Inspection on 29/06/05 for Brynsworthy

This inspection was carried out on 29th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Brynsworthy 22/01/08

Brynsworthy 19/10/06

Brynsworthy 07/11/05

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 Higher Woodway Road Teignmouth Devon TQ14 8RB Lead Inspector Judy Hill Announced 29 June 2005 th 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. Brynsworthy D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Brynsworthy Address Brynsworthy, Higher Woodway Road, Teignmouth, Devon, TQ14 8RB 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) 01626 779364 01626 417800 Atlas Healthcare South West Ltd Vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Brynsworthy D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd February 2005 Brief Description of the Service: Brynsworthy is registered to provide accommodation and care for a maximum of four people with learning disabilities. The home specialises in providing a service for people with complex needs who can display challenging behaviour. The home is located in a residential area of Teignmouth and is approximately one mile from the town centre and sea front. The property is detached and has a good sized garden. Each of the residents has his or her own bedroom with an en-suite bath or shower room. The residents share a lounge and a lounger/dining room. The home is staffed on a twenty-four hour basis. Brynsworthy D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and was carried out from 10.05am to 17.15pm on Tuesday 29th June 2005. The information contained in this report was gained in conversation with the companies Operations Director, the acting manager and the staff on duty. Four members of staff were interviewed in private and all three residents were seen and spoken with. Additional information was gained from a tour of the premises and from documentary evidence including completed comment cards from the three residents and from their closest relatives, a completed pre-inspection questionnaire, the Service User’s Guides and the Statement of Purpose, the resident’s assessments and care plans, staff records and staff rotas. What the service does well: What has improved since the last inspection? The Service Users’ Guides has been redrafted and now includes individual contracts and statements of terms and conditions. The Statement of Purpose has been redrafted. The residents care plans have been reviewed and updated and achievable goals are being introduced. Risk assessments and action plans have been updated and are now easily accessible to the staff. Better provision is being made to ensure that the residents are able to go out on a regular basis. The complaints procedure is now available in the Service Users’ Guides, Statement of Purpose and in a brochure as well as in pictorial and audio form. Brynsworthy D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brynsworthy D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Brynsworthy D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc Version 1.20 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 standard(s) 1, 2, 3, 4 & 5 The prospective new resident and his representatives are given the information they need to make an informed choice about where to live. EVIDENCE: The Service Users’ Guides have been updated since the last inspection. A standard copy was provided for the Commissions files and individualised copies, containing the resident’s contracts and terms and conditions, were seen on their case files. The acting manager said that the residents knew that information about them was kept in their case files and that they could access their case files at any time. The Statement of Purpose has also been revised and a copy has been given to the Commission. These documents provide current and prospective service users and their representatives with the information that they need about the service provided. At the time of this inspection the home had one vacancy but assessments had been completed for a prospective new resident who was due to move in the following week. The assessment process was seen to be thorough and included visits to the home. Arrangements had been made for four members of staff to work with the prospective resident in his current home to enable both the staff and the prospective resident to get to know each other before the move. This is recognised as good practice. During the inspection the three residents were seen to be happy and actively engaged. The staffing levels were high enough to enable one to one care to be Brynsworthy D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc Version 1.20 Page 9 provided for each of the residents, with an additional care worker on hand to give support where necessary, for example, to provide a second escort if a resident chose to go out and to provide assistance if a resident displayed challenging behaviour. From conversations with the acting manager it was apparent that she and the staff are receiving active support from the Community Learning Disability Team and that together they are developing a better understanding of the complex needs of the residents and how their needs can be met. Brynsworthy D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc Version 1.20 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 & 9 The individual care planning, including risk assessment and action plans, is good and the residents are becoming more involved in their personal development. EVIDENCE: The resident’s care plans were inspected and had been reviewed and updated by the acting manager. The care planning system includes risk assessments and action plans. Some very structured routines are used in the provision of care, which take individual choice and decision making away from the residents. This was discussed with the acting manager and it was agreed that because the residents have complex needs and can display challenging behaviour, a structured approach was often necessary to safeguard the residents and staff. The individual care planning process is being used to draw up weekly diary sheets of activities and outings that the residents may wish to participate in, but these are used flexibly and in accordance with the wishes of the residents. Achievable goals are being introduced into the care planning system and discussion with the acting manager identified that the number of goals would gradually be increased. Brynsworthy D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc Version 1.20 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) 13, 15 & 17 The resident’s do go out regularly but would benefit from more outdoor activities and interests. Family contact is actively encouraged and valued by the residents. The residents enjoy a balanced diet, but could be more involved in meal planning. EVIDENCE: The resident’s weekly diaries which form part of their individual plans were inspected and showed that arrangements for taking the residents out of their home environment have improved significantly. Group outings have not proved to be popular with the residents and so arrangements are being made for each of the residents to go out daily with two members of staff to escort them, if they wish to do so. Regular outside activities include the Gateway Club, which two of the residents attended once a fortnight, one of the residents goes to the Rainbow Club, bowling and to the pub, one goes to Talk Training & Music & Mayhem. Two of the residents enjoy going swimming and shopping. One of the residents does not currently go out into the community but does go for drives and short walks, which is a personal achievement for him and an achievement for the staff. Although this is an area which could be further Brynsworthy D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc Version 1.20 Page 12 developed, it is recognised that because of the complex needs of the residents, integration into the community may be a slow process. All three of the current residents and the resident due to move into the home have local connections and are regularly visited by at least one member of their families. Completed comment cards were received from a relative of each of the residents, all of which said that they were made welcome at the home and that they are kept informed of important matters affecting their relatives and involved in decision making. The acting manager said that four weekly rotating menu plans are currently being drawn up by two members of staff which take into account the individual likes and dislikes of the residents. Two of the weekly menu plans were inspected and these showed that the residents were offered a balanced diet and that alternative meal of sandwiches is always available if the residents do not want the set meal. The need for rotating menu plans was discussed with the acting manager and it was suggested that the residents could be more involved in meal planning, with guidance from the staff to ensure that they maintain a healthy and well balanced diet. Brynsworthy D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc Version 1.20 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 The personal support provided meets the resident’s needs. EVIDENCE: The resident’s care plans include structured routines that the staff are instructed to follow when providing personal support for the residents. These structured routines were discussed with the acting manager. The routines are frequently reviewed but are currently considered to be necessary because of the resident’s complex needs and challenging behaviour. It was agreed that structured routines are necessary to help protect and safeguard the residents and staff and will only be used where necessary and for as long as necessary. The residents are encouraged to choose what to wear and how they present themselves. Brynsworthy D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc Version 1.20 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 residents are protected from abuse, neglect and self-harm, however care must be taken to ensure that their rights are recognised and respected. EVIDENCE: The homes complaint procedure is included in the Service User’s Guide, the Statement of Purpose and in a separate brochure. It is available in written, pictorial and audio form. Two of the three Comment Cards that were returned by three relatives indicated that they were not aware of the complaints procedure, but that they had never had to make a complaint about the service. The home has policies and procedures to protect the residents from abuse. These include adult protection, and prevention of abuse and whistle-blowing policies. A copy of the ‘Alerter’s Guide’ is available at the home along with a copy of the Department of Health’s video ‘No Secrets’. Some of the staff have attended professionally run training courses on adult protection and abuse. The resident’s all have complex needs and copies of regulation 37 notices which have been sent to the Commission identify that all of the residents can display challenging behaviour that may be verbally and/or physically aggressive. The pre-inspection questionnaire completed by the acting manager and approved by the responsible individual identified a total of fiftyone incidents where physical restraint had been used by the staff in the past year. To insure that the home is not contravening the resident’s legal rights, any form of restraint used should be approved by the multi-disciplinary support team and/or the Ethics Committee. Brynsworthy D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc Version 1.20 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 & 30 The residents live in a well decorated and comfortably furnished home, which provides them with a pleasant home environment. EVIDENCE: An inspection was carried out of the premises. The home was seen to be well decorated and comfortably furnished throughout. The communal areas are a little bare and consideration could be given to gradually introducing a few ornaments to give the rooms a more homely feel. The standards of hygiene and cleanliness were good. A tap in the first floor bathroom needs attention, but other than this the home appeared to be in a good state of repair. Brynsworthy D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc Version 1.20 Page 16 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) 32, 33, 34, 35 & 36 The care staffing levels are not always high enough to meet the assessed needs of the residents this can place restrictions on their activities and have a detrimental effect on their behaviour. Enhanced CRB checks and/or POVA First checks are not always obtained before new staff start working with the residents. This does mean that unsuitable staff could be employed. EVIDENCE: One senior care worker and three care workers were interviewed in private during this inspection. Two have worked at the home since it opened and two were recently employed. One of the newer staff said that she was being given a four-week induction and that she felt that she was being well supported by the existing staff. All four members of staff spoken with have received some training, but additional training needs were identified in conversation with them and with the acting manager. All four members of staff interviewed said that they were happy in their work and that the team was worked well together and was being well managed by the new manager. Brynsworthy D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc Version 1.20 Page 17 The staff selection processes are satisfactory but some of the staff have not had not had an Enhanced CRB or POVA first check carried out before starting work with the residents. The staff rota identifies that some of the staff regularly work double shifts and occasionally work triple shifts. This is not good practice as the staff may become overtired and unable to function at a satisfactory level. Each of the service users has been assessed as needing one to one support in their home environment and two to one support to go out. Additional staff support may also be needed to assist residents when they display challenging behaviour. The rotas show that there are not always enough staff on duty during the day (8am to 10pm) to meet the assessed needs of the residents. There is no indication that the current night staffing levels are not sufficient to meet the assessed needs of the service users. Brynsworthy D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc Version 1.20 Page 18 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) 39 The views of the residents and other stakeholders are not sought as part a system of quality assurance or quality monitoring, therefore there is nothing to demonstrate that they are able to contribute to the development of the service. EVIDENCE: There is currently no quality assurance or quality monitoring system in place, which is based on seeking the views of the service users, their families and professional representatives and the staff. Brynsworthy D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc Version 1.20 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 Brynsworthy x x 3 x 3 Standard No 31 32 33 34 35 36 Score 3 2 1 1 2 3 Version 1.20 Page 20 D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc 16 17 x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x x x Standard No 37 38 39 40 41 42 43 Score x x 1 x x x x Brynsworthy D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc Version 1.20 Page 21 Yes 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 32 Regulation 18 Requirement The staffs individual training needs must be identified, recorded and met. This training must include subjects relating to the specific needs of the residents as well as the statutory health and safety issues. The staffing levels must be maintained at a level that is high enough to meet the assessed needs of the service users. To ensure that the staff are competent at all times, the practice of working double shifts must stop. Enhanced CRB and POVA checks should be commissioned before new staff start working with the residents. As a minimum requirement a POVA First Check must be obtained before a new member of staff commences work. As Requirement 1 Timescale for action 12/10/05 2. 33 18 12/8/05 3. 34 19 12/8/05 4. 35 18 12/10/05 Brynsworthy D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc Version 1.20 Page 22 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. Refer to Standard 17 23 Good Practice Recommendations Enable the service users to be more actively involved in planning their meals. To ensure that the home is not contravening the residents legal rights, any form of restraint used must be approved by the multi-disciplinary support team and/or the Ethics Committee. Introduce a quality assurance or quality monitoring system based on seeking the views of the residents and their representatives. 3. 39 Brynsworthy D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton Devon 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 Brynsworthy D54_D07_S59603_Brynsworthy_V221703_290605 Stage 4.doc Version 1.20 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!