Inspection on 07/03/08 for Sunnybrook

This inspection was carried out on 7th March 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sunnybrook 17/12/09

Sunnybrook 05/02/09

Sunnybrook 29/03/07

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Sunny Brook 88 Lyndhurst Road Ashurst Southampton Hampshire SO40 7BE Lead Inspector Tim Inkson Unannounced Inspection 7th March 2008 09:30 Sunny Brook DS0000068312.V359466.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 Sunny Brook DS0000068312.V359466.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. Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sunny Brook Address 88 Lyndhurst Road Ashurst Southampton Hampshire SO40 7BE 01306 885354 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) Corich Community Care Limited Vacant Care Home 9 Category(ies) of Learning disability (0) registration, with number of places Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: 2. Learning Disability - (LD). The maximum number of service users who can be accommodated is 9. Date of last inspection 26th September 2007 Brief Description of the Service: Sunny Brook began operating in November 2006 and Corich Community Care Limited is the Registered Provider. It is a care home that provides support and help for adults with learning difficulties and with complex needs and behaviours that challenge the service. The building is a detached two-storey house situated in its own grounds and it is close to local shops and services. All people living in the home are accommodated in single rooms with en-suite facilities. The garden is enclosed and includes a summerhouse in which activities take place. All people that move into the home are referred through local authority adult services departments or health care trusts. When consideration is being made to use the service on behalf of someone by such organisations they are provided with information about the home’s service and the facilities. A copy of a report of the most recent inspection of the home carried out by the Commission for Social Care Inspection is readily available in the home. The reported fee structure at the time of the site visit on 7th march 2008 was £1800 -£3665 per week. Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This site visit was part of the process of a key inspection of the home. It was unannounced and took place on 7th March 2008, starting at 09:05 and finishing at 16:50 hours. During the visit accommodation was viewed including bedrooms, communal/shared areas and the home’s kitchen and laundry. Documents and records were examined and staff working practice was observed where this was possible without being intrusive. The views of people living in the home could not be obtained because none had the verbal skills or cognitive ability to converse or communicate normally. Relatives of people living visiting the home at the time of the site visit and staff working there were spoken to in order to obtain their perceptions of the service that the home provided. At the time of the inspection the home was accommodating 5 people, 4 were male and 1 was female ages ranged from 19 to 41 years. None was from a minority ethnic group. The home’s deputy manager was present for much of the visit and was available to provide assistance and information when required. Staff, relatives of people living in the home, general practitioners and social care professionals were canvassed for their views using questionnaires before the site visit took place and their responses have been also taken into consideration when producing this report. Other matters that influenced this report included information that “the Commission” had received, such as complaints or statutory notices or about incidents/accidents that had occurred in the home. The home opened in November 2006 and as such it had only been operational for some 14 months and it had a number of vacancies because it was still “building up” the service. Ownership of the home changed in November 2007 and the company operating the home (Caring Homes Group ) has a range of different care services and a division called “Consensus” that specialises in services for people with learning disabilities. At the time of this site visit some of the home’s documentation was being changed form Corich (old name) to Consensus and this included policies and procedure but the process had not been completed. The home’s registered manager had also resigned in the month before the site visit took place and some temporary management arrangements were in place. Ther had been a number of requirements that had been made as a result of the last key inspection of the home in September 2007 and some of these would have been due to the conduct or practice of the manager that had Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 6 resigned. A number had been addressed and rectified and people working in the home indicated that the new owners and management were making improvements. What the service does well: What has improved since the last inspection? What they could do better: Ensure that when staff have to make a decision on behalf of a person living in the home who lacks capacity that they have received appropriate training and also that they record in detail the reason for doing so, who was involved and consulted about the decision and how it benefits that individual. This is to ensure such decisions are made properly and that the interests of the person are protected. Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 7 Establish a system for taking into account the views of people living in the home and other interested parties about the quality of the service that the home provides. This is to ensure that they are able to influence day-to-day life in the home. 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. Sunny Brook DS0000068312.V359466.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 Sunny Brook DS0000068312.V359466.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 a visit to this service. The home had systems and procedure in place to identify the help people needed before they moved in, in order to ensure that the home could properly provide it. EVIDENCE: One person had moved into the home since the last inspection of the home was completed on 26th September 2007. A senior manager employed by the organisation/company that owned the home obtained information about the specific needs of the person and the type of help and support that they required. The transition arrangements to ensure that the move of the person into the home was successful included staff from the place where the person lived before they moved into the home visiting Sunnybrook with him. The information that was obtained some months before the person moved into the included details about the following aspects of the person’s life: Behaviour; personal care; mobility; eating and drinking; risks; communication; social skills; sleep and rest; activities; family support; physical health; medication. Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 10 The conclusion reached by the senior manager conducting the assessment of the person’s needs and recommending Sunnybrook as a home suitable to meet his needs stated: “A is a complex man with high care needs. He responds to firm boundaries … he needs an environment that provides structure to his day and where he feels safe …”. The documents examined included information provided by health care professionals about the person. One member of staff described the process and her involvement in getting information about another person that had moved into the home. “I went to his school, respite care and home and he came for overnight stays every other week for a little while. This enabled us to watch, observe and build up information about him. It was really good because it also helped him settle and I knew what to do in certain situations”. A requirement was made as a result of the last inspection of the home that, “residents must not be admitted to the home unless the service can demonstrate that they can meet their needs”. There was evidence on this occasion that information had been obtained about the person who had moved into the home by a senior manager who had determined that the home was suitable to meet the individual’s needs. Sunny Brook DS0000068312.V359466.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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had systems and procedures in place for planning the care and support that people received. People were helped to exercise choices about day-to-day life. The potential of harm to individuals was identified and plans were put in place to promote responsible risk taking. EVIDENCE: Since the last inspection of the home on 26th September 2007, ownership of it had changed. The new owners were changing the format and style of documents containing information about the help and support that people needed was provided i.e. plans of care. A sample of the records about 3 of the people living in the home was examined. They included plans of care and it was apparent that the new format was in a style that would be easier for people living in the home to understand as symbols were used to help convey/impart information. Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 12 The plans seen were very detailed with clear instructions for staff about how the help needed was to be provided. They included information about the way the person communicated e.g. pictures, objects of reference, etc. The plans were focussed on the choices and wishes of the individual, demonstrating e.g. details about preferred type of music and drinks. The ability of individuals living in the home to exercise choice and control about their day-to-day life was noted from what was seen during the visit and daily records that were examined. One person was having a late breakfast (11:00 a.m.) because he liked to lie in. One individual on occasions would readily leave the home to participate in activities in the community that she enjoyed, but on occasions she would not do anything. A senior member of the home’s staff said that before the person moved into the home she had not gone out for a period of 2 years. The new plans covered a range of aspects of a person’s daily life and needs including the following areas: Managing emotions; daily living skills; relationships; sexual needs; community presence and participation; recreation and relaxation; and cultural and spiritual needs. An individual’s needs, wants and strengths were set out in their records and the care plans were broken down into the following four sections as illustrated below: Aims To prevent breakdown of skin around mouth Steps to achieve Ensure that area around mouth is kept clean and dry. If problem persists seek advice from GP Expected outcome For M to take an independent role in his personal hygiene Date to review Expected outcomes noted in plans included: • • • • Reduce self- injurious behaviour To develop communication skills To develop social skills For expectation of meal to be met The plans of care and support were supplemented by daily notes and also where required specific records of actions taken by staff e.g. use of restraint Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 13 (see section Concerns, Complaints and Protection). There was evidence from documents and discussion with visiting relatives that care plans were reviewed regularly. A range of assessments of potential harm to each person had been completed and informed the plans of care that included strategies about how these risks would be managed. The risks identified included the following; 10 pin bowling; foot-spa; accessing the garden; hydrotherapy/swimming; eating and drinking; accessing shower room; walking. The plans did include where necessary clear instructions about how staff were to manage behaviour of particular individuals that was difficult or challenging. Responses in questionnaires received from relatives of people living in the home and discussion with 2 different relatives during the site visit indicated that they believed that the home generally gave the support to the people living in the home that they expected or agreed. Comments included • “ I feel that the home has made a real effort to give our son a decent quality of life within his limitations and they have listed to our suggestions for improving his interests”. “The home provides the level of practical support needed …”. “I have no problems at all with the personal care they provide. His skin is always intact and he is well looked after”. • • The comments from one social care professional about what they believed that the home did well were as follows: • “The home communicates well with me and keeps me informed. It supports individuals positively with behaviours that challenge the service. It facilitates person centred activities and learning experiences. It sets boundaries and is consistent in communication with the service user”. Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home promoted the right of people living in the home to live ordinary and meaningful lives. They were supported to take part in social and recreational activities. The food provided by the home was varied, nutritious and according to individuals’ specific needs and choices. EVIDENCE: It was apparent from observation during the site visit, examining records and discussion with staff and visiting relatives that people living in the home were supported to pursue their own particular interests and also to use amenities in the local community such as shops, swimming pools, bowling alleys, and pubs. The home had a min-bus that enabled staff to take people to a range of different places including beaches, beauty spots and activity centres. There were individual activity plans for everyone living in the home and these varied and changed from week to week although for everyone there were some regular and consistent activities e.g. one person went horse riding and another hydrotherapy. Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 15 On the day of the site visit one person was horse riding during the morning and others went shopping. One went out for lunch to a local pub with a relative and then later went out with some others to a beach with the support of staff. Some others went fro a drive to a local and well-known ice cream parlour. The day after the site visit a number of people were going to visit a local zoological complex/reserve. The degree of support required by each person because of their level of functioning, complex needs and unpredictable and sometimes challenging behaviour limited the opportunities and ability of many to develop life skills that would enable them to live more independently. The home had a summerhouse in the grounds that was used for activities and there was a range of board games available for the use of people living in the home as well videos and DVDs in the home’s lounge where there was also a television set for communal use. Individuals had televisions and other equipment in their rooms so they could enjoy their personal tastes in music or viewing in the privacy or their bedrooms. One relative included the following in comments about the home: • “It offers a stable home … activities 24 hours a day and 365 days a year … it offers a range of activities and outings …”. The home had only been operating since November 2006 some 14 months. It was “building up” and some individual had only been living there a short time. Arrangements therefore had not been made to ensure that each person living there benefited from an annual 7-day holiday but the home’s deputy manager said that this would be done and also stressed that many of the people living in the home stayed with relatives for periods of time. One individual was going home with a relative for the weekend on the day of the site visit. There was a requirement arising from the last inspection of the home on 26th September 2007 that, “residents must be provided with meaningful activities suited to their expectations and needs”. It was apparent that the home had and continued to address this requirement. Regular contact was maintained between people living in the home and their relatives. Two called at the home on the day of the site visit and one said: • “I come at any time I want and without them knowing although I usually phone up because he may be out”. Individuals living in the home had their own single rooms promoting their right to privacy. Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 16 The home employed a cook and the meal menus were based on the like and dislikes of people and also their specific health needs. If anyone did not like or want was provided they were offered something that they liked and had the opportunity to exercise choice from a range of alternatives at certain meals e.g. cereals at breakfast. The cook was very experienced and enthusiastic and the records of food provided indicated that a healthy and nutritious diet was promoted. There was evidence of the ready availability of fresh fruit. The specific details of the diets for two of the people living in the home were readily available in the kitchen. One person’s diet was influenced by advice from a speech and language therapist because of swallowing difficulties and food had to be mashed also because of other health problems it also had to be a high fibre diet. Another person had been on a gluten and dairy free diet but on advice from the individual’s doctor was being reintroduced on a limited basis to food with gluten in it. The home was working towards introducing the use of pictures to enable and encourage people living there to be more actively involved in planning menus. Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people received was based on their individual needs and their medication was managed safely. EVIDENCE: The home’s staff team was relatively stable and comprised a core group as well as a number of regular agency staff. This was because the home was still “building up” having opened some 14 months earlier and was not fully occupied. Male staff were not involved in assisting any females living in the home with any intimate physical care needs. Records examined concerning the people living in the home indicated that they were supported to make visits to healthcare professionals or received them when necessary. These included among others; general practitioners; chiropodists; speech and language therapists: and dentists. There was also evidence from the records examined that that advice had been obtained from a general practitioner about problems that one person had developed with their mobility and daily records being kept indicated that progress with the condition was being monitored. Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 18 The company that owned the home employed a behavioural therapist who provided support to the staff team and helped to develop plans to assist individuals manage specific behavioural problems. Responses in questionnaires received from two general practitioners that had contact with the home indicated that they were satisfied with the overall care provided by the home and believed that the home: • Communicated clearly and worked in partnership with them • Always had a senior member of staff on duty to confer with them • Enabled them to see their patients in private • Demonstrated a clear understanding of the care needs of people living in the home A requirement had been made as a result of the last inspection of the home on 26th September 2007 that “residents must have their health needs assessed, planned for and the support they receive recorded”. It was evident on this occasion that this was happening. The home had detailed written policies and procedures about the management of medication. There was also reference information readily available to staff about medicines. Medicines were kept in a suitable locked metal cabinet and the home used a monitored dosage system with most prescribed medicines put into blister packs for a period of 28 days by a pharmacist. The exception being those items that would deteriorate when removed from their containers or liquids. Records that were kept of the receipt into the home, administration (giving out) and disposal of unwanted medicines were accurate and up to date. There were clear instructions for the use of medications that were prescribed for use on occasions that it was required (i.e. PRN). All staff who were responsible for giving out medicine had received training in the safe management of medication and in accordance with good practice there were sample copies of their signatures available. Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home did not have access to an easy to understand complaints procedure but there is one given which relatives are aware of and hade confidence in using that would enable them to raise their concerns and the home to address them. The ability of people living in the home to have their views listened would be improved by ensuring that they had access to independent advocacy services . The safety of people living in the home is compromised because the systems for protecting them from do not include a process to ensure that decisions about how an individual’s money spent on their behalf are recorded properly. EVIDENCE: The home’s complaints procedure was included in the Service Users Guide that was provided to everyone living in the home. It was not in an easy to understand format designed to meet the specific needs of people living there e.g. pictures/symbols. There was no copy of the procedure on display in the home. The home’s deputy manger indicated that the home and the company that owned the home were working on producing information including the complaints procedure in alternative format such as pictures and symbols to help people living in the home understand them more easily. Responses in questionnaires returned by relatives of 2 of the people living in the home indicted they knew how to make a complaint and also that the home had responded appropriately when they had raised concerns. One relative spoken to during the site visit indicated that she had raised concerns with the home and that they dealt with most of them. She indicated that she thought Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 20 that the home could advocate more strongly with statutory agencies on behalf of people living there. There was a requirement made as a result of the last inspection of the home on 26th September 2007 that, “the registered person must ensure that any complaints made under the complaints procedure are fully investigated”. There was no evidence to suggest that this requirement was not being met at the time of this site visit. One person in the home had an independent advocate that worked with them and this had been arranged before they moved into the home. There was no evidence that the home had engaged with or had made contact with any independent advocacy services for people living there. There were written procedures readily available in the home for the guidance of staff, about safeguarding vulnerable adults. These included a copy of the local authority’s adult protection procedures. All staff spoken to had received training in the subject of adult protection and demonstrated that they knew what to do if they suspected or knew that abuse had occurred in the home. Despite staff being aware of what to do when they suspected abuse the behaviour of a member of staff that subsequently resulted in them being suspended had not been brought to the attention of the relevant authorities by the home. The home was subject to investigation by the local authority adults services department in accordance with its safeguarding of vulnerable adults procedures. This was due to concerns brought to their notice about the use of restraint in the home. As a result of these investigations procedures and practice in the home had been improved and accurate records were being kept of the use of restraint. It was also apparent from observation during the site visit that the very detailed instructions/guidelines that the home had recently developed about the use of restraint were being adhered to by staff. Staff spoken to and records examined indicated that many of the staff working in the home had received training in control and restraint and breakaway techniques. There was a requirement made as a result of the last inspection of the home that, “residents must be safeguarded by suitably trained staff, including staff that have trained to enable them to care for those residents with challenging behaviour”. No evidence could be made available at the time of the site visit about the quality of the training and whether it or the person providing it had been accredited by the British Institute of Learning Disability (BILD) in accordance with Department of Health expectations. This information must be available for the next key inspection of the service. Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 21 Because individuals living in the home had very limited understanding of financial affairs their respective relatives managed such things on their behalf. The home did however look after cash/money on behalf of people living there and the money being held at the time was checked with the records being kept. There was some difficulty reconciling these as some money had been taken out of the balances being held, for an activity that was taking place the following day. The home’s deputy manager said that an individual’s money had been spent on behalf their behalf purchasing some bed linen. There was no record of how the decision to spend the money in this way had been agreed and on what basis. There was no evidence that any one working in the home had received training about the Mental Capacity Act 2005 and how it applied to making decisions on behalf of people who lack capacity. Consequently a requirement was made regarding this matter. Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s environment was comfortable safe, and well-maintained for the benefit of the people living and working in it. EVIDENCE: At the time of the site visit, the premises, its décor, fixtures, fittings and furnishings were generally well maintained and in good repair. There was an absence of easy to read/understand signage/symbols that could enable people living in the home to identify independently the location of stored items or the purpose/use of a room and promote their independence. Similarly there was an absence of the use of such materials to inform people living in the home of the staff that would be working and of the planned and agreed individual and group activities. It was however apparent that the staff team were working on building up materials e.g. photographs, which would be used to convey information. The company that owned the home had a property services department and there were written procedures that clearly identified the responsibilities of Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 23 different personnel in the organisation for dealing with and responding to matters such as repairs to and maintenance of the building. At the last inspection of the home on 26th September 2007 it was noted that people living in the home had restricted access to their bedroom accommodation as well as communal bathing and toilet facilities. Consequently a requirement was made that, “the registered person must ensure that the physical design and layout of the premises meets residents needs, ensuring that they have access to all parts of the home by key or otherwise, unless indicated by a risk assessment. This includes personal rooms and bathrooms”. Access to bedrooms and the communal bathroom/WC was obtained with a sensor key fob carried by staff. It was noted however that the room of one individual was open because she liked to wander in and out of her room at will. Discussion with the home’s deputy manager indicated that the unsupervised behaviour of a number of individual living in the home could cause damage to either the building or to the belongings and property of other people e.g. flooding from blocked sinks or destructive behaviour such as tearing, ripping or soiling. She said: • “They are able to make their needs known and if they want to go to their own room they will be able to. We so have some here that will interfere with other peoples things also P and L will stuff the toilet or sink until they overflow”. The reason why the decision to limit a person’s access to their room and any communal facilities was made must be recorded in each individuals care plan because the arrangements may be perceived as a restriction of their rights. It was agreed that this would be done. The home had infection control policies and procedures and staff had received training in the subject. Good practice noted during the site visit included the provision of hand sanitising products and paper hand towels in the communal WC and bathroom. There was a well-equipped and suitably sited laundry on the site and the home’s procedures included a system for safely and effectively managing soiled items. Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recruitment of staff needs to be more robust to ensure the safety of people in the home is properly promoted. The training, deployment level and skill mix of staff ensured that most of the needs of people living in the home were met. Further staff training is required to ensure that the interests of people living in the home are fully protected. EVIDENCE: At the time of the site visit the home’s permanent staff team comprised 16 care staff, a cleaner, cook and laundry person. Out of the care staff 2 had relevant qualifications (i.e. 13 ), one was a registered nurse specialising in learning disability and mental health and the other had a National Vocational Qualification (NVQ) at level 4 in care. A number of staff spoken to said that they were working towards obtaining NVQ at either level 2 or 3 through a local college. The home’s deputy manager said that 7 members of the staff team were doing so. The low number of staff with a relevant qualification reflects the fact that the home had been operational for only 14 months and was still “building up” to full capacity. The home relied on the use of agency staff to cover many shifts but the deputy manager said that they only used certain agencies and were provided with the Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 25 same consistent and regular agency staff. Staff recruitment was being carried out by the home to replace agency with permanent staff. An agency member of staff spoken to said that she had experience of working with people with similar needs to the people living in the home and that she had received training in fire safety, adult protection/abuse, infection control, moving and handling and also that the agency had obtained checked her background with the Criminal Records Bureau. There was evidence from examining staff records and an improvement plan developed by the new owners of the home, discussion with staff on duty and the home’s staff training programme that there was a commitment to staff training and development. Also to ensuring that all staff received regular training and updates in essential health and safety topics as well as those that were about the specific needs of people living in the home. The improvement plan indicated that among other things the following training was being commissioned and planned for the staff team. • • • • • • • • E learning programme Value base and learning disability Communication Autistic spectrum disorder Challenging behaviour Physical Intervention Care planning Record keeping Essential training for all staff working at the home must include proper procedures for making decisions on behalf of people who lack capacity (see section above about “Concerns, Complaints and Protection”). Comments from staff about the training that they received included the following: • “I have been here since the home opened and I have had training in health and safety, 4 days about autism and behaviour, and adult protection. I am doing NVQ. I also did contributing to the care setting when I started and infection control … I have read about de-escalation but I have had no training in physical intervention”. “I started here when it open … we had induction and completed a pack that was signed off when we did it … I have been on courses about autism, communication, infection control, challenging behaviour … I have done breakaway training but not control and restraint. We have done in house abuse training, food hygiene and fire safety … we could do with some training being repeated …”. • Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 26 • “I have done moving and handling, infection control, first aid, abuse and breakaway. I have done everything that they have thrown at me. I start an NVQ in cleaning next week”. The records were examined of 3 staff that had started work in the home since the last key inspection of it had been completed on 26th September 2007. The home had written employment procedures in place that should preclude someone from working in the home until all the necessary checks into the suitability of that individual to work with vulnerable adults had been completed. However it was also apparent that these had not been fully adhered to because although the home’s procedures stated that two references must be obtained including the current or most recent employer. The records of 2 of those examined included only personal references. Essential checks with the Criminal Records Bureau had been carried out before they started work. Reliance on purely personal references excludes the possibility that a previous employer may indicate that an individual may be unsuitable because of poor performance or behaviour. Responses in questionnaires returned by staff and discussion with staff at the time of the site visit indicated that the level of staffing and the number on duty at any time was usually sufficient to meet the needs of people living in the home. One said: • “There were 7 staff on this morning which is good. It depends on what we are doing if that is enough. We tend to operate on 6 or 7 and it can depend on the behaviour of the residents – if ther are any less we can’t do a lot because some of the residents need a 2:1 ratio and also it depends on their moods, sometimes they don’t want to do things anyway”. The basic minimum rota 7 days a week was as follows: Time Number of staff 07:00 to 14:15 6 13:00 to 21:00 6 20:15 to 07:15 2 wakeful Comments about the qualities and approach of the staff team from relatives of people living in the home included the following: • • “The staff are able to understand his language and consequently he talks more … there are some real stars among the staff here”. “There is by and large a good atmosphere and they can cope with periods of difficult behaviour … ther is a stable staff group who have Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 27 remained constant and who are familiar and friendly and are good at relating to my son”. Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 28 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 adequate. This judgement has been made using available evidence including a visit to this service. The management of the home was generally effective but there were some weakness identified (see “concerns, complaints and protection” and “staffing” above). There was no formal system in place to enable people living in the home to express their views and influence the day-to-day service provided. There were robust systems and procedures for promoting the health and safety of everyone living and working in the home. EVIDENCE: The homes registered manager resigned in February 2008. We (the Commission for Social Care Inspection) were informed by a telephone call about the temporary management arrangement by the person who was providing support to the home fort 2/3 days a week as well as managing another service owned by the company that owned Sunnybrook. Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 29 The company that owned the home failed to inform us of the departure of the manger and of the temporary management arrangements in accordance with their responsibilities under Regulation 38 of the Care Home’s Regulations 2001. Discussion with staff during the site visit indicated that a lot of them believed that in the short time the former manager had been gone that things had improved and that the temporary manager had already made a difference and was getting things done. • “Things are getting a lot better … I have seen the new style care plans, the temporary manager has changed a lot, things are getting done on health and safety that weren’t before. A bath panel has been repaired and radiators fixed to walls …”. • “If we asked for things like special fittings for M wheelchair so we could take it on the minibus it took months but we get things done now. The home lacked structure before and we seem to have that now … everyone is now going in the right direction, you need someone at the helm … you were Ok if you agreed with her …”. There was evidence from minutes examined that meetings were held at which staff could share information and discuss concerns. However these had only happened shortly before the site visit took place. There was no evidence of meetings or other systems being implemented such as the use of questionnaires that would enable people living in the home or their advocates to influence day-to-day life in the home. The organisation that owned the home had a procedure about monitoring the quality of the home’s service that referred to internal audits and questionnaires being used for people living in the home and their representatives. These need to be implemented as Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 30 another demonstration that the ethos pf the home is based on person centred planning. A very detailed copy of a report of a recent visit carried out by a senior manager of the company that owned the home in accordance with Regulation 26 of the Care Homes Regulations 2001 was seen. A requirement had been made as a result of the last inspection of the home on 26th September 2007 that, “the registered person must ensure that the care home is visited in accordance with regulation 26 of the Care Homes Regulations 2001 to monitor the conduct of the care home”. Records seen and discussion with staff indicated that safe working practices were promoted in the home. Up to date certificates were on file concerned with gas safety and electrical wiring. Records and discussion also indicated that fire safety and other systems and equipment were checked and monitored (e.g. shower heads, hot water outlets and M.O.T. certificate for the home’s mini-bus) and staff had received fire and other health and safety training. A requirement was made at the last inspection of the home on 26th September 2007 that, “ the home must ensure that after consultation with the fire authority they take adequate precautions against the risk of fire”. A signed fire risk assessment was seen and it was also apparent that the home had implemented some matters identified by the local fire and rescue service following a visit by them to the home i.e. method of opening the main entrance to the home had been altered. Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 31 The home had a range of policies and procedures and other information available and readily accessible to staff who said that they informed their working practice. They included among others the following: • • • • • • • • Risk management Sexuality and relationships Physical intervention Quality assurance Pharmacy and medication Procedure for administering medication Appointing staff Abuse procedure The new company that owned the home and had been responsible for it for some four months was in the process of replacing the home’s policies and procedures with its own. The old procedures that were seen at the time of the site visit in some cases bore no relationship to the actual situation or practice in the home. This was illustrated by the procedure about medication that referred to a pharmacy and a system that the home was not using. Also the laundry procedure referred to the location of the home’s laundry as the basement but it was located in a separate building in the grounds of the home. It was apparent that some of the procedures had been written for other homes and had not been amended or tailored to fit what was actually being done at Sunnybrook. Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 32 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 X 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 X 2 2 X 3 X Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 33 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA23 Regulation 12(3) Requirement Where decisions are made on behalf of a person living in the home who lacks capacity. The rationale for the decision, who was involved and how it is in the best interest of the individual, must be recorded. This is to ensure that the rights and interests of the person are properly protected. Staff who make decisions on behalf of people living in the home who lack capacity must have received relevant training. This is to ensure that they are aware of their responsibilities and make proper provision to protect the interests of the person concerned. Systems for monitoring and improving the quality of the service that the home provides must be implemented that included obtaining the views of people living in the home and other interested parties. This is to ensure that they are able to influence the service that they receive. Timescale for action 31/05/08 2 YA35 18[c] 31/05/08 4 YA39 39 30/09/08 Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 34 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Sunny Brook DS0000068312.V359466.R01.S.doc Version 5.2 Page 36 - 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. 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