CARE HOME ADULTS 18-65
The Brambles 104 Station Road Soham Cambridgeshire CB7 5DZ Lead Inspector
Elaine Boismier Unannounced Inspection 19th November 2007 10:00 The Brambles DS0000015227.V355070.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 The Brambles DS0000015227.V355070.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. The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Brambles Address 104 Station Road Soham Cambridgeshire CB7 5DZ 01353 722971 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) Mr Anthony Eric Barnes Mr Anthony Eric Barnes Care Home 3 Category(ies) of Learning disability (2), Learning disability over registration, with number 65 years of age (1) of places The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One service user over 65 years of age with learning disabilities (LD(E)) for the duration of their residency 20th June 2007 Date of last inspection Brief Description of the Service: The Brambles is a small home for three people with moderate to profound learning disabilities, and some physical disabilities. The home is a converted bungalow, and each service user has their own room, sharing communal accommodation, which includes a lounge/diner, kitchen bathroom and two WCs. Current fees are £900 per week with additional costs for chiropody and clothing. A copy of the inspection report is available at the home or via the CSCI website. The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This summary includes information about the home following the last key unannounced inspection carried out on 20th June 2007 and up to this key unannounced inspection of the 19th November 2007. Improvement plan Following our inspection on 20th June 2007 we had assessed The Brambles to be a poor performing service. We wrote to the home and our letters told the Manager what had to be done to make sure that people living at The Brambles were safe from the risk of harm to their health and safety. We received the home’s response to our letters and we considered that this written response was completed to a satisfactory standard. Random unannounced inspection-30th July 2007 On the 30th July 2007 we, the Commission for Social Care Inspection (CSCI), carried out a random unannounced inspection of the home. The reason for this inspection was to assess what progress had been made, in the following five areas since the key unannounced inspection of 20th June 2007: 1) Hot water temperatures A recommendation had been made following the inspection in June 2007 for any checks on hot water temperatures to be recorded. This recommendation had been considered, as there were records of these hot water temperatures. 2) Staffing We were unable to assess what progress had been made with regards to the recruitment of staff. We were pleased to see that the staff files were now kept at the home although we could not gain access to these. We reported that it is our expectation for arrangements to be made to allow us to gain access to this information at all times. We did not formally assess the progress made with regards to staff training as the timescale for this requirement to be met, had not passed. We reported that we would assess the progress made in this area, at a later inspection. 3) Management-Staff working hours and duty roster Following our key unannounced inspection of 20th June 2007 we were concerned about the number of hours the Manager was working. During the random unannounced inspection of 30th July 2007 our concerns remained with
The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 6 regards to the safety of people being cared for by staff working such long hours. It was difficult, although not impossible, to make sense of the staff roster as to what hours of the 24-hour day staff were due to work. This was due to a lack of details of what shifts were to be worked, as there was no key or code or usage of the 24-hour clock. In addition the full names of staff were not included on the roster and we suggested that these should be recorded. Neither a requirement nor a recommendation was made about the duty roster, as it was our expectation that this would be managed by the home as part of good practice. 4) Moving and handling A requirement has been made for all staff to receive training in safe moving and handling and this training is to be specific to the home environment and specific to the specialist needs of the people living at The Brambles. A requirement was made for action to be taken for people to be assessed in their moving and handling needs and this assessment is to be carried out by a healthcare professional. 5) Medication A recommendation was made following the inspection in June 2007 that when hand written additions or alterations were made to the printed medication administration record charts, supplied by the pharmacy, these were to be initialled, dated, and checked for accuracy. This recommendation had been considered. Following the inspection on 20th June 2007, a requirement was made for medication to be stored safely and according to the manufacturer’s instructions. This requirement was not met in full and a new timescale for action was given. As a result of this random inspection of 30th July 2007 four new requirements were made. A copy of the full report letter of the random inspection carried out on the 30th July 2007 is available on request at Cambridge CSCI office. Quality assurance and specialist input- letter 29th September 2007 On the 1st October 2007 we received a letter, dated 29th September 2007, and a copy of the home’s quality assurance document from the Home Manager. The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 7 The letter requested our views of the content of this document and advice about gaining specialist healthcare input into the home. We wrote to the home, on the 16th October 2007, to explain the CSCI role in offering advice on such matters. We acknowledged that the home had aimed to develop a detailed and comprehensive quality assurance system for The Brambles in response to a requirement made at previous inspections. We provided also written advice with regards to improving specialist input into the home. Key unannounced inspection-19th November 2007 This is the second key unannounced inspection of The Brambles in 2007 and was carried out by two Inspectors between 10:00 and 13:45 and took just under 4 hours to complete. Before the inspection we sent out 3 surveys for the residents, 4 surveys for staff and 2 surveys out for relatives. We received 2 residents’ surveys (although only one of these was completed in full), all the surveys from the relatives and 3 surveys from staff. During the inspection we spoke with people, including a visitor, and the member of staff on duty, looked around the home, watched people and staff and examined documentation. The Manager was on a training course at the time of our inspection but was able to attend the last part of the inspection, including the inspection feedback session. Evidence suggests that The Brambles has improved from being a poor quality service to that of being an adequate quality service. It is our expectation that internal management of the home, rather than reliance on our inspection and regulation, sustains any improvements that have been made. The home is to be commended in obtaining information, about a relevant medical condition, from the Internet. For the purpose of this report people living at The Brambles are referred to as “people”, “residents” or “service users”. What the service does well:
People live in a clean and friendly home. They have opportunities to live a very good quality of life and that they are consulted, as much as possible, in making decisions of how they want to live. The home and the people living at the Brambles is well integrated with the local community of Soham village. A relative’s survey told us that they were really pleased with the standard of care that is provided at the home in that the home, “Provide(s) a fantastic service to my son.”
The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection?
A requirement was made following inspections in 2006 and 2007, for the care plans to be kept under review in accordance with the regulations to ensure that people are receiving the appropriate care. This requirement has been met. A requirement was made for care plans to be implemented to provide staff guidance in how to appropriately care for people who have a change of need. This requirement has been met. A requirement was made following inspections in 2006 and 2007 for care plans to provide sufficient detail for staff guidance in how to provide appropriate care for people to reduce the risk of harm to their health, welfare and safety. This requirement has been met. A recommendation was made for documentation to be in a format that people might be able to understand. This recommendation has been considered. A requirement was made following inspections in 2006 and 2007 for the decisions of people to be obtained and these decisions to be recorded in the care plan to ensure that people are not being controlled. This requirement has been met. A requirement was made following inspections in 2007 for medication to be stored safely and according to the manufacturer’s instructions to ensure the quality of medicines given to people who use the service. This requirement has been met. A requirement was made for clear guidelines to be in place for non-prescribed medicines used in the home to ensure that people who live at the home are safe from harm. This requirement has been met. A requirement was made for staff to be trained in medication, infection control and food hygiene. This requirement has been met. A requirement was made following inspections in 2006 and 2007 for effective, formal quality assurance systems to be in place to ensure that care provided is up to date, procedurally safe and reflects the wishes of the people living at the home. Information about the quality assurance systems was submitted to the Commission. This requirement has been met. A requirement was made for all staff to be trained in first aid procedures to reduce the risk of harm to people’s health and safety. This requirement has been met. The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 9 A requirement was made for all staff to be trained in fire safety to reduce the risk of harm to people in the event of a fire. This requirement has been met. A recommendation was made for fire checks to be recorded in a way that demonstrates what has been checked. This recommendation has been considered. A requirement was made for all of the residents to be referred to a qualified professional for an assessment of their safe moving and handling needs. This requirement has been met. Staff are receiving formal supervision sessions. The duty roster is easier to read as the 24-hour clock is being used to show at what time of day or night staff are working. The surnames of the staff were recorded on the duty roster. What they could do better:
A requirement was made for complete and accurate records to be kept of all medication administered or not, together a reason why the medicine was not given, in order to demonstrate that people who use the service receive the medicines prescribed for them. This requirement has not been met and has been carried forward with a new timescale for action. Records of people’s personal allowances, including all transactions must be kept at the home. We expect the home to manage this, rather than we make a requirement on this occasion. Staff training in medication and safeguarding procedures must improve. We expect the home to manage this, rather than we make a requirement on this occasion. A recommendation was made for policies and procedures appropriate to the home to be developed and implemented with reference to Appendix 2 of the Care Home Regulations 2001. This has not been assessed on this occasion but will be assessed at a later inspection. As such this recommendation remains. A requirement was made for all staff to receive training in moving and handling every 6 months and this training to be domain specific. This requirement has not been met and has been carried forward with a new timescale for action. The fire safety officer has been contacted for their advice on fire safety in the home. No fire drill practice has been carried out. We expect the home to manage this, following consultation with the fire safety officer. The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 10 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. The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 11 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 The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 12 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. People have access to a good standard of information to assist them in their decision where to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no new admissions to the home since the inspection in June 2007. This standard had been assessed as met at the last inspection and remains met. The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 8 & 9 Quality in this outcome area is good. People are safer as there has been an improvement in the standard of records. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were three requirements made following the inspections of The Brambles in 2006 and 2007. These requirements were related to care plan documentation. We examined all three people’s care plans and we acknowledge that there has been a considerable improvement in the standard of detail within these care records. The records provided the reader good information about the people, their social and medical history and their current needs, likes and dislikes. There was clear guidance of how people should have their care provided. Care plans had been reviewed as they had been developed and any changes in the person’s condition were clearly recorded to include how the person was to be cared for in the light of this change of condition. Risk assessments were in place for care practices such as moving and handling and the risk of falls. As a result of this evidence all three requirements have been met.
The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 14 A recommendation was made for the care plans to be developed in a format for the person to understand. We noted that there has been an improvement in this area; care plans were provided with pictures of the person’s preferences and interests. The Manager informed us that, since the last inspection, he has attended a training course in communication with people who have a learning disability. This recommendation has been considered. A requirement was made for people’s decisions to be obtained and these decisions to be recorded in the care plans. This was with particular regard to the wearing of lap/mobility belts for people whilst they were sitting in their chairs. The risk assessments for falls included the use of mobility belts and the agreement of the person, or their relative, to use this form of restraint, was recorded. One of the 2 residents’ surveys that we received told us that the home always supports the person in making decisions and that they could do what they wanted anytime of the day and at any time of the week. The remaining survey was not completed. We observed the member of staff interacting with the residents and the people was frequently consulted in what they wanted and wanted to do. People are supported by staff in daily living activities, as people currently living at the care home are dependent on staff in fulfilling their health and social care needs. Risk assessments were in place and we saw from the care records that there are no restrictions imposed on people’s activities within or without the home. The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 15 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 &17 Quality in this outcome area is excellent. People are provided with opportunities to live an excellent quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A relative’s survey told us that they were really pleased with the standard of care that is provided at the home in that the home, “Provide(s) a fantastic service to my son.” Currently no person attends educational courses or work facilities. Standard 12 is therefore not applicable. There has been no change in people’s standard of lifestyle since our key inspection in June 2007. We noted from people’s care records that the home continues to provide people with an excellent range of activities to include going to local shops, cafes and able to receive their guests in the home or go
The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 16 out to visit their families. The home remains an integral part of the community of Soham village. We observed the member of staff talking to people in an inclusive manner and the person’s preferred name of address was recorded in the care records. Records of what people had eaten during the day are recorded in clear detail within the daily records. Care records indicated that, meals are provided at flexible times. We saw that the lunchtime was unhurried and people were encouraged to be as independent as possible in eating their food. Food was pureed in individual constituents. A visitor told us that the food was “lovely”. The Brambles DS0000015227.V355070.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): 18, 19 & 20 Quality in this outcome area is adequate. People benefit from an improved standard of personal and health care that could be better. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The surveys that we received told us that people are very well supported in their care and we observed this to be the case. A visitor told us that staff are kind and caring. We saw people were dressed in individual style of fashions and that personal care was provided at flexible times and in private. Care records told us that people have had access to a range of healthcare professionals including the local GPs, district nurses and diabetes specialist nurses. The district nurses, for a person who has a history of developing sore skin, have supplied a pressure-relieving mattress. Care records told us that medical conditions are monitored by the home i.e. diabetes. Within a person’s care file we saw information about a medical condition. The home is to be commended in obtaining this information from the Internet. A specialist pharmacist inspector examined practices and procedures for the safe handling and recording of medicines. Storage provided for medicines is
The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 18 satisfactory and the quantity of medication held, including those not prescribed for residents, but bought over the counter have been much reduced. However, there is a need to ensure that when medication whose shelf-life is reduced once the container is opened that the date of opening is recorded. This will ensure residents receive medication of suitable quality. There was a container in the fridge which carried that instruction “[name] eye solution. Bicarb soda or Camomile Tea”. It was unclear what was in this container and when it was prepared although the resident’s care plan did contain detailed instructions on how to make up this solution and when to use it. There was an oxygen cylinder in one of the resident’s room which is no longer prescribed and should be disposed of. There is a good, clear audit trail of medicines received into the home and disposed of. The records made when medicines are given to residents have improved but there were still some unexplained gaps in the records giving no indication of whether they had received their medicines or not. The Brambles DS0000015227.V355070.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): 22 &23 Quality in this outcome area is adequate. People are listened to although they are at some risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The completed relatives’ and residents’ surveys told us that people knew how to make a complaint and who to speak to if they were unhappy about something. We have received no complaints about the home and according to the Manager no complaints have been made. As a result of this the Manager informed us that there is no record for complaints. All the staff surveys told us that the member of staff knew what to do if a person, or visitor to the home, made a concern known to them. It was difficult to know how the home was safeguarding people’s personal monies, as no record was available at the home for us to inspect. We expect this information to be kept at the home, in accordance with Schedule 4 of the Care Homes Regulations 2001. We expect the home to manage this rather than we make a requirement on this occasion. In an unlocked kitchen drawer we found monies in individual envelopes and a purse. All of these were labelled with the name of one of the residents. The kitchen door was not locked. We expect the home to manage this, to ensure that people’s monies are properly safeguarded, rather than we make a requirement on this occasion.
The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 20 The Manager and staff informed us that safeguarding training for staff has not been attended. We expect arrangements are made, by the home, for staff to attend training in safeguarding vulnerable adults against abuse. We observed that the member of care staff was caring for people in a kind and attentive way. The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 21 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 & 30 Quality in this outcome area is good. People live in a safe, comfortable and clean place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Brambles provides a comfortable and friendly “home from home” place for people to live. Gardens were tidy and the general maintenance of the home was good. Records of hot water temperatures were seen and these were recorded on a daily basis. The temperature of the hot water was delivered at a safe level. The resident surveys that we received said that the home was always clean and fresh. On the day of the inspection the home was clean and free of odour. The Brambles DS0000015227.V355070.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): 32,33,34,35 & 36 Quality in this outcome area is adequate. People are safer as they receive care from well-recruited staff who have attended an improved standard of training and supervision. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The surveys that we received told us that people are looked after by kind and caring staff and that “Staff are always very helpful and courteous.” The Manager informed us that there has been no change, since our inspection in June 2006; the number of staff with an NVQ level 2 in care remains at 57 . The duty roster was examined and we found that it was easier to read than at a previous inspection as the 24 hour clock was being used to show what time of day or night staff worked at the home. The surnames of the staff were recorded on the duty roster. A survey from a member of staff indicated that, when staff are working on their own, this could pose difficulties to residents. The survey told us that should more than one resident need help at the same time, then this could be difficult. During the inspection we found that people were receiving appropriate
The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 23 care from the member of staff in an unhurried manner. The Manager informed us that he is actively recruiting to fill a staff vacancy. Two staff files were examined and all the required information was available about the person before they started working at the home. A requirement was made for staff to be trained in medication, infection control and food hygiene. Examination of the staff files indicated that progress has been achieved in this area as some, but not all staff have attended such training. We consider this requirement has been met, although we expect the home to continue with this training to ensure that all staff attend training in medication, infection control and food hygiene. All the staff surveys said that the person had received an induction training that very well covered everything that the member of staff needed to do the job. These surveys from staff told us also that they are being given training, which is up to date and is relevant to their role. The two staff files that we saw indicated that the Manager has commenced formal supervision sessions with staff. The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 Quality in this outcome area is adequate. People benefit from an adequately managed service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined the duty roster for the week before and the week of the inspection. Whilst acknowledging that the number of consecutive hours that the Manager has worked has been reduced we remain concerned about the number of consecutive hours that he has worked and is scheduled to work. These long hours range from 14 up to 20 consecutive hours of working. We noted, from care records, that some of the residents need attention at night. We discussed our concerns with the Manager at the time of the inspection. Since our inspection in June 2007 he has attended training in administering insulin injections, communication with people who have a learning disability and on the day of the inspection was attending training in safe food handling.
The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 25 We acknowledge that the Manager has taken his responsibilities seriously as a registered person and we have evidence to suggest that he has met the majority of requirements made following our previous inspections. A requirement was met from previous inspections for effective quality assurance systems to be in place and that we were to receive this information by 30th September 2007. On the 1st October 2007 we received a copy of the home’s quality assurance documentation. We acknowledged in writing that home had aimed to develop a detailed and comprehensive quality assurance system for The Brambles in response to a requirement made at previous inspections of the care home. We wrote also that, “It is our expectation that any quality assurance system that is used is appropriate to the service that it is intended for. It is our expectation also that any policy document becomes part of the management of that service, to ensure that people are receiving the right care.” This requirement has been met. We made a recommendation, following the inspection in June 2007, for policies and procedures to be developed. We have not assessed this standard on this occasion but will assess this at a later inspection. As a result of this, this recommendation remains. A requirement was made for all staff to attend training in first aid. We saw certificates of this training in staff files. This requirement has been met. A requirement was made for staff to attend training in fire safety. We saw certificates of this training in staff files and the member of staff confirmed that they had attended such training. This requirement has been met. We saw that the Manager has made contact with the fire safety officer and is waiting for a visit from their department. The Manager informed us that there has been no fire drill practice carried out. We expect the home to manage this, following consultation with the fire safety officer. A recommendation was made for the records for the fire safety checks to be improved. The standard of recording of these checks had improved; emergency lighting and fire alarm checks were carried out each week. A requirement was made for all staff to receive training in moving and handling every 6 months and this training to be domain specific. Staff training records and discussion with both the Manager and staff indicated that this requirement has not been met. This requirement has been carried forward with a new timescale for action. A requirement was made for action to be taken for people to be assessed in their moving and handling needs and this assessment is to be carried out by a The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 26 healthcare professional. We saw emails from the Manager to managers responsible for such community services. This requirement has been met. The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 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 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 x 12 N/A 13 4 14 x 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 3 x x 2 x The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 28 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 YA20 Regulation 13(2) & 17(1)(a) Requirement Complete and accurate records must be kept of all medication administered or not, together with a reason why the medicine was not given, in order to demonstrate that people who use the service receive the medicines prescribed for them. Previous requirement not met by 14/08/07. New timescale for action given. 2. YA42 13(5) All staff must receive training in moving and handling every 6 months and this training to be domain specific to ensure that service users are safe when being assisted by staff with moving and handling. Previous requirement not met by 01/09/07. New timescale for action given. 04/01/08 Timescale for action 31/12/07 The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1.. Refer to Standard YA40 Good Practice Recommendations Policies and procedures appropriate to the home should be developed and implemented with reference to Appendix 2 of the CHRS The Brambles DS0000015227.V355070.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Inspection Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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
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