Inspection on 02/08/06 for The Brambles

This inspection was carried out on 2nd August 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Brambles 10/06/08

The Brambles 13/02/06

The Brambles 15/07/05

The Brambles 21/12/04

The Brambles 14/07/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Brambles Six Acres Close Roman Road Taunton Somerset TA1 2BD Lead Inspector Judith Roper Key Unannounced Inspection 2nd August 2006 09:25 The Brambles DS0000036187.V306434.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 DS0000036187.V306434.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 DS0000036187.V306434.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Brambles Address Six Acres Close Roman Road Taunton Somerset TA1 2BD 01823 327714 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) Somerset County Council (LD Services) Robert Phillips Care Home 7 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places The Brambles DS0000036187.V306434.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users may be admitted with a concurrent physical disability. Date of last inspection 13th February 2006 Brief Description of the Service: The Brambles is a single storey building situated close to Taunton town centre. There is a large lounge, dining room and two assisted bathrooms at the home. Building work to increase the size of bedrooms has been completed. The home is set in pleasant gardens that are accessible to residents. The Brambles is registered with the Commission for Social Care Inspection to provide care and accommodation for up to seven people with learning disabilities, including two people who have physical disabilities. The home run by Somerset Social Services. The Registered Manager is Mr Rob Philips. The Responsible Individual is Mr. David Dick. The Brambles DS0000036187.V306434.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was carried out by one inspector and took place over one day between the hours of 09.25 am – 13.10 pm. Seven residents were at the home on the day of the inspection. Six of the current residents have lived together at the home for a considerable amount of time and one person moved into the home in March 2006. There are no vacancies at the home. All current residents are described as white/British. There is a mix of male and female residents. The inspector was able to see and interact with all residents. There were no visitors to the home during the inspection visit. Prior to the inspection the CSCI received two comment cards from visiting community health professionals associated with the home. The home also completed and submitted a detailed pre-inspection questionnaire about the service, as requested by the CSCI. Staff on duty were able to give time to speak with the inspector. The registered manager Mr. Phillips and the shift leader Mrs. Milton were available for comment during the inspection. The inspector would like to thank the staff for their time and hospitality shown to the inspector during her visit. The atmosphere at the home was friendly and active. Staff carried out their duties in an attentive and supportive manner. The aim of this inspection visit was to inspect key National Minimum Standards as part of the Commission’s ‘Inspecting for Better Lives’ strategy. Inspectors focus on outcomes for service users and measure the quality of the service under four general headings. These are - excellent, good, adequate and poor. The judgement descriptors for the seven chapter outcome groups are given in this report. What the service does well: The Brambles provides care and support to residents who have a learning disability. The staff team are continuing to deliver a high standard of care and demonstrate a good understanding of residents’ individual needs. Residents are provided with a range of social activities and regular opportunities to access the local community. The home is maintained to a high standard of cleanliness. The manager and senior staff access and receive the support of other professionals from the health and social services to deliver person centred care. The Brambles DS0000036187.V306434.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Brambles DS0000036187.V306434.R01.S.doc Version 5.2 Page 7 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 DS0000036187.V306434.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4. The overall outcome for these assessed Standards is good. Residents and their families are provided with clear information regarding the home and its services provided. Appropriate assessments are completed to ensure that the home will be able to meet residents’ needs. Residents are given the opportunity for visits to the service prior to admission for them to decide if the placement seems favourable to them. EVIDENCE: The home has a Statement of Purpose and Resident Guide that provide details of the services and facilities offered at The Brambles. The Statement of Purpose has been recently updated to reflect a new manager following the retirement of the previous manager. A pre-admission assessment was seen for the recently admitted service user. Prospective residents are encouraged to visit the home, and spend short periods there, before deciding to move in on a permanent basis. The Brambles DS0000036187.V306434.R01.S.doc Version 5.2 Page 9 There is a settled and established staff team at the service who communicate effectively in relating current service user needs to one another on a shift-byshift basis. The Brambles DS0000036187.V306434.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, 10. The overall outcome for these assessed Standards is good. A detailed current care and support plan has been developed for each resident enabling staff to deliver continuity of care that meets resident’s needs. Residents are supported to make choices regarding their life, and individuals’ decisions and preferences are respected. Records relating to residents are stored securely. EVIDENCE: Care and support plans are maintained for each resident. These follow the standard model used by Somerset Social Services. Three care plans were examined in detail. The care plan recorded necessary information for the delivery of person centred care. Care plans provided information regarding residents needs, daily routines and preferences. The Brambles DS0000036187.V306434.R01.S.doc Version 5.2 Page 11 Risk assessments had been completed where required. Care plans had been regularly reviewed. The home is utilising a baby monitor as a surveillance devise at night and at periods in the day for one resident. This has been discussed with the resident’s care manager. In addition to this it is recommended that the parameters for use of a listening devise be agreed with the resident/staff team and care manager and recorded in the care and support plan with reference to the individual’s need for privacy. This should be reviewed on a monthly basis. Residents are encouraged to exercise choice regarding their daily routines. A board is displayed showing which staff will be on duty. Residents’ money is kept in a secure place. Records are maintained of all transactions involving residents’ finances. Two signatures are recorded for any spending of resident’s monies and all transactions are transparent with receipts retained for auditing purposes. Resident’s records were generally stored in a manner that protected confidentiality. A discussion was held with the shift leader regarding some information in resident communal bathrooms of a person nature to individual residents. It was reported that no current service users have the ability to read and therefore others would not know the information, such as individual preferences for bath products. It was suggested by the inspector that a discreet place in individual rooms might be a more appropriate place to display individual bathing preference information to assist staff, rather than communal spaces. This would also make the bathroom less ‘institutional’. The Brambles DS0000036187.V306434.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17. The overall outcome for these assessed Standards is good. Residents are provided with a range of activities that are appropriate to their individual needs, and are supported in accessing the local community. Residents are provided with a well balanced diet, and offered support as required. The home has a recently refitted kitchen. Some attention to the completion of the cooking facilities needs to be addressed. EVIDENCE: Residents are able to participate in a wide range of activities. These include: music, light room, soft play, hydrotherapy, massage, walks and flexercise. On the day of the inspection there was live musical entertainment with storytelling in the morning for all residents in the communal lounge. This appeared to be enjoyed very much by the residents. The Brambles DS0000036187.V306434.R01.S.doc Version 5.2 Page 13 Several residents attend a local college on a part-time basis and some residents access the gym for upper body exercise at the nearby Six Acres day centre. Staff support residents in maintaining contact with friends and family members. A board near the dining room displays photographs of the meals planned for each day. The menus are decided at the residents meetings. The staff have access to and input on nutrition from the dietician who visits monthly. One resident needs a special diet requiring special foods. The main meal of the day is at lunchtime with a light meal provided in the evening. Residents also enjoy meals out at various places including the fast food outlets. The kitchen has been recently upgraded. The extraction hood is missing from the cooker and the tiling behind the cooker is incomplete. There are clear kitchen cleaning records maintained. The kitchen was clean and tidy on the day of the inspection. Daily fridge/freezer records are maintained. The Brambles DS0000036187.V306434.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. The overall outcome for these assessed Standards is good. Residents are provided with good management and appropriate assistance for their personal and healthcare needs. Medications are generally managed well. EVIDENCE: Residents are provided with assistance to undertake personal care tasks as required and documented in care and support plans. Personal care is provided in private. Two rooms have ceiling hoists to assist with mobility. Residents’ psychological well-being is supported by staff aware of service user’s individual needs and how to address needs when they occur. There is staff expertise in managing challenging behaviours on the staff team and staff can also call on professional support services. Staff support residents in their daily life skills; going shopping, helping them to choose and buy everyday goods. Hearing and eye tests are provided to residents. The Brambles DS0000036187.V306434.R01.S.doc Version 5.2 Page 15 Staff support residents in accessing health care services, and ensure that specialist advice is sought as required. Pressure-relieving equipment had been provided for one resident. Care plans included details of epilepsy and nutritional guidelines. Feedback cards from two community healthcare professionals associated with the service were received prior to the inspection. The overall responses were positive. Staff at the home receive medication administration training. All medications are stored securely. Medication Administration Records were examined and found to follow good practice. Advice was given regarding obtaining from the pharmacy clearer printed advice for the administration of one medicine. A record is maintained of all medications entering the home. The home has a fridge for cold storage of medicines. The fridge temperature was too warm for safe storage, although no medicines are currently being stored in the fridge. Advice on correct temperature ranges for cold storage of medicines was given to the home. The residents’ GP reviews individual medications six monthly. The Brambles DS0000036187.V306434.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. The overall outcome for these assessed Standards is good. There have been no complaints to the home since the last inspection and the home has an accessible complaint’s procedure. The home has appropriate policies for the protection of vulnerable adults. EVIDENCE: The complaints procedure has been developed by Somerset Social Services and includes details of external agencies that may be contacted, including CSCI. The complaint’s procedure is available in written English, Somerset Total Communication and DVD formats. There have been no complaints about the service received by the home or the Commission since the last inspection. There are policies relating to the Protection of Vulnerable Adults and Whistle blowing. Staff reported an open atmosphere at the home for the raising of concerns. The Brambles DS0000036187.V306434.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 29, 30. The overall outcome for these assessed Standards is good. The Brambles continues to provide a warm, homely and safe environment for all residents. The home is clean and hygienic. EVIDENCE: The service has benefited from a number of environmental upgrades during 2005/2006 that has included increasing bedroom sizes for some residents, improved bathing and showering facilities for physically disabled service users and a re-fitted kitchen. All bedrooms are single and are personalised reflecting the occupant’s personality and tastes. The environment and bedrooms is adapted to meet physical or sensory needs of residents. The Brambles DS0000036187.V306434.R01.S.doc Version 5.2 Page 18 The home has suitable and sufficient facilities and equipment for the management of infection control and cross infection. There are no foul odours in the home. The Brambles DS0000036187.V306434.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 36. The overall outcome for these assessed Standards is good. Staffing levels are appropriate to meet residents’ needs. Staff are competent and provide a good standard of care. Staff receive good support and supervision where individual performance is regularly assessed with the staff member in order to maintain high standards of care delivery at the home. EVIDENCE: Four weeks of staffing rosters were supplied to the Commission on request as part of the pre-inspection questionnaire. There is a minimum of three care staff on duty in the morning, in addition to a cook and domestic assistant. There are three care staff during the afternoon, and one sleep-in and one waking staff throughout the night. One person appointed since the last inspection confirmed their POVA/CRB check prior to commencing work. Newly appointed staff are provided with Induction training. Staff are encouraged to attend further training, and are provided with regular updates in The Brambles DS0000036187.V306434.R01.S.doc Version 5.2 Page 20 food hygiene, health and safety and fire safety training. More than 50 of the current care team hold an NVQ level 2. Staff reported they receive regular support and supervision in order to gain feedback on their work performance. The Brambles DS0000036187.V306434.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. The overall outcome for these assessed Standards is good. The home is competently and confidently managed offering service users a good quality of care and support. Quality assurance and health and safety are monitored constantly to ensure a safe, good quality service. EVIDENCE: Mr. Phillips was approved by the Commission in March 2006 to be the home’s registered manager, on retirement of the previous registered manager. Prior to this appointment he was deputy manager at The Brambles. The staff team appeared happy and were observed to be working and communicating well with each other. The Brambles DS0000036187.V306434.R01.S.doc Version 5.2 Page 22 The home has a range of quality assurance policies and procedures. A network manager conducts monthly unannounced Regulation 26 visits and a quality report of the findings is sent to the home. Hazardous substances had been stored securely and were not accessible to residents. Accidents were reported and recorded as required. One resident has been assessed as needing a bedrail at night to prevent them falling out of bed. The bedrail safety check is recorded as part of monthly equipment checks generally in the home. It is recommended, however, in addition to the person’s rationale for using a bedrail, that the bedrail equipment in itself be risk assessed against the need and abilities of the service user to ensure that the bedrail design does not pose specific safety risks to any individual. The Brambles DS0000036187.V306434.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 3 32 X 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 3 3 3 X The Brambles DS0000036187.V306434.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA17 Regulation 16 (2) (g) Requirement Suitable equipment for the preparation and cooking of food is required in the kitchen. This specifically means that the cooker requires an extraction hood and the splash back tiling behind the cooker needs to be extended to reach the floor. Timescale for action 02/10/06 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 YA6 Good Practice Recommendations It is recommended the use of baby monitors as health surveillance devices be reviewed for individual service users on a monthly basis and that the parameters for using the devises in terms of privacy be clearly recorded in the individual’s care and support plan. It is recommended that in the care and support plan for any service user utilising bedrails that the type of bedrail in itself be risk assessed as suitable and safe for the service user in addition to the written risk assessment of clinical safety need for service user requiring a bedrail at night. DS0000036187.V306434.R01.S.doc Version 5.2 Page 25 2 YA42 The Brambles Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 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 The Brambles DS0000036187.V306434.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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