CARE HOME ADULTS 18-65
Brookside 99 High Street Kempston Bedfordshire MK42 7BS Lead Inspector
Dragan Cvejic Unannounced Inspection 3rd November 2005 08:30 Brookside DS0000014888.V264510.R01.S.doc Version 5.0 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 Brookside DS0000014888.V264510.R01.S.doc Version 5.0 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. Brookside DS0000014888.V264510.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Brookside Address 99 High Street Kempston Bedfordshire MK42 7BS 01234 854623 01234 854453 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) BUPA Care Homes (Bedfordshire) Ltd Mrs Debra Dalton Care Home 22 Category(ies) of Learning disability (22), Learning disability over registration, with number 65 years of age (22) of places Brookside DS0000014888.V264510.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 07/06/05 Brief Description of the Service: Brookside was a 22 bedded home for adults with learning disabilities. Some may have an additional physical disability. The home was built by the Local Authority in the 1960s. The improvements to the building after the last inspection included some redecoration and renewals that were carried out in a planned way. All service users have single bedrooms. The home offered pleasant and tastefully furnished communal areas. The Morley Lodge, a unit adjacent to the main building, was run separately, but the manager was still accountable for its operation. More independent service users were accommodated in Morley Lodge. The area to the front of the building provided ample parking space and there was a garden at the rear. This was mainly grass but with a patio area and some flowerbeds. The service users living in the flat have their own small garden area. The home was located close to the shops of Kempston, near pubs and churches and on a bus route. The home had two vehicles, a minibus for the main building and a people carrier for Morley Lodge, the second belonging to service users. Brookside DS0000014888.V264510.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. Five service users who were waiting for the minibus to go to their day centres greeted the inspector and one user who was staying in that day took the inspector into the home. Another service user joined the inspector and provided information, explanations, access and inspected the home jointly with the inspector. Six more service users commented on the home and their life there. Three files were inspected, 2 by the inspector, and one belonging to the user who joined the inspection which was looked at jointly. The manager, deputy and 3 more staff contributed to the inspection. The main findings came from the joint work of the service user and the inspector, so that outcomes were clearly identified. The inspection lasted 4.5 hours. What the service does well:
The service users were deeply involved in the running of the home. Their wishes dictated daily life and all decisions were made together with service users. The service user who jointly inspected the home with the inspector stated: “I have books about the home. Everything is described there. I also use tape and video that the manager has got for us to show us what to expect in the home. I have everything I need here. I love my home. Our car has just gone through an MOT”, he stated proudly showing that the car used by the home belonged to service users. “I have just had a shave and am now waiting for a new carer to take me for a blood test and then to visit my mum. Food is nice. I like Weetabix for breakfast. My favourite food is pie and staff get it for me from the shop across the road. I would not feel safe to cross that road. I love my room. I am a disco manager in Morley Lodge. I go to bed and get up when I want.” The service user and the inspector went through the user’s file. All stated above by the user was recorded in his care plan including the risk assessment, dated and signed by the user. Crossing the road was assessed. The other two inspected files contained the same type of information and were up to date. A service user explained activities organised in the home and said: “I am looking forward to Bob’s evening tonight. He is a good entertainer.” A user talked in length about his holiday in Spain and flying to his destination. Staff training was very good. It included management of challenging behaviour and some sessions, for example on dementia and moving and handling, that were held with external professionals and were combined with other homes from the same organisation, BUPA. Staff were exceptionally motivated, committed, open and supportive. They were good listeners and showed commendable respect to service users. The home effectively used the comments from the quality assurance review to organise life in the home as service users wanted.
Brookside DS0000014888.V264510.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
Although the staffing level was appropriate and was in accordance with Department of Health guidelines, this area was assessed as a potential risk. Staff commented that they worked hard, to the top of their abilities. They liked stopping physical work to chat to service users. Service users very much benefited from this approach and from the existing atmosphere in the home. However, the constant increase in users’ physical needs put extra pressure on staff. As the service users were becoming older, their physical needs were gradually more and more expressed. The manager, the staff and the inspector agreed that cumulative minor changes pushed staff to the top of their abilities. Everyone, including service users, wanted to retain the existing atmosphere in the home. Demand for physical work with users was slowly overtaking the social, moral and emotional support that staff could offer. Now, at its peak, it was assessed as a hazard so that other aspects of care and support would be endangered and the quality of work could fall if even a minimal increase of physical needs occurred. The manager was advised to, urgently, arrange for a review of service users level of dependency with social services and to act and seek the solution to prevent a fall in standards. Brookside DS0000014888.V264510.R01.S.doc Version 5.0 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brookside DS0000014888.V264510.R01.S.doc Version 5.0 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 Brookside DS0000014888.V264510.R01.S.doc Version 5.0 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): 1,3,4 The home provided very good details about itself, and the services provided, in a pictorial format welcome pack and, as a new product, on tape and on video. The service users stated that they had all the information to make an informed decision about the choice of home and confirmed that their needs were met. EVIDENCE: Apart from written information about the home, also in illustrated format, the home offered information on tape and on video. A service user was very pleased with this option and used to listen to the tape repeatedly. All service users spoken to confirmed that their needs were met. However, a service user who inspected the home jointly with the inspector, noticed that the staff did not have the same time to spend to talk to service users as before. He explained that staff were called by other users who needed more and more physical help. Brookside DS0000014888.V264510.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Service users were empowered to make a choice, suggest changes, contribute to running of the home and take appropriate risks. EVIDENCE: A service user explained his care plan to the inspector and confirmed that he took part in creating the plan, in regular reviews and in determining what the content of the plan was. An accompanying risk assessment addressed all significant risks and provided instruction as to how the risk could be minimised. A user confirmed that the risk assessment was accurate. By taking part in care planning and deciding on their daily routine, service users demonstrated that they took an active part in running the home and expressing their choices. The taped and videoed information about the home exceeded the expectation of developing appropriate communication methods. A user with a serious hearing impairment was consulted by writing on a pad communication content. Some, capable users held their money, while some others stated that they wanted help from the home. By doing a joint inspection, the users showed how much they participate in the life of the home and decision making process. The possessive attitude towards the car belonging to service users, arrangement for maintenance, repair and MOT also demonstrated participation.
Brookside DS0000014888.V264510.R01.S.doc Version 5.0 Page 11 A service user explained his risk assessment to the inspector, demonstrating how he was enabled to take part in the life of the home with properly assessed and managed risks. Inclusion in car maintenance demonstrated that this standard exceeded expectation. Another example was provided when another user commented to the inspector on staff training and showed how clear he was of the benefits of staff training to service users. The user that took part in the inspection fully respected confidentiality and explored only his file with the inspector, while the other two files were inspected with full respect of confidentiality. Brookside DS0000014888.V264510.R01.S.doc Version 5.0 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,14,15,16 The home offered the choice to service users of choosing their lifestyle, their activities and to form relationships as they wanted. EVIDENCE: Most service users attended day centres as part of their daily programme. One user changed a day centre for a different one that she considered as offering her more. Some users, including the one who helped the inspection, wanted the home to help them with their finances. This was organised and reviewed to make the entire process safer and to fully protect service users. The home was using two vehicles, one minibus and one car-a people carrier, that belonged to service users. They were proud of having responsibility for the car and ensuring it passes MOT. The user was looking forward to his trip with a staff member to Luton. Three service users expressed their satisfaction with the activities. A user confirmed that they were consulted about activities in the home. He continued and talked in length about his holiday in Spain. A user was quite clear who he wanted to socialise with and stated that he could choose the company of people he liked.
Brookside DS0000014888.V264510.R01.S.doc Version 5.0 Page 13 A daily routine was arranged according to service users wishes. Lockable facilities were provided to all that wanted that provision. Service users were treated as individuals and one of the main achievements in the home was the friendly, personal relationship between staff and service users. However, this was seen as being under threat by staff. Three staff stated that there was less and less time to stop and talk to service users due to the increase in physical needs. The manager identified this atmosphere as being under serious threat and risk. Brookside DS0000014888.V264510.R01.S.doc Version 5.0 Page 14 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): 18,20,21 The staff encouraged independence, but also supported service users to meet all their healthcare needs. EVIDENCE: A service user stated that dignity was highly respected and that their personal care needs were met according to their wishes. He confirmed that he was getting up and going to bed when he wanted. Five users that met the inspector in the front of the building stated the same, although two of them said that day centres start working early and that they had to get up early for transport. A user getting ready to go out with a staff member stated: “I have just had a shave, now I am only waiting for the staff to take me”. External health professionals were deeply involved in work with the service users, either in the home or cooperatively in day centres. Key workers knew the allocated service users quite well, with their likes and dislikes. A service user explained that he wanted staff to keep his medication. He confirmed that he knew what medication he was taking and the timing set on the MAR sheet. A service user who was self medicating stated that she had a lockable drawer and the key provided to ensure that her medication was kept safe. Staff spoken to also presented good knowledge of the medication and the processes of handling medication within the home. Some files contained the recorded last wish, but some did not, as the manager explained that discussion about death would upset some service users.
Brookside DS0000014888.V264510.R01.S.doc Version 5.0 Page 15 The manager explained that training was now tailored to needs associated with older age, as these were identified as increasing. Most service users, including all spoken to stated that this was their home and that would not like to move when they “get older”. The home would however, need to consider a solution for how to effectively respond to the increasing physical needs, as staff were already working at the maximum of their physical abilities. Brookside DS0000014888.V264510.R01.S.doc Version 5.0 Page 16 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 The home had the organisation’s complaints procedure that was adapted and presented in graphic form to be more accessible to service users. EVIDENCE: The procedure was displayed and a service user stated that he would comfortably report if he had any complaints. Brookside DS0000014888.V264510.R01.S.doc Version 5.0 Page 17 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 purpose built home was well maintained and the manager ensured that renewals were made according to the planned programme and all these factors made the home a nice, pleasant place to live, where service users had their input acknowledged. EVIDENCE: A service user commented: “I love my room. I have everything I need in it.” He continued commenting on communal areas in the main building: “I can come here whenever I want. I can use all the facilities here”. Premises were clean, bright and well maintained. Furnishing was domestic in style. A service user that used to break her drawers had got a different type of furniture that did not break and allowed her to independently operate drawers. Water temperatures checked were within the appropriate, safe range. Brookside DS0000014888.V264510.R01.S.doc Version 5.0 Page 18 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): 31,32,33,35 The home employed competent, efficient and committed staff and the service users felt well supported and properly looked after. However the staff work at the maximum of their physical abilities and any, even small increase in physical need would affect the staff capabilities to meet these needs. EVIDENCE: Staff were clear of their roles. Service users also knew staff roles. The excellent relationship between service users and staff was threatened by the increase of users’ physical needs. The NVQ programme was promoted and five staff had just completed their programme, while two new entries were recorded. With the new training provider, the NVQ programme was brought up to speed and the home exceeded the standard and was on the way to maintain this level of qualified staff. All new staff undertook LDAF training during their induction. At the time of the inspection two staff were doing LDAF training. The manager and a deputy were booked for “Challenging Behaviour trainers training”. The other specialist training accessed by the manager included new fire training, Infection Control, Epilepsy and Dual Diagnosis. Moving and handling was held together with another BUPA home. The staff team was compact, knowledgeable, with skills and experience that ensured the meeting of users’ needs. Current staff ratio was appropriate, but as the staff were stretched to the maximum of their physical capabilities, there was an assessed hazardous
Brookside DS0000014888.V264510.R01.S.doc Version 5.0 Page 19 situation whereby even a very small increase of physical needs could affect the home’s ability to respond to users needs so well as at the present time. Staff meetings were held regularly and used to ensure the constant improvement of services. Brookside DS0000014888.V264510.R01.S.doc Version 5.0 Page 20 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, The home was well managed by the experienced and skilful manager, that ensured service users’ satisfaction, a good staff atmosphere, efficiency in the running of the home, respect for policies and procedures and safe working practice. EVIDENCE: The same manager was managing the home using her skills and experience. An open and inclusive atmosphere resulted in staff expressing their initiative and indicating the potential hazard of the excessive work-load. Working in a big company, like BUPA, still did not create enough opportunities for staff progress and there was no clear incentive for staff that managed to complete their NVQ. Despite these limiting elements, the staff were enthusiastic about the NVQ programme and 2 more staff were enrolled for the NVQ in the coming year. Policies and procedures were reviewed in a planned way. The latest reviewed policy was the “Whistle blowing” policy. Health and safety were discussed in the last staff meeting. Service users were involved in creating policies and consulted on any changes. The home exceeded this standard. Brookside DS0000014888.V264510.R01.S.doc Version 5.0 Page 21 Records were accurate and up to date and financial records for service users, that were checked, ensured their protection. Safe working practices were in place. Risk assessments, discussed with service users, were accurate. All accidents/incidents were analysed at two levels: in the home and within the higher management structure of BUPA and were regularly reported to the appropriate authority. All staff were trained through LDAF programme. The home displayed insurance policy and service users were involved in insurance for the vehicles belonging to the home and to them. Involvement of service users at this level exceeded standard expectations. Brookside DS0000014888.V264510.R01.S.doc Version 5.0 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 4 3 3 X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 4 4 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X 3 X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 X 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Brookside Score 3 X 3 3 Standard No 37 38 39 40 41 42 43 Score 3 4 X 4 3 3 4 DS0000014888.V264510.R01.S.doc Version 5.0 Page 23 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 YA33 Good Practice Recommendations The manager should make a written presentation of a high risk regarding staffing level. Although the level coincided with the requirements, the increased physical needs of service users threatened the social needs, met at the time of the inspection, but assessed as high risk as physically there would not be time for staff to effectively communicate with service users if there was even minor increase in their physical needs. The manager should act proactively and try to address the problem before it emerges a level impossible to respond to. Brookside DS0000014888.V264510.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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