. The service appeared to have the facilities and staffing to meet the assessed needs of the current residents accommodated. One resident with mobility difficulties is accommodated in a ground floor bedroom located next to a communal WC and accessible shower. The resident explained that there had been some difficulties in accessing the shower independently recently and action has been taken to remedy access issues to the specialist shower and an Occupational Therapist had visited Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 10 Brooke House and has assessed the resident. Action is being taken to provide aid and adaptations to overcome the difficulties. The resident concerned is very happy living at Brooke House, she confirmed that assessments of need had been carried out and information regarding the service provided prior to admission, and visits to the home had been arranged before making any decisions to move in. Two residents spoken to specifically about admission and assessment confirmed that they had been enabled to make informed choices about moving into Brooke House and were also aware that the accommodation is temporary. Assessment materials were person centred and action had been taken since the last inspection report to develop risk assessments. These documents still need further development and need to be more specific in language and guidance to staff. Terms such as appropriate or adequate recorded in plans or assessments do not provide sufficient information to enable staff to make clear judgements in consultation with individual service users. Service Users who were case tracked and had communication skills confirmed they had received information about the service prior to admission, and had visited also as part of the process to enable them to make informed choices. Care is taken to involve existing residents in admissions and there was generally a happy feel about the service, which is provided along hostel lines as opposed to a permanent home. Some aspects of the service user guide need updating and clarification, and additional medias are needed to improve access to this information by people with learning disabilities, this was discussed with the manager at the time of the visit. The service has a challenge to gain the confidence of local commissioners and placement officers. However, the service is now working more closely with the Community Learning disability Team, and is forging new links in the community. All residents were placed within the current conditions of registration. However, some additional facilities may be needed. Due to the needs of one resident the provider should consider the provision of an en suite for this resident or alternatively offer the resident a bedroom located nearer to a WC. Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6-7-9 Service users’ are fully involved in the development and maintenance of their personal support and care records. These documents are person centred, meaning they focus on both the needs and dreams of the resident. Risk assessments need more detail in order to ensure residents are supported to take reasonable risks as part of achieving the potential benefits greater independence. Quality for this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each service user has a Person Centred Plan (PCP) developed in consultation with residents and based on an assessment of need and wishes. These plans were found to be living documents, and each contained the stated goals of each service user. In one instance where a resident’s goals had changed there was a need to review the residents PCP and the necessary resources identified to see if the new goals are achievable at Brooke House. This review will need to involve the residents and other relevant stakeholders working with the resident. Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 12 Resident’s case tracked provided documentary evidence of consultation and participation. Service users’ are aware of and happy with their key workers. Reviews are held at regular intervals and where the need arises reviews are called more frequently and involve other stakeholders and people involved in the residents’ life outside of the home. The home and the organisation will need to rebuild the trust of some local stakeholders. Service users participate in the running of their home and decisions about their individual lives. While less able residents are supported to participate, some practices and routines identified above appeared to be institutional in outcome for service users. These routines need to be reviewed in order to develop and promote service user independence to the full. In other areas residents are encouraged to cook and be involved in all aspects of housekeeping promoting independence and responsibilities as well as rights. Residents with full verbal skills confirmed they were consulted and involved in decision-making. More dependent residents are offered support and advocacy in making important life decisions. Residents are fully involved in the running of the service and are enabled to participate. It was noted that there were some practices and routines in need of review due to institutional outcomes for residents. At the time of the visit the residents’ kitchen was locked. More able residents had been given keys, but less able residents could not access their kitchen without permission. The inspector was advised that the kitchen area is locked due to the needs and behaviours of one resident. Consequently there is a need to look more carefully at the needs and behaviours of this resident, and support provided in a manner that does not restrict others’ living at Brooke House. Staff members in one instance were holding a resident’s personal tobacco. This led to the resident having to request constantly for staff to give him a cigarette. The potential outcome of this is to teach the resident dependency, and alternative support should be considered. Risk assessments had been put in place. Staff members confirmed that they are encouraged and enabled to explore information about residents’ particular needs and the home is working with the local Community Learning Disability Team, more closely and relations are improving. Residents’ meetings are held weekly and minutes kept of the outcomes and action needed. There was evidence that action is taken based on the residents’, views, wishes and needs. Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-13-15-16-17 The service provides a range of choices and options for residents’ for personal development. There are links to external agencies and services that provide specialist and integrated educational opportunities. Service users confirmed they feel part of the local community and participate in their community as both individuals and as a group. Residents’ use local leisure facilities and lead full and active lives. Service users’ are encouraged to maintain and develop relationships, and counselling is provided where needed by external professionals. The service provides residents’ with opportunities to eat well, and healthily with an emphasis on promoting independent living skills. Quality for this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From case tracking records, resident feedback and some care manager feedback plus observation during the site visit residents’ are provided with opportunities for personal development. There are a number of different opportunities for residents to pursue education and/or occupation outside of the service, and residents’ are supported to develop and/or maintain Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 14 community links with an emphasis on social inclusion. Active support is provided to enable residents to choose from a range of leisure activities, and residents’ are supported and encouraged to maintain existing and develop new relationships. Some routines at the service could potentially promote institutional outcomes for some service users. Residents’ are regularly consulted and involved/supported in all aspects of housekeeping and catering arrangements at the service. Residents’ stated that the food was good, and they always had a choice, as weekly menus were planned with residents during the weekly meetings. It was noted that there was an emphasis on healthy eating. One SU with dietary needs was posing some challenges and the current response of the service could potentially be placing restrictions on other residents as identified above. Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18-20 Service users receive personal care and support in the manner they have chosen and been consulted on. Medication management systems do not fully promote independence. Quality for this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One service user with minor mobility problems advised the inspector that an occupational therapist had visited to assess access and usage needs in the shower. The inspector was advised that arrangements are being made to provide appropriate facilities/aids to promote independence and safety of this service user. One resident may benefit from the provision of an en suite WC or having a room located nearer to a WC facility in order to overcome issues of incontinence/behaviours that leave the bedroom smelling of urine. Residents’ confirmed that they are supported in a way that promotes their wishes and meet their needs. One resident did not have access to tobacco without asking staff. This is potentially leading to this SU learning and adopting institutionalised behaviours and needs to be reviewed in order to ensure the SU is being supported and encouraged to relearn skills that have been lost due Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 16 to injury. It should be noted that this resident has not been placed very long and is still in the process of being fully assessed. Residents’ spoken to and those case tracked all appeared well, and in good general health. Action is taken to ensure service users’ see health professional when needed and in line with the wishes of individual resident. One care manager advised the inspector that his client had never looked so well for a long time, and the last 3 months of his clients’ placement had been very stable and was greatly benefiting his client. Where service users’ have complex health care needs the service works with commissioners/care managers to develop contingency plans for the future care needs of the resident. Craegmore as an organisation encourage their services nationally to use a monitored dosage system for the administration, recording and storage of medications. While such systems are useful to enable staff in nursing and high dependency services, to standardise medication administration practices and promote safety, it is unlikely that such systems will be able to promote the degree of independence that service users will potentially need in the context of Brooke House’s stated aims for it’s service users. Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22-23 The complaint procedure is not available in formats some residents would readily understand. More able residents are enabled and feel safe enough to make any concerns known. Residents are listened to at Brooke House. Residents are safeguarded from possible abuse. Quality for this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has not fully developed the complaints procedure and provided appropriate medias for service users who may have learning disabilities in formats that they can fully under stand. More able service users were aware of the complaints procedure and demonstrated their abilities to share concerns. One resident stated that they felt they had a clash of personality with one staff member. This was positive as the resident shared her concerns with the both the manager and the inspector. The manager explained she was aware and is actively monitoring the issue. There was some evidence to support the view that the resident and the staff member are being appropriately supported and the resident is being encouraged to self-advocate. Staff members receive training in adult protection and Craigmore have clear policies and procedures that link to the local adult protection arrangements coordinated by local authority social services department. These policies and procedures are guided by “NO SECRETS”. The service displays the company whistle blowing process, and the inspector called the number provided and received a response from a senior manager within two and a half hours, who explained how the process worked. Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 18 Craegmore act as appointee for some service users. The Benefits Agency should be informed of this. The commission recommend that organisations should avoid acting as appointee wherever possible. Service users said they could access their personal allowances whenever they needed to. Monies allocated to residents are recorded and signed for by the service users concerned. Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24-26-30 The accommodation is comfortable and residents’ were found to be contented with how their home was run/organised. Service users are encouraged and supported to be involved in the daily running of their home. The service needs to review the WC access arrangements for one SU. Quality for this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was cleaned and well maintained. One room smelt of urine. The resident accommodated in this room may need to be provided with an en site or located nearer to a WC. The resident will need to be assessed further in this area of daily living, as the current arrangements are contrary to the stated purpose for the service and National Minimum Standards. Service users are encouraged and supported in all aspects of housekeeping thus promoting independence and right s and responsibilities. Action is being taken to provide aids and adaptations to a resident with mobility problems when accessing the specialist shower on the ground floor. Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 20 Residents had personalised their own rooms. One more dependent resident recently admitted will need further support in this area of daily living and choices. Residents’ said they would be consulted about how the home is decorated via the weekly SU meetings; this was confirmed by the manager. Residents’ were aware that the accommodation was not long term and that they would be moving on into alternative arrangements once they had developed the necessary skills. One resident showed the inspector the garden where he works keeping this area tidy and planted. He was very proud of his achievements, carrying the key to the garden shed. Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32-34-35 The service employs sufficiently trained staff in numbers adequate to support residents’. Staff training is a high priority for the organisation who resource this aspect of the service. Thorough recruitment practices support and promote the protection of residents’. Staff members are well supported and supervised. Quality for this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One senior support worker has NVQ3 with a (Learning Disability Award Framework) module. The organisation provided evidence of a clear commitment to staff training and development, the manager is currently undertaking a course of study to NVQ 4 plus the Registered manager award (RMA ). Staffing levels were of a good standard, and each service user has a designated Key Worker and time with the key worker was planned via the person centred care plan and activities timetables for each resident. Accurate staff rotas were available and accurately reflected the staff on duty at the time of the unannounced site visit. Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 22 Staff recruitment practices were of a good professional standard and all necessary checks are carried out prior to employing the applicant. Staff members spoken to confirmed that they received regular supervision session, and each staff member receives at least 6 supervisions in a year. The inspector was advised that annual staff performance appraisals are to be arranged, as the service has only been running for 6 months. The staff team appeared to be well supported and there was evidence of positive relations and a clear commitment to the meeting of the service user groups needs. Residents’ spoke highly of the staff group and the manager, with one exception identified above. A Professional external to the service said Brooke house was well run and meeting the needs of his client. Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37-39-42 In general the service is well run. Some routines and interventions need to be reviewed in light of outcomes for residents, especially less able residents. The manager is committed to making improvements to the service that will further benefit and enhance the quality of life experienced by the resident group. Arrangements are in place to promote the Health & Safety of staff and service users’. Quality for this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager demonstrated an understanding of her role and responsibilities. The manager is committed to consultation with service users. The organisation has in place a Quality Assurance System that was audited by the organisation recently. Service users’ have recently been surveyed for their views. Weekly consultation with residents’ takes place. In-house advocacy is promoted via key working. While some developments and improvements are still needed at the service there was no lack of commitment by the staff team and the Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 24 manager to achieving these improvements with residents at the centre of this process. The residents’ are consulted formally on a weekly basis and informally at all other times. Residents’ confirmed that they felt staff and the manager listened to them . The home was run smoothly and efficiently and Residents were able to feel at home and safe and supported. Service users’ confirmed that they are learning new skills all the time at the home and their PCPs are shared with them, and updated with them and their key workers. Residents’ views have recently been sought via a survey and the results of this are being collated by the organisation. Some routines identified above could be described as institutional, and some practices and management systems such as medications may fail to fully promote independence and these may need to be reviewed. Issues of H&S and food hygiene are considered in the daily running of the home. Some routines identified above need review in light of the outcomes for service users. Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 25 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 X 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 3 25 X 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 x Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA16YA20 Regulation 12-13 Requirement The registered person must review practices that fail to fully promote the services’ stated purpose. Routines such as locking the kitchen, how service users are enabled to selfmedicate safely and how service users are supported to keep their own possessions such as tobacco must be reviewed, in consultation with service users and/or advocates. The registered persons must review arrangements for the provision of WC facilities within the bedroom, or nearby for one resident who has specific needs in this aspect of daily living. The registered persons must advise the CSCI of the action they intend to take to support this service user. The registered persons must declare which service users they act for as appointee to the relevant Benefits agency office. Timescale for action 10/06/06 2 YA26 16 10/06/06 3 YA23 12-13 10/06/06 Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA9 Good Practice Recommendations It is recommended that the registered persons further develop risk assessment details. Risk assessments must contain specific information about the level of risk and the benefits for the service user, and how staff members are to support residents’ in taking acceptable risks in the pursuit of improved quality of life outcomes. The registered persons should review the person centred plan for one resident who has changed his life goal. This review should be carried out with the service user, the social worker, the home staff and any other relevant people involved in supporting this service user. 2 YA6 Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brooke House Care Home DS0000037569.V287827.R01.S.doc Version 5.1 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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