Inspection on 19/10/06 for Brynsworthy

This inspection was carried out on 19th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Brynsworthy 22/01/08

Brynsworthy 07/11/05

Brynsworthy 29/06/05

Brynsworthy 22/02/05

Brynsworthy 01/09/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Brynsworthy Brynsworthy Higher Woodway Road Teignmouth Devon TQ14 8RB Lead Inspector Judy Hill Unannounced Inspection 19th October 2006 10:00 Brynsworthy DS0000059603.V302832.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 Brynsworthy DS0000059603.V302832.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. Brynsworthy DS0000059603.V302832.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brynsworthy Address Brynsworthy Higher Woodway Road Teignmouth Devon TQ14 8RB 01626 779364 F/P 01626 779364 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) Atlas Healthcare South West Ltd Mrs Suzanne Geraldine Evans Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Brynsworthy DS0000059603.V302832.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 4 people who have a Learning Disability aged between 18 and 65 may be accommodated at any one time. Announced 29th July 2005 Unannounced 7th November 2005 Date of last inspection Brief Description of the Service: Brynsworthy is registered to provide accommodation and care for a maximum of four people with learning disabilities who are under 65 years of age. The home specialises in providing a service for people with complex needs and who can display challenging behaviour. Brynsworthy is located in a residential area of Teignmouth. It is approximately one mile from the town centre and sea front. A public bus service runs close to the home. Information about the service is available from the service provider in a Statement of Purpose and a Service Users’ Guides. The fees are calculated according to the individual needs of the service users and currently range from £1,012 to £3,012 per week. The fees cover the costs of accommodation, board and care. The fees do not cover items of a personal nature, including toiletries, clothing and meals out. Brynsworthy DS0000059603.V302832.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was carried out on Thursday 19th October 2006. The information contained in this report was gained in conversation with the registered manager, staff and residents and from documentary information including a pre-inspection questionnaire that had been completed by the registered manager, six questionnaires completed and returned by staff members and one questionnaire completed and returned by a Social Care Professional. Information was also taken from the homes Statement of Purpose and Service Users’ Guide. Records were inspected, including service users assessments, care plans and reviews and staff recruitment and training records and staff rotas. An inspection of the premises was carried out. What the service does well: The individual needs and risk assessments carried out by the manager and staff are comprehensive and well documented. These are used to draw up detailed care plans and risk management strategies, which are regularly reviewed to reflect the service users changing needs. The social, recreational and occupational needs of the service users are included in their assessments and care planning. New opportunities for social activities are being introduced gradually the service users gain confidence. Continued family contact and healthy eating are actively encouraged. The service users personal care needs are identified in their care planning and met sensitively, ensuring that they are encouraged to do as much as they can for themselves. The service users health care is monitored and timely referrals are made to the primary and secondary health care services as and when necessary. The complaints procedure has been produced in written, audio and pictorial formats and is accessible and service users and their representatives. The service users can be confident that their complaints will be taken seriously and handled sensitively. Staff training, policies and procedures are in place to protect the service users from the threat of abuse. Each of the service users has their own bedroom with en-suite bath or shower facilities. There is a shared lounge, dining room, kitchen, laundry room and gardens. Brynsworthy DS0000059603.V302832.R01.S.doc Version 5.2 Page 6 The service users home is kept clean, hygienic and well maintained. The service users can be confident that safe recruitment practices are used to ensure that unsuitable staff are not employed. The staff receive appropriate training and are well supervised. The manager has a very good understanding of the needs if the service users and manages the service very well. A robust system of management oversight is in place. A quality assurance system is being introduced to gain feedback from the service users and their representatives about the quality of the care provided. Regular monthly audits are carried out to ensure that the home is safely maintained and that the service is meeting the National Minimum Standards and regulations. What has improved since the last inspection? Since the last inspection the care staffing levels have been raised although there is scope for further improvement to ensure that the residents can go out as and when they choose to do so. New locks have been fitted to bedroom and communal bathroom doors, which make them easier for the residents to operate. The provision of keys for the residents is being worked towards. The manager and staff are moving away from crisis management to prevention of crisis management and this has led to a reduction in the need to use control and restraint methods. Improvements have been made to the clarity of the medication administration record sheets. Improvements have been made to the process of determining the staffs training needs and more specialised training is being provided. The care staff are no longer working double shifts, although they are continuing to work excessively long shifts which may result in overtiredness and loss of concentration. A quality assurance/quality monitoring system is now in place to gain feedback from the service users and their representatives on the quality of care provided. Regular monthly visits are now being carried out on behalf of the persons in control. Brynsworthy DS0000059603.V302832.R01.S.doc Version 5.2 Page 7 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. Brynsworthy DS0000059603.V302832.R01.S.doc Version 5.2 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 Brynsworthy DS0000059603.V302832.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users can be confident that their individual needs will be comprehensively assessed. EVIDENCE: The admission procedure is included in Statement of Purpose and summarised in Service Users’ Guides, although one of these documents needs to be updated as the information provided on emergency admissions is contradictory. Case management assessments had been obtained for the current service users. The Homes admission procedure states that all aspects of a service user’s physical, social, cultural and emotional well-being are included in their individual needs assessments and an inspection of the assessments for all four of the current service users demonstrated that detailed in house assessments are carried out. Brynsworthy DS0000059603.V302832.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): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users can be confident that their assessed and changing needs will be reflected in their care plans and, subject to individual risk assessments, that they will be able to make decisions about their lives. EVIDENCE: Detailed care plans have been developed from the service users individual needs assessments and these were seen in their case files. The care plans seen were relevant and comprehensive and included risk assessments and risk management strategies. A member of staff said that the process of care planning had improved since the service had become part of Southern Cross and that more emphasis was now being given to preventing situations that could lead to a service user displaying challenging behaviour. Brynsworthy DS0000059603.V302832.R01.S.doc Version 5.2 Page 11 Regular formal reviews of the residents needs are carried out and these are supplemented by informal reviews and good communication and teamwork between the manager and staff. The service users ability to make decisions about their lives is still sometimes limited by their capacity to make informed choices, however it was evident that improvements have been made in this area and that the service users are being actively helped and encouraged by the staff to make decisions about their daily lives. Brynsworthy DS0000059603.V302832.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): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users can be confident that their social, recreational and occupational needs will be developed and that continued family contact and healthy eating are actively encouraged. EVIDENCE: None of the service users are currently assessed as able to take up positions of employment but two are attending social/educational day care services. One attends dance classes, art and craft classes and Music & Mayhem and one visits a farm and attends Music and Mayhem. Both also regularly attend Gateway Club. The registered manager said that the other two service users were not yet ready to attend external day care services, but that they were going out with the staff on a regular basis. Brynsworthy DS0000059603.V302832.R01.S.doc Version 5.2 Page 13 All of the service users maintain regular contact with members of their families. This is facilitated by telephone and by regular visits to and from their homes. It was observed that all of the service users are now more involved in carrying out duties around their home. This acceptance of their rights and responsibilities has been promoted and encouraged by the manager and staff. The main meal of the day is served in the evening and the menu plans show that healthy eating is encouraged. Although the evening meal is a set meal alternatives will be offered if requested. The service users have a choice of meals for breakfast and tea. It was observed that meal times are flexible and that consideration is being given to the service users wishes and needs to eat alone or in a group. It was observed that the service users are prevented from entering their kitchen and do not have facilities to make themselves drinks and snacks. Although it is accepted that one or more of the service users would not be safe using the kitchen unsupervised, it is suggested that they could be move involved with meal preparation and clearing up after meals under staff supervision. Brynsworthy DS0000059603.V302832.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): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents can be confident that their personal care needs will be identified and met sensitively and that their health care will be monitored. EVIDENCE: The service users personal care needs are recorded in their care plans. The pre-inspection questionnaire identifies that the service users need very little help to maintain their personal hygiene and appropriate levels of support and encouragement are given. Brynsworthy does not provide nursing care but records demonstrated that the staff monitor the residents health and make referrals to primary and secondary health care services as and when necessary. All of the service users are registered with a local GP practice and have regular six monthly consultations with a consultant psychiatrist. Support is available from the Community Learning Disability Team as and when needed and two of the service users have named Social Service/Health Authority case managers. Brynsworthy DS0000059603.V302832.R01.S.doc Version 5.2 Page 15 The service users medication is stored in a locked cupboard that is fixed to the wall in the office. None of the service users are on controlled medication and none need medication that requires refrigeration. An inspection of the medication administration record sheets was carried out and these were seen to be clear and up to date. Unused medicines are returned to the pharmacist promptly. Brynsworthy DS0000059603.V302832.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): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is accessible and service users and their representatives can be confident that their complaints will be handled sensitively. Staff training, policies and procedures are in place to protect the service users from the threat of abuse. EVIDENCE: The written complaints procedure is included in the Statement of Purpose and Service Users’ Guides. The procedure is also available in picture and audio formats and the registered manager said that the staff have gone through the procedures with the service users. The responses from recent questionnaires sent to the relatives of residents by the home demonstrate that they are very happy with the service provided. The registered manager had recorded recent complaints made to her by a neighbour about noise from the garden and it was clear that the situation had been handled appropriately. Staff training records show that all of the staff have attended training in the Protection of Vulnerable Adults from Abuse and the pre-inspection questionnaire completed by the registered manager identified that policies and procedures were in place to safeguard the residents from abuse. Brynsworthy DS0000059603.V302832.R01.S.doc Version 5.2 Page 17 As the service has moved away from crisis management to trying to prevent a crisis situation developing the use of control and restraint methods has diminished. There are, however, instances where methods such as safe holding do need to be used to prevent self harm and harm to other service users and the staff. This have been discussed with the multi disciplinary support team. Brynsworthy DS0000059603.V302832.R01.S.doc Version 5.2 Page 18 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): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users benefit from living in a clean, comfortable and well maintained home. EVIDENCE: Brynsworthy is a detached house set in its own grounds on the outskirts of Teignmouth. The town centre and beach are approximately one mile away but there is a local shop close by. The home has a car for the residents use and one of the service users also has her own car. A tour of the premises was carried out. Each of the service users has his or her own bedroom with en-suite bathroom or shower facilities. There is a shared lounge, dining room, kitchen and laundry room. The home is well decorated, comfortably furnished and is kept clean and hygienic. Because of behavioural issues parts of the home are a little bare but Brynsworthy DS0000059603.V302832.R01.S.doc Version 5.2 Page 19 the staff are aware of this and are trying, with some success, to introduce suitable ornaments and soft furnishings. Where repairs have been necessary these have been carried out satisfactorily and records show that the routine maintenance is identified, planned and provided. Since the last inspection the locks on the service users bedrooms doors and on the communal bathroom and toilet doors have been changed to a type that is more suitable for the service users. Brynsworthy DS0000059603.V302832.R01.S.doc Version 5.2 Page 20 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): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users can be confident that safe recruitment practices are used to ensure that unsuitable staff are not employed and that the staff receive appropriate training and supervision. EVIDENCE: In addition to the registered manager, there is a team leader, three senior support workers, nine support workers and two waking night support workers. The records of recruitment for the two most recently employed members of staff were inspected and found to be satisfactory. Application forms had been completed and references had been taken up. CRB and POVA First checks had been carried out. Evidence was seen that new staff are provided with induction training. Only one of the care staff has completed an NVQ but a further seven are working towards gaining an NVQ in Care at Levels 2 & 3. Brynsworthy DS0000059603.V302832.R01.S.doc Version 5.2 Page 21 Records of staff training provided evidence that the staffs training needs are being identified and that arrangements are being made to meet these needs. In addition to the health and safety related training, the staff have been attending specialised training courses covering topics that including Autism, Mental Health and Learning Disability, Total Communications, Positive Values, Understanding Challenging Behaviour and Conflict Resolution. The staffing levels have improved since the last inspection and there are now five care staff on duty for most of the day, however, issues raised during the inspection indicate that the quality of care provided for the residents, particularly outside their home environment where each of the residents needs two to one support, could be improved if more staff were available to take them out. It was noted from the staff rota that although the practice of staff working double shifts has stopped, the staff continue to work very long shifts and could become overtired. It is acknowledged that most of the staff prefer to work long shifts as it enables them to reduce the number of days they work. Brynsworthy DS0000059603.V302832.R01.S.doc Version 5.2 Page 22 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): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users can be confident that the their home is well managed, that their views are taken into account and that the premises and working practices carried out by the staff are safe. EVIDENCE: The registered manager is working towards gaining her NVQ in Care at Level 4 and Registered Managers Award. Brynsworthy is not an easy home to manage as the service users have complex needs and their behaviour can be extremely challenging, however the registered manager was able to demonstrate throughout this inspection that she has a very good understanding of the needs of the residents and that she has been able to cope comfortably with the Brynsworthy DS0000059603.V302832.R01.S.doc Version 5.2 Page 23 changes and developments brought about by the change of the companies ownership. Regular monthly monitoring visits are being carried out on behalf of the registered service providers. These are being carried out by either the Responsible Individual or the Operations Manager and copies of reports of visit were seen at the Home. A quality assurance system is in place to enable the service users to have an input into the running of their home. Questionnaires that had been completed by relatives of the residents were seen and their comments were very positive. The registered manager is required to complete a very detailed Monthly Home Audit covering all aspects of the service provided and the premises. A completed audit was seen and this was provided evidence that the home is well maintained and that any outstanding issues are recognised, reported and dealt with. Brynsworthy DS0000059603.V302832.R01.S.doc Version 5.2 Page 24 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 4 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 3 36 X 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 Brynsworthy DS0000059603.V302832.R01.S.doc Version 5.2 Page 25 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 2 3 4 Refer to Standard YA2 YA17 YA33 YA33 Good Practice Recommendations The service providers should amend the information on emergency admissions in either the Statement of Purpose of the Service Users’ Guide. The service users should be allowed access to their kitchen with staff supervision, if necessary. Consideration could be given to increasing the day care staffing levels to ensure that there are sufficient staff on duty to enable the residents to go out when they want to. Consideration should be given to reducing the length of shifts to reduce the risk of the staff becoming overtired. Brynsworthy DS0000059603.V302832.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Brynsworthy DS0000059603.V302832.R01.S.doc Version 5.2 Page 27 - 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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