Inspection on 10/08/06 for Broughton House and College

This inspection was carried out on 10th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Broughton House and College 24/10/05

Broughton House and College 27/04/05

Broughton House and College 11/11/04

Broughton House and College 12/05/04

Broughton House and College 15/01/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Broughton House and College Brant Broughton Lincolnshire LN5 0SL Lead Inspector Wendy Taylor Key Unannounced Inspection 10th August 2006 09:30 Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broughton House and College Address Brant Broughton Lincolnshire LN5 0SL 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) 01400 272929 Cambian Care Services Limited Care Home 24 Category(ies) of Learning disability (24) registration, with number of places Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. A maximum of 10 children (male and female) aged between 16 and 17 years of age on admission, may be accommodated. One place is for a child who is under the age of 16 years, as named in the Pre-Registration Letter dated 31 May 2006. The maximum number of service users to be accommodated is 24. Date of last inspection 24th October 2005 Brief Description of the Service: Broughton House College is registered as a residential care home and owned by Cambian Education Services Ltd. The home is situated in the village of Brant Broughton and provides a 52-week placement for up to 24 young people between the ages of 16 and 25, who have special educational and social care needs resulting from severe learning disabilities and autism coupled with challenging behaviour. The home, set in landscaped grounds, provides accommodation, education and therapeutic services. Accommodation consists of single bedrooms and a variety of communal areas located in five areas of the property; the main part of the home - York and Lincoln house, the Coach House, the flat and Sandbeck House. The Statement of Purpose promotes an approach based on non-aversive positive intervention and the purpose is to develop each student’s independence through education in an environment that offers warmth, security, consistency and understanding. The extensive staff team receives training and development opportunities relevant to the educational and social needs of the service users. The current fees for the service are £4700 per week. Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on 10 August 2006 over a 6-hour period. The care and support received by four students was looked at in detail. Individual student records and general house records were looked at; students, relatives, staff and the acting manager were spoken to, and an observation of how care and support is provided was made. Students and relatives indicated that they were pleased with the care and support provided. What the service does well: What has improved since the last inspection? What they could do better: A good standard of care and support is already maintained. All of the key standards are met and in some cases exceeded. The acting manager and staff said that they would be carrying out some minor repairs to the décor, highlighting a step to an outside patio area to reduce the Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 Page 6 risk of trips or falls; and monitoring improvements to the levels of communication in the staff teams. A recommendation has been made to separate some records from those of another service. 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. Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Quality in this outcome area is good. The judgement has been made using the available evidence including a visit to the service. There are comprehensive admission and assessment systems in place, which assure students and their families that their needs will be met. EVIDENCE: There is an updated statement of purpose and service user guide available, and the service user guide is available in makaton signs (a form of sign language developed for people with a learning disability). Students and relatives said that they have had very positive experience of transition; they said that they were given lots of information, the staff were very helpful, they were offered the opportunity for several overnight stays, and they were impressed with the levels of care and support provided. There are detailed and comprehensive pre-admission assessments in student’s files. There are clear links from this assessment to the initial 3 month placement assessments and plans, which look at needs such as behaviour, personal care and communication. A range of assessment formats are used which are specific to needs. There is evidence that all of the student’s support networks are involved in the assessment processes, including the student where they are able to be, and their relatives. Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. The judgement has been made using the available evidence including a visit to the service. Care plans are in place and students are enabled to develop their lifestyles in a safe and supported manner. EVIDENCE: Four student’s files were looked at in detail. There are care plans and individual learning plans available for personal care, social interaction, making choices and communication. Staff were observed to use a variety of communication methods to ascertain choices throughout the visit, including verbal communication, sign-a-long (a form of sign language developed for people with a learning disability), PECS (Picture Exchange Communication System) and objects of reference, (for example, using a cup to indicate that the person wants a drink). Two staff members are trainers for the sign-a-long method of communication, and there are communication boards around the college environment to reinforce the alternative methods. Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 Page 10 There is evidence in records of good behaviour management strategies and there are risk assessments for the use of physical restraints. Where restraint is used it is mainly of a protective nature. There are also risk assessments available for travelling and the use of audio equipment for example. Daily journals are completed with details of the student’s achievements and their progress with learning plans. Records provide evidence of regular reviews of care and learning plans that occur at least every 6 months. The acting manager said that he is looking towards extending the on site services that are available to students, for example introducing art therapy and music therapy. Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 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 the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. The judgement has been made using the available evidence including a visit to the service. Students enjoy a varied social life and benefit from using local and wider community facilities. EVIDENCE: Individual care files contain clear evidence that relationships with family and friends are encouraged and maintained. During the visit there were students going on and returning from visits with their families. Staff said that the key worker system helps to maintain relationships such as making sure birthday cards are sent and informing families of specific events in the student’s lives. A policy relating to maintaining relationships was reviewed in February 2006. There is evidence in records and from observations during the visit that students make good use the local and wider community settings for activities such as shopping, eating out and going to college. Students were also seen engaging in activity within the college environment such as art and sand Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 Page 12 play. There are photographs around the building of students engaging in activities such as fun days and going on walks. Any restrictions on daily routines due to assessed needs are recorded in care plans. Staff were observed giving respectful interactions and promoting and supporting choice making. Interactions and activities were in line with care plans. Menus are developed on a 4 week rolling plan. They are balanced and varied, and the choices are based on known likes and dislikes and what the students ask for. Choices are recorded on a daily basis, and there are choice cards at the kitchen area if students change their minds on the day. Specific dietary needs such as not having dairy products are recorded in care files and menus and information is kept with catering staff. Although a mealtime was not observed, students indicated that they enjoyed their food. Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 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 the following standard(s): 18,19,20 Quality in this outcome area is good. The judgement has been made using the available evidence including a visit to the service. Student’s health needs are met and there are clear medication policies and procedures in place. Appropriate actions are taken where risks to student’s health and welfare are identified. EVIDENCE: There have been two incidents of medication errors and records show that they have been investigated and managed appropriately. There is a good medication policy, which was reviewed and amended following the first error. Medication is provided in a monitored dosage system, and records are satisfactory. One member of staff is responsible for the ordering and monitoring of medication and for training other staff. Each student has a health care file, which includes records for visits to opticians, GP’s, hospital, chiropody, psychiatry and dentists. They demonstrate that individual needs are taken into account when preparing and using the services. Relatives described how a student was positively supported to attend hospital visits. Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 Page 14 Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. The judgement has been made using the available evidence including a visit to the service. Good policies and procedures and a knowledgeable staff team protect students’ health and welfare. EVIDENCE: Policies and procedures are available for complaints, safeguarding adults and Whistleblowing. There is evidence that these policies have been reviewed within the last year. Two adult protection referrals and two complaints have been recorded since the last inspection visit. Records demonstrate that the referrals and complaints were managed appropriately. One issue was unsubstantiated and three were substantiated. The acting manager has introduced a new front sheet for the complaints and adult protection files, which allow for quick reference to individual reports. The files are held as a central record for the college and an associated service, a recommendation has been made. There is evidence of training for staff in child and adult protection procedures, and they demonstrated sound knowledge of those procedures. Relatives said that they could talk to staff about any problems they have and are confident that they will be dealt with. Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 Page 16 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): 24,30 Quality in this outcome area is good. The judgement has been made using the available evidence including a visit to the service. The environment is well maintained, safe and clean; and it is designed to meet the needs and preferences of students. EVIDENCE: The existing bungalow been replaced by a new building which was completed in December 2005. The building provides a spacious and modern extension to the college living space. The environment was clean and tidy throughout but some minor repairs to the décor are needed; staff said that they are currently looking for a contractor to do the work. Staff said that they would highlight a step to the patio area in the new building due to the risk of trips and falls. Bedrooms are personalised to gender and likes and dislikes. There are personal photographs outside bedrooms for recognition purposes, and furniture and ornamentation is designed to meet the specialist needs of students. The acting manager said that they are planning extra lounge space in one part of the building for quiet time or for family visits. Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 Page 17 Environmental risk assessments are available that relate to specific student needs, for example access to stairs and kitchens, and household management skills. Assessments and information sheets for art materials, and assessments for kitchen fire escape locks and cleaning student’s bedrooms are in place. There is written permission from the local fire officer to keep fire doors open at night for observation and support purposes, and a risk assessment is in place. Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 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): 32,34,35,36 Quality in this outcome area is good. The judgement has been made using the available evidence including a visit to the service. There is a well trained and knowledgeable staff team who are able to meet the needs of the students. EVIDENCE: Rotas show that numbers of staff at times exceed contracted hours as there is currently reduced student occupancy; however staff said that they needed more staff on duty. The acting manager said that he would continue to monitor staffing levels closely. He also said that they have recently recruited into posts for people that have left since the last inspection. Staff said that they receive a very good induction and training package. There is a plan for 2006 which shows training is booked for areas such as basic food hygiene, disability awareness, epilepsy, behaviour management, communication, child and adult protection, equality and diversity, reflexology and medication. There is a training officer in post, and there are up to date records of individual staff training achievements. Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 Page 19 There is evidence of appropriate recruitment information such as Criminal Record Bureau checks, identification and references. Staff said that they have regular supervision and appraisal and records confirm this. Staff said that there have been some recent improvements to communication between staff and managers, but further improvements could be made. A recent staff survey identified issues with communication, roles and relationships within the teams. The acting manager described changes to team structures that will commence in September 2006 that are aimed at addressing this issue, such as team leaders managing one team and the reintroduction of team meetings alongside unit meetings. The acting manager said that the senior management team would monitor these issues. Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 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): 37,39,42 Quality in this outcome area is good. The judgement has been made using the available evidence including a visit to the service. Students are protected by good health and safety and quality assurance systems; and records are well maintained. EVIDENCE: Since the last inspection visit a new acting manager has been appointed. Staff said that he is approachable and they have seen some improvements in communication and accountability since he has commenced in role. He has held the post of deputy manager at the college for a number of years and as such has a comprehensive knowledge of the service. There is a fire risk assessment in place, which was reviewed in July 2006, and there are fire procedures for day and night shifts. The local fire officer conducted a visit in February 2006 and no issues were identified. Records show that fire equipment checks and fire drills are carried out regularly. Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 Page 21 The local Environmental Health Officer visited in July 2006 and no issues were raised. Accident records are clear and they cross reference with student’s individual daily records. Staff said that an external health and safety consultant is reviewing the health and safety policy in August 2006. There is a new policy for the control of Legionella and records show that regular testing, in accordance with the policy, takes place. Electrical appliance testing records are satisfactory. Policies include quality assurance, Control Of Substances Hazardous to Health, medication, fire safety, first aid and the use of restraint, and there is clear evidence of an on-going review process for policies. Care plan audits are carried out monthly; there is evidence of a recent survey for staff, an external education audit and monthly medication audits. At student support reviews, relatives are asked for their opinions of the placement, which are recorded and included in the quality assurance process. A representative of the parent company carries out monthly visits and produces a report and there is a development plan for the college for next five years. Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 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 Standard No Score 1 3 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 4 X Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 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 YA22 Good Practice Recommendations It is recommended that complaints and adult protection records be kept separately from another Cambian service whose records are kept centrally at the College. Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Broughton House and College DS0000002334.V307768.R02.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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