Inspection on 03/09/07 for Bryony Lodge

This inspection was carried out on 3rd September 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 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

Bryony Lodge 16/10/06

Bryony Lodge 06/09/05

Bryony Lodge 19/04/05

Bryony Lodge 24/01/05

Bryony Lodge 17/06/04

Bryony Lodge 13/02/04

Similar services:

Flint House

The Cotswold Home

Fairways

Treloar College

Rush Court

The Maypole Nursing Centre

Fir Tree Lodge

Chilmington House

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

CARE HOME ADULTS 18-65 Bryony Lodge 19 St Mary`s Road Hayling Island Hampshire PO11 9BY Lead Inspector Tim Inkson Unannounced Inspection 3rd September 2007 09:00 Bryony Lodge DS0000028547.V344515.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 Bryony Lodge DS0000028547.V344515.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. Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bryony Lodge Address 19 St Mary`s Road Hayling Island Hampshire PO11 9BY 023 9246 0358 02392 463446 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) Mr A Rutter Mrs J V Rutter Mr Shaun David Brough Mrs J V Rutter Care Home 9 Category(ies) of Physical disability (9) registration, with number of places Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user (date of birth 27/09/65) in the LD category may be accommodated at the Home. 16th October 2006 Date of last inspection Brief Description of the Service: Bryony Lodge is a large modernised house, furnished and decorated in a contemporary style, and is set in a quiet residential street on Hayling Island. The home is registered to accommodate nine younger adults with physical disabilities including one service user with a learning disability. The people who live at this service make use of the local shops that are within walking distance, and use public transport or the homes mini bus. The home is able to accommodate service users who use wheelchairs. All service users have ensuite bathrooms and these contain assisted bathing facilities. When a vacancy arises the home notifies a number of local authorities. When an approach is made by people interested in living at the home or social care professionals on their behalf they are sent some literature/information about the home and the service it provides and then invited to visit the home. A “clients book” with a copy of the home’s service users guide and copies of reports of all the inspections of the home is readily available in the home’s communal lounge. At the time of the site visit to the home as part of its key inspection the weekly fees ranged from £450 to £1,000, and this did not included the cost of items such as, hairdressing, newspapers, and toiletries and other sundries. Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was part of the process of a key inspection of the home it was unannounced and took place on 3rd September 2007, starting at 08:45 and finishing at 15:30 hours. During the visit accommodation was viewed including bedrooms, communal/shared areas and the home’s kitchen and laundry. Documents and records were examined and staff working practice was observed where this was possible without being intrusive. People living in the home, staff and visitors were spoken to in order to obtain their perceptions of the service that the home provided. At the time of the inspection the home was accommodating 9 people, of these 6 were female and 3 male and their ages ranged from 31 to 62 years. They had a range of complex needs including impaired mobility and difficulty with communication and all required either assistance or supervision and prompting with dressing and undressing and bathing, as well as other intimate personal care needs. The home’s registered manager was present during the visit and was available to provide assistance and information when required. The registered provider/owner was also available for discussion at times during the visit. Before the site visit took place, relatives/representatives of people living in the home and health and social care professionals that have contact with the establishment were canvassed for their views about the home using questionnaires. Their responses were taken into consideration when producing this report. Other matters that influenced this report included: An Annual Quality Assurance Assessment completed by the registered manager in which he set out how he believed the home met and planned to exceed the National Minimum Standards (NMS) for Care Homes for Adults (18 –65) and evidence to support this. A “dataset” containing information about the home’s staff team, and some of its managements systems and procedures. Information that the Commission for Social Care inspection had received such as statutory notices about incidents/accidents that had occurred. What the service does well: There was detailed written information available about the complex needs of the people that lived in the home that enabled the staff to provide the specific help and support that each individual required. The home promoted equality and diversity and its routines were flexible. Individuals were routinely consulted about the service they received and able to influence day- to-day life. They were encouraged and supported to make choices for themselves and use the amenities in the local community. The building was comfortable, well furnished and decorated. Confidence in the home’s management was expressed by; people working there; relatives of people living in the home; and health and social care professionals that had contact with the home. Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 6 There was a commitment to staff support, training and development to ensure that they were able to fulfil their roles and responsibilities and meet the complex and diverse needs of people living in the home. What has improved since the last inspection? 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. Bryony Lodge DS0000028547.V344515.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 Bryony Lodge DS0000028547.V344515.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had systems and procedure in place to identify the help people needed before they moved in order to ensure that the home could properly provide it. EVIDENCE: There had been one admission to the home since the last inspection of the establishment on 16th October 2006. The documentation for this individual was examined and it indicated that the registered manager had visited the person concerned where they were living before they moved into the home. The purpose of the visit was to collect information about the abilities of the individual and ascertain the type of assistance and level of staff support that they required. The documentation also included a comprehensive assessment of the person’s needs carried out by the adult services department of the local council funding the individual. There was also a detailed plan of care setting out what help the individual required, how it was to be provided and who was responsible for carrying out various actions, that had been developed by the same department. The individual concerned was spoken to and she said: • “I came in April … Shaun (the registered manager) came to see me, to see if I could move here …”. Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 9 The home encouraged people considering moving into the home to visit as part of the admission process and in order to observe them in the environment that they could eventually live in and identify what their specific needs and requirements were and how they could be accommodated. Social care professionals canvassed for their views before the site visit took place indicated that, the home’s “assessment arrangements ensure that accurate information is gathered and that the right service is planned and given to individuals”. Bryony Lodge DS0000028547.V344515.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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had systems and procedures in place for planning the care and support that people received. People were helped to exercise choices about day-to-day life. The potential of harm to individuals was identified and plans were put in place to promote responsible risk taking. EVIDENCE: The records were examined of 3 people living in the home. These records included comprehensive plans setting out details of the support that each of them needed and how it was to be provided. The plans focussed on the choices and wishes of the individual indicating that “person centred planning” was the principle upon which they were based. e.g. “E gets up at 7:30 or 9:30 depending on whether he is going to the day centre. He will press the buzzer when he wants to get up … He will say what he does and does not like … ”. They plans clearly described how the help that a person required was to be provided and how independence and choice was to be promoted. Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 11 e.g. “Staff need to put toothpaste on the brush and he will clean his teeth himself … he will choose what clothes he wants to wear …”. The risk associated with all the help and support an individual required were identified in the care plans and they also included personalised fire evacuation plans. e.g. “Has a good understanding of evacuation procedures but because of hearing impairment may not hear the fire alarm …”. Where an individual had specific communication needs there were clear instructions in plans of how this was addressed. Individuals’ likes and dislikes and food preferences and leisure/social interests were clearly documented. Where plans indicated that special equipment, medication or specific support was required this was noted to be available and provided e.g. plate guard and food cut up at mealtimes; cream for skin care; overhead hoist; wheelchair: etc. There was documentary evidence that care plans were reviewed regularly and people living in the home were involved in the development of their plans and where they were able to they agree their contents. This was also confirmed in discussion with individuals and their relatives and care managers. Discussion with staff during the site visit indicated that they were familiar with the contents if the care plans and the specific needs of individuals living in the home. The home operated a key worker system that enabled good relationships to be promoted and develop between staff working in the home and the people living there. Responses from questionnaires sent to relatives of people living in the home and social and healthcare professionals that have contact with the home indicted that all were of the view that the home responded to the different needs of individual people. One care manager/social care professional commented: • “There is good personal care and support and communication. It has a good person centred approach and pays attention to peoples emotional needs”. People living in the home that were spoken to confirmed that they received all the help and support that they required from the staff in the home and their comments included the following: • “They help me with everything … “. Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 12 • • “The staff are very good and very kind … they help me with anything that I can’t do myself …”. “I need help with everything and I get it … ”. During the site visit it was noted that staff discussed decisions and choices with people living in the home about a range of matters, such as activities they wished to pursue and food to be eaten. Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 13 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 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home promoted the right of people living in the home to live ordinary and meaningful lives. They were supported to take part in social, educational and recreational activities and to develop life skills. EVIDENCE: It was apparent from records kept by the home, observation and discussions with individuals that people living in the home were able to pursue their own particular hobbies or interests and these were noted in their care plans. Daily notes and a record of activities indicated that individuals were also supported to use amenities in the local community such as pubs and restaurants, shops, and banks and that they went out regularly for to pursue individual and group activities such as going to local places of interest or going to social clubs, attending football matches, and some individuals attended local churches. Some individuals had an annual holiday while others went out for day trips depending on their choice or preference. The home had a vehicle that was used to convey people to places they wished or needed to go but one individual preferred to make her own arrangements and used taxis to go out. Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 14 Most people living in the home attended day services for part of the week where they had the opportunity to pursue educational courses and also develop and learn life skills e.g. cooking, as well as socialise. Staff also supported individuals with such activities at the home within limitation imposed by the size and type of equipment in the home’s kitchen. Comments about these matters from people living in the home who were spoken to included: • “I go to the Horizon Centre where I do needlework and cook cakes and tarts … I go to the local shop and the shops … I have several friends that visit me … “. • “I go to the day centre and I do crosswords there … On Saturdays I watch football, I go and see Portsmouth … I also watch football on my television … I go away on holiday sometimes … ”. • “ I am going to day services to do adult education …”. Responses from questionnaires sent to relatives of people living in the home and social and healthcare professionals that have contact with the home indicted that all believed that the home provided support to individuals to live the life they chose wherever possible. One individual living in the home said: • “I can do what I want. I get up and go to bed when I want … I use taxis when I go out ” Regular contact was maintained between people living in the home and their relatives and friends. One individual ‘s relative who was spoken to said that their daughter spent alternate weekends with them. Seven of the people living in the home had their own single rooms with ensuite facilities. This fact helped to promote their right to privacy and staff were clearly expected to knock on bedroom doors and seek permission to enter them and people spoken to indicated that they did. Individuals were offered keys to enable them to lock their own rooms if they were able to use one wished to do so. It was also apparent from where individuals were seen in the building during the site visit that they were free to choose whether to be alone or to mix with others living in the home. There was screening available in the one shared bedroom in the home in order to promote privacy. A person’s preferred form of address was noted in their plan of care and during the site visit staff were noted to be using them. Responses from questionnaires sent to relatives of people living in the home and social and healthcare professionals that have contact with the home indicted that all believed that the home respected individuals’ privacy and dignity. The home had a 4 -week menu. The home’s registered manager said: Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 15 • “We sit down with the clients and discuss what they want and like and we have a winter and summer menu. Ther are always 2 options on the menu. If they don’t like what is there we ask them what they want and prepare it”. The food provided each day was recorded, particularly if someone had something different to what was on the planned menu. If required the food and fluid intake for an individual was monitored. It was evident that the food provided was varied and took into account individuals’ preferences that were recorded in their care plans and people spoken to said that they enjoyed the food. Comments form people living in the home about the food included: • “The food is quite alright actually … “. • “The food is wonderful … we get as much as we need … we get a choice, we have options for our main meal …”. The menu was varied and it was evident that the home attempted to promote healthy eating. There was fresh fruit readily available and evidence that fresh vegetables were used in meals. At the time of the site visit no individuals required special diets although one person’s care plan included an “eating plan” that referred to a low fat diet and all staff spoken to were aware of this and tried to encourage the person to adhere to this. Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 16 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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people received was based on their individual needs and their medication was managed safely. EVIDENCE: The care plans examined (see section about “Individual needs and Choices” above) set out in detail how the help and support an individual needed with matters such as personal hygiene and physical care was to be provided. The home operated a key worker system that ensured as far as possible consistency and continuity of support for individuals. This was illustrated when staff spoken to were able to describe the specific needs of the individuals whose care plans were examined and how these were met. Records examined concerning the people living in the home indicated that They received visits from or made visits to healthcare professionals when necessary. They were supported to attend routine and regular visits to dentist, opticians and the home had also arranged when required assessment and the provision of continence products through the relevant agency/service. The district nursing service provided support and treatment for individuals when necessary with dressings and trained the home’s staff to manage the care of a “stoma”. Heath care professionals who were canvassed for their views about the home indicated that individuals’ health care needs were promoted by the home”. Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 17 Comments about the home form this source included: • “They are caring. The staff appear involved with patients. The care manager, Shaun, is an excellent leader and he knows his patients and staff well … ”. The home had written policies and procedures about the management of medication. These were part of an “off the shelf” package and did not reflect the actual practice in the home. They referred to a different monitored dosage system of medication (i.e. Nomad) than was actually used in the home. They also referred to carrying out routine assessments in order to ascertain whether an individual could self medicate but there was no documentary evidence that this had been done. The home’s registered manager said that he would produce amended, accurate and home specific procedures without delay and would bear in mind individual’s rights and the expectations of the Mental Capacity Act when reviewing the policy and procedures about self-medication. At the time of the site visit one individual was looking after their own inhalers, but no other person was responsible for their own medication. Medicines were kept in a suitable locked metal cabinet and the home used a monitored dosage system with most prescribed medicines put into blister packs for a period of 28 days by a pharmacist. The exception being those that could not such as liquids or items that would deteriorate when removed from their containers. Records were kept of the receipt into the home of medicines, giving out and disposal of unwanted items and all were accurate and up to date. The home’s registered manager said that all staff received training in medication and had to spend some time shadowing and being observed dealing with medication before they were deemed competent. The home’s procedures required 2 staff to give out medication at all times. Staff were observed giving out medication during the lunch meal and were spoken to about the process. Their practice was appropriate and they were confident and knowledgeable about what they had to do. Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 18 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home had access to a complaints procedure that would enable the home to address their concerns. There was a system in place in the home to protect vulnerable adults from harm. EVIDENCE: The home had a clear and simple written complaints procedure and alternative version could be made available in suitable formats for individuals with special communication needs. People living in the home who were spoken to and relatives/representatives who were canvassed for their views about the home knew how to complain. Individuals in the home also expressed confidence in being able to raise concerns with the registered manager. • “Shaun is very good, If I was unhappy about anything he would sort it out …” • “I would speak to Shaun if I was unhappy and I would also speak to my Mum …”. The home had received no complaints during the 12 months preceding the site visit and the Commission for Social care Inspection had received none about the service during the same period. There were written procedures readily available in the home for the guidance of staff, about safeguarding vulnerable adults. These included a copy of the local authority’s adult protection procedures and related policies including “Whistle Blowing”. The home had taken delivery of some new “off the shelf” policies and procedures and the registered manager was advised to ensure that they were up to date and included clear reference to the local authority adults services Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 19 department as the agency with the lead responsibility for investigating any allegations or suspicions of abuse that may occur in the home. This was because the procedures the home had been using that were examined referred inappropriately to the home’s management conducting investigations of allegations of abuse”. The home had in the recent passed been proactive in making an appropriate referral to the relevant authorities of an allegation of abuse and all staff spoken to during the site visit had received training in the subject of adult protection and knew what to do if they suspected or knew abuse of a person living in the home had occurred. The home looked after the personal monies for some individuals living there and kept records of its receipt and any expenditure. These were compared with a sample of the balance of monies being held for some individuals and they were correct. It was noted that rails were used to protect some people from falling out of bed and injuring themselves. It was pointed out that such equipment can be used inappropriately and is considered a form of restraint. The home’s registered manager said that he would arrange to complete reviews and get these and the agreement of all interested parties for the use of bed-rails where their use was considered necessary properly documented. Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 20 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s environment was comfortable safe, and well maintained for the benefit of the people living and working in it. EVIDENCE: At the time of the visit the exterior and interior of the home was generally in good decorative order and its furnishings and fittings were in good repair. The premises were clean and hygienic. The registered provider/owner said that he had identified a number of areas of the home where replacement and refurbishment was needed. The use of a large number of wheelchairs in the home had resulted in some damage to the walls and doors in communal areas and a protective strip was being installed to provide some protection to these areas. There was specialist equipment installed to ensure that people could be provided with the help that they needed in a way that promoted the safety of themselves and the staff e.g. ceiling hoists. All bedrooms had en-suite baths or showers/wet rooms depending on the particular needs of the occupant. Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 21 Beds had been provided according to the needs of individuals and they included divan types and nursing beds (i.e. they could be raised and lowered and had built in bed rails). There was some signage i.e. symbols, that enabled people to identify or locate facilities such as the communal WC, which was also fitted with grab rails to help promote peoples’ independence. People living in the home that were spoken to all said that they liked their bedroom accommodation and that the home was kept clean. There was evidence from discussion with staff, relatives and people living the home that the condition of the building and its furnishings, décor and equipment was always being attended to. • “Tony (registered provider/owner) decorates the building regularly … the TV in the lounge started off with a big set now they have a plasma screen on the wall … they have had 2 or 3 washing machines, when one packs up it is just replaced … I can’t speak highly enough of the place … the carpet in the lounge was ripped up and replaced and there have been 3 new 3 piece suites ... the rooms are always clean …” (visiting relative). The home had written infection control procedures and one matter of good practice that was noted was the use of liquid soap and paper towels in the communal WC. The local environmental health offices report following a visit to the home on 17th August 2006 included the following statement: • “A good standard of food hygiene practice was observed during my visit. I was pleased to note the successful implementation of the “Safer Food Better Business” pack”. Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 22 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 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The recruitment, training, deployment level and skill mix of staff ensured the needs of people living in the home were met and their safety was promoted. EVIDENCE: At the time of the site visit the home’s staff team comprised 10 including the registered manager and of these 6 (60 ) had qualifications equivalent to at least National Vocational Qualification (NVQ) at level 2 in care and 1 other was working towards a relevant qualification. At the time of the site visit the minimum deployment of staff at any time was as set out below: 08:00 to 22:00 2 22:00 to 08:00 1 wakeful and 1 sleeping The manager was normally available from Monday to Friday from 09:00 to 17:00 and there was an additional member of staff on duty from 09:30 to 14:30 on Wednesday and Thursdays. The registered provider/owner lived on the premises and there was always a member of the home’s management team on call “out of hours”. Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 23 There were no concerns expressed from discussions with people living in the home, relatives or staff members about the levels of staffing in the home and one person said, “ There are always staff here if I need them”. Comments from staff about this matter included: • “Most of the time 2 is enough, but if they are all in it can be difficult to take them out, some days S comes which gives us a 3rd person to take them out and Shaun helps us as well”. • “Staffing levels seem to work because Monday to Friday there are usually 2 or 3 out at day services, so we can take them out shopping … we have an extra person on Wednesday and Thursday and so they go out then as well … Shaun also comes out and works with the clients when he has not got paperwork to do so it is OK … ” There was evidence that staff turnover was low and staff members that were spoken to expressed enthusiasm about working in the home and described working relationships with their colleagues as good and the work itself as enjoyable because they were able to take people and support tem to access the local community and worked in a pleasant environment. The records of 2 staff that had started work in home since the last inspection of the establishment on 16th October 2006 were examined. It was apparent that all the necessary pre-employment checks had been completed to ensure that anyone considered unsuitable to work with vulnerable adults was not employed. All new staff that were employed if they did not already have a relevant qualification completed a formal induction training programme that complied with the expectations of “Skills for Care” i.e. the social care workforce development body. There was evidence from examining staff records and discussion with staff on duty that there was strong commitment to staff training and development and also to ensuring that all staff received regular training and updates in heath and safety subjects that were regarded as essential. Responses from questionnaires sent to relatives of people living in the home and social and healthcare professionals that have contact with the home indicted that all believed that the home’s staff and management had the right skills and experience to look after the people living in the home properly. Comments from staff about their training and professional development included the following: • “I am doing NVQ level 3 or an advanced apprenticeship in health and social care … for my induction I was shown how to do procedures in care and I had to shadow staff for at least a week and I also did fire training and health and safety – I have done some in house training in health and DS0000028547.V344515.R01.S.doc Version 5.2 Page 24 Bryony Lodge safety, moving and handling, drug and alcohol awareness, vulnerable adults, stoma care, medication, basic food hygiene and first aid … one of my NVQ assignments is about privacy, dignity and choice …”. • “I had NVQ level 2 and 3 before I came here … I have done adult protection since then …”. The registered manager was arranging some training through partnership arrangements between the local authority and care homes in the independent sector. These included “train the trainer” courses that enables individuals to cascade/pass on their learning to other staff. He was planning to do this in among other subjects, infection control, medication management and managing a safe home. It was suggested that it would be beneficial to arrange training for staff in subjects about the specific needs of some of the people living in the home to increase their knowledge and understanding of matters such as; multiple sclerosis; epilepsy; strokes; etc. Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 25 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 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s registered manager provided effective leadership There were systems and procedures in place for monitoring and maintaining the quality of the service provided and also for promoting the safety and welfare of everyone living and working in the home. EVIDENCE: The home’s registered manager was very experienced with some 27 years of working with young adults with complex needs including “profound challenging behaviour”. He had obtained relevant competency based qualifications including the registered managers Award in 2006. He was also arranging to attend some training arranged through the local authority (see previous section) that would ensure that he kept up to date with developments in social care practice. From discussion with the registered manager, and from observation and discussion with staff, people living in the home and comments from people whose views were canvassed about the management of the home. It was Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 26 apparent that the registered manager was; motivated; enthusiastic; sensitive to and understanding of the needs of both the home’s staff team and the individuals accommodated there. Comments about his qualities and management approach of the home included: • “The care manager, Shaun is an excellent leader and knows his patients and staff well … “ (healthcare professional). • “Shaun is good to talk to, he knows his stuff …” (member of staff). • “Shaun is approachable. You can talk to him about anything … he sorts out problems … he generally knows anything that you ask him …” (member of staff). • “Shaun is a lovely bloke and nothing is too much trouble for him …” (visiting relative). • “Shaun is very good … “ (person living in the home). The home regularly used questionnaires to obtain the views of people living in the home about the quality service that it provided and regular “residents meetings” were held by the home at which individuals were able to comment about everyday issues that were important to them. As a result of consulting the people that lived at Bryony Lodge the home had altered menus, built a covered pergola area in the grounds of the home, altered the colour scheme in the building and arranged more and different activities. All people living in the home that were spoken to expressed satisfaction with living in the home and their comments included the following: • “ … I would not go anywhere else …”. • “ … This is the third home that I have been in and it is the best one … “. • “ … I like it here …” Comments form relatives/representatives in questionnaires returned before the site visit took place about the things that they thought the home did well included the following: • “It is a friendly and happy environment”. • We can find nothing but praise for this lovely caring home. It is a home from home, what more can parents ask for?” • “The home have amplified his strong points and taught him to speak up for himself and carefully mapped out a programme of development that is achievable for, for example to go on holiday. A small goal perhaps, but not for him”. • “It has a lovely homely atmosphere”. There were a range of written policies and procedures in the home that influenced staff working practice and staff spoken to said that they found them helpful to refer to when they were uncertain about something. They included a policy about equal opportunities and instructions in a care plan about Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 27 supporting an individual who wished to smoke exemplified the home’s approach to equality and diversity. e.g. “X must not be refused the opportunity to have a cigarette just because of the prejudice that people may have against smoking”. Records seen, observation and discussion with staff indicated that safe working practices based on risk assessments were promoted in the home and that fire safety systems and other systems and equipment (e.g. gas appliances and system; hoists; portable electrical appliances; etc) were checked. Also that chemicals used in the home were stored safely and staff had received fire and other health and safety training. Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 28 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 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 3 x Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 29 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. Refer to Standard Good Practice Recommendations Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Bryony Lodge DS0000028547.V344515.R01.S.doc Version 5.2 Page 31 - 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!