CARE HOME ADULTS 18-65
Brookside 99 High Street Kempston Beds MK42 7BS Lead Inspector
Dragan Cvejic Announced 07 June 2005 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 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 Stationary 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 I51 s14888 BROOKSIDE v226842 070605 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Brookside Address 99 High Street Kempston Beds MK42 7BS 01234 854623 Telephone number Fax number Email 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 Debra Dalton Care Home 22 (22) (22) Category(ies) of LD - Learning Disability registration, with number LD(E) - Learning Disability over 65 of places Brookside I51 s14888 BROOKSIDE v226842 070605 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 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 I51 s14888 BROOKSIDE v226842 070605 Stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection carried out during one working day. The inspector used a case tracking methodology and checked the cases of 3 service users. The Inspector spoke in detail to 3 service users, briefly to a further 4 service users, to the management, to 3 staff members and checked records. Service users comment cards in picture format and the manager’s preinspection questionnaire were also used to create this report. What the service does well:
The home gave information in a welcome pack about the services offered to potential service users before admission, to ensure an informed choice was made. This pack contained the statement of purpose and service user’s guide and was up dated regularly. While the inspector read the welcome pack, a service user protectively said: “You will give the pack back to the manager when you finish with it, won’t you?”, demonstrating how proud he was of the home and the pack. The admission procedure was phased for some service users. The manager visited them in their homes and they were invited to visit the home several times before admission. On each visit the home assessed their needs and abilities. Once a service user moved in, the home used continuous assessment forms, star profiles, BASOLL forms, comments from relatives and service users comments to create a care plan. A service user commented: “ I take part in care planning, I can say anything if I want to. Staff take my clothes for washing. My key-worker goes with me when I go shopping. ” Another service user said: “I had a bath this morning. They help me how I like it. I prefer the new activity room to the old one.” Care plans were good working documents and staff knew service users well from these, as well as from direct contact with them. Service users’ wishes regarding the daily routine and choice of daily programmes were highly respected. A service user changed one day centre for another that she preferred. Another user stated at his care planning meeting that he wanted to spend his “retirement days at home” and the resulting action was that he stayed 3 days a week at home. The home provided teaching sessions to the service users for use of Makaton signs, 6 signs per day were taught. Some service users were engaged in gardening, some in cleaning the new lounge, and they had access to food and drink preparation facilities. Some of them made their pack lunches, while some ate a hot meal at day centres. The home had an effective complaints procedure, displayed in a pictorial form and a service user stated: “If I had a complaint, I would say to the manager”. The home protected service users very efficiently.
Brookside I51 s14888 BROOKSIDE v226842 070605 Stage4.doc Version 1.30 Page 6 All areas were clean, bright and domestic in style. The manager was experienced and skilled. She motivated staff by personal example and by introducing a “Person Centred Approach” and the organisation’s “Personal Best” programme. The staff knew service users well and offered a good standard of care. The staff files showed good training records and appropriate recruitment procedures. Recruitment was very successful with the flyer displayed in the front of the home, facing the high street. Staff were supported and supervised. Safe working practices were in place. What has improved since the last inspection? What they could do better:
Although the service users’ money was monitored and well controlled through BUPA’s system, the home should ask service users to sign their transactions on the hard copies of the records. The inspector suggested that a complaints procedure should get added to the welcome pack and this was done immediately. With the hot weather and summer approaching, the access from the garden should be improved by adding a door bell on the door that did not have a handle on the outside. In service users’ files, the property list should be signed by service users or their representatives whenever possible.
Brookside I51 s14888 BROOKSIDE v226842 070605 Stage4.doc Version 1.30 Page 7 The home should start monitoring the need to increase the staff number in future, parallel to the increased needs of service users. A cracked wall in a dining room needed to be repaired and protected from further damage caused by wheelchairs, individually driven by service users. 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 I51 s14888 BROOKSIDE v226842 070605 Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Brookside I51 s14888 BROOKSIDE v226842 070605 Stage4.doc Version 1.30 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 standard(s) 1,2,3,4 The home provided very good details about itself, and the services provided, in a pictorial format welcome pack. Appropriate assessment, trial visits and shared information ensured that service users had an opportunity to choose the home that suited their needs. EVIDENCE: The welcome pack contained a regularly reviewed and up dated statement of purpose and the service user’s guide. It contained good pictorial information for service users who understood this format better than if it was written. A copy of the pictured complaints procedure was added to the pack during the inspection. Assessment of service users was carried out appropriately. The initial care plan was drawn up from the initial assessment, continuous assessment sheets and the information collated from service users, their relatives and appropriate referring agents. The home clearly demonstrated how they developed communication with service users, by using the Makaton, a flip chart and written notices in one –to one communication. An advocacy service was used by 3 service users and the information about this service was available to all. The trial periods were individually arranged, to suit service users’ needs. Brookside I51 s14888 BROOKSIDE v226842 070605 Stage4.doc Version 1.30 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 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: The home had well devised and completed care plans. Where service users did not want to take part in care planning, this was recorded appropriately. Some service users were on the internal Makaton training, learning 6 signs each day. The home emphasised the development of appropriate communication for each individual. Another example was the use of a flip chart for a deaf service user. A service user did not like a day centre and, with encouragement and support from the home, and her social worker, she changed the day centre and became much more assertive, confident and happy. Care plans were reviewed and up dated regularly. Three service users used an advocacy service, one was a member of the advocacy group. The information for service users was provided in a graphic format that suited their abilities. Brookside I51 s14888 BROOKSIDE v226842 070605 Stage4.doc Version 1.30 Page 11 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 standard(s) 11,12,13,14,16,17 The home offered the choice to service users of choosing their lifestyle, their activities and to form relationships as they wanted. EVIDENCE: The home enabled service users to develop communication skills that suited their abilities. Different and varied activities were combined with the activities at day centres to widen the choice for service users. They could choose how to plan their time; eg. as a service user stated on his care plan meeting that he wanted to “slowly retire”. The action resulted in him staying at home, as he wished, for 3 days. Another service user was provided with a shed and woodcraft tools and an appropriate risk assessment was drawn up for this chosen activity. This particular group of service users were not keen to take up educational activities, mainly due to their age that, on average, exceeded 45 years. This age factor did not stop them enjoying local facilities, such as shops, churches and the pub across the road. They also enjoyed outings in two vehicles, one belonging to service users and the other, a minibus leased from the council. Two service users were getting ready for their holiday in Spain.
Brookside I51 s14888 BROOKSIDE v226842 070605 Stage4.doc Version 1.30 Page 12 Several service users chose to take some housekeeping responsibilities. There were no restrictions on smoking or drinking, as no service users were at risk and the consumption was monitored and made safe. Service users liked their beer after Sunday lunch. Some service users made their own packed lunches, while some were making snacks in the home. Most day centre attendants had a meal at their day centre and the rest was provided and available in the home. The cook knew their preferences and regularly discussed the menu with them. Any alternative choices were provided and recorded accurately. Brookside I51 s14888 BROOKSIDE v226842 070605 Stage4.doc Version 1.30 Page 13 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 standard(s) 18,19, The staff encouraged independence, but also supported service users to meet all their healthcare needs. The home included external professionals to ensure that all special and healthcare needs were met. EVIDENCE: Staff provided sensible and flexible support to service users. A service user stated that she was helped as she liked. Another service user expressed his wish to go for a haircut and asked staff to accompany him. Fifteen minutes later they had gone. Service users’ files contained the records of professional visits and included an OT and a physiotherapist. Some service users were receiving professional support in day centres and the home communicated with these specialists. A Key-working principle was in place and service users knew and felt comfortable with their key-workers. Advocates were engaged for three service users that wanted that level of support. The home had some relevant charts to record service users’ healthcare needs and the input of dentists, chiropodists, a dietician and a CPN. The manager and the staff stated that it would have been inappropriate to discuss questions about a death with the current group of service users. Brookside I51 s14888 BROOKSIDE v226842 070605 Stage4.doc Version 1.30 Page 14 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 standard(s) 22,23 The home had the organisation’s complaints procedure that was adapted and presented in graphic form to be more accessible to service users. The home dealt with complaints efficiently and within the time scale. EVIDENCE: Like many other procedures, documents and information, the home developed a graphic complaints procedure and information about their rights, and directed them to an independent advocate if they needed that level of support to raise their potential concerns or place a complaint. Staff were also open to receive any potential complaint or concern from service users. Two received complaints, not substantiated after investigation, were dealt with within the specified time scale and recorded appropriately. Brookside I51 s14888 BROOKSIDE v226842 070605 Stage4.doc Version 1.30 Page 15 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 standard(s) 24, 26, 27, 29,30 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: The building was suitable for its purpose. It was arranged in a domestic style, as service users wanted. The home was on the high street and service users had access to all local facilities. The home was accessible to wheelchair users throughout. The access to the home from the garden was limited, as garden doors did not have handles on the outer side and, potentially, service users could stay locked out. The manager stated that she would look for a door bell that would allow calls to the staff, if necessary, from outside. Furnishings and fittings were domestic in style, nice and comfortable. Some bedrooms had been redecorated, the smoking lounge had got a completely new outlook with redecoration, new flooring and an expeller fan. Individual rooms were really individual with pictures, ornaments and other personal items. One of the inspected rooms had special furniture that best
Brookside I51 s14888 BROOKSIDE v226842 070605 Stage4.doc Version 1.30 Page 16 suited the user’s needs and allowed for the user’s habits to be carried out safely. She was delighted with this furniture arrangement. A service user decided to decorate her bedroom and the manager made plans for it and for staff to help her. Some service users used room keys, while some preferred to keep the rooms unlocked, although they had the keys. The home and service users benefited from enough storage space. Toilets and bathrooms were appropriate for users’ needs. The relocation of the staff room to a previous activity room that was hardly used, created another lounge that service users loved and were proud of. A service user even requested to be responsible for keeping the lounge clean and tidy. The home had equipment that was efficient in assisting service users in maintaining their independence. Infection control procedures were in place and were effective. A new tumble drier was installed and a new washing machine had been ordered. Brookside I51 s14888 BROOKSIDE v226842 070605 Stage4.doc Version 1.30 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36 The home employed competent, efficient and committed staff and the service users felt well supported and properly looked after. EVIDENCE: The staff were clear of their roles and responsibilities. They knew service users well; their preferences, likes and dislikes, and respected them as individuals. They knew their limits and were engaging professionals when needed, as one of the inspected files demonstrated. Staff were well trained and 50 had reached NVQ qualifications. A staff member expressed her concerns on, up to now, the available time to spend talking to service users, as their physical needs were becoming more expressed and identified. The manager was aware of this issue that would need addressing in the near future. At the time of the inspection a team-working principle and commitment allowed staff to meet the users needs. The use of agency staff was minimal and the manager ensured that shifts were covered by engaging the home’s own bank of casual staff. Thus, the continuity of care was ensured and service users were less stressed if permanent staff were absent. The rota was flexible, ensuring more staff were deployed when the needs were more expressed or when a specific activity that required more staff took place. The company’s recruitment procedure was respected and staff files confirmed that the home carried out all necessary checks before starting new staff.
Brookside I51 s14888 BROOKSIDE v226842 070605 Stage4.doc Version 1.30 Page 18 All staff were up to date with their mandatory training and the home offered specialist training related to the service users conditions. The induction was based on LDAF principles. Staff received regular and appropriate supervision. Brookside I51 s14888 BROOKSIDE v226842 070605 Stage4.doc Version 1.30 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 40,41,42,43 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 manager was qualified and experienced. Allocation of responsibility was evenly spread among staff members and created an open, transparent inclusive and protective atmosphere. The manager and staff ensured that relevant policies and procedures were prepared in a graphic format to enable service users to get involved in the operation of their home. Records kept in the home were accurate and up to date. Service users confirmed that they had access to their files if they wanted. Safe working practices were in place. Accidents/incidents were recorded accurately and the manager was reviewing them to better identify potential
Brookside I51 s14888 BROOKSIDE v226842 070605 Stage4.doc Version 1.30 Page 20 patterns, or hazards. Safety procedures were displayed in a pictorial format and made available to service users. General risk assessments were drawn up and reviewed regularly. The manager explained the business plan, especially in relation to Morley Lodge, the adjoined annex where three service users lived more independent lives. The up to date insurance certificate was displayed. Brookside I51 s14888 BROOKSIDE v226842 070605 Stage4.doc Version 1.30 Page 21 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 3 4 3 4 x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 3 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x 3 3 x 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x 3 3 Standard No 31 32 33 34 35 36 Score 3 3 4 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Brookside Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 4 x 3 3 3 3 I51 s14888 BROOKSIDE v226842 070605 Stage4.doc Version 1.30 Page 22 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 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. 2. 3. Refer to Standard 23 26,41 24 Good Practice Recommendations Service users capable of doing so should be signing their hard copies of records of expenditure and persoal allowances when they are supported by the homes staff. The list of service users individual possessions should be signed, dated and contain dates and signures when it is updated. The damaged wall in the dining room should be repaired. Brookside I51 s14888 BROOKSIDE v226842 070605 Stage4.doc Version 1.30 Page 23 Commission for Social Care Inspection 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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