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Inspection on 24/03/09 for Brookfield Residential Care Home Limited

Also see our care home review for Brookfield Residential Care Home Limited for more information

This inspection was carried out on 24th March 2009.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 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 manager is experienced in managing a care service and this was shown in how Person centred thinking and planning had been introduced into the care of people living at the home so the care of people using the service was arranged around their lifestyles and needs. People living at the home experience enduring mental health needs and they are supported to live a lifestyle of their choosing that need long term care so they have stability in their lives. People living at the home said they had lived there for many years and said, " I can`t tell you enough how lovely the place is. Staff are nice and we all get on well. If I need anything I have help. I choose what I want to do. I just want to live here it`s great no complaints and you can say if you don`t like or agree with something". Another person said, "I have my own bedroom. I chose the furniture and the paint. They put down a new carpet. The staff make it for me, they are really friendly. When I get bothered about things I can go and talk to them which helps me relax". The home demonstrated a commitment to staff training with a varied staff training programme taking place so staff were provided with training and support to do their jobs. The home treats people with dignity and respect. People that use services are offered a variety of recreational activities so they had a variety of everyday things to do. People that use services had access to a complaints procedure so could be confident they can raise concerns so they will be acted upon. The home provides a clean and comfortable place to live so people that use services live in a homelike environment with access to local amenities. Appropriate staffing levels are provided so people that use services were supported around their needs.

What has improved since the last inspection?

The home had introduced documents called risk assessments for people that wanted to look after their own medicines so they could decide if people that use services had the skills and experience to manage their medicines safely. The home had been repaired and cleaned outside as required following our last visit so people live in a safer building but further improvements need to be made. The care plans of people that use services contained information on the abilities of people that use services to care for their own needs so staff knew when people needed support and help to meet their needs. The care plans of people that use services contained guidance for staff on how to help and support people remain safe and maintaining their safety so they could receive the right help and support when taking risks but further improvements are needed. Staff training has improved with more staff holding an NVQ level 2 qualification so there is a more skilled staff team. The representative of the owners of the home called the responsible individual was visiting the home regularly and producing a report of the visit so we could see someone was looking at how the home was being managed.

What the care home could do better:

The fire prevention and health and safety practises in the home must improve so people that use services are not allowed to smoke in their bedrooms and cause a fire. Smoking arrangements for people that live at the home must improve so people that live and work their are not put at risk form secondary cigarette inhalation. Hand drying facilities must improve and communal towels not used for hand drying so people living and working in the home are not at risk of cross infection. Risk assessment for staff and people that use services that are involved in cooking and cleaning and helping around the home must improve so safe systems of moving and handling are maintained. The health and safety signs in the building must improve so access to the laundry is seen as a risk to people using the laundry facilities. The manager and responsible individual must ensure that all relevant information and checks required prior to new staff commencing employment are completed so people that use services are not placed at risk. Quality assurance must improve so mistakes made during the recruitment process are recognised by the manager or owners and not repeated. Quality assurance should improve so the manager has administration support so he can concentrate on the management of the safety of building, records and staff supervision and training so the home is managed more effectively. The decor and facilities available to people that live at the home and staff should be improved so the home is brighter and reflect the choices of people that live there and that improved facilities offer privacy for staff who do sleep in duties at the home. The home should improve how decisions about daily living made by people that use services are reflected in their care plans so staff and others involved in their care understand how important peoples` daily decisions about their lives and decisions about their future are to them so the agreements about how they make or are supported to make decisions are clearly understood. Risk assessments to promote the mental health of people living at the home should improve so they include advice identified by the mental health professionals involved in their care and described in the Care Programme Approach care plan. The variety of training staff receive should improve so they have training that helps them to understand the different needs of people and deal with their different needs with confidence.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Brookfield Residential Care Home Limited Brookfield St Anns Road Prestwich Manchester M25 9QE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anthony Cliffe     Date: 2 4 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Brookfield Residential Care Home Limited Brookfield St Anns Road Prestwich Manchester M25 9QE 01617731165 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Brookfield Residential Care Home Limited care home 14 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The service should employ a suitable qualified and experienced manager, who is registered with the Commission for Social Care Inspection. Within the maximum registered number 14, there can be up to 14 Adults with Mental Disorder (MD); 3 Adults with Mental Disorder over 65. Date of last inspection Brief description of the care home Brookfield is a care home providing personal care and accommodation for 14 adults with a mental disorder and helps to support people recovering from severe and long term mental health needs. The fees range from three hundred and fifty to five hundred and fifty pounds per week depending of the individual needs of people living at the home. The home is situated in Prestwich, close to the shopping centre, local pubs and Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 3 14 Brief description of the care home bus routes. Brookfield is an old Victorian house and provides accommodation on 3 levels. It has 14 single bedrooms, a large lounge, dining room, kitchen and separate laundry. The home is set in its own grounds with a well-maintained garden and patio area to the rear of the property. There is a small car park area to the front of the building. Information about Brookfield can be obtained by contacting the manager directly at the home Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: References to we, our or us represent the Commission for Social Care Inspection This unannounced visit took place on the 24th March 2009 and lasted over eight hours. One inspector carried out the visit. This visit was just one part of the inspection. Other information received was also looked at. Some weeks before the visit the manager was asked to complete a questionnaire called an Annual Quality Assurance Assessment (AQAA) telling us what they thought they did well, what they needed to do better and what they had improved upon since the last visit, to provide us with up to date information about the services provided. This helps us to determine if the management of the home see the service they provide in the same way we do and if our judgements are consistent with home owners or managers. We did not receive the AQAA in time to use the information Care Homes for Adults (18-65 years) Page 6 of 32 during the visit. During the visit various records and the premises were looked at. People that use services, staff and a visiting health professional were spoken with and gave their views about the service. We were unable to provide questionnaires to people using the service, staff or health and social care professionals involved in their care due to the late return of the AQAA. What the care home does well: What has improved since the last inspection? The home had introduced documents called risk assessments for people that wanted to look after their own medicines so they could decide if people that use services had the skills and experience to manage their medicines safely. The home had been repaired and cleaned outside as required following our last visit so people live in a safer building but further improvements need to be made. The care plans of people that use services contained information on the abilities of people that use services to care for their own needs so staff knew when people needed support and help to meet their needs. The care plans of people that use services contained guidance for staff on how to help and support people remain safe and maintaining their safety so they could receive the right help and support when taking risks but further improvements are needed. Care Homes for Adults (18-65 years) Page 8 of 32 Staff training has improved with more staff holding an NVQ level 2 qualification so there is a more skilled staff team. The representative of the owners of the home called the responsible individual was visiting the home regularly and producing a report of the visit so we could see someone was looking at how the home was being managed. What they could do better: The fire prevention and health and safety practises in the home must improve so people that use services are not allowed to smoke in their bedrooms and cause a fire. Smoking arrangements for people that live at the home must improve so people that live and work their are not put at risk form secondary cigarette inhalation. Hand drying facilities must improve and communal towels not used for hand drying so people living and working in the home are not at risk of cross infection. Risk assessment for staff and people that use services that are involved in cooking and cleaning and helping around the home must improve so safe systems of moving and handling are maintained. The health and safety signs in the building must improve so access to the laundry is seen as a risk to people using the laundry facilities. The manager and responsible individual must ensure that all relevant information and checks required prior to new staff commencing employment are completed so people that use services are not placed at risk. Quality assurance must improve so mistakes made during the recruitment process are recognised by the manager or owners and not repeated. Quality assurance should improve so the manager has administration support so he can concentrate on the management of the safety of building, records and staff supervision and training so the home is managed more effectively. The decor and facilities available to people that live at the home and staff should be improved so the home is brighter and reflect the choices of people that live there and that improved facilities offer privacy for staff who do sleep in duties at the home. The home should improve how decisions about daily living made by people that use services are reflected in their care plans so staff and others involved in their care understand how important peoples daily decisions about their lives and decisions about their future are to them so the agreements about how they make or are supported to make decisions are clearly understood. Risk assessments to promote the mental health of people living at the home should improve so they include advice identified by the mental health professionals involved in their care and described in the Care Programme Approach care plan. The variety of training staff receive should improve so they have training that helps Care Homes for Adults (18-65 years) Page 9 of 32 them to understand the different needs of people and deal with their different needs with confidence. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed before they move into Brookfield so they know their needs can be met. Evidence: As part of the arrangements for moving in people that may choose to live at the home can visit and spend time to get to know the other people that live as well as staff so they can familiarise themselves with the home. This includes visits during the day and overnight so they can get to know the other people that live there. The home gathered the necessary information on the needs of people using the service and this included information from the mental health services involved in the care of people using the service and the Care Programme Approach (CPA) care programme, Mental Health Tribunal notes, medical and discharge summaries so important information about the mental health needs of people using the service was shared among those involved in their care. Where arrangements for people that use services had been agreed to live at the home from the Mental Health Tribunal details were also available in care files with details of any conditions and support to be provided. The information we saw was detailed and provided information about people Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: that use services, their mental health history, medication, support needs and potential areas of risk so staff could arrange care based on their needs. Care Homes for Adults (18-65 years) Page 13 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to live their preferred lifestyles, however information held about them does not support that they are directly included in the decision making process. Evidence: Information gathered about the needs of people using the service was detailed and outlined their needs, as well as areas of potential risk. Care plans and documents that identified where people that use services were a risk to the health and welfare of others and themselves called risk assessments were completed and reviewed at least every six months or as needed so staff were aware of how to support people that use services to live a safe lifestyle. The home needed to record if the risk assessments in place were working and supported people that use services to live a healthy and safe lifestyle and support the information in the Care Programme Approach care plan from the local mental health services so staff knew what to do if they needed help. The information we saw included support for personal care, alcohol intake, health and family contact but did not what people wanted to achieve in the future as their dreams Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: or aspirations were not recorded so staff would not know the personal goals of people living at the home. Each person had information gathered about what was important to and for them in their lives so staff provided care based on their needs and choices. This included information about their daily routines and how they wanted their care to be arranged. This was included in the information gathered about person centred care. We saw that staff treated people that use services with courtesy, dignity and respect and sought their views about how they wanted to be supported and saw staff help them make decisions. We did not see information about how people that use services made decisions or where they lacked capacity, experience or judgement to make decisions so could not confirm why, when, where and how staff supported them to make decisions or what decisions they made for them or supported them to make. Examples of this were in risk assessments for people managing their own medicines or where they had agreed restrictions due to their vulnerability. People living at the home were on a formal after care programme which was monitored by the mental health services called the Care Programme Approach (CPA) so people living at the home had support should they need it. Their mental health needs were monitored via reviews and visits and strategies in place should the mental health of people that use services deteriorate so they could get the right help. Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use services are supported to maintain relationships and make choices about lifestyle and leisure activities so have control over their lives and a lifestyle based on their personal choices. Evidence: We saw that people living at the home chose to spend their day as they wished so could decide on their lifestyle. People had a variety of leisure pursuits such as therapeutic employment or cooking and and cleaning at the home so they were involved in everyday activities. Meals were generally cooked by staff but people living at the home could make drinks and snacks as they wished and some cooked their own meals so could do everyday things for themselves. People said they went to college, work, visited friends and family and had Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: relationships outside of the home so had opportunities to socialise outside of the home. People said they liked to clean their bedrooms and wash their own clothes so could be responsible for their own personal care. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical, emotional and personal needs of people using the service were looked after and they received support to look after their medicines or support to take them safely so their health and welfare was cared for. Evidence: People that use services and staff at the home were supported by the community mental health services and included visits from community mental health nurses and a psychiatrist so had good consistent professional support. Additional support was available from General Practitioners, occupational therapists, opticians, dentists and district nurses. People living at the home chose their daily living routines, managed their own personal care, and come and go as they pleased so took responsibility for their health. A visiting community mental health nurse was at the home during the visit and said, Im here every week sometimes 2 or 3 times visiting to do blood tests. Staff know and follow procedures very well as they picked up an important matter about the health of one of the people living here as they know the routines that if they have not been told about a blood test after a week they contacted me and I was able to do the blood test Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: so we will know how his health is. Care here is excellent from the manager down, staff are great with clients. Clients say how much they like the staff and living here. This is our preferred place for people moving from a forensic service. The place is calm and people living here have a relaxed lifestyle and are safe. Staff communicate well and the whole place is organised. We saw that staff at the home were monitoring the health of people using the service and helping them keep fit, loose weight and look after their health conditions such as diabetes so they could remain fit and well. If people that used services wished they could make their own doctors appointments and see doctors in private so were responsible for their health. People that use services said they had a balanced diet which varied from a cooked breakfast to main meals and snacks. People that use services said they enjoyed their meals so were satisfied with their diet and some said they had put weight on as the meals were very good. We looked at the arrangements for medicine. Medication policies were sufficiently detailed so staff had guidance on how to receive, store, administer, record and dispose of medicines safely. The home had a medicine trolley for the storage of medicines which was safely secured. Policies and procedures for medicine administration were kept in the managers office with specimen signatures for the staff responsible for the management and administration of medicines so staff were aware of their responsibility and accountability for managing and administering medicines. Storage included controlled drugs storage. The arrangements for the storage and administration of controlled drugs were looked at and found to be safe. Arrangements were in place for people that use services to manage their own medicines so could take them independently. Some people managed their own medicines and the home had completed documents called risk assessments so they could decide if people that use services could take their medicines safely. Medication was supplied from a local pharmacy. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use services are protected by the safeguarding adults procedure in place so people that use services will be confident they are protected at all times. Evidence: We looked at the complaints records kept at the home and no complaints had been received by the service and we had not received any either. The records of people that use services we looked at contained copies of the complaints procedure so people that use services were aware of how to make a complaint. We could see from the relationships between people that use services and staff that they related well to one another. People that sue services said they could say if they were unhappy with anything so were comfortable in raising concerns or complaints. Policies and procedures were in place to protect vulnerable adults called the safeguarding adults procedures. The safeguarding adults procedure is how we, the local council, police and other agencies respond to and manage allegations or suspicions of abuse against vulnerable adults. Staff at Brookfield had received safeguarding training which helped them to respond to suspicions or allegations of abuse or neglect to make sure vulnerable adults were protected. Staff spoken with during the visit knew what to do if they suspected someone was being neglected or abused and described the actions they would take so could protect vulnerable people. Staff were issued with guidance on the standards Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: expected of them so they were aware of their responsibilities and practise when providing care to people that use social care services. Staff also had access to the whistle blowing policy, which is a policy they could follow if they needed to tell members of the public or other organisations about things in the care home that concerned them and needed to be placed in the public interest. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use services live in a comfortable and safely maintained building but improvements in safety, hygiene and facilities would benefit people living at the home and staff so they could live more safely and independently. Evidence: We looked around the inside and outside of the building and the exterior of the building had been cleaned and damage caused by pigeons repaired. A hole in the fascia above a bedroom had been repaired and fascias and guttering repaired as required at our last visit. We looked in the bedrooms of people living at the home. Some had been redecorated and the people occupying the bedrooms had been able to choose the colour of the paint and furniture as well as having new carpets fitted. Another bedroom was vacant and this was to be redecorated and a bedroom that someone was going to move into had been repainted but looked sparsely furnished with the wardrobe being old but functional and the mattress of the bed looked worn so the dignity of people using the service was not being upheld. In another bedroom the carpet was soiled and black with cigarette burns as well as the quilt cover and bed where the occupant had been smoking so was not keeping to the health and safety policies of the home. The home had fitted a shower to a first floor bathroom as the bath we saw at the last visit was not safe. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: People that use services were being allowed to smoke in the main lounge which was not a designated smoking room so the health of people that use services and staff that did not smoke was not protected. This room was next to the main dining area so anyone living, working or visiting the home was at risk of secondary smoke inhalation. We looked around the public areas of the building and found these to be safe but the decor was dark and the lighting in use not giving out sufficient light. The main office was used as a sleep in bedroom for staff to sleep in at night. Staff had to sleep on a collapsible bed. The office had not separate toilet or bathing facilities so female staff who slept in during the night had no separate toilet or bathing facilities. Communal toilets did not have disposable hand towel dispensers in them so people that use services or staff could not dry their hands hygienically. The responsible individual or owners representative was present during the visit and gave an agreement and commitment to look at the smoking arrangements in the home. The responsible individual said she had discussed with the manager the building of a conservatory to the rear of the building to provide a self contained smoking facility or separate dining area. The responsible individual also agreed and gave a commitment to look at the room available in the home in large bathrooms and toilets to see if the interior could be re designed to create a separate smoking room or staff sleep in bedroom and redecorate the corridor and stairwells of the ground, first and second floors to lighten up the building and use more natural and efficient lighting so people that use services lived in a home with suitable facilities to meet their needs. The proposed arrangements would be done with people that use services so they could be involved in the proposed changes to their home. Minutes of staff meetings we saw said that people living at the home were responsible for drying their own laundered clothing and taking this to their bedrooms. The laundry is located in the basement of the home and accessed by a set of very steep stairs. The stairs to the basement did not have sufficient lighting nor were there any signs indicating that the steps were steep and a trip hazard so people could be at risk of falling. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient employment policies are in place however employment procedures could be improved so people that use services are better protected. Varied training is in place however ensuring training takes place needs to be improved so that staff are trained and competent to do their jobs. Evidence: We saw the staff numbers in place supported the needs of people that use services so they had sufficient help with their needs. There were two staff on duty as well as the manager with one of the additional staff members a domestic staff. Care staff were also responsible for the cleaning of the home and supported people that use services to keep their bedrooms clean. Staff we spoke with described training as good and they could have additional training if needed so they were kept up to date with working practise. Staff had received training on a variety of subjects. Staff said they had the opportunity to complete NVQ level 2 and 3 qualifications which are nationally recognised qualification in social care. The manager confirmed at the time of the visit that 7 staff were employed 4 had NVQ level 2 qualifications and two staff were working toward an NVQ level 2 NVQ qualifications so all staff had access to a qualification in social care. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: We examined the recruitment records of two staff employed at the home. Recruitment procedures were completed and included staff having to complete an application form, full employment history and two references sought about their suitability for employment. The recruitment of staff also included a Criminal Records Bureau (CRB) disclosure which is a check of staff to see they are suitable people to provide personal care and support to vulnerable adults. During the visit the manager realised that the organisation the responsible individual used to provide a CRB check had not given them the correct information about a staff member employed and the responsible individual was contacted by the manager and explained the agency they used had given the responsible individual the incorrect information so the staff member had been employed without the necessary checks being in place so people that use services were not protected at all times. Staff were provided with a variety of training which included health and safety, food hygiene, safeguarding adults, medicine management and dealing with difficult and aggressive behaviour but staff training records were not all up to date so we could not confirm that all the necessary training had been completed. Staff were not provided with training on the different cultural or religious needs of people living at the home or how to support people that use services to deal with the negative effects of their mental health needs so would not understand all their needs. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality assurance could be improved so areas for further development are identified so the welfare of people that use services is promoted. Evidence: The manager had worked at the home for many years and is experienced in managing the home. The manager described his weakness as administration which he said was the reason for information we asked to be completed before the visit called the AQAA not being returned on time. The home did not have a computer so could not access information on how we inspect care homes so do not have access to important information to help and support providers and managers of social care services to manage their services more effectively. The responsible individual said she was aware of the managers weakness over administration and that she would provide her own administrator to support him so he could manage the home more effectively. There was no organised quality assurance system in place at the home so mistakes were made around the administration and management of the home. Some quality monitoring was place such as annual surveys were to sent to people that use services, Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: relatives and professionals involved in care so they could comment on the quality of service, care and management of the home, Surveys were last completed in 2007. The manager said that surveys had been given to eight people living at the home in March 2009 but these had not yet been received so could not provide up to date information on what people thought of living at the home. The responsible individual visited the home regularly and completed reports on behalf of the directors of the registered provider. We saw these reports and they looked at new care plans being introduced into the home, the purchase of new chairs and how people that lived at the home were storing their personal belongings so the home was safe to live in. During the visit the responsible individual spoke with people living at the home so they could give their views about living there and they said they were happy living at Brookfield. Regular meetings between the manager and people lining at the home were held so people that use services hand an opportunity to discuss the management of the home and the manager could discuss matters about health and safety and living together. The manager did regular health and safety checks of the building and ensured a cleaning schedule was in place so the home was clean and safe to live in. This included a food management system which included the operating temperatures of fridges and freezers used to store food in the home recorded daily so staff knew the equipment was working to safety standards. The manager did not have any financial control within the home so was not able to do the required repairs, replace equipment when needed or purchase things without asking the responsible individual so could not make decisions about improvements needed to the home. The home held staff meetings and these had taken place in June, August, October and December 2008 but none in 2009. Staff meetings were used to discuss the management of the home and an opportunity to discuss how the staff team supported people living at the home so they were aware of their responsibilities when supporting people with their care. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 34 19(1) The manager must ensure 31/05/2008 that all relevant information and checks are held on file prior to new staff commencing their employment ensuring people are not placed at risk. Care Homes for Adults (18-65 years) Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 13 The health and safety signs 18/06/2009 in the building must improve so access to the laundry is seen as a risk to people using the laundry facilities. 2 24 13 Hand drying facilities must improve and communal towels not used for hand drying so people living and working in the home are not at risk of cross infection 18/06/2009 3 24 13 Risk assessment for staff 18/06/2009 and people that use services that are involved in cooking and cleaning and helping around the home must improve so safe systems of moving and handling are maintained. Care Homes for Adults (18-65 years) Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 24 23 The fire prevention and health and safety practises in the home must improve so people that use services are not allowed to smoke in their bedrooms and cause a fire. 18/06/2009 5 28 13 Smoking arrangements for people that live at the home must improve so people that live and work their are not put at risk form secondary cigartette inhalation. 17/07/2009 6 34 19 The manager and responsible individual must ensure that all relevant information and checks required prior to new staff commencing employment are completed so people that use services are not placed at risk. 18/06/2009 7 40 24 Quality assurance must improve when staff are recruited so mistakes made during the recruitment process are recognised by the manager or owners and not repeated. 17/07/2009 Care Homes for Adults (18-65 years) Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 The home should improve how decisions about daily living made by people that use services are reflected in their care plans so staff and others involved in their care understand how important peoples daily decisions about their lives and decisions about their future are to them so the agreements about how they make or are supported to make decisions are clearly understood. Risk assessments to promote the mental health of people living at the home should improve so they include advice identified by the mental health professionals involved in their care and described in the Care Programme Approach care plan. The decor and facilities available to people that live at the home and staff should be improved so the home is brighter and reflect the choices of people that live there and that improved facilities offer privacy for staff who do sleep in duties at the home. The variety of training staff receive should improve so they have training that helps them to understand the different needs of people and deal with their different needs with confidence. Quality assurance should improve so the manager has administration support so he can concentrate on the management of the safety of building, records and staff supervision and training so the home is managed more effectively. 2 9 3 24 4 35 5 40 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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