Inspection on 05/11/07 for Pembroke Lodge

This inspection was carried out on 5th November 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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pembroke Lodge 08/12/09

Pembroke Lodge 12/03/07

Pembroke Lodge 03/10/05

Pembroke Lodge 21/04/05

Pembroke Lodge 04/10/04

Pembroke Lodge 08/07/04

Pembroke Lodge 09/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Glenside Centre for Brain Injury Assessment & Rehabilitation South Newton Salisbury Wiltshire SP2 0QD Lead Inspector Susie Stratton Key Unannounced Inspection 5 and 9th November 2007 9:00 th Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.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 Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.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. Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glenside Centre for Brain Injury Assessment & Rehabilitation South Newton Salisbury Wiltshire SP2 0QD 01722 742066 Address 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) Glenside Manor Healthcare Services Ltd Vacant Care Home 14 Category(ies) of Physical disability (14) registration, with number of places Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The staffing levels set out in the Notice of Decision dated 18 November 2002 must be met at all times 12th March 2007 Date of last inspection Brief Description of the Service: Glenside Centre for Brain Injury Assessment and Rehabilitation (the ARC) is a 14-bedded nursing assessment, rehabilitation and long stay unit for younger adults with acquired brain injury. Following rehabilitation, the person will move to another appropriate facility or home. At the time of the inspection 50 of the patients were admitted for assessment and rehabilitation and 50 for long term care due to complex nursing needs relating to their profound brain injury. There were 12 people resident, with both empty beds being booked. The building was purpose built for the client group. All bedrooms and living facilities are on the ground floor, with wide corridors. The bedrooms are single all with an en-suite facility providing a good standard of accommodation. A team of nursing staff, physiotherapists, occupational therapists and rehabilitation assistants provide care and support to the patients. The ARC is one of six registered care homes on one campus which are owned by Glenside Manor Health Service Ltd. Mr Andrew Norman is the nominated responsible individual and the registered managers post is currently vacant, with a person acting into the role. Glenside Manor Health Services are situated in the village of South Newton, on the A36, five miles north west of Salisbury. The basic fee for high dependency nursing care is £1495 per week. This is subject to individual assessment, which can affect fee levels. Supporters of prospective service users are given their own copy of the service users’ guide. Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included visits to the service and takes into account the views and experiences of people using the service. Service users are known as “patients” at the Assessment and Rehabilitation Centre (ARC) as their needs primarily relate to medical care, so that is how they are referred to throughout the report. The home employs rehabilitation assistants, rather than care assistants, so that is how they are referred to throughout the report. As part of the inspection, questionnaires were sent out to residents and their relatives and six were returned. Comments made by relatives in questionnaires and from patients during the inspection have been included when drawing up the report. An annual quality assurance assessment was submitted by the home prior to this inspection. This document provided information to support the inspection. The site visits took place over two days, on Monday 5th November 2007 between 9:00am and 2:35pm and on Friday 9th November 2007 between 9:00am and 12:05pm. The prospective manager was on duty for the first site visit. The responsible individual, Mr Andrew Norman and owner, Mr Denis Barry was present for feedback at the end of the inspection. During the site visits, we met with three patients who were able to express views on service provision and observed care for six patients who had complex brain injury or were minimally conscious. We reviewed care provision and documentation in detail for four patients, one of whom had been admitted recently, one of whom was in the 16 –18 years age group, one of whom was undergoing assessment and rehabilitation and one of whom was minimally conscious. As well as meeting with patients, we met with the deputy manager, two registered nurses, three rehabilitation assistants, a social worker employed by the group and a speech and language therapist employed by the group. We also met with the human resources manger, the finance manager, the training manager and the operations manager. We toured all the building and observed a lunch-time meal. We observed systems for administration of medicines. A range of records were reviewed, including staff training records, staff employment records, maintenance records and financial records. What the service does well: The ARC has a comprehensive system for pre-admission assessments, with all of the multi-professional team being involved in the process, depending on the patient’s individual need. The home is purpose built and was designed to meet the needs of people with complex nursing and care needs associated with brain injury. A very wide range of equipment is available to meet the needs of patients and staff were Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 6 observed to be competent in its use. The prospective manager has managed to forge an effective staff team while she has been in post and staff worked closely together to meet the needs of the patients. The Glenside group have a thorough recruitment system, which ensures that prospective staff are only given employment after a rigorous recruitment process has been carried out. Patients and their supporters expressed their appreciation of the service provided. One person commented “The general skill level appears high. I have been very impressed by the overall level of commitment”, another person reported “There is a commendable overall sense of unity and commitment” another person described staff as “all caring, considerate, friendly, are always willing to help and advise” and one person summed the service up as “Kindness, cleanliness and comfort”. What has improved since the last inspection? What they could do better: Three requirements and six good practice recommendations were made at this inspection. All staff must conform to company policy on record keeping, so that staff have access throughout the 24 hour period to relevant information from the multiprofessional team. All instructions in patients’ rooms relating to directives from clinical staff should be dated and signed by the person drawing up the instructions. All care plans should use precise terminology, the use of words such as “regularly” should be avoided and care plans relating to diabetic care should state blood sugar levels needed in a measurable form. Where a patient user has an infection, the site of the infection should be documented in their records. Where senior, competent nursing staff have trained other staff in complex procedures, a written system for competency levels and certification should be developed. Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 7 When using non-slip mats in communal bathrooms, systems must be in place to ensure that they do not present a risk of cross infection. Where restraints such as safety rails or lap belts are used, a full written assessment of the patient’s need for such equipment and suitability for the individual patient, must be undertaken. Such assessments must be reviewed on a regular basis. Where staff look after patient’s own moneys, records should always be clear and include a full audit trail. Items returned from the laundry should not be sorted in communal area. 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. Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good This judgement has been made using available evidence, including visits to this service. Patients are supported by comprehensive assessments, from relevant professionals, prior to and after admission. EVIDENCE: All patients admitted to the ARC have a full multi-professional assessment of need prior to admission. The professionals involved in the assessment relate to the person’s presenting needs. Following initial assessments, further assessments may be requested from other members of the multi-professional team or external professionals. The prospective manager reported that she is always full involved in the pre-admission assessment process. The prospective manger reported in the annual quality assessment on how they tried to ensure that there was close liaison with the transferring hospital both before and after transfer. Assessments seen were clear and completed in detail. They showed that family supporters and significant others were also fully involved in the assessment and admission process. Prospective patients are encouraged to visit the unit prior to admission if they are able. One person reported “Family visited before. I was asked if I wanted to see it before I was moved”. Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 10 Another person described how they had come with their family on one occasion and that their family had also made additional visits before they came. As part of the admission process, relevant staff assess prospective residents and their family’s individual aspirations for the future, to ensure that they are realistic and aim to ensure that they can understand the specific services offered by the ARC to patients. One person met with had had assessments performed by physiotherapy, occupational therapy, speech therapy and psychology staff, as well as nursing staff prior to admission. Following this, decisions were made with the patient and their family as to the main areas for assessment following their admission. Once full assessments have been completed into the person’s needs, a multiprofessional rehabilitation programme is developed. Where a person has profound brain injury, a maintenance care plan is put in place. Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 11 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 visits to this service. Supporting patient’s individual needs and choices is a central area in care provision for this home. EVIDENCE: For patients admitted for assessment and rehabilitation, their needs are regularly assessed by relevant persons on the multi-professional team. Following assessment, goals are set with the patient. Goals are in the form of long-term and short-term goals. Goal planning takes place fortnightly and patients and their families are actively involved, as well as clinicians, including the patient’s consultant. Where patients are minimally conscious detailed personal plans are developed and regular contact is maintained with relatives and other relevant supporters to review the care plan. Where plans need further development, relevant persons on the multiprofessional team assist in further care plan development. One relative reported on how well the home communicates with relatives. Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 12 The acting manager reported in the home’s annual quality assurance that they have improved observational charts to reflect individual care. She also reported that the home are continuing to work on capacity and consent protocols. Where patients are admitted for assessment and rehabilitation, supporting them in assisting them to make decisions about their lives is a key part of their care. Where relevant, regular assessments are drawn up by psychologists to identify in what areas the patient has capacity to make a choice and how individuals are to be supported in making choices. One rehabilitation assistant was observed to encourage a patient in deciding what DVD they would like to watch when they were not engaging in therapies. Patients who are minimally conscious are not able to exercise choice, so staff rely on families to inform them of what the person liked and preferred. This was well documented and many rooms showed pictures and posters and other items relating to the person’s life before their injury. Patients admitted for assessment and rehabilitation have individual time-tables specifying what rehabilitation programmes they are to be involved in, depending on their individual needs and stage in their assessment and rehabilitation programme. Patients who are minimally conscious also have individual daily programmes, manly relating to maintenance of their current physical state and observation for any signs of development. All patients have individual risk assessments drawn up. This relates to all activities of daily living. For patients involved in assessment and rehabilitation programmes, psychologists are often closely involved, to assess the person’s ability to be aware of risk and level(s) of ability to consent. For some patients, assisting them in being aware of risks is a key part of their rehabilitation programme. Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.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, 14, 15, 16 & 17 Quality in this outcome area is good This judgement has been made using available evidence, including visits to this service. Different patients are supported in returning to how they liked to live their life or in continuing lifestyles in a way that is appropriate to them. EVIDENCE: Patients who are admitted for assessment and rehabilitation spend most of their days working with a range of multi-professional staff in activities which are suited to them, to develop their skills with the aim of them reaching their full potential after a serious brain injury. Patients are also supported in choosing what they would like to do. For example, one patient asked a rehabilitation assistant to read to them from a magazine. Where patients are minimally conscious, staff rely on information from relatives, so that music, television or other stimulants reflect what they liked to do in the past. One relative reported “Certainly the efforts to create a programme of activity that overcomes my [relative’s] impairments has been praiseworthy”. The Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 14 manager reported in the annual quality audit that the occupational therapy department were very supportive. Where patients are admitted for assessment and rehabilitation, the ARC is not their permanent home, so becoming part of the local community is not relevant to them. Patients are taken out to local shops and other amenities if that it part of their programme. Some patients are supported in going back to their own homes, so that they can maintain links with their own community where they come from. Patients are also part of the community on the Glenside site and may attend rehabilitation in other units on site, mixing there with other patients. Patients who are minimally conscious are not able to be part of the local community, however contact with friends and family is supported and encouraged. One relative reported “Staff make great efforts to enable my [relative] to communicate with me. Their care plan actively encourages it”. Patient’s rights are emphasised throughout the care planning process. One relative reported “Glenside works hard to maintain the rights and dignity of its service users”. Staff spoken with were aware of the importance of legislation relating to up-holding individual patients’ rights. Where residents show complex behaviours, as part of the rehabilitation process, the multiprofessional team work with them to support them in becoming aware of their responsibilities towards other people. All of the patients who are minimally conscious are artificially fed. There are clear records from dieticians relating to feeding regimes, which direct staff precisely on actions to take. Patients’ weights are regularly monitored and information relating to changes in weight fed back to clinicians with regimes being adjusted where relevant. Many of the patients admitted for assessment and rehabilitation need support in eating, this may include liquidised or softened diets, feeding aids or assistance from staff. Where a patient is at risk of choking, there are very clear care plans, which have been drawn up by a relevant clinician to direct staff on how the person is to be assisted. Occupational therapists are fully involved in provision of relevant aids to assist patients in eating. Patients are supported in choosing an appropriate diet, one person commented how they appreciated the way that that staff helped them to choose their food. Portion size related to the individual needs of patients, for example the ARC cares for one adult of 17 years and they were noted to be given a portion of food which related to their increased appetite needs. A rehabilitation assistant who was preparing lunches showed a very detailed understanding of specialist diets for individual patients cared for in the ARC. Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 15 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 visits to this service. Patients receive full supports for their healthcare needs. Not all staff are following company policy on record keeping for newly admitted patients, this means that not all relevant professionals would have the information that they needed throughout the 24 hour period. EVIDENCE: Patients admitted for assessment and rehabilitation are supported in developing self-care skills as part of their programme. All people have regular assessments from relevant persons in the multi-professional team and care plans are adjusted accordingly. One person reported “I walk three times a day, I’m getting on”. Patients who are minimally conscious need regular interventions from staff to ensure that their personal hygiene needs are met. There are clear and detailed care plans relating to individual interventions needed by people. One relative reported “We are very impressed by the care [my relative] is given.” A speech and language therapist and a social worker commented on the good liaison between the members of the multi-professional team and how staff kept Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 16 to agreed care plans and informed relevant persons of any changes which might affect the goal for the patient. All patients on the ARC have complex nursing and care needs. Relevant professionals draw up care plans relating to individual needs and interventions. As company policy, all clinical staff are expected to complete in one ret of records, so that all relevant professionals and staff can have access throughout the 24 hour period. Records seen were clear and written in approachable language. For newly admitted people, while it was clear that certain professionals had assessed the person’s needs after admission, they had not all completed the multi professional record. This could present a problem for staff providing a 24 hour service, as they would not have direct access to relevant information. Many patients had clear instructions available in their rooms to instruct staff on how to perform certain interventions. Some of these instructions were signed by the professional and dated, others were not. This is needed, so that staff can ensure that such instructions are current, are reviewed regularly and who was responsible for drawing up the documentation. Most care plans were clear, however some continues to use terminology which was not measurable such as “regularly”. One diabetic patient had very clear instructions on actions to take in the event of instability in their condition but did not state the precise blood sugar levels where they would be considered to be unstable. None of the patients were assessed as being able to self-medicate. The acting manager reported that the home would support residents in self-medicating if this was part of their rehabilitation programme. The home has two clinical areas for the storage of medicines. Two registered nurses were observed performing medication rounds, they performed them in accordance with company policy and good practice guidelines. Where patients were not able to communicate or respond, it was noted at good practice that both registered nurses always explained what they were doing to the patient. Where a patient had swallowing difficulties, the registered nurse was observed to allow the patient to take time to take their medication. A rehabilitation assistant was observed to know a patient with complex communication abilities well enough to understand that they were in pain. The rehabilitation assistant promptly contacted a registered nurse and ensured that the patient was given pain relief. All medicines were correctly stored and there was a full audit trail of medicines received into the home, given to patients and disposed of from the home. Where patients were given medicines by injection there were clear records relating to rotation of injection sites. Some patients were prescribed medicines on an “as required basis”, where this was the case, there were care plans drawn you to direct staff on the indicators for the use of such medicines. Registered nurses spoken with showed an awareness of the actions of the ranges of drugs used in the ARC. Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 17 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 visits to this service. Patients feel that they are listened to and this vulnerable client group is protected by the group’s procedures. EVIDENCE: The Glenside Group has a clear complaints policy and procedure which is available to people in the service users’ guide and is displayed in the entrance area. A relative confirmed that they were aware of the complaints policy because it was written in the brochure. One patient reported “I can make them understand if I’ve got a concern” one relative reported “Our concerns have always been met with action” and another person reported “Staff do listen”. In the home’s annual quality audit it was reported that the charity Headway holds coffee afternoons once a month as brain injury support group for patients, their friends and relatives. The home documents all complaints received and these are reviewed regularly during visits by managers. A review of the complaints file showed that managers respond to complaints and concerns in accordance with company policy and procedure. No complaints have been received by us since the previous inspection. A review of records and discussions with staff showed that all staff have been trained in safeguarding adults since the previous inspection. Additionally staff also showed an awareness of the implications of the Mental Health Act for the client group. One patient reported “I can say what I like here”. Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 18 The prospective manager and senior managers showed an awareness of the local vulnerable adults procedure. No referrals have been made via the local procedure since the prospective manager came into post. All patients have advocates who are able to raise matters on their behalf. These advocates also manage their financial affairs. The group has one central financial department who receives invoices for items such as toiletries or newspapers and then debits the patient’s individual account. Advocates are then invoiced quarterly. Records seen showed a full audit trail. It was reported that in practice, very few patients were at that stage of rehabilitation where they were re-learning skills in handling moneys. One patient did have some moneys, which the staff were looking after. The money was securely stored. Records of their moneys were maintained and all amounts tallied, however individual receipts were rolled together into one figure and it is advisable that individual receipts are always documented, to provide a full audit trail. Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 19 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, 27, 29 & 30 Quality in this outcome area is good This judgement has been made using available evidence, including visits to this service. The home environment meets patients’ needs and include high standards in the provision of equipment to meet patients’ disability needs. One matter needs to be addressed to prevent risk of spread of infection to patients while bathing. EVIDENCE: The ARC was purpose-built and provides ground floor accommodation, all on one level. The accommodation is of a high standard, with corridors wide enough to allow two wheelchairs to pass and all doorways are accessible for wheelchairs and even beds. The ARC is maintained to a high standard throughout. Staff reported that the maintenance department responds quickly when any matters are raised. All rooms which could present a risk to patients, such as the kitchen and clinical rooms are secured, so that patients cannot inadvertently access them. Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 20 During the inspection, it was observed that staff were sorting items returned from the laundry in the dining/lounge area. It is advisable that a domestic task like sorting laundry should take place away from communal areas. The home has two assisted bathrooms and all bedrooms are en-suite. One of the assisted baths is fully height adjustable. Unfortunately due to matters relating to the building of the home, the en-suite shower rooms cannot be used as such. It was reported that one of the two bathrooms is to be converted into a disabled shower. The home shows very high standards of equipment provision. All beds are electrically operated and fully profiling. A wide range of hoists are provided to support staff when assisting patients with different needs. Patients are assessed by relevant professional staff for specific seating needs and equipment is provided individually. A new hoist with integral scales has been purchased since the last inspection. Other equipment is provided when needed, for example one patients had a Possum, which enabled them to turn their tv on and off, summon assistance, turn pages in books and other such basic needs, to support their independence skills. Patient’s rooms are laid out so that technical equipment, while visible, does not dominate the room, so rooms continue to reflect the individual’s likes and interests. The home was clean throughout, including areas such as bed frames. Staff showed an awareness of the principals of spread of infection. Relevant equipment to reduce risk of spread of infection was provided. A hand cleaning solution dispenser has been placed in the entrance of the building. It was observed in one of the assisted bathrooms, that a non-slip mat had been placed in the bath. The mat was clean, but it was wet. Communal use of such mats can present a risk to cross infection and as three patients were known to have an infection, they need to be provided with their own non-slip mat when bathing, to reduce risk to other residents presented by communal use of such mats. Bathmats need to be fully cleaned after use and kept as dry as possible. The three patients who had infection were provided with all equipment needed to reduce risk of spread of infection. It was noted as good practice, that despite such person’s vulnerability, there had been no spread of infection to other patients. The actual site of the infection for each patient is not documented and it is recommended that this should take place so that staff unfamiliar with the resident can be fully informed. Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good This judgement has been made using available evidence, including visits to this service. Patients are supported by the numbers of staff on duty and the emphasis placed on training by the provider. There are safe systems for assessing the suitability of prospective staff. EVIDENCE: On the day of the first site visit, the home was well staffed, with a range of registered nursing and rehabilitation assistant staff. Additionally multiprofessional staff are based on site and come to the ARC regularly. Occupational therapists were running a group in the therapy kitchen on the morning of the inspection. The Group’s social worker and one of the speech and language therapists were visiting. Therapy staff work 9-5 Monday to Friday with registered nurses and rehabilitation assistant staff providing a full 24 hour service. There has been some turnover in staff since the previous inspection. All staff spoken with showed an enthusiasm for their work. One relative reported that they were “hugely impressed” by the staff. Another described how “It operates well as a team working in the interests of its service users.” Staff work with one another and are prepared to help the home, for example at Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 22 times of unplanned absence, such as sick leave. Central site services have developed an absence management procedure, to ensure that staff are supported and relevant action taken in case of sickness. The Glenside Group encourages training and has a department run by an experienced and qualified training manager to support all registrations on site. One new member of staff described how they were supported throughout their induction period and had been linked to a “buddy” and a mentor. Induction programmes seen were fully completed and complied with current guidelines. Staff are supported in undertaking National Vocational Qualifications (NVQs) and over 50 of care staff are trained to NVQ2 or above. Training is also provided to registered nursing staff, most recently they have been supported in developing their management skills. The training department supports staff in developing skills relating to brain injury and run a Cognitive Rehabilitative Training course for all rehabilitation assistants. One rehabilitation assistant reported on how interesting they had found the course, making them understand a range of interventions which they could then use when providing care. One relative reported “The general skill level appears high. I have been very impressed by the overall level of commitment.” Single training sessions are offered to staff on areas relating to resident care, such as diabetes and swallowing difficulty. The multi-professional team can access courses run by the training department and also attend external courses relating to their professional skills. All staff training records are held on computer file and can be regularly reviewed by relevant persons, to ensure that staff are maintaining their skills base. Some of the registered nurses and rehabilitation assistants are performing advanced technical skills to support the complex needs of patients who are minimally conscious. They have been trained by persons on site who have developed the competency skills. It is advised that this be supported by full documentation with a written system for competency levels and certification once these levels have been achieved. A central human resources department supports all registrations on site. This is run by an experienced human resources manger. Files showed that all staff provide a cv/application form and that any gaps service records are probed at interview. All people have references from at least two people on file, all of which are directly sourced, and complete a health check. All people have relevant police checks performed. People from aboard have a full check on their immigration status. All applicants are interviewed by two people, this includes prospective staff from abroad, and a full interview assessment completed. Copies of relevant certificates are retained on file and registration with relevant professional bodies checked. One of the senior managers reported that they have recently introduced a “trial” shift for the most recent employees and have found it useful, particularly where people are not used to the specialities at Glenside Manor. Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 23 One relative reported “I think it recruits well, so ensuring a good team leadership that runs right through to auxiliaries”. Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good This judgement has been made using available evidence, including visits to this service. Patients are supported by the home’s management systems, however certain areas relating to health and safety need to be further developed, to fully reduce risk to residents. EVIDENCE: The home currently does not have a manager but a person is acting into the role. This person is a registered nurse who is experienced in the field of brain injury and she was the deputy manager on another home on the Glenside site. She is currently applying to us to become the registered manager for the service. The acting manager is supported by a deputy. She is also supported by the senior managers on the Glenside site. Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 25 In her time in post, she has managed to forge an effective team out of staff who have previously worked there and the newer members of staff. She also works closely with the multi-professional team who work in the unit. The Glenside Group has an established system for reviewing quality of care provision. All units are visited regularly by a member of the senior management team and a monthly report drawn up. These reports are of a good quality and identify issues which need to be addressed, not only good practice matters. Senior managers seek views of residents and their supporters by making questionnaires freely available in the home. There was evidence that the managers respond when matters are raised. Complaints and accidents are regularly reviewed by senior mangers. Systems are being developed to progress link nurses in matters such as manual handling and infection control, who can lead on these areas and report back to managers, to further improve quality of service provision. The training department has systems available to ensure that all relevant staff complete all mandatory training, this includes the multi-professional team, as well as nursing and rehabilitation assistant staff. All staff at all levels, undertake manual handling training on an annual basis. Staff were observed several times to perform manual handling during the inspection and they were observed to complete the procedure in a safe manner, supporting the resident throughout. Staff are also trained regularly in fire safety and it was noted as good practice that there was increased training in fire safety for people who work night duty. Records show a good uptake of first aid and all staff who handle food have appropriate training. One recently employed catering assistant was being supported to attend college to undertake NVQs in catering. Staff are trained in infection control and those spoken with showed an awareness of the area. Cross-site health, safety and fire meetings are held once a month. Many residents needed safety rails on their beds or lap belts on their chairs. Documentation relating to this needs more development. The prospective manger reported that she was aware that they had had some “near misses” relating to bed rails in the past. At the start of the inspection, the managers were advised to consider guidelines from the Health and Safety Executive relating to risk assessments for safety rails and the needs for regular evaluations of their use. By the end of the inspection, they had obtained this information and were considering how to include it within their current documentation systems. They were advised that where a resident needs safety rails or devices such as lap belts, that an assessment of need must always be drawn up and that this must be regularly reviewed, to ensure that the person’s risk can only be managed by use of such equipment. Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 26 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 3 28 X 29 4 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 4 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000047643.V345302.R01.S.doc 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x Version 5.2 Page 27 Glenside Centre for Brain Injury Assessment & Rehabilitation 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. 1. Standard YA18 Regulation 13(1)(b) Requirement All staff must conform to company policy on record keeping, so that staff have access throughout the 24 hour period to relevant information from the multi-professional team. When using non-slip mats in communal bathrooms, systems must be in place to ensure that they do not present a risk of cross infection. Where restraints such as safety rails or lap belts are used, a full written assessment of the service user’s need for such equipment and suitability for the individual service user, must be undertaken. Such assessments must be reviewed on a regular basis. Timescale for action 30/11/07 2. YA30 13(3) 31/12/07 3. YA42 14(a)(c) 31/12/07 Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA18 YA18 Good Practice Recommendations All instructions in service users’ rooms relating to directives from clinical staff should be dated and signed by the person drawing up the instructions. All care plans should use precise terminology, the use of words such as “regularly” should be avoided and care plans relating to diabetic care should state blood sugar levels needed in a measurable form. Where staff look after service user’s own moneys, records should always be clear and include a full audit trail. Items returned from the laundry should not be sorted in communal area. Where a service user has an infection, the site of the infection should be documented in their records. Where senior, competent nursing staff have trained other staff in complex procedures, a written system for competency levels and certification should be developed. 3. 4. 5. 6. YA23 YA24 YA30 YA35 Glenside Centre for Brain Injury Assessment & Rehabilitation DS0000047643.V345302.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA 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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