Inspection on 17/08/07 for Burgess House (Flat A)

This inspection was carried out on 17th August 2007.

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

The inspector found 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

Burgess House (Flat A) 09/05/06

Burgess House (Flat A) 08/12/05

Burgess House (Flat A) 19/04/05

Burgess House (Flat A) 12/10/04

Burgess House (Flat A) 15/04/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Burgess House (Flat A) 3 Blyth Road Bromley Kent BR1 3RS Lead Inspector Wendy Owen Unannounced Inspection 17th August 2007 09:30 Burgess House (Flat A) DS0000006938.V360951.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 Burgess House (Flat A) DS0000006938.V360951.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. Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Burgess House (Flat A) Address 3 Blyth Road Bromley Kent BR1 3RS 020 8460 0636 020 8460 0597 bromleyautistic.trust@btinternet.com 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) Bromley Autistic Trust Mrs Pauline Cremore Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 360951 Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th May 2006 Brief Description of the Service: Burgess House is owned by Kelsey Housing and leased to the Bromley Autistic Trust (BAT). The premise comprises four flats with the ground floor flat (the home) being the registered establishment. The remaining flats are leased to tenants who are provided support through BAT. The home is registered to provide care to four adults between the ages of 18 and 65, with learning disabilities, specifically autism. Bromley Autistic Trust is a local organisation that has a range of services, including three care homes and a day centre, operating within the Bromley area. All referrals and placements are made through the Bromley Social Services and people using the service attend the day centre located a few doors away. Burgess House is located on a residential road within walking distance of Bromley town centre and its good transport links, as well as excellent shopping facilities. It has four bedrooms, large and small lounge, two bathrooms/WCs and a kitchen. There is a large rear garden, which houses a sensory equipment and games. The home is staffed by a Manager and support workers, providing 24-hour care. These staff also provide support to the residents in the remaining three flats. There is access to specialist health services via the Bassetts Centre, which also accommodates the adult learning disability team. Service users access a range of activities through a variety of outlets, including the Trust’s day centre and community activities. Placements to the home are made in line with the Service Level Agreement between BAT and Bromley Social Services. The inspector is awaiting information on the current fees. Residents pay privately for newspapers, personal telephone calls, hairdressing, some activities, toiletries and medical services not provided by the NHS. Payment towards transport costs are taken from individual mobility allowances. Information in the form of a Service Users Guide and Statement of Purpose are available for people interested in the service, although these are currently not Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 5 all in a format suitable for people with communication difficulties. Copies of inspection reports are included in this information. Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit to the home, viewing of the recently completed assurance assessment (AQAA) and the information held on the file. The inspector also received four comment cards from residents (supported to complete by staff); three from relatives and one from a Care Manager. The inspector also had a brief discussion with a member of the Speech and Language team. The visit took place over one and a half days. The second day visit was made to coincide with residents returning from the day centre. During the visit the inspector had discussions with the manager, a staff member and, briefly, with one resident. Records were also viewed and observations of the day to care practices were also observed. A tour of the home also took place. The main response and feedback detailed in this report has been provided by relatives and health professionals through surveys. What the service does well: Burgess House provides a relaxed, yet stable and structured environment, for those living there. Each person had been provided with details of their terms and conditions and what the home has to offer, in a way that they may be able to understand. Staff provide a positive environment where communication in different forms is important. The staff have good information on how they may best provide the support for each individual that is person centred and with residents and family involvement in these decisions. They try to balance everyday risks with promoting independence and choices. “ I think the care services tries to support the people to live their lives within their own capabilities to reach their potential.” Residents are stimulated through a variety of activities, balancing leisure with structured daily living activities to promote some independence and involvement. Four of the five residents are due shortly to go on their annual holiday to Butlins in Minehead, a holiday chosen by them. One relative wrote of the home: “Thanks to the staff’s efforts, X receives a variety of activities which I was unable to provide when X was at home” Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 7 When asked what they like to do one resident said “go to the pub”, “go shopping” They do their best to encourage each person to be involved in their own care with basic decisions and choices being made on how they wish to live. “I think the care home tries to get the best out of the clients with a great deal of care and support.” Said one relative. Residents are supported in their health needs by ensuring regular access to both NHS and specialist healthcare and sound systems for medication administration. They have sound relationships with the Community Learning Disability team that enables them to support each individual in their changing needs. They “did an excellent job on understanding the health needs of my service user, especially difficult as he cannot feel pain due to autism.” Wrote one individual. There are good systems to ensure any concerns are listened and responded to ensuring individual care is improved. They also ensure each person is protected from abuse with procedures and practices together with a staff understanding of what they could do if confronted with allegations of abuse, therefore minimising the risks to individuals. One relative wrote when responding to a survey: “I cannot suggest anything which could improve the care bearing in mind the difficulty of communicating with my X.” The manager is qualified and experienced in the care of people with autism and uses this knowledge to look at ways of improving the service as well as ensuring the health and safety of those in her care is maintained. What has improved since the last inspection? Since the last inspection the way in which medication is administered and recorded has improved with good records in place. Adult protection procedures have been reviewed and now provide staff with updated guidance that reflects good practice and ensures residents are protected. There has also been some progress in changes to the environment with a new hall carpet providing a more welcoming entrance and one of the bathrooms has been recently painted. Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 8 There has been some improvement in the monitoring undertaken by the Provider with reports being written on the outcome of the visits and in the way in which residents monies are maintained. There is now a clear recording system with receipts in place. 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 Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 9 be made available in other formats on request. Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 10 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 Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 11 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): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has procedures in place to ensure prospective residents are able to make a decision on whether the home is suitable for them. This could be further improved by providing all information on the home in a way that each individual is able to understand. EVIDENCE: The home has developed a Statement of Purpose and Service Users Guide in order to provide information to prospective residents and their family or other representatives. The Statement of Purpose is in the written format and not suitable for prospective residents whose disabilities mean their literacy and communication skills are less developed. At the last inspection the manager stated that both documents were being reviewed. However, this has not happened and it remains in the same format. It is not possible to make a judgement on whether information is sent out to prospective residents before admission, as commented on in the last inspection, as there have been no new referrals or admissions. (See recommendation) Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 12 The Service Users Guide is produced in a simple easy to read format with associated pictures and symbols. Each resident has a copy of the “Guide” kept in their room. I noted that they contain details of fees paid for each resident. This information should just relate to the one individual. The manager stated that she is looking to providing this information in other ways such as taps or video to enable residents to have a better understanding of what the home has to offer. We look forward to viewing this. There have been no new admissions since the last inspection, although policies and procedures provide comprehensive guidance for staff on managing referrals and admissions to ensure they are able to make decisions on whether they are able to meet the person’s needs. Referrals are made through Bromley Social Services departments with assessments provided by the Care Management team. The manager also assesses the individual to ensure the home can meet their needs. Integral to this is the prospective resident being invited to the home to meet with staff and other residents. This can take place over more than one occasion to ensure the dynamics of the home are balanced. It is evident from the feedback that the staff have the knowledge and understanding to support residents with autism. The Manager is aware that, once the home has agreed after assessment that they are able to meet the individual’s needs, this must be confirmed in writing. All residents are funded by the Local Authority, with agreement on the care and support detailed in the Service Level Agreement between BAT and the Local Authority. There is also a tenancy agreement between the Housing Association and the tenant (resident) and BAT has recently developed a new contract between the home and resident. The files viewed contained evidence of the tenancy and placement agreements. Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good information is provided to staff to ensure they are able to give support to residents in meeting their individual needs. Staff encourage residents to be involved in the care provided and to make basic choices to enable them to make basic decisions on the way they wish to live. EVIDENCE: I received feedback from three relatives, four residents and one Care Manager. The feedback provided positive comments on good care and support provided by the staff, as well as the way they have enabled residents to improve in many areas of their lives. “ I think the care services tries to support the people to live their lives within their own capabilities to reach their potential.” Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 14 Residents within the home have various abilities to communicate and the staff encourage each person to communicate through pictorial form, the TEACHH system of signs and symbols, as well as verbal communication. I saw evidence of the pictures in use for the different residents. This enables some residents to make basic choices and decisions. However, this is often limited due to the level of understanding. I also observed staff interacting with residents in a simple and clear way that enabled the person to understand. It was also clear from the observations that staff are aware of how each person communicated to them through actions rather than words. There was evidence of residents’ meetings taking place regularly. These were found to focus each time on leisure activities, food preferences and outings. I suggested that the scope of the meetings could be widened to include other areas. (See recommendation) Care plans are developed for each of the four residents. These detail the care and support required for the residents. Two individuals’ file were viewed in detail and were found to contain guidance on care and support required and a support plan. The guidance is individualised and comprehensive to ensure staff give care and support in a structured way that is suitable for each person. One example is that one resident receives personal care after breakfast while others prefer to shower and dress before eating. They generally meet the needs of the individual, although more information could have been documented regarding medication and finances which had been completed by the second day of the inspection. Feedback showed that the resident, and their family member, are involved in the care provided, attending regular reviews with the Manager, key-worker and Care Manager. For one person their care had been reviewed in April 07, but since that time there had been further changes. A reassessment by social services had taken place but the care plan had not been updated to reflect some of the changes. This, once again had been completed by the second day of the inspection. There were good guidelines in respect of daily routines and leisure activities and risk assessments had been developed where required and updated. Once again I noted that one risk assessment had not detailed fully the risks or when it was likely to happen. This may be potentially dangerous, especially if new staff were to support the resident and were not aware of the full risk. Each resident is supported by a keyworker who has specific responsibilities for that person. The home is also in the process of purchasing a lockable fridge for the kitchen to minimise the risks relating to the one resident. This obviously restricts other residents. Perhaps the home should also consider purchasing a small fridge for the individual’s room that contains some acceptable small amount of foodstuff in it. (See recommendation) Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 15 There was evidence of multi disciplinary input into the residents’ care with documentation from a speech and language specialist, dentist, GP, consultant psychologist, the day centre and chiropody. Discussions with a health professional who has supported the home with one resident in particular shows that they have tried to implement the plans determined by the professional but this has not always been successful, possibly due to the residents lack of motivation. Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Most of the residents enjoy a varied and stimulating lifestyle that matches their expectations. They are provided with meals that are nutritious and varied ensuring a healthy diet. EVIDENCE: On the second day of the inspection I visited the home when three of the four residents returned from the day centre located a few doors away. They were due to go to the Gateway club that evening and the time between returning from the day centre to going out can be a time of excitement and agitation. The staff showed that they understood this and provided residents with a calming environment at this time. The records viewed and observations made during the visits showed three of the four residents to be attending a variety of activities. These include the day Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 17 centre, shopping; pubs; bowling; visits to the park; Gateway project and drum workshop. The home also intends to increase the number of train rides taken as residents also enjoy these. One resident, speaking with a member of staff and the inspector, spoke of shopping trips, visits to pubs and drumming lessons. They also like to colour, especially when there needs to be a calmer time. For one resident there has been a shortfall in this area due to their changing needs and staffing levels in the home. These are determined by the Service Level Agreement (SLA) and do not provide for one to one care. This has left the resident, until very recently, without community contact. Although they have been in receipt of in-house day care, the current level of dependency means there needs to be a two to one staffing to ensure the safety of the resident whilst outside of the home. This has not been possible until recent agreement with social services. It is now hoped that the resident will be provided with activities and stimulation to further meet his needs. Each year the residents choose a holiday and, despite the efforts of staff to vary the choice, they continue to want to go to Butlins (somewhere they know). So very soon three of the four supported by staff will be off on holiday for a week away. It is clear from discussion with staff and feedback that residents families continue to play a large part in their lives with most having frequent visits to the family home. It is also good to note the attendance of at least two residents attending the local church on a Sunday. Residents receive a varied diet with a daily hot meal provided at the day centre and an evening meal in the home. The choices are shown to residents through a pictorial format, although likes and dislikes are also noted to ensure they are offered foods they like and meals are discussed during the residents’ meetings. The manager is also planning to ensure the alternatives offered are noted to ensure they can monitor nutrition and food intake. The mealtimes are structured as residents require the predictability and routine, otherwise they can become very anxious. On the second day of the inspection one resident told the inspector of the fish and chips due that evening which they were looking forward to. Each person takes it in turn to be involved in the preparation, shopping, setting the table and clearing away, according to the roster. This input varies between individual dependency but all are encouraged and supported. Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are provided with good information on the way they support residents in their personal care that is individual and in their preferred way. Healthcare needs are met through sound medication procedures and practices and access to the healthcare required. EVIDENCE: The manager and staff have developed clear and detailed guidelines on how to support residents in their personal care, dressing and grooming. In the two files viewed the guidelines are specific and individualised according to the resident’s ability and needs. Residents are encouraged to do things for themselves with staff support, and guidelines are specific in this. Residents also choose their clothing for the day and often purchase personal items and clothing during shopping trips. During the visit the inspector overheard one resident having a discussion with a member of staff on what they would be wearing out that evening, showing that they make these decisions and not staff. Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 19 Previous comments have detailed how the home should ensure that the guidelines are up to date. For example, the grooming and continence issues etc. No residents currently require assistance and support with mobility. The files viewed also contained good details of risk assessments and healthcare support required with epilepsy guidelines in place and evidence that seizures are being monitored with support from specialists. The inspector has commented previously the need to ensure risk assessments are specific to ensure there is clear information for staff on risks and how to manage these. There were also comprehensive health questionnaires recently completed (OK Health Check) and the support plan detailed any healthcare checks required, including dentist and optician for staff to follow up. Records viewed contained information on various NHS and specialist healthcare appointments. Where residents are not complaint with medical examination of intervention this is made clear from the records and health professionals supporting them are made aware of this. The home also records all such refusals. Some residents receive support regarding their medication needs from the psychiatry team and these are reviewed regularly to try and improve the persons overall well-being. Prescribed medication is supplied from a local pharmacist, mainly in blister pack form. Medication procedures and practices were audited and found to be satisfactory. There is a need to ensure allergies are recorded on medication administration and, if not known, this be made clear. This had been identified at the last inspection and despite the efforts of the home to ensure the chemist is aware of this it has not been consistent. The list of authorised signatures also included people who had since left the home (this also had been highlighted at the last inspection). These must be updated with those no longer responsible taken off the list. The manager did this immediately by crossing off the names. The care plans did not fully identify where medication is to be given by the staff and where there may be issues. This has now been addressed as part of the support plan. Guidelines were in place for medication given when required and medication records showed medications entering and leaving the home were signed and counted with appropriate signatures. There were gaps with some medication, particularly medication given to the daycentre for one individual, had not been recorded out of the home. (See requirement) Medications were adequately stored. All, except new employees, are currently undertaking a distance-learning, safe handling of medication course. The manager was also advised of the medication module provided for care staff on the Skills Sector website. Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are able to raise concerns in a safe environment that ensures they are listened to and concerns acted upon. There are good systems and practices in place for protecting vulnerable people from any form of abuse. EVIDENCE: Bromley Autistic Trust (BAT) have policies and procedures in place to ensure residents are listened to, concerns investigated and action taken to resolve the problems. Complaint procedures have been developed and are on display in the home and meet with the Commissions’ requirements. This is also in text format and, as previous comments have suggested, this information should also be provided in a format suitable for the people using the service. A copy of the procedure is also included in the Service Users Guide which is available in residents’ rooms. The Commission has not received any complaints regarding the service during the last twelve months and feedback from relatives was positive. The complaints register viewed during the visit and the information provided on the AQAA shows the home to have received one complaint since the last inspection. This concern related to an individual’s personal care and grooming. This appears to have been dealt with satisfactorily and issues addressed. The Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 21 manager has introduced a new system for recording complaints since the last inspection as recommended. Procedures have also been developed to protect vulnerable individuals from abuse. At the last inspection these were due to be updated and now have been. Hey reflect the changes relating to the POVA register including the recruitment of new staff and the referral of any person where abuse has been substantiated. The organisations’ policies also reflect the need to work with other agencies and, to this effect, a copy of the Bromley Local Inter-agency guidelines for the Protection of Vulnerable Adults is kept in the home to ensure they follow the procedures laid down. It is clear from the training records that staff have been provided with training in this area. The inspector had the opportunity to speak to one member of staff, who had a basic understanding of this area. It is important that all staff are aware of the role of the Local Authority in co-ordinating any allegations of abuse to ensure vulnerable people are afforded protection. Feedback through surveys show that relatives feel able to raise concerns with the manager. The home also protects residents through the recruitment procedures and ensuring the required checks have been made before they start working in the home. The home has restraint procedures in place and all staff have (except new staff) been trained in positive interventions and physical restraint in the management of challenging behaviour. Care plans document the types of behaviour that may challenge staff and include the restraint that may be used for that individual. There are times when there are issues between residents that may result in implementing the adult protection procedures. In these instances the home notifies the appropriate agencies to ensure those that are vulnerable are protected. Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 22 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): 24,25,27,28,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Burgess House provides an environment that is homely and comfortable, although systems for ensuring the cleanliness should be improved to make it safe for all those living there. EVIDENCE: Burgess House (Flat A) has a homely and comfortable feel with personal touches made in residents’ rooms. The furniture is comfortable and practical. There continues to be areas that require attention and are looking a little tired and worn. The organisation must have a system in place for redecorating and refurbishing all areas of the home. The bathroom has been decorated since the last inspection and a new hallway carpet has also been provided. It is unfortunate that the home has very little natural light, particularly to the front of the house. (See requirement) Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 23 Some new kitchen equipment has been ordered, including a carpet shampooer and lockable fridge and freezer for the protection of a resident. There is a long garden to the rear with a summerhouse is located. Here there is a range of sensory equipment with soft seating and numerous games for individuals to enjoy. This area is used by some more than others but it provides a safe place to escape away from the home where they can relax. In general the home is to a fair standard of cleanliness with hand wash facilities in place in the necessary areas such as laundry and kitchen. However, there is now a need to ensure staff are familiar with good infection control procedures due to incontinence issues. Soluble bags should be provided where there is soiled clothing or laundry and specific resources for cleaning soiled areas, such as carpets and that soap dispensers are replenished when empty. It is positive to note that odour control has also been placed in many rooms due to the continence issues. (See requirement) Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34,35,36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff understand the needs of the residents living there and are supported in this though good training. This could be further improved through prompt access for staff to training on offer. Recruitment practices and records provide assurance that residents are safe when new staff are employed. EVIDENCE: The staffing in the home comprises of a manager, deputy manager and support workers supporting residents 24 hours a day. All but one staff member are female, with all but one resident being male. The manager has recognised this gap has recently recruited a new male staff member. When residents are in the home there are generally two members of staff on duty. All but one of the residents attends the day centre with one resident supported with day care in the home by another member of staff. Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 25 There are currently six staff employed, excluding the Manager. Of these six, four have NVQ 2 or above; one has the Learning Disability Ward Framework (LDAF). LDAF induction includes BILD materials, a workbook and three days training through BAT. Induction training is implemented for those who are new to the organisation, although LDAF induction is not always provided to those who have achieved this already with another employer. However, the manager was made aware that the home must provide training in those units that are specific to the current service setting and service user, such as policies and procedures, training in aspergers syndrome. It is clear that the training and core units may not be readily available with some staff being in employment a number of months before undertaking core training, including first aid and food hygiene. The core training is necessary to ensure staff are competent in these areas, especially when the number of staff on duty are low and they are involved in numerous activities such as preparing and cooking meals. This has not been the first time that the Commission has raised this with the organisation and it is potentially placing residents at risk as staff will not have the skills to support residents in their day to day lives. (See recommendation) BAT provides both core and specific training. The training matrix provided shows evidence of staff training to date and training arranged for staff. As with LDAF (induction training) this is provided through a consortium comprising of BAT, PCT and Social Services. Training on core and specific is arranged as a rolling programme for the year. However, as stated earlier it is clear that staff often experience long delays in undertaking it. This may be because there are not enough training dates or that other groups have priority. The training matrix showed staff attending a variety of training with planned training for new staff. The manager is aware that all staff are provided with leaning disability, autism and epilepsy training to ensure they have a good understanding of how they can meet individuals’ needs. The manager or deputy hold regular staff meetings. These meetings focus on the residents and do not enable discussions that staff wish to raise staff or general issues about the service provided. If staff are able to discuss other issues this will ensure they contribute to the running of the home and the quality of care, making them feel more valued. (See recommendation) Five new staff have been recruited since the last inspection. Some have completed LDAF induction (see above), whilst others have NVQ 2 or above. The inspector viewed four files in relation to those employed or due to commence employment. Despite the requirements from the last inspection the majority of the documentations are still not available in the home. It is apparent that Head Office staff are responsible for ensuring the checks are completed. However, there is little liasing with the home to confirm to the Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 26 manager that they have undertaken the checks required. Whoever is responsible for this duty must ensure that they are fully aware of the regulations and confirm that they have undertaken the full checks required. It is also difficult for managers to determine the training required without having sight of the training certificates, wherever possible or, in the case of references, where there may be possible issues such as sickness or regular lateness. I was able to fully view the files on the second day of the inspection after they had been collected from the Head Office site. They were found to be generally satisfactory, although there are clear gaps in the check on verification of previous employment in care. It is also necessary to ensure that the home has information on the individual staff member such as next of kin details and emergency contact numbers in the case of an emergency and Head Office staff are not available. (See requirement) Discussions with a member of staff showed adequate qualifications and training in relation to the client group. Two members of staff also confirmed they have received the GSCC Codes of Conduct. There was evidence of regular supervision with most staff formally supervised approximately every six weeks or so. Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 27 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): 37,38,39,40,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager ensures the health and safety of residents and there are some systems in place to ensure the care provided meets residents’ expectations. EVIDENCE: The manager is well qualified with a number of years experience of working with residents with learning disabilities, specifically, autism. She has qualifications specific to the autistic client group and has achieved the Registered Managers Award (a qualification designed specifically for managers of residential care settings. Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 28 Feedback from relatives showed that the home is well managed with the manager ensuring regular contact and communication with families and external agencies. Feedback from two health professionals confirmed a sound working relationship between the home and the agency to ensure the care needs of each person are monitored. The required insurance and registration certificates are in place. The way in which the Provider monitors and reviews the quality of care is important to ensure continued improvement in the service. The last report detailed the need to ensure visits by the Provider took place monthly, as required by Regulation 26. There is evidence of regular visits now taking place. There are also regular meetings with residents and this has been addressed elsewhere in the report. Previous reports have also highlighted the need to undertake a review of the quality of care provided. This must include consultation with residents or their relatives. There is no evidence that any review has taken place in the last twelve months although such reviews had previously taken place. Without such a review it is difficult for the organisation to be clear about whether they continue to provide a good service for those living there. The manager has agreed to undertake a review of the service, along with ensuring she obtains feedback from residents as well as other stakeholders. This would be a step in the right direction, although it is important that the Providers are aware of their responsibility in this area. (See requirement) It is also apparent that, where residents’ needs change, the Service Level Agreement does not allow for changes to the staffing and therefore the staffing costs are met by the organisation through the employment of is often provided by “sessional” or temporary workers. This places the viability of the home in question if they cannot sustain increased staffing without increased fees and it also means continuity of care is disrupted through the use of “sessional” and not permanent staff. This is not ideal for a client group who clearly need familiar faces, continuity and staff who understand their needs. The Commission expect all homes to complete an annual assurance review. This has been completed by the manager and it shows areas where they are doing well and areas for improvement. The inspector found that she was in agreement of many of the findings and it shows that the manager is able to be objective about the service and look to make improvements. The organisation also monitors the service as required by the agreement between Bromley Social Services and BAT and regular reporting takes place in relation to this. The systems in place for ensuring the health, safety and well-being of residents and staff are satisfactory with regular service checks made on the Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 29 equipment. The inspector saw sight of fire, gas, electrical equipment and wiring certificates showing that they had been serviced regularly. There are also emergency “on call” procedures to enable staff to contact a manager (or senior manager, if required) in the event of an emergency. Staff spoken to were aware of these procedures and could give examples of when they would contact someone. There was also evidence of adequate systems in place in relation to fire procedures and fire prevention and ensuring the protection of residents from outbreak of fire. I have previously highlighted to BAT the concerns they have regarding the management of residents’ personal monies. BAT are in receipt of all allowances in respect of the residents’ monies and then provide allowances each fortnight totalling £20 per week. Any mobility money is kept by the organisation and then goes towards transport costs. I have requested details of the procedures relating to the pooling of individual mobility monies and how this is apportioned between residents. However, the Commission has still not received this information. The personal monies relating to three residents were audited and found to be accurate with the appropriate signed receipts in place for most expenditure. (See requirement) Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 30 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 2 2 3 3 3 4 3 5 3 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 2 25 3 26 x 27 3 28 3 29 x 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 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 3 2 3 x 3 x Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 31 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 YA9 Regulation 13 (4) Requirement Timescale for action 01/10/07 2 YA9 13 (2) 3. YA34 17 & 19 Risk assessments must be specific to ensure the risks are fully identified to ensure staff have the information to protect the individual. Medication records must identify 01/10/07 all medications leaving the home. This must include medication whilst “on leave”. Employee references must be 01/10/07 verified prior to staff being employed to work in the home and the organisation must confirm in writing to the manager that they have completed the required checks to ensure residents are protected. An action plan must be provided 01/11/07 for the redecoration of the home. Infection control procedures 01/11/07 must be implemented to ensure the home is clean and infection risks are reduced for those living there. A review of the service must be 01/12/07 completed each year to enable the service to continually improve and meet individual DS0000006938.V360951.R01.S.doc Version 5.2 4 5 YA24 YA30 23 13 (3) 6 YA39 24 Burgess House (Flat A) Page 32 expectations. 7. YA23 25 The procedures in relation to management of residents’ monies must be made clearer. In particular, the Provider must address how it apportions residents’ mobility allowances in accordance with the usage. This is a repeated requirement with the timescale of 01/08/06. 01/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The Statement of Purpose and other information produced by the home should be made available to prospective residents and their families and in a format suitable for prospective residents. Residents meetings should include a wider range of topics. Induction training should be available with more regularity and a more timely manner. 2 3 YA8 YA35 Burgess House (Flat A) DS0000006938.V360951.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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