Inspection on 21/06/07 for Brownhill Care Limited

This inspection was carried out on 21st June 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Townley Road, 2-3

Foxley Lane (121a)

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Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOME ADULTS 18-65 Brownhill Care Limited 307 Brownhill Road Catford London SE6 1AL Lead Inspector Rosemary Blenkinsopp Unannounced Inspection 21st June 2007 11:30 Brownhill Care Limited DS0000068794.V341819.R01.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 Brownhill Care Limited DS0000068794.V341819.R01.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. Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brownhill Care Limited Address 307 Brownhill Road Catford London SE6 1AL 020 8465 0048 020 8465 0048 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) Brownhill Care Limited Oudaysingh Shyam Dooraree Care Home 7 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7) of places Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care (excluding nursing) and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following category:Mental disorder, excluding learning disability or dementia (Category MD) The maximum number of service users who may be accommodated is 7 2. Date of last inspection Not Applicable Brief Description of the Service: 307 Brownhill Road is a registered care home for those residents suffering mental health disorder. It accommodates up to seven residents of both sexes. The home is an adapted large domestic house on a main road in Catford. It is well served by local buses and the main line station is relatively close. All amenities are situated in Catford town centre. All bedrooms are single and there are communal areas located on the ground floor. There are no adoptions in the home or equipment. The stairs are steep in places and all residents will need to be physically able to live in this home. The focus of the home is rehabilitation for those residents who have enduring mental heath problems. It is envisaged their length of stay will be up to five years. Move on to more independent accommodation is the ultimate goal. All health care support will be provided through the local community and residents with staff support will be expected to access services. Aftercare in respect of mental health issues will be provided through multi disciplinary teams and outpatient attendance. Educational, leisure and employment will also be accessed within local resources. Visiting will be open, family contact and that with the local community encouraged. Weekly fees will start at £950.00. Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector conducted the site visit by arrangement as it was established with the Registered Manager, that the home is not yet open or operational. As all new services have to be inspected before the end of June 2007, this visit had to take place. The home had been sent the AQAA for completion although the lead in time for this was less than the eight weeks allowed, hence this was not completed prior to the site visit, this needs to be completed and forwarded to the CSCI. On the day of the visit the Registered Manger was on site with another person. The inspector recognised this person as a staff member in another mental health facility namely London Mental Health Centre. Both staff work for this home, which is also located in Catford. The Registered Manager provided all information, included in this report, verbally, there was little in the way of supporting evidence provided. The information provided verbally, in many areas could not be tested. The inspector requested that standard formats for certain documentation be supplied. All evidence, including the service certificates, care plan and risk assessment documentation and reports had been checked by the CSCI when registration had been completed February 2007. This report relies on the registration report, in addition to that provided verbally, as there were no other opportunities for obtaining information. What the service does well: What has improved since the last inspection? This is not applicable. Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 Page 6 What they could do better: 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. The summary of this inspection report can be made available in other formats on request. Brownhill Care Limited DS0000068794.V341819.R01.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 Brownhill Care Limited DS0000068794.V341819.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information provided indicated good procedures would be in place to ensure residents would be fully assessed for their suitability to live in the home, however these could not be tested, as the home was not yet operational. EVIDENCE: The home had provided satisfactory information including a Statement of Purpose and Service User Guide at he point of registration. The Statement of Purpose was inspected and found to contain relevant information. The document was clearly set out and in an easy to read format. The inspector requested the standard format of all assessment documentation to be provided. This was unavailable at the site visit hence it was requested that this be sent to the office. At the point of writing this report it had not been received. The Manager stated that all residents would be subject to robust assessments conducted by senior staff in the home. Information and reports received through the multi disciplinary team and the funding authorities would be sought prior to placement. Trial visits and an overnight stay would also be offered and where possible an introductory three day stay. An initial care plan and supporting risk assessments would be in place within 24 hours of admission. Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 Page 9 Terms and conditions, house rules and a contract would be in place. A trial period of three months would be standard as would a four-week notice period. Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard format for care planning and risk assessments was not available hence it was impossible to establish how comprehensive in content this was, and therefore how it will inform and guide resident’s support. EVIDENCE: The inspector was advised that care plans would be drawn up from information obtained through the assessment procedures and would, where possible, have input from the resident. The care plans would be reflective and work in conjunction with those set out under Care Programme Approach (CPA). Reviews would be conducted through CPA procedures and care plans in the home kept under review as required. Care plans would include physical, mental, social and rehabilitation needs with supporting risk assessments in place. A copy of the standard care plans proposed for use was requested by the inspector, these are still awaited. The home will operate a key worker system therefore staff will be responsible for coordinating the care and updating relevant documentation for the individual resident. Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 Page 11 All information will be stored in the staff office and lockable cabinets available for such. Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information provided indicated choice, independence and support to maximise resident’s daily lives. EVIDENCE: Information provided is that residents will be encouraged and supported to access a wide range of leisure facilities. Full details are included in the homes Statement of Purpose. Contact with families and friends will be promoted and supported. Any issues arising in respect of culture and ethnicity will be met where possible. Rehabilitation will be provided through the Community Opportunities programme. This service is provided in the community through South London and Maudsley Mental Heath Trust. This is a service where key workers are provided to assist residents in attending external activities as part of rehabilitation and integration into the community. Day centres and local leisure facilities will be accessed. Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 Page 13 In house activities as part of daily rehabilitation will be decided upon with the residents and once an assessment of needs has been completed. Residents will be involved in maintaining their own bedrooms and communal areas. They will be involved in menu planning and address their own laundry. Community meetings will offer an opportunity to input into the running of the house. Daily newspapers and Sky TV will be provided. Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Services are in place to ensure that resident’s healthcare is met, however again this could not be tested at the site visit. Single bedrooms are provided therefore residents will be afforded sufficient privacy for personal care. EVIDENCE: The Manager described satisfactory systems, which will be in place to ensure that health and personal care needs of residents will be met. All residents will be registered with local GP’s, or one of their choice if this is possible. The home will have established appropriate links with other professionals e.g. the local mental health team. Depot medication would be administered by CPN’s or by way of residents attending depot clinics. Medications will be supplied through a local chemist. The medication system will be blister packs with supporting medication administration records (MAR) in place. The Manger confirmed that all staff would receive training in the medication policy and procedures to ensure safe administration. The training would be either in house or through local colleges. Policies and procedures for medication administration, storage, and disposal are in place. Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 Page 15 Medication storage is provided in the home. There was discussion regarding residents self-medicating. In rehabilitation premises, self-medication is promoted, as this is an essential skill for independent living. Specific protocols need to be in place to ensure residents are safe to self-administer. Regular reviews of the situation need to be undertaken to confirm on going safety and that residents remain able and capable in this area. The home needs to further investigate this and develop policies and procedures to address it. Please see recommendation 1. Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Evidence of complaints policies and procedures was available. Information relating to interagency adult protection procedures were not available, hence staff would not be equipped with sufficient information to take appropriate action. EVIDENCE: There is a satisfactory complaints procedure, which meets the standard. The Manager demonstrated an awareness and knowledge of procedures for the protection of residents. He was aware of his responsibilities in relation to reporting of such matters and creating an open transparent system for residents and staff to feel able to report areas of concern. Training will be provided to staff to ensure that they are fully conversant with procedures for the protection of vulnerable people. At the site visit the Manager had not yet established contact with the adult protection coordinator for Lewisham, nor obtained a copy of the interagency guidelines. It is essential that these be obtained to ensure that the correct procedures are followed in such events. Once these guidelines have been obtained staff will need to be fully conversant with them and suitable training provided. Please see requirement 1. Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is to a good standard and will provide comfortable accommodation to those who live in it. Single bedrooms provide privacy and communal areas large enough for community activities. EVIDENCE: The home is an adapted domestic house in Catford. It has been extended provide seven bedrooms, staff accommodation and communal rooms. There is parking to the front of the building and a garden to the back. There is building work still ongoing in the garden and this is one of the reasons that the home has not opened. All bedrooms were clean, bright, well decorated and reasonably furnished. The furniture isn’t matching in some rooms so does not look very coordinated, however replacement furniture is being provided. All bedrooms are of a similar standard. All bedrooms meet minimum standards in terms of furnishing and fittings. The residents may personalise their rooms if they wish when they move in. All rooms are provided with a lockable cabinet and bedroom doors are Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 Page 18 lockable. Residents will be provided with their own key. There are ensuite facilities of a shower and WC in each bedroom. There is a kitchen, dining room, lounge and smoking room on the ground floor. There is also a bathroom with a bath for use by all residents on the first floor and a separate toilet. The garden is secure and work to make it more attractive underway. The Manager stated that he had a particular interest in gardening and hopes to make it a feature of the home. The lounge was bright and newly decorated with comfortable sofas. There are further plans to make it more homely with he addition of some more pictures and ornaments. There is a separate room containing a washing machine and dryer. There was discussion regarding residents and the front door key. It is felt that this would not be appropriate .The inspector advised that individual risk assessments should be in place for this and a blanket statement should not be made. The Manager has registered with the local Environmental Health Department as a food premises. Overall the premises were of a satisfactory standard. The standard of cleanliness, decoration and furnishings was good. Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The proposed recruitment and induction will ensure staff are safely recruited. Staffing levels as proposed are satisfactory but will need to be kept under review to reflect resident’ dependency. EVIDENCE: The Manager confirmed that there would be a minimum of two staff on duty during daytime shifts and one staff member awake at night. The Manager will be on duty for office hours and will also work some shift patterns. The shift patterns will allow adequate time for staff handover periods. The person in charge on each shift will have designated responsibility in the event of an emergency. The Manager also confirmed that all staff will complete an induction period of two weeks, prior to starting work at the home. A wide range of relevant training for staff will be provided on an ongoing basis both internally and externally. The Manager provided details of this training, which will include food hygiene, fire safety, first aid and any specialist training in mental health issues, which may be required. At the time of the site visit no staff had yet been appointed. Adverts were out in local press. Applications had been received, short listing and interviewing was due to take place in the forth-coming weeks. Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 Page 20 There was discussion around NVQ expectations of new staff. It is not the expectation of the CSCI that all newly appointed staff will have NVQ, although the home should ensure 50 of staff do have this qualification. All staff need to have the statutory training and that specific training to enable them to undertake their role in the home. CRB’s are due to be undertaken by the sister home in Arran Road, although this is under a different company name. This should be checked with the CRB to ensure the correct procedures are followed. All staff must be subject to enhanced CRB checks, two references and appropriate checks prior to employment. Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is managed by an experienced individual. An open ethos will be promoted where residents feel safe to raise issues. The health and safety documentation was not available hence the inspector was unable to establish if these were current. EVIDENCE: The Manager is a Registered Mental Nurse. He has 11 years experience as a senior nurse in hospital settings. His most recent experience has been as a Deputy Manager in the registered care home where his brother is the Registered Manager. The Manager has 2 years experience at this home, which provides a service to people with mental ill health. He has completed the CSCI procedures to become the Registered Manager. He plans to start the RMA by the end of 2007, by which time the home should be fully operational. Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 Page 22 The Manager confirmed that the home has all required policies and procedures. Those sampled were generally satisfactory and had been re titled with the correct name of the home . The certificate of installation and commissioning of a fire alarm system was issued on 27/5/06. Four emergency lights were also fitted on that date. The NIECC electrical installation certificate was issued on 11/06/06. The gas safety certificate was issued on 17/5/06. Copies of all certificates were said to be available on file although not seen at the site visit. Copies of the updated service certificates were requested. The applicant had confirmed that insurance cover would be in place upon registration being approved. This was not available at the site visit. The LFEPA conducted a second visit to the premises on the 26/2/07. Mr Dooraree confirmed via email to the Central Registration Team , that the LFEPA were now satisfied with fire safety arrangements at this premises. The LFEPA report needs to be forwarded to the CSCI. This was not available. There was evidence from discussion with the Manager to indicate that the home will be run in compliance with Health and Safety legislation. The Manager intends to have a first aider on every shift. The Manager confirmed that regular monitoring of the home will take place. In respect of financial arrangements it is envisaged that each resident will have their own bank account. Staff will support residents with finances as part of rehabilitation. Within the house there will be petty cash available of about £ 100 for any expenditure required. Please see requirement 2 and 3. Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 Page 23 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 X 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 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 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 x Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 Page 24 N/A 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 YA23 2 YA37 3 YA42 23 9 Standard Regulation 13 Requirement The Registered Manager must ensure that the interagency guidance is available and staff aware of it’s content The Registered Manager must ensure that he makes provision to start the RMA by the end of 2007. The Registered Manager must provide up to date certificates as stated in the report, namely the gas certificate, fire report and annual electrical test. Timescale for action 30/07/07 30/12/07 30/07/07 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 YA20 Refer to Standard Good Practice Recommendations The Registered Manager should investigate self-medication policies and procedures for use in the home. Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Brownhill Care Limited DS0000068794.V341819.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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