Inspection on 05/12/06 for The Brambles

This inspection was carried out on 5th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Brambles 19/11/07

The Brambles 20/06/07

The Brambles 12/01/06

The Brambles 06/07/05

The Brambles 07/03/05

The Brambles 10/12/04

The Brambles 13/02/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 The Brambles 104 Station Road Soham Cambridgeshire CB7 5DZ Lead Inspector Elaine Boismier Key Unannounced Inspection 5th December 2006 10:00 The Brambles DS0000015227.V321744.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.V321744.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.V321744.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 (3) registration, with number of places The Brambles DS0000015227.V321744.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th January 2006 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.V321744.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the key inspection of the Brambles for 2006/7. The inspection was unannounced and was carried out between 10:00 and 14:30 and took 4.5 hours to complete. At the time of the inspection all 3 residents were at the home and these people were spoken to although not everyone was able to tell the Inspector their views due to their complex communication abilities. Staff were also spoken to, a tour of the premises was made and documentation was seen. Three residents’ surveys were sent out prior to the inspection and one of these was returned. Reference to the contents of this returned survey is made in this report. At the time of the inspection the Manager was at the home although was due to leave his duties when the inspection commenced. The Commission for Social Care Inspection (CSCI) wishes to express its gratitude to the Manager as he agreed to remain at the home to assist with the inspection process, including making a journey to obtain documentation required for the purpose of the inspection. The current certificate of registration is that of the former registration authority, the National Care Standards Commission (NCSC) and has the category of Learning Disability under 65 years of age. Currently the home provides care for people from 18 years old and over 65 years of age. The Manager stated that the home was registered for this age range with a former local registration authority previous to that of the NCSC. The Manager has agreed to put in writing this information, about the registration of the home, for the CSCI to consider. The home provides person centred care but due to the standard of record keeping, poor medication practices and lack of formal quality assurance systems this service has been assessed, using the CSCI rules based approach, as adequate. The Brambles has the potential to becoming a good service should appropriate action be taken in meeting with the requirements, complying with the regulations and considering the recommendations of this report. It is also the CSCI’s expectation that any improvements that are to be made, should be sustained. What the service does well: The Brambles DS0000015227.V321744.R01.S.doc Version 5.2 Page 6 The home is well integrated with the local community and residents have access to a range of activities. Links with families of residents is strong and the home operates on a “family” ethos given the small size of the home. The Brambles provides a comfortable and clean home for residents to live in. Staff reported that the home is a “lovely” place to work, is friendly and the Manager is approachable and supportive. What has improved since the last inspection? What they could do better: The Statement of Purpose must include all details of Schedule 1 of the Care Homes Regulations 2001. A requirement has been made about this. A requirement was made for action to be taken by 31/10/05 for care plans to be reviewed at least every 6 months. This requirement was assessed as not met during the inspection of January 2006. Evidence suggests, during this inspection of December 2006, that this requirement has not been met and has been carried forward with a new timescale for action. Care plans must provide sufficient detail to provide staff the guidance in how to meet the assessed needs of the residents. A requirement has been made about this. Decisions made by residents, or their representatives, must be recorded in the residents’ care records. A requirement has been made about this. Residents, or their representatives, must be consulted about their choice of preferred name and this choice be recorded as evidence in the residents’ care records. Individual portions of food should be pureed separately, rather than together. A recommendation has been made about this. Records for the receipt of medication must be accurate. A requirement has been made about this. The Brambles DS0000015227.V321744.R01.S.doc Version 5.2 Page 7 Medication must be administered safely. A requirement has been made about this. Medication must be stored safely. A requirement has been made about this. The temperature of the hot water accessed from the bath should be checked and recorded. A recommendation has been made about this. Existing methods of formal supervision of staff should continue to be developed. A recommendation has been made about this. Quality assurance systems must be developed. A requirement has been made about this. 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.V321744.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 The Brambles DS0000015227.V321744.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): Quality in this outcome area is adequate. 1&2 This judgement has been made using available evidence including a visit to this service. EVIDENCE: Currently the home provides care for 3 male residents, with a learning disability, aged from 18 years old and over 65 years of age. Examination of the certificate of registration indicated that the home is registered for people, with a learning disability, under 65 years of age. According to the Manager the home is registered for people from 18 years over 65 years of age and has agreed to provide written information about this matter for the Commission for Social Care Inspection to consider. The current Statement of Purpose omits the required information about the age range and sex of residents that the home intends to provide accommodation and care for. A requirement has been made for the Statement of Purpose to include all the required information as detailed in Schedule 1 of the Care Homes Regulations 2001. No new admissions have been made to the home since the inspection of January 2006. Examination of 2 residents’ care files indicated that the home The Brambles DS0000015227.V321744.R01.S.doc Version 5.2 Page 10 has a satisfactory preadmission procedure to obtain a full assessment of the prospective residents’ needs. The Brambles DS0000015227.V321744.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): Quality in this outcome area is poor. 6, 7 & 9 This judgement has been made using available evidence including a visit to this service. EVIDENCE: A requirement was following the inspection of 6th July 2005 and as this requirement was assessed as not met at the inspection of 12th January 2006 this requirement was carried forward with a new timescale of 31st March 2006. This requirement was related to the review of care plans. Examination of 2 residents’ care records and discussion with the Manager indicated that this requirement has not been met. Summaries of residents’ care had not been carried out since the last inspection and none since 2004. This requirement has not been met and has been carried forward with a new timescale for action. Discussion with staff and examination of care records indicated that the care records do not provide sufficient guidance for staff in how to meet the needs of The Brambles DS0000015227.V321744.R01.S.doc Version 5.2 Page 12 the residents. For example there was no care plan for what staff are to do in the event of a resident experiencing a seizure. It was also noted that staff interacted with a resident in a manner more appropriate to that of a younger person. According to the Manager this was the manner of communication known to the resident. There was no record of this assessment in the resident’s care record. Observation and discussion with residents and staff indicated that 2 of the 3 residents wore mobility belts whilst seated in stationary wheel chairs. A resident stated that this was his decision although there was no written record that the person had been consulted and consented to this care practice. There was no evidence that the other resident, who had communication difficulties, had been risk assessed for the use of a mobility belt or active consultation had taken place with this person’s representative. A requirement has been made about this. Other risk assessments included those for moving and handling and development of pressure sores and these risk assessments were seen on the 2 of the 3 residents’ care files that were examined. The resident’s care plan is the yard stick for judging where appropriate support is being delivered. Due to poor record keeping the outcome judgement has been given a “poor” standard descriptor. The Brambles DS0000015227.V321744.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. 12, 13, 14, 15, 16 & 17. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No current resident attends educational or employment facilities due to their complex learning and physical disabilities. During the inspection staff took residents out to the local shops and according to staff the residents are known and welcomed by the local community. Examination of care records and discussion with the Manager indicated that residents have access to a range of activities including going to shops, pubs and coffee shops. Staff were seen to be engaging residents in activities in the home. Records of preferred activities were detailed in the residents’ care files. Due to the small size of the home there are strong links with families of residents and the completed survey confirms that family contact is made with The Brambles DS0000015227.V321744.R01.S.doc Version 5.2 Page 14 the resident. According to the Manager he takes a resident to visit his family on a weekly basis. Care records indicated that an assessment has been made for the suitability of bedrooms doors to be lockable. Staff were seen to request permission from residents before entering their bedrooms. Discussion with the Manager and staff and observation of staff interaction with the residents indicated that more familiar names are used by staff when talking to residents. These names include “Lad” and “Mate”. However there was no record of what residents’ preferred name. A requirement has been made about this. Records of what residents had eaten were seen in the daily diaries. Staff reported that residents are given a choice of what they would like to eat. Observation of the presentation of lunch was carried out and residents appeared to enjoy their meal. Staff, including the Manager were spoken to about how food was presented when the food was to be pureed. Evidence suggests that food is generally pureed altogether, rather than in separate constituents. A recommendation has been made about this. The Brambles DS0000015227.V321744.R01.S.doc Version 5.2 Page 15 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 adequate. 18,19 & 20 This judgement has been made using available evidence including a visit to this service. EVIDENCE: Observation of residents and staff indicated that residents were happy with the care that was being provided to them. During the tour of the premises, and discussion with staff, evidence suggests that residents have access to aids to help with their mobility, including overhead tracking. According to staff a resident has an adjustable bed head that the person can self-operate. Discussion with the Manager and staff indicates that the home provides care and support as a small family. This support includes all aspects of the health, emotional and social care needs of the residents. Examination of care records and discussion with the Manager indicates that residents have access to a range of health care professionals including GPs, occupational therapists, physiotherapists and district nurses. The Brambles DS0000015227.V321744.R01.S.doc Version 5.2 Page 16 No current resident is responsible for their own medication. Examination of medication administration records was carried out and these records were of a satisfactory standard. According to the Manager he assembles medication from original packing into dosett boxes for staff to administer at a later time. This is an unsafe method of administration of medication and a requirement has been made about this. Records of receipt of medication are maintained although these records were not sufficient in detail to provide the reader as to what quantity has been received in to the home. A requirement has been made about this. Keys to the cupboard that stores medication were kept in an unlocked drawer in the kitchen; the kitchen was not locked. A requirement has been made about this unsafe storage of medication. The Brambles DS0000015227.V321744.R01.S.doc Version 5.2 Page 17 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 good. 22 & 23. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Commission has received no complaints about the home and no allegations have been reported with regard to abuse of residents. The Manager confirmed that there has been no concerns, complaints or allegations made against the home. The Manager and staff confirmed that arrangements are in place for staff to attend training in protection of vulnerable adults. The Brambles DS0000015227.V321744.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. 24 & 30 This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the tour of the premises it was noted that the home provides a comfortable and well maintained place for residents to live. According to the Manager hot water temperatures, from the bath, are not carried out. These hot water temperatures were checked at the time of the inspection and were of a safe temperature. A recommendation has been made for temperature checks to be carried out of hot water, accessed from the bath, to ensure that there are no failings with the existing safety mechanisms. At the time of the inspection the home was clean and fresh. The Brambles DS0000015227.V321744.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. 32,34, 35 & 36. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has 60 of care staff who have NVQ level 2, or equivalent, qualification. Examination of 2 staff files indicated that the majority of required information is obtained about staff before they work at the home. A photograph of a member of staff was not available. However the Commission has taken the reasonable view that the remaining required information was available and satisfactory about this person and, on this occasion, has not made a requirement. Nevertheless it is the Commission’s expectation that this shortfall is to be remedied by the Manager. Discussions with staff and Manager indicated that staff undertake an induction programme and this is in close supervision with the Manager. Discussion with staff and examination of staff files indicates that staff have attended training in The Brambles DS0000015227.V321744.R01.S.doc Version 5.2 Page 20 how to care for someone with epilepsy. The Manager reported that access to other training, including infection control, is being considered. Following inspections from 10th December 2004, 7th March and 6th July 2005 to the last inspection of 12th January 2006 there has been a requirement that has not been met and carried forward. The last timescale for action for this requirement was 31st March 2006. This requirement was related to staff receiving formal supervision. Examination of 2 staff supervision records indicates that action has been taken to start formal supervision of staff. However records seen indicate that the members of staff have received one session of supervision in May and June 2006. As a result of this finding a recommendation has been made for current systems to be developed further to meet this Standard. The Brambles DS0000015227.V321744.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. 37, 38, 39 & 42. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager is also the home owner and has a range of clinical and managerial experience for people with learning disability needs. He has an award equivalent to the Registered Managers Award. Staff reported that the home is a “lovely” place to work, is friendly and the Manager is approachable and supportive. The inspection report of December 2004 notes, “The home informally monitors the quality of the service at on an ongoing basis, but without a formal, The Brambles DS0000015227.V321744.R01.S.doc Version 5.2 Page 22 recorded quality assurance programme, with the required annual report, cannot meet the requirements of this standard.” A requirement was made as a result of this finding. This requirement was carried forward following the inspection of 7th March 2005 in which the inspection report states, “The homes quality assurance policy and service user survey are yet to be fully developed.” Similar findings were reported in the inspection report for 6th July 2005. During this inspection there was insufficient evidence to suggest that this requirement has been met and has been carried forward with a new timescale for action. Records for fire alarms and emergency lighting were seen and these checks were carried out each week. The Manager and staff confirmed that staff attend training in moving and handling. The Manager reported that the home had an inspection carried out by the Environmental Health Officer in July 2006 and this was satisfactory. A copy of this inspection report was not seen on this occasion. The Brambles DS0000015227.V321744.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 2 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 3 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 x 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 x 3 x LIFESTYLES Standard No Score 11 x 12 N/A 13 4 14 3 15 4 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 x 3 3 1 x x 3 x The Brambles DS0000015227.V321744.R01.S.doc Version 5.2 Page 24 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 YA1 Regulation 4(1)(c) Requirement Timescale for action 31/03/07 2. YA6 15(2)(a) The Registered Person must ensure that the Statement of Purpose includes the information as detailed in Schedule 1 of these regulations. The Registered Person must 28/02/07 ensure that care plans must be kept under review in accordance with the regulations. Requirement carried forward as timescale of 31/10/05 and 31/03/06. New timescale for action made. The Registered Person must ensure that the care plan provides sufficient detail for staff guidance in how to meet the assessed needs of service users. The Registered Person must ensure that decisions of service users are obtained and these decisions are recorded in the care plan. The Registered Person must consult with service users, or their representatives the service users’ preferred name of address and method of communication. The Registered Person must DS0000015227.V321744.R01.S.doc 3. YA6 15(1) 15/01/07 4. YA7 12(3) 15/01/07 5. YA16 12(4)(a) 15/01/07 6. YA20 13(2) & 13/12/06 Page 25 The Brambles Version 5.2 17(1)(a) 7. 8. 9. YA20 YA20 YA39 13(2) 13(2) 24 ensure that records of the receipt of medication, including the quantity, are accurate. The Registered Person must ensure that medication is administered safely. The Registered Person must ensure that medication is stored safely. The Registered Person must ensure that effective, formal quality assurance systems are in place. Requirement carried forward as previous timescale of 30/03/05 not met and new timescale for action has been made. 13/12/06 06/12/06 05/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA17 YA24 YA36 Good Practice Recommendations The Registered Person should consider ways to present pureed food in an appealing manner. The Registered Person should consider ways to ensure that the hot water from the bath is always of a safe temperature. The Registered Person should consider ways to develop existing methods of formal supervision of staff. 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