Inspection on 07/11/05 for Brynsworthy

This inspection was carried out on 7th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brynsworthy 22/01/08

Brynsworthy 19/10/06

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 7th November 2005 11:20 Brynsworthy DS0000059603.V264486.R01.S.doc Version 5.0 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.V264486.R01.S.doc Version 5.0 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.V264486.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Brynsworthy Address Brynsworthy Higher Woodway Road Teignmouth Devon TQ14 8RB 01626 779364 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 Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Brynsworthy DS0000059603.V264486.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th June 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. Brynsworthy 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 lounge/dining room. The home is staffed on a twenty-four hour basis. Brynsworthy DS0000059603.V264486.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was carried out from 11.20am to 1.50pm on Monday 7th November 2005. The information contained in this report was gained in conversation with the acting manager, staff and service users. Additional information was gained from a partial tour of the premises, direct and indirect observation and from documentary records including the staff rota, staff training and staff recruitment records, menu plans, medication administration record sheets and the residents weekly activity plans. What the service does well: What has improved since the last inspection? More attention is being given to identifying suitable social, recreational and occupational activities for the service users both within and outside their home. Changes have been made to the systems of menu planning to enable the service users to be more involved. The service users are also being encouraged to participate in meal preparation. The identification of the staffs training needs and achievements has improved but some gaps still remain in training provision. Staff recruitment procedures have improved. Brynsworthy DS0000059603.V264486.R01.S.doc Version 5.0 Page 6 The acting manager has started to work towards developing a system of quality assurance/quality review. 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. Brynsworthy DS0000059603.V264486.R01.S.doc Version 5.0 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 Brynsworthy DS0000059603.V264486.R01.S.doc Version 5.0 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): 0 EVIDENCE: Standards 1 to 5 were assessed as met at the last inspection and were not inspected in depth on this occasion. Brynsworthy DS0000059603.V264486.R01.S.doc Version 5.0 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): 0 EVIDENCE: None of the above standards were inspected in depth of this occasion. The key standards 6, 7 and 8 were all assessed as met at the last inspection. Brynsworthy DS0000059603.V264486.R01.S.doc Version 5.0 Page 10 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, 16 & 17 The work done by the manager and staff to identify suitable activities for the service users to participate in is good but low staffing levels continue to restrict some planned outdoor activities. The staff interact well with the residents and are actively encouraging them to accept more responsibilities. EVIDENCE: Each of the service users has complex needs and can display challenging behaviour. None of them are currently able to find employment but evidence, in the form of weekly diaries, demonstrates that the acting manager and staff are working with the residents to increase both their planned and informal activities both at home and outside in the community. The weekly diaries also show that the staff are working with the service users to enable them to play a more active role within their home by contributing to the housework and meal preparation. The staff rotas demonstrate that the home continue to operate with staffing levels that are not high enough to meet Brynsworthy DS0000059603.V264486.R01.S.doc Version 5.0 Page 11 the assessed needs of the service users and so not all planned activities can safely take place. An inspection of the weekly menu plans demonstrated that the service users are being encouraged to choose what they would like to eat at lunch times and conversations with the manager identified that the service users participation in menu planning had increased. Each of the service users has his or her own bedroom with an en-suite bath or shower room. The bedrooms are all lockable but the service users do not hold their own keys and cannot lock their bedroom doors from the inside or outside. This was discussed with the manager and consideration should either be given to changing the locks to make them better suited to the service users needs or, if it is practicable to do so, setting individual goals for each of the service users to enable them to work towards holding their own keys. The staff and other service users clearly respect each others right to privacy and although one to one support is commissioned for each of the service users within their home, and made available most of the time, the service users need to spend some time alone in their rooms is respected. The service users are treated with respect by the staff and the individual interaction between the service users and the staff was observed to be good. Brynsworthy DS0000059603.V264486.R01.S.doc Version 5.0 Page 12 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): 19 & 20 The staff are conscientious and doing everything they can to ensure that the residents physical and emotional health care needs are met. The service users medication is handled safely and conscientiously by the staff, however, the records could be clearer. EVIDENCE: Two of the service users have the support of a specialist Social Service care managers. The other two service users do not have named Social Service care managers but support can be provided if requested through the Social Service ‘Helpline’. All four service users are registered with a consultant psychiatrist who is employed by the Devon Partnership NHS Trust and who maintains regular contact with them. The service users are all registered with a dentist, optician and GP and receive regular check ups and, when necessary, treatment. One of the service users is registered with a chiropodist. The staff monitor the service users mental and physical well being on a daily basis and report any concerns that they have to the relevant healthcare professional in a timely manner. The service users all have severe learning disabilities and would not be able to manage their own medication. The service users medication is kept in a locked medicine cabinet in the office. The records of medication administration were Brynsworthy DS0000059603.V264486.R01.S.doc Version 5.0 Page 13 seen and were generally satisfactory but there was one entry that was confusing as it was unclear whether or not a prescribed item had been discontinued. The manager said that a Pharmacy check had been carried out in October 2005 and that no recommendations were made. Brynsworthy DS0000059603.V264486.R01.S.doc Version 5.0 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 the following standard(s): 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 home has policies and procedures to protect the service users from abuse. These include adult protection and the 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’. Most of the staff have attended professionally run training courses on adult protection and abuse. All of the service users have complex needs and can display challenging behaviour. There have been a number of incidents where the staff have been attacked and regulation 37 notices are being sent to the Commission so that this can be monitored. The staff have been trained to use gentle teaching, breakaway techniques and, as a last result, methods of control and restraint. In the last inspection report it was recommended that in order to insure that the staff are not contravening the service users legal rights, the service providers should ensure that any form of restraint used have been approved by the multi-disciplinary support team and/or the Ethics Committee. The manager said that she had not been successful in gaining this approval. Brynsworthy DS0000059603.V264486.R01.S.doc Version 5.0 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 the following standard(s): 0 EVIDENCE: The key standards, 24 and 30, were assessed as met at the last inspection and were not inspected in depth on this occasion. It was, however, noted that additional furniture, pictures and ornaments had been brought into the home and that these additions had given the house a much more homely appearance. Brynsworthy DS0000059603.V264486.R01.S.doc Version 5.0 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 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, 33, 34 & 35 The care staffing levels are not always high enough to meet the assessed needs of the residents and this can place restrictions on their activities and have a detrimental affect on their behaviour. Safe staff recruitment practices are used to ensure that unsuitable staff are not employed to work with the service users. The system in place for identifying the staffs training needs and achievements is good but there are still some gaps in training provision. EVIDENCE: Each of the service users has been assessed as needing one to one care within their home. Three have been assessed as needing two to one support outside their home environment and one as needing one to one support. The staff rotas for September/October and October/November show that there are frequently only four care workers on duty. This does not provide high enough staffing levels to meet the assessed needs of the residents. The rotas also show that care workers frequently work double shifts. Shifts of fourteen or eighteen hour duration are not recommended as the work can be very stressful and the care staff can become overtired. The manager has drawn up a chart to identify the staffs training needs and achievements. The chart identifies that specialist training in the care of people Brynsworthy DS0000059603.V264486.R01.S.doc Version 5.0 Page 17 with learning disabilities, as well as health and safety related training. There are gaps in the provision of training that still need to be met. Eight of the care workers have started working towards gaining an NVQ at Levels 2 or 3 in Care. Progress has been slow but the manager said that this was because they were experiencing delays in having their completed modules assessed and returned. An inspection of staff files shows that the manager is using safe methods to recruit staff. The manager said that any applicants for vacancies are asked to bring the documentation needed to send for an Enhanced CRB check to their interview with them. This is checked and recorded and will be destroyed is the applicant is not successful. For successful applicants the Enhanced CRB check will be sent for as soon as they have been offered and accepted the post. POVA First checks are also being carried out. There is an induction programme for new staff but an inspection of a sample of induction training records demonstrated that there were gaps in provision. The staff seen and spoken with during the inspection were all observed being very attentive to the service users and working well with them. Brynsworthy DS0000059603.V264486.R01.S.doc Version 5.0 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 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 The acting manager is competent and able to manage the everyday running of the home well, although the provision of management support and oversight is poor. There is no structured quality assurance/quality monitoring system in place to ensure that the service users views underpin the development of the home. The premises are well maintained and the safe. EVIDENCE: The person formerly registered as manager has been transferred to another home and the deputy manager has been promoted to manager. She has applied to the Commission be registered and her application is currently being processed. The acting manager is working towards gaining her NVQ in Care at Level 4 and her Registered Managers Award and the staff training records demonstrated that she is updating her skills and knowledge. There is currently no structured quality assurance/quality monitoring programme in place to ensure that feedback on the service provided and how the service should develop can be obtained from the service users, their families and other representatives. However, the manager has started to Brynsworthy DS0000059603.V264486.R01.S.doc Version 5.0 Page 19 develop a system and has written to the service users families to ask them to give their views on how well the service is meeting the service users needs. The premises are regularly inspected by an estates manager who is employed by the Company and records are kept of this. Services and appliances are regularly serviced. A COSHH risk assessment has been carried out and recorded. Risk assessments have been carried out on working practices and on the premises. There were no records available for inspection at the home to show that regular monthly visits are being made by a representative of the persons in control. Brynsworthy DS0000059603.V264486.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 2 13 X 14 X 15 X 16 2 17 Standard No 31 32 33 34 35 36 Score X 2 2 3 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Brynsworthy Score X 3 2 X Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X 2 X DS0000059603.V264486.R01.S.doc Version 5.0 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 YA12 Regulation 18 Requirement Timescale for action 08/12/05 2 YA20 13 3 4 YA32 YA33 18 18 The staffing levels must be maintained at a level that is high enough to enable the service users to participate safely in valued and fulfilling activities outside their home. The information provided on the 08/12/05 medication administration record sheets must be kept clear and up to date. The staffs identified training 08/04/06 needs must be met. 08/12/05 The staffing levels must be maintained at a level that is high enough to meet the assessed needs of the service users. Previous timescale for compliance 12th August 2005 – not met. To ensure that the staff are competent at all times, the practice of working double shifts must stop. Previous timescale for compliance 12th August 2005 – not met. As requirement 3. A representative of the persons DS0000059603.V264486.R01.S.doc 5 YA33 18 08/12/05 6 7 YA35 YA42 18 26 08/04/06 08/12/05 Page 22 Brynsworthy Version 5.0 in control must visit the home at least once a month and provide copies of his report to the persons in control, the manager of the home and the Commission. 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 YA16 Good Practice Recommendations In order to protect the privacy and dignity of the service users, staff and visitors to the home a suitable lock should be fitted to the communal bathroom door. The locks on the service users bedroom doors should either be changed to provide locks that a suitable for their needs or individual goals should be set to enable the service users to work towards holding their own keys. 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 by the Ethics Committee. Introduce a structured quality assurance/quality monitoring system based on seeking the view of the residents and their representatives. 2 YA23 3 YA39 Brynsworthy DS0000059603.V264486.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. 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