CARE HOME ADULTS 18-65
Queen Elizabeth Foundation Brain Injury Centre Banstead Place Park Road Banstead Surrey, SM7 3EE Lead Inspector
Lisa Johnson Unannounced 19 September 2005, 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Queen Elizabeth Foundation Brain Injury Centre Address Banstead Place, Park Road, Banstead, Surrey, SM7 3EE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01737 356222 Queen Elizabeth`s Foundation Lynne April Hensor Care Home 28 Category(ies) of PD Physical disability, 28 registration, with number of places Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 3 The age/age range of the persons to be accommodated will be: 16-36 YEARS Date of last inspection 19 August 2004 Brief Description of the Service: Queen Elizabeth Brain Injury Centre is a residential and education facility in Banstead Surrey and offers rehabilitation and education for young adults who have acquired disabilities or associated learning difficulties as a result of brain injury. The service is accessed by clients from all over the U.K. and it is owned and run by a charity. The maximum number of clients that the service is able to is twenty eight. The average length of stay is twelve to eighteen months, although each case is assessed individually. All of the accomodation is on the ground floor and all bedrooms are for single occupancy. Some rooms and accomodation are equipped for indipendent living. Clients are supported by a large multi-disciplinary team. Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes first inspection for 2005/2006. One inspector carried out the announced inspection over seven hours. The main focus of the inspection was to review any requirements made at the last inspection. A tour of the premises took place. Care plans, policies and procedures and other required documentation were sampled. The inspector spoke to three service users anf four members of staff. The inspector would like to thank the residents and staff for their hospitality and cooperation in carrying out this inspection. What the service does well:
The service provided evidence of detailed and comprehensive care plans for each individual and risk assessments were completed. Plans are compiled with the involvement of clients and all of the professionals in the team. Individuals are consulted on and supported to make decisions in their lives. The service provides an extensive range of activities to support service users rehabilitation process such as art, woodwork, pottery, education and vocational studies. Health care needs are well catered for with the support of a number of health professionals including physiotherapy, occupational therapy and psychology. A range of social activities was on offer including going to the cinema, pub, bowling, visiting restaurants, swimming and archery. At the time of the inspection some clients were away on a canal boat trip. One service user stated, “I enjoy the karaoke evenings”. The service is well maintained and clean and new bathrooms have been installed. The service provides a range of adapted equipment to support individuals with their rehabilitation and to encourage independence including adapted kitchens. It was clear that clients spoken to have felt supported at the service. One client stated, “It’s a nice place to be”. Another client stated, “It’s a good place, it has helped me a lot”. Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better:
A requirement was made that all regular bank staff must receive training in the Protection of vulnerable adults as this was not evident on the staff training schedule. This is to ensure that all staff are provided with knowledge to protect service users from abuse. Staff supervision records were sampled and some staff were found not to have been receiving regular supervision sessions with their manager/ supervisor. A requirement was made that all staff must receive formal, documented supervision at least six times a year to ensure that staff are supported to carry out their job. Two recommendations were made in respect of medication. The service should consider making photographs available of individuals on the medication and administration records and the list of staff signatories of staff who are able to administer medication should be made available with the records. A recommendation was made that the registered manager should consider amending the homes complaint procedure to state that the Commission for Social Care Inspection can be contacted at any stage of a complaint should the complainant wish to do so.
Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 7 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. Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 & 5 Adequate information was available that would assist prospective clients and relatives make an informed choice as to whether the service would be a suitable place to live. Pre admission assessments were implemented and trial visits and stays are accommodated. Each client is issued with a written contract. EVIDENCE: There is a comprehensive Statement of Purpose in place, which clearly describes the services and facilities that it is able to offer and is provided to individuals at the time of admission. Pre admission assessments are completed prior to admission. There is opportunity for prospective clients to make a oneday informal visit and a further two-day visit is undertaken to carry out further assessments. Contracts are completed and clients are provided with information in the contract to state what the individual is expected to pay for. Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9 & 10 The service is able to demonstrate that each individual has an agreed plan. Clients are provided with opportunities to attend meetings. Detailed risk plans were in place. Staff respect information given by service users in confidence. EVIDENCE: A key worker system is in place and an agreed plan is completed for each individual. Plans sampled were signed by clients where possible. The plans are based on comprehensive assessments and include health, personal and social support. The plans include rehabilitation and therapeutic interventions. Risk plans were completed for a wide range of activities including moving and handling, behaviour interventions and community access. Each client has a programme tutor who reviews their progress with them weekly. At the end of each session therapists and teachers review progress towards clients objectives. Clients are encouraged to discuss their individual needs and are fully involved in the target setting process. Daily meetings are held with clients and they also have the opportunity to attend meetings in the service to discuss any issues of concern. A suggestion box has been implemented and a monthly newsletter was available. A feedback questionnaire is given out at the end of clients stay. The service arranges for people to come in to carry out talks such as the police.
Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 11 Records were maintained adequately and kept secure. A confidentiality policy was in place with a procedure in place in respect of client’s access to records. Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14 & 17 Residents participate in fulfilling activities and participate in the local community. Residents are supported in engaging in a range of leisure activities. The home is able to demonstrate that residents are offered nutritious and varied meals. EVIDENCE: It was clear that residents have access to a range of fulfilling activities and social events, which are tailored to meet individual’s needs and preferences. Individuals are supported with a range of programmes through out the day by care staff and health professionals to develop communication, emotional and independent living skills. One client was seen in the adapted kitchen undertaking cooking and washing up which he was clearly enjoying. The service promotes independence and one client was very pleased to have his own kitchen. Individuals are supported with therapeutic interventions through a range of specialists including art therapy and pottery. A large mosaic was on display which all individuals were making a contribution to. The service provides educational and vocational studies. Depending on individual needs there are opportunities for attending college and one person was undertaking
Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 13 work experience. Exercise equipment and computers were available. As part of the rehabilitation process shopping trips, use of public transport and visits to the pub (dependent on risk assessment), visiting the cinema, going to restaurants, swimming and archery are some of the activities available. Individuals arrange quizzes and one client stated that he enjoyed the karaoke evenings. Some clients were leaving and some returning from a canal trip. Family contact is maintained and some clients go home at the weekends. Lunch was seen being served and there were a range of choices on offer, which were nutritious, and staff were observed to be seated and interacting with clients. Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 20 The home ensures that the health and emotional care needs of service users are met. Service users are supported to access specialist health facilities. Service users are protected by the homes medication administration procedures. EVIDENCE: Health and emotional needs are documented in individual care plans and service users have access to a range of health professionals including the GP, psychology, physiotherapy, and occupational therapy. Arrangements were in place for access to chiropody, optician and dentist. It was clear that plans were reviewed and updated. A weekly case conference is held and three monthly reviews take place with all professionals being involved. Clients are supported to attend external appointments if required. Records were sampled and were maintained appropriately. Protocols were in place for homely remedies and procedures were in place for non-prescription medication, which is brought into the service from clients. The medication was stored appropriately and safely. Boots provide pharmacy inspections and provide training, advice and support to the service. One individual is commencing support with self-medication and risk plans were in place to support this. Two recommendations were made. The service should consider making photographs of clients available with the medication records and a staff
Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 15 signatory list to be made available with the medication and administration records. Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 The home is able to demonstrate that there is an accessible complaint procedure. Policies and procedures were in place to ensure that service users are protected from abuse. However all bank staff must be included and receive appropriate training. EVIDENCE: No complaints have been received since the last inspection. A complaints policy is available and is accessible. A recommendation was made that the registered manager should consider amending the procedure to state that the Commission for Social Care Inspection can be contacted at any stage of a complaint should the complainant wish to do so. There was a local written Protection of vulnerable Adult procedure and an updated copy of the local authority protection of vulnerable adults policy was available. There is currently one investigation being undertaken which is following the local authority procedure. The manager confirmed that senior staff had attended the local authority protection of vulnerable adult training. Training schedules indicate that training is taking place and two staff spoken to confirmed that they have received training in this area. However there was no evidence recorded to indicate that bank staff have received the appropriate training. A requirement was been made that all bank staff must receive training to ensure that individuals are protected from abuse. Discussion took place with the registered manager and the Principle in respect of incidents that must be reported due to the particular needs of the clients. The inspector advised that if the service was unsure of any individual incident then staff must continue to consult with the local authority team for advice. Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25,26,27,28,29 &30 Individuals live in a comfortable environment, which is accessible is clean and hygienic. Clients have spacious bedrooms. Adequate toilets and bathrooms are available which provide privacy. The service has ensured the provision of environmental adaptations that meet the assessed needs of individuals. EVIDENCE: The service is spacious, well maintained clean and hygienic. The home is adapted to meet the needs of clients who use wheelchairs with automatic doors. The bathrooms and showers include specialist baths and equipment and call alarm systems were in place There are a number of activity rooms provided for education with separate rooms for art therapy and a physiotherapy suite. The service provides a transitional area where there are adapted kitchens for clients to cook and a separate group home where clients are provided with their own kitchen area. to increase independence. Televisions and videos were provided in the communal lounges. There is a separate, large kitchen and dining room in the main complex, which was adequately maintained. A recent environmental health inspection report was sampled and was satisfactory. Bedrooms were spacious and were suitable to
Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 18 meet the needs of the client group. Individuals are invited to bring personal items into the home and this was evident. Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,34 &36 Staff were supported to undertake training and development. Individuals are protected by the homes recruitment policies and procedures. Formal supervision should be updated to ensure that all staff are competent to carry out their roles EVIDENCE: The staff-training schedule was sampled and it was evident that mandatory training including food fire training and health and safety is undertaken. Medication awareness and first aid training was implemented for senior staff. Staff have been completing adult protection training, which was confirmed by two staff spoken to. There is ongoing in-house training programme for all staff. All staff receive training in; - Brain Injury Awareness, Disability Awareness and Behaviour management as well as a range of other topics. However a requirement was made that bank staff working in the home must have up-to-date training in the protection for vulnerable adults to ensure that individuals are protected from abuse. Staffs spoken to had good awareness of the clients needs and were working within a multi-disciplinary approach to care. Staff personnel files were sampled and contained the required documentation. Staff appraisals were completed annually. However there were gaps in supervision records and a requirement was made that all staff must receive
Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 20 formal supervision with their manager/supervisor at least six times a year to ensure that staff receive support they need to carry out their role. Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37. 38, 39 & 42. The home is managed in an open atmosphere. The manager has implemented a quality assurance system based on seeking the views of residents. Records were adequately maintained and kept secure. EVIDENCE: The registered manager is a qualified nurse and has a degree in psychology and holds a masters degree in Counselling Psychology. The manager is currently completing the Registered Managers Award. Staff spoken to stated that the manager and principle were accessible and approachable. Staff meetings are held two weekly and all new staff receive induction and foundation training. The service completes exit questionnaires when individuals have completed their stay. Carers and professionals questionnaires are also sent out yearly. There is a member of staff is in post that is responsible for all quality assurance projects and a copy of an analysis of client feedback questionnaires was sampled. The home also receives OFSTED inspections.
Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 22 Fire records were sampled and were adequately recorded with evidence of fire equipment checks and evacuations completed. PACT testing takes place for all equipment. Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23
ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score x 2 x 3 x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Queen Elizabeth Foundation Brain Injury Centre Score x 3 3 N/A Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x 3 x h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 24 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 13(7) Regulation YA 23 Requirement The service must continue to report all instances that fall within the remit of the protection of vulnerable adults, to the local authority team and the Commission of Social Care Inspection. The registered manager must ensure that all bank staff who work in the home must recieve training in the protection of vulnerable adults to ensure that that the wellbeing and safety of service users are protected. All staff in the service must recieve formal, documented supervision sessions at least six times a year to ensure that staff are given the support they need to carry out their job. Timescale for action immediate 2. 32 18( c )(1) 2 months 2/12/05 3. 36 18( 2 ) 1 month 19/1020/0 5 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 20 Good Practice Recommendations The service should consider making photographs available
h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 25 Queen Elizabeth Foundation Brain Injury Centre 2. 3. 20 22 on the medication and administration records. The service should consider making the list of staff signatories who are trained to administer medication available with the medication and administration records. The registered manager should consider reviewing the service complaints procedure to state that the Commission for Social Care Inspection can be contacted at any stage of a complaint . Queen Elizabeth Foundation Brain Injury Centre h58 S13754 Queen Elizabeth foundation v233902 190905 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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