Inspection on 26/09/07 for Queen Elizabeth's Foundation Brain Injury Centre

This inspection was carried out on 26th September 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Queen Elizabeth's Foundation... 07/09/09

Queen Elizabeth's Foundation... 21/09/06

Queen Elizabeth's Foundation... 09/01/06

Queen Elizabeth's Foundation... 19/09/05

Queen Elizabeth's Foundation... 01/11/04

Queen Elizabeth's Foundation... 19/08/04

Similar services:

Thorndene

Sutton Lodge Nursing Home

Wingham Court

Bethany Lodge

17 John Street

Red Oaks

Clare House Nursing Home

Broad Oak Manor Nursing Home

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

CARE HOME ADULTS 18-65 Queen Elizabeth Foundation Brain Injury Centre Banstead Place Park Road Banstead Surrey SM7 3EE Lead Inspector Mike Murphy Unannounced Inspection 26 September 2007 09:30 Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.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 Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.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. Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Queen Elizabeth Foundation Brain Injury Centre Address Banstead Place Park Road Banstead Surrey SM7 3EE 01737 356222 01737 359467 rehab@braininjurycentre.org.uk 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) Queen Elizabeth`s Foundation Lynne April Hensor Care Home 28 Category(ies) of Physical disability (28) registration, with number of places Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age/age range of the persons to be accommodated will be: 16-36 YEARS 21st September 2006 Date of last inspection Brief Description of the Service: Queen Elizabeth’s Foundation Brain Injury Centre is a residential and education facility in Banstead Surrey which offers rehabilitation and education for young adults who have acquired disabilities or associated learning difficulties as a result of brain injury. Clients from all over the U.K access the service, and it is owned and run by the Queen Elizabeth’s Foundation, a registered charity. The maximum number of clients that the service is able to accommodate is 28. The average length of stay is twelve to eighteen months, although each case is assessed individually. Most of the service users bedrooms are on the ground floor, with a few bedrooms situated on the first floor. All the bedrooms are for single occupancy. Some rooms and other accommodation are equipped for independent living. A multi-disciplinary team supports clients. Annual fees at the time of this inspection ranged from approximately £81,600 £105,600 per annum dependant upon assessed needs. Separate fees apply for the two day assessment - the vocational programme is an intrinsic part of the rehabilitation programme for all clients. Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector in September 2007. The inspection included a whole day visit to the service, discussion with clients (as service users are known in this service, and therefore, referred to in this report), staff and managers, examination of documents (including care plans and personnel files), perusal of the organisation’s website, consideration of information supplied by managers in advance of the inspection, a tour of the buildings and grounds, telephone conversations with managers after the inspection visit on quality assurance and health and safety, and consideration of views of the service communicated by clients, relatives and health and social care professionals through questionnaires returned to CSCI. Overall, the inspection finds that key stakeholders – clients, relatives and health and social care professionals – experience a high level of satisfaction with the service. It is a service which is successfully meeting a diverse range of needs. The Centre’s arrangements for assessing the needs of prospective clients are thorough. The process involves a two-day residential assessment of needs by a range of professional staff. Where the outcome of that assessment leads to an offer of a place a package of care is drawn up and costed and forwarded to the agency responsible for funding the place. Standards of care planning are good, and involve a multidisciplinary team which include physiotherapists, occupational therapists, psychologists, speech and language therapists, care staff and others. Clients are involved in the process. Liaison between different professionals within the Centre are good and it maintains good liaison with healthcare services in the community. A gap in skills has now been filled with the appointment of a psychiatrist on a sessional basis. The programme for the day is highly structured and involves the client’s attendance at a range of therapeutic and educational activities between 9.30 am and 5.00 pm. The environment meets the needs of clients. It is an older style building. Most of the accommodation is on the ground floor. All rooms are single. None have en-suite facilities. The accommodation is organised according to clients needs. It varies from the main Centre, in which the highest level of support is provided, to self-contained flats, in which clients have a high level of independence. Staffing levels are good and the home maintain good standards in the recruitment and induction of new staff and in providing ongoing staff training and development. The benefits of this are reflected in the high level of satisfaction expressed by clients, relatives and health and social care professionals. Overall, this is a service which is achieving very good outcomes for its clients. Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? A programme of improving the environment is continuing. Since the last inspection a number of bedrooms have been refurbished, new lighting and flooring have been installed in one corridor and an assisted bath installed. This improves the quality of the environment for clients. Staff training has improved and the Centre expects the proportion of care staff with NVQ 2 and above to increase. This will improve the skills of staff proving support to clients. Security has been improved through the installation of a video entry phone for access to the building out of hours. This improves the security for clients. A psychiatrist has been appointed on a sessional basis. This meets an unmet need which the Centre reports is due to an unwillingness on the part of the local NHS community mental health team (CMHT) to accept referrals from the Centre. Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.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 Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.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, 3, and 4 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The needs of prospective clients are thoroughly assessed by an experienced multidisciplinary group before an offer of a permanent place is made. This process aims to ensure that the Centre can meet the person’s needs and to minimise the chances of admitting a person whose needs it cannot meet. EVIDENCE: The service accepts referrals in writing from health and social services professionals and private referrals submitted direct from prospective clients and their families or through a professional such as a solicitor. An initial assessment is carried out based on information supplied at the time of the enquiry. Where it is decided to progress the enquiry then further information may be requested. Arrangements are made for a visit to the service. The visit provides the prospective client and their family and professional representative with an opportunity to view the facilities, talk about their needs, and for both sides to come to an initial decision on whether the referral should be carried forward. Where it is then a two-day assessment visit is arranged. Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 10 The two-day assessment visit normally starts at noon on Monday and finishes at lunchtime on Wednesday. During the course of this time the prospective client meets staff and other service users, gains an experience of the service, and has a full assessment of needs carried out by a range of professional staff. A detailed report of the assessment is filed in the person’s notes. The outcome of the assessment is normally discussed at a multidisciplinary case conference on Thursdays. At the conference the person’s needs are discussed and how these are to be met by the service. A decision is then made on whether to offer a place to the person. A package of care is drawn up and costed. This includes any additional costs such as one to one care. This is then forwarded to the referrer. The assessment aims to ensure that a full assessment of needs is carried out and that the service has the capacity to meet those needs. Professional staff advise on any particular requirements which need to be taken into account. The service is currently unable to offer a service to a person who is blind. Where the referrer and prospective client accept the offer of a place then arrangements are made for admission. On admission a plan of care is formulated and implemented. Progress is formally reviewed after three months or earlier where necessary. Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.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, 8, 9 and 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. A comprehensive care plan is in place for each client. Care plans include detailed risk assessments, evidence of good liaison with health and social care agencies in the community, and of the involvement of the client. Together, these activities aim to ensure that peoples’ needs are met and that their independence is supported. EVIDENCE: A key worker system is in place. There is a care plan for each client. A manager said that the overall structure of care plans may be reviewed in the near future. While there is always scope, in all organisations, for documents to be rationalised and improved, the care plans examined in this service during the course of this inspection were detailed, comprehensive and are considered to be of a good standard. Care planning records are divided into sections. In broad terms they include a photograph of the person, basic information on the person, a copy of the preQueen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 12 placement assessment, risk assessments, ‘rehabilitation plan’, ‘action plan for the next three months’, progress report, ‘care plans’, ‘care review’, notes by speech and language therapy, notes by occupational therapy, notes by psychology, medical notes, dental, chiropody and sight notes (where applicable), records of weight, daily notes written by care staff at the end of each shift, and correspondence. The section headed ‘Care Plan’ summarised key aspects of the person’s situation and care. The ‘Action Plan’ summarised care needs under such headings as ‘physical’, ‘communication’, ‘attention and memory’, ‘planning and problem solving’, ‘literacy and numeracy’, ‘ confidence and self-esteem’, ‘cognitive’ matters, ‘speech and language’ matters’, ‘physical needs’, and ‘occupational therapy’ matters. Risk assessments were of a god standard and covered (among others), falls, harm to self, harm to others, misuse of alcohol and drugs, road safety, and absconding. Occupational therapists carry out mobility risk assessments and clients are provided with mobility status cards. Care records included guidance on specific aspects of care such as using an exercise bicycle, the use of ankle and knee splints, and details of the precise support required in day to day activities. Care records included evidence of good liaison and communication between the different professional disciplines working in the service and with relevant NHS services in the community. Evidence of the clients consent to certain therapies, such as to participation in recreational activities or to video or audio recording in music therapy, was noted. Action plans included notes by professionals and care staff on progress in different activities (such as Art & Design, Vocational or Educational) or from different professional perspectives. They included comments by the client. Daily notes were of a good standard being a summary of the client’s participation in different activities, socialisation, mood or other matters noted over the course of a staff shift. Clients may access their notes if they wish. Care plans are reviewed quarterly – more often where necessary. Arrangements for the safe keeping of confidential information appear satisfactory. Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.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): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Clients lead a varied lifestyle according to their individual needs, abilities and interests. This ensures that clients experience a range of therapeutic, educational, social and leisure activities and are involved with the local community. EVIDENCE: The aims of the service are to enable clients to become as independent as possible. This is achieved by staff providing physical, psychological and social support as required and through the client’s participation in a range of activities – some formal and timetabled, others informal and planned at short notice. The day is structured by a timetable of activities carried out between 9.30 am and 5.00 pm five days a week. A number of clients go home for the weekend on Fridays. The activities include physiotherapy, education, art and design, Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 14 speech and language therapy, psychology, occupational therapy, gymnasium, and support in external activities such as shopping, bowling or horse riding. The mix of activities varies according to individual and group needs. The programme includes education on health and social matters. Staff in the recreational department organise activities such as shopping trips, swimming, trampolining and trips to the cinema in Sutton. The Centre has three vehicles which have been adapted in order to accommodate the needs of clients. Attendance at the education unit is an essential part of the programme. Some clients may also attend sessions at a local college. The work of the education unit is outside the remit of CSCI and is not, therefore, considered as part of this inspection. It is noted that the Centre had an annual assessment visit from Ofsted earlier in 2007. The main findings of that visit are available through the Ofsted website. Outside of the formal programme clients also make use of the amenities of Banstead, which is about a quarter of a mile from the Centre. These include shops, cafes, pubs and a library. Clients acknowledged the benefits of living at the Centre and those met during the course of the inspection visit said that they had made good progress there and were looking forward to the future. Comments included (among others): “(I am) always busy swimming, trampolining, pub etc.”; “It’s good. I get to walk a lot and go shopping and practice speaking”; “Most of the staff are very supportive and always approachable”; “During the day we have to follow the set timetable and in the evenings we can arrange visitors, who are trusted, to take us out”; “Overall I cannot fault this place but would love more independence and free will. Overall very nice but still cannot wait to leave”; and, “In the evenings there are activities organised but we don’t necessarily have to take part”. Clients maintain contacts with families and friends and as stated above many go home for the weekend. Clients privacy is respected. Clients have a key to their own room but for security reasons not to the main door of the Centre. In answer to the question in the CSCI survey ‘What does the care service do well?’ a care manager wrote ‘Individual Rehab’. In answer to the same question a relative wrote ‘It is very well run to a high standard. They listen, they don’t judge. They are all working together. All staff and clients work well together. They understand young people and have great insight in understanding their needs. They choose very good staff in all areas of the Centre”. Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 15 Meals are provided three times a day with snacks and drinks being available at other times. Clients make their choices from the menu the night before. Breakfast usually consists of cereals, toast and preserves, beverages and fresh fruit. A cooked ‘Brunch’ is provided on Sundays. Lunch is a two course meal, with a main choice of meat or fish or a vegetarian alternative followed by fresh fruit and yoghurts. Supper is a two course meal, again with a main choice based on meat or fish or a vegetarian alternative accompanied by potatoes and vegetables. This is followed by dessert of ‘Home Made Pudding’ or fresh fruit and yoghurts. Assorted salads are also offered at both meals. Meal arrangements at weekends are different. A ‘packed lunch’ is provided on Saturdays and a brunch on Sunday morning. An ‘Assorted Buffet’ is provided on Sunday afternoons which is followed by fresh fruit and yoghurts. One person expressed some dissatisfaction with weekend catering, in particular that it lacked choice and can be repetitive. It was indicated that others may also hold that view. It would be advisable for managers to seek the views of clients on the weekend dining arrangements in particular – but also perhaps to collect such information on a regular basis.. It was acknowledged that there was a need for more client input into the meal planning process. The advice of a dietician is sought through local NHS services when required. The Centre’s own speech and language therapists advise on any swallowing problems which a client may be experiencing. Clients’ weights are recorded and nutritional status monitored. Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clients are well supported by the home’s multidisciplinary team of staff. Arrangements for liaising with health and social care services in the community are good. Arrangements for the control of medicines are generally satisfactory. These aim to ensure that clients healthcare needs are met. EVIDENCE: The Centre is staffed by a multidisciplinary staff team with the aim of ensuring that clients’ healthcare needs are met. Clients needs are outlined in detail in their care plan and it is noted that in some instances instructions on moving and handling are supplemented by the use of photographs on the correct procedure when using equipment. Because of the specialist nature of the Centre clients accept some limitations on daytime activities. Clients are required to participate in the daytime programme which is a central part of their rehabilitation plan. Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 17 All clients are registered with a GP practice in Banstead unless they prefer to retain their own GP and such an arrangement is feasible. The Centre employs its own psychologists, occupational therapists, physiotherapists, speech and language therapists, art therapist and orthoptist. It has recently appointed a psychiatrist on a sessional basis. Other NHS medical services, including neurology, are accessed through the client’s GP. NHS community nursing services are also accessed through the GP although specialist continence nurses can be contacted direct. Chiropody is provided through the local health centre. NHS dentists are available at Tattenham Corner. A full optician service is available through Boots Chemists in Sutton. Technical aids are provided to clients as required. Medicines are prescribed by the clien’s GP and are dispensed by Boots Chemists in Sutton. The Centre has a policy governing the storage and administration of medicines. A senior support worker has a lead responsibility for ensuring conformance to policy. This role is rotated among the senior support worker group on an annual basis. Medicines are recorded on receipt at the Centre and on return to the pharmacy. The arrangements for the storage of medicines are satisfactory. Medicines are stored in locked metal cabinets which are fixed to the wall and in a metal medicines trolley which is also fixed to the wall. Internal and external preparations are stored in separate cabinets. It was noted that some external preparations had not been labelled when opened – a point also noted in the August 2007 audit of the home’s arrangements by a pharmacist. Medicines requiring cold storage are stored in a lockable medicines refrigerator. Reference texts available to staff included a copy of the Royal Pharmaceutical Society of Great Britain guidelines on ‘The Administration and Control of Medicines in Care Homes and Children’s Services’ and a recent British National Formulary (BNF). The deputy manager undertook to enquire into obtaining a more general text such as the BMA guide to medicines and drugs which might be helpful to clients. Some care plans included information leaflets on some medicines used by the client. Medicines records include a photograph of the client, the medicines administration record (‘MAR’ chart), and relevant medical correspondence. Examination of the MAR charts of those clients whose care was being case tracked found no errors. The homes arrangements were audited by a pharmacist in August 2007, and, with the exception of dating external creams as noted above, were found to be satisfactory. Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The Centre has good procedures for investigating complaints. It has a framework of policy, staff training and support with regard to safeguarding vulnerable adults and for responding to challenging behaviour. These aim to protect clients living in the Centre from abuse, to ensure that complaints are properly investigated, and to present a constructive response to challenging behaviour. EVIDENCE: The Centre has a good and straightforward complaints policy. No complaints have been recorded since the last inspection. CSCI have received no complaints about this service since the last inspection. All client respondents to the CSCI survey carried out in connection with this inspection reported that they knew how to make a complaint and all expressed confidence in the Centre to respond appropriately. One wrote ‘I have never made one and never felt the need to complain’. One relative respondent to the survey had complained about a matter in the past and had received a prompt and satisfactory response from the Centre. Some professional respondents highlighted good multi-professional communications within the Centre, again it is felt, reflecting confidence in the Centre to respond appropriately to any concerns. The Centre has a comprehensive policy to guide staff practice in relation to safeguarding vulnerable adults (also known as Protecting Vulnerable Adults (POVA)). This is supported by the inclusion of the subject in the Centre’s staff induction and mandatory training programme. The Centre’s’s practice in Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 19 relation to the recruitment of new staff includes appropriate background checks. A copy of the Surrey County Council policy of 2005 was available in the Centre. Some monies are managed on behalf of clients. These are managed by finance and clerical staff in the administrative offices and are subject to the organisation’s finance procedures. The service extends to supporting clients to manage their own money. Training on responding to challenging behaviour through the use of de-escalation techniques is provided for all staff. The registered manager reports that Psychology staff provide support to the multidisciplinary team in managing challenging behaviour. Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Centre offers a well-located, accessible, clean and well-maintained environment which provides clients with a comfortable and safe place to live and enables clients to access local amenities. EVIDENCE: The service is located in its own grounds about a quarter of a mile from Banstead high street. There is parking to the front of the building. A bus stop is nearby. Banstead rail station is located at the other end of the village and Sutton station is considered to be more convenient for visitors travelling by train. Banstead has many shops, cafes, pubs and other amenities which are used by clients of the Centre. The accommodation is divided into a number of defined areas according to the level of support required by clients (the numbers in brackets below refer to the number of clients resident on the day of the inspection visit): ‘Main Centre’ (9); ‘Main Building’ – two flats (5); Group Home (5); Transitional Living Unit Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 21 (4); Flats (0). Most of the accommodation is at ground level and all areas are accessible to clients. Corridors are wide and comfortably accommodate wheelchair activity. Different buildings are linked through covered walkways. Grab rails are in place around the building. There are a number of independent living flats on the first floor of one building – the ‘Transitional Living Unit’. There are stairs and a lift to that accommodation. The security of the building has been improved since the last inspection. All bedrooms are single, of a good size and those seen during this inspection were well decorated and pleasantly furnished. Clients expressed satisfaction with their accommodation. None of the bedrooms have en-suite facilities at present. A programme of refurbishment was in progress at the time of this inspection. This entailed the removal of old units from some bedrooms, redecoration, and laying new flooring. A number of showers and WC’s are located in one area. This area had been refurbished in recent years. According to information supplied by the registered manager, since the last inspection the Centre has refurbished three bedrooms, installed new lighting and flooring in the dining room corridor, installed a Parker bath in one bathroom, replaced windows, and refurbished one bathroom. The laundry is suitably equipped to meet current needs and is staffed by two laundry assistants. The kitchen is open plan and is considered to be adequately equipped to meet current needs. On the evening of the inspection visit inspection all areas of the kitchen seen were in good order, clean and tidy. There are a number of areas of shared accommodation throughout the Centre and overall the Centre provides a spacious and comfortable environment for clients. There appeared to be sufficient staff accommodation - offices, meeting rooms, therapy rooms etc.- to meet current needs. Standards of cleanliness were very good and all areas seen over the course of the inspection visit were in good order, clean and tidy. Overall, the Centre provides a safe environment for clients. Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are good, procedures for the recruitment of new staff are thorough and staff have access to a wide range of training and development opportunities. These aim to ensure that there are sufficient numbers of appropriately trained and supervised staff to meet clients’ needs. EVIDENCE: All staff have job descriptions and are supplied with a copy of the GSCC Codes of Practice on appointment. The home has a training manager who is also an NVQ assessor. According to information supplied by the service 14 of 32 staff have completed NVQ 2 or above (44 ). Four more staff would be undertaking the training by October 2007 (having started between June 2006 and October 2007). Staff report that the home is very supportive of NVQ training. Staffing at the time of this inspection provided for 10 care staff in the morning, 9 care staff plus 2 recreational staff in the afternoon and evening, and 4 care staff at night. These figures exclude the registered manager. The deputy Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 23 manager is available in addition during office hours. In addition to care staff a mix of professional staff (psychologists, occupational therapists, speech and language therapists, art therapist and physiotherapists) provide support to clients. The Centre also employs other managerial, administrative, domestic and laundry staff. The staff group is mixed in terms of age and ethnicity. Staff turnover at care worker position was reported to be low to moderate. The recruitment of new staff is managed by the home. Applicants are required to complete an application form, provide two references, have occupational health clearance in terms of fitness for the post, attend interview, and have an enhanced CRB certificate. Four personnel files were examined and, with the exception of one file which did not have a recent photograph, were found to be in order. This was an exception which the deputy manager said would be promptly corrected. A recent photograph of the person is a requirement of Schedule 1. The induction of new care staff is based on the ‘Skills for Care’ induction standards using the ‘Skills for Care’ books. This is to be completed within 12 weeks and provides a good standard of induction for new staff. This is supplemented by a five day full-time induction programme to the organisation and to the new employee’s own department. This is followed by further inhouse induction training, the content of which is based on the person’s job and the department they are to work in. Newly appointed care staff work through the induction standards booklet with a senior care worker. The completed book is signed off by the training manager. A training needs analysis is drawn up on an annual basis by the head of training and training manager and the training programme is updated monthly. A copy of the monthly programme was provided for this inspection. The programme states the frequency of training required and covered a range of subjects including: Confidentiality and Professional Boundaries, Behaviour Management, Brain Injury Awareness, Disability Awareness, Fire Safety, First Aid, Moving & Handling (‘Back for Life’), Food Hygiene, Vulnerable Adults Awareness, and Infection Control. Teamwork was described as good and managers as supportive. Supervision was said to be getting back on course again and sessions were taking place at two to three monthly intervals. Staff appraisals are held annually and a link with performance related pay (PRP) has recently been established. Staff meetings were held but at variable frequency. It was acknowledged that meetings had been cancelled on occasions due to pressure on staffing. Most respondents to the CSCI survey in connection with this inspection thought that staff had the right skills to look after people properly – eight rating this question in the questionnaire ‘Always’ and four rating ‘Sometimes’. Two declined to answer on the basis that they were not in a position to comment on such a matter. Relatives comments included ‘At the case conferences which Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 24 are held every three months, all the staff attend, from all departments at the Centre. They are all able to explain to me in a very clear way exactly what each member of staff is doing to help [name]. The staff skills are of a high standard”. Another wrote ‘What is impressive is that [relationship] severe epilepsy is a problem outside of the remit of the brain injury unit, yet the staff there have gone out of their way to train in epilepsy…..and this on top of all the other wonderful things they do…’. Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a well managed home where a positive approach to monitoring the quality of the service is providing good care outcomes for clients. Arrangements for health and safety appear thorough and aim to maintain a safe environment for clients, staff and visitors. EVIDENCE: The registered manager is a qualified nurse, has completed the Registered Manager’s Award (RMA) and holds a master’s degree in counselling psychology. The registered manager has extensive experience in healthcare including 18 years in working in services for people with a disability. The registered manager is accountable to the Principal of the service. Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 26 Quality assurance involves a number of activities. These include an annual survey of clients and of carers and professionals, client and carer satisfaction surveys forming part of the quarterly review meetings, managers being required to systematically address matters in their department over the course of the year, and client action plans being periodically audited to check progress towards goals. The results of the most recent annual survey were made available for this inspection. The client questionnaire looked at satisfaction with the ‘…quality of the teaching, therapy and support at this Centre?’ The survey looked at: overall satisfaction; overall rating of the staff; ‘wasted’ sessions; client feelings about feedback on progress; overall satisfaction with the learning experience; likelihood of undertaking further learning; and, outcomes (skills, social confidence, ability to learn, time management, attitude to learning, creativity, coping with daily life, impact on health and well-being, and participation in the community). The ‘Carers and Professionals’ questionnaire looked at: how easy or difficult it was to obtain funding for a placement at the Centre; the interval between first enquiry and admission; usefulness of the induction pack; information prior to admission; being kept informed of progress; concerns; usefulness of written reports; how helpful respondents found review meetings; responses to written communication; attending appointments; and, views on contacts with staff. The results of the most recent survey of parents were made available to this inspection. Regulation 26 visits are conducted by the Principal of the Centre and reports are filed. CSCI received 34 written responses in the form of completed questionnaires in connection with this inspection. 17 from clients, 4 from relatives, 11 from healthcare professionals, and 2 from care managers. The overwhelming response was positive. In response to the question ‘Do the staff treat you well?’ 10 of 17 clients answered ‘Always’, 6 of 17 answered ‘Usually’, and 1 of 17 did not answer that question. Comment included: ‘I think they treat you as a human being and are very good at it?’; ‘Most of the staff are very supportive and always approachable’; and ‘The only downside I have is that people do not always treat you as who you are, but as someone with an injury’. All client respondents knew how to make a complaint and indicated confidence in the Centre to deal with it appropriately. In response to the question ‘Do the carers listen and act on what you say?’ 6 of 17 answered ‘Always’, 6 of 17 answered ‘Usually’, and 5 of 17 answered ‘Sometimes’. Comment included: ‘I say sometimes because it can depend on what you say’; ‘Sometimes they’re too busy but they will try and see you’; ‘If Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 27 lots of students are around it is hard for me’; ‘I requested a change of worker, it did not happen’; and, ‘Yes, if not I would make a proper complaint going to the highest authority’. Three of four relative respondents were very positive in their comments on the Centre. Both answered ‘Always’ to questions on information about the Centre prior to admission, the Centre meeting the clients needs, keeping in touch with families, being kept up to date on important issues, the service providing support as expected, staff having the right skills and experience, meeting diverse needs (including ethnicity, disability, and gender), how to make a complaint and on the Centre enabling clients to live the life they choose. Comments from relatives included: ‘I would recommend to many. I feel that [client’s name] has greatly improved since being at Queen Elizabeth Foundation. [Name] has become more confident…memory is brilliant now to what it was before going there…walking is greatly improved’; ‘The atmosphere at this unit is unique; we feel everything about the foundation sets a precedent for care and that they should be given extra funding to advise other care providers about many aspects of care for young people…’; ‘My [son or daughter] has improved more than I had hoped for under their care’; and, ‘My [son or daughter] has been in Banstead since [date] and everything they do is really very good – [name] is improving all the time and really pleased with progress. They have found out [name] likes and dislikes and have created a programme to suit…this place has given [name] something to live for’. The responses of healthcare professionals and care managers were also positive with responses to questions rated in the ‘Always’ or ‘Usually’ sections of the questionnaire. Comments included: ‘Banstead Place provides very good quality of care for residents’; ‘I was very impressed by the skills and knowledge of the staff, also the specialisation within the team’; (What the service does well) ‘Liaison, communication. We have always experienced excellent rehab input with expected outcomes’; (What the service does well) ’Good combination – multidisciplinary approach on one site’. Arrangements for maintaining health and safety are good. There is a Health and Safety Committee and health and safety policies and procedures. One manager has a lead responsibility for health and safety matters. Staff receive training on induction and at periodic update events on fire safety, food hygiene, moving and handling, infection control, first aid, and safeguarding vulnerable adults. Processes for conducting risk assessments are in place. The kitchen and food safety practice were inspected by an environmental health officer in 2006 and found to be satisfactory. The building was visited by the fire service in 2006 and found to be satisfactory. The fixed electrical wiring was examined in 2006 and managers report that the home is carrying out work arising from that Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 28 inspection. Contracts are in place for the maintenance of fire safety equipment, wheelchairs, and the maintenance of gas appliances. Security has been improved since the last inspection by the installation of a video entryphone for out of hours access. The water in hot and cold outlets was checked for clarity in March 2007 and found to be satisfactory in all areas. Showers are regularly disinfected. Systems are in place for recording accidents. Overall, the service appears to have good systems in place for ensuring the health and safety of clients, staff and visitors. Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 29 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 4 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 4 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000013754.V346334.R01.S.doc 4 3 3 4 3 LIFESTYLES Standard No Score 11 4 12 4 13 3 14 3 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 2 X 3 X 4 X X 3 X Version 5.2 Page 30 Queen Elizabeth Foundation Brain Injury Centre No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA17 Good Practice Recommendations It is recommended that the registered manager regularly seek the views of clients on the food provided at the Centre It is recommended that the registered manager ensure that staff label all medical creams on opening. It is recommended that the registered manager ensure that supervision and meetings for care staff are held on a regular basis. YA20 YA36 Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Queen Elizabeth Foundation Brain Injury Centre DS0000013754.V346334.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!