CARE HOME ADULTS 18-65
The Brambles 104 Station Road Soham Cambridgeshire CB7 5DZ Lead Inspector
Alan Buttery Unannounced 6th July 2005 @ 13:00 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 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 Stationary 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 I53 I03 s15227 THE BRAMBLES v235553 060705 STAGE 4.doc Version 1.40 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 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 I53 I03 s15227 THE BRAMBLES v235553 060705 STAGE 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 7th March 2005 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. The home is owned and managed by Mr Anthony Barnes who is supported a small staff team, with administrative support from his wife. The service provided is of a particularly high standard, with a great deal of emphasis on the wishes of the service users living in the home. The Brambles I53 I03 s15227 THE BRAMBLES v235553 060705 STAGE 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, and the first of the current inspection year. On the day of the inspection, the proprietor/manager of the home was out with a service user, but the inspector has since spoken with him. It has been agreed that the second inspection of the year will be announced, to ensure he is available, and any records required can then be seen. The inspection lasted around three hours, during which time the member of staff working provided all information required, and was very helpful. One service user was also present, and he indicated his happiness living in the home. The home is a small home for adults with a learning disability, and has no vacancies at present. What the service does well:
The Brambles offers a particularly personal and domestic scale of service, and this is ideally suited to the needs of the service users living there. The proprietor is fully involved in all aspects of the service, and ensures the service users living in the home have full contact with family and friends, assisting them with transport where needed, and equally welcoming visitors into the home at all times. The atmosphere within the home is very much that of a family home, very welcoming and relaxed. Service users needs have all been fully assessed prior to them moving in, and health needs are kept under review at all times. The Brambles I53 I03 s15227 THE BRAMBLES v235553 060705 STAGE 4.doc Version 1.40 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 I53 I03 s15227 THE BRAMBLES v235553 060705 STAGE 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Brambles I53 I03 s15227 THE BRAMBLES v235553 060705 STAGE 4.doc Version 1.40 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 standard(s) 2 Individual needs are assessed prior to admission, and service users can be confident when moving into the home that their needs will be met. EVIDENCE: The Brambles is a very domestic setting, providing a home for three adults with a learning disability. Few changes take place, but procedures are in place to ensure that in the event of a vacancy occurring, a detailed assessment of need would be undertaken, ensuring that the home would be able to meet any new service users needs, and that they were compatible with the service users already resident. The last vacancy, three years ago, resulted in the manager actually spending time working with him in his previous hoe, to ensure that the home was appropriate, and that they could meet his needs. The Brambles I53 I03 s15227 THE BRAMBLES v235553 060705 STAGE 4.doc Version 1.40 Page 9 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 standard(s) 6,7 and 9 Although individual plans of care are in place, and kept under constant review, this must be formally recorded, to ensure evidence is available to the CSCI, demonstrating the involvement of service users. EVIDENCE: Although care plans and risk assessments have been written, these are not currently being formally reviewed in accordance with the regulations. It is clear from discussions with staff and management that the care plans are kept under constant review, but in an informal fashion, with no written evidence available. Formal reviews must take place at least twice a year, and the risks assessments should also be updated to take into account changing need, for example, the moving and handling requirements of one service user have changed since the previous risk assessment was done. Staff and management support and guide service users in making choices and decisions that affect their lives, for example around day time activities, holidays and leisure activities.
The Brambles I53 I03 s15227 THE BRAMBLES v235553 060705 STAGE 4.doc Version 1.40 Page 10 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 standard(s) 12, 13, 15 and 16 All three service users are able to take part in meaningful activities of their choice both at home and in the local community, and visit family and friends on a regular basis. EVIDENCE: The home is particularly good in terms of the relationship with families, for example one service users is taken to visit his mother weekly, and she also regularly visits him, another has friends in the village and is supported to meet with them regularly. The service users are all very much part of the local community, using local facilities, visiting local pubs and restaurants, and being well known to the community. Appropriate arrangements are made for them to take holidays or short breaks, with support in choosing where to go. The Brambles I53 I03 s15227 THE BRAMBLES v235553 060705 STAGE 4.doc Version 1.40 Page 11 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 standard(s) 19 Service users health needs are constantly assessed, and met at all times, with support from health professionals where required. EVIDENCE: Evidence was available in the service users files of health needs being identified and met, and changes to the health needs of one of the service users were discussed with the staff member working on the day of the inspection. The home receives good support from the local GP and district nurses, and medication is kept under review at all times. The Brambles I53 I03 s15227 THE BRAMBLES v235553 060705 STAGE 4.doc Version 1.40 Page 12 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 standard(s) 22 and 23 Policies and procedures are in place to ensure any complaints would be dealt with, and allegations of abuse suitably managed. EVIDENCE: Although policies and procedures are in place, there have been no issues in respect of complaints or vulnerable adult concerns. Staff are aware of actions to take in the event of an issue arising. The Brambles I53 I03 s15227 THE BRAMBLES v235553 060705 STAGE 4.doc Version 1.40 Page 13 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 standard(s) 24 and 30 The home provides a comfortable, clean and safe environment for the service users living there. EVIDENCE: The Brambles is a home that is deliberately domestic in nature, and ideal for the service users living there. It offers a comfortable lounge, and dining area, and individual bedrooms with overhead hoists to assist in moving and handling. The home was clean and hygienic on the day of the inspection and is well maintained and decorated with a pleasant garden area. The Brambles I53 I03 s15227 THE BRAMBLES v235553 060705 STAGE 4.doc Version 1.40 Page 14 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 and 36 The staff team in the Brambles all receive training to ensure they are able to meet the service user’s needs, and informal supervision. However, a formal process of supervision must be introduced. EVIDENCE: The staff member working on the day of the inspection indicated the training received in the last twelve months, which included first aid, Pova awareness, moving and handling, food hygiene and a course specifically on epilepsy. Supervision however remains an issue, although informal supervision takes place on a regular basis, this is not recorded and therefore cannot be evidenced. A formal system must now be introduced, as this is an ongoing requirement from previous inspection, and at present the proprietor is in breach of regulations. The Brambles I53 I03 s15227 THE BRAMBLES v235553 060705 STAGE 4.doc Version 1.40 Page 15 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 and 42 The home is extremely well managed, and policies and procedures in place to ensure the health and safety of service users and staff is maintained at all times. Further work is required to ensure a formal process of recording service user views is in place. EVIDENCE: A previous requirement has identified the need for a quality assurance programme to be introduced, and in discussions with the proprietor after the inspection, it has been agreed that this will be included as part of the next, announced inspection as an area of discussion to ensure that in the future a satisfactory policy is in place. Health and safety procedures and training are in place to ensure the safety of service users and staff, and these were discussed during the inspection. The Brambles I53 I03 s15227 THE BRAMBLES v235553 060705 STAGE 4.doc Version 1.40 Page 16 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 x Standard No 31 32 33 34 35 36 Score x x x x 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Brambles Score x 3 x x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 3 x I53 I03 s15227 THE BRAMBLES v235553 060705 STAGE 4.doc Version 1.40 Page 17 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. 2. Standard YA6 YA36 Regulation 15(2)(a) 18(2) Requirement Care plans must be kept under review in accordance with the regulations. A formal process of supervision must be introduced, This requirement is carried forward and must be addressed to avoid further action being taken A formal quality assurance process must be introduced to ensure service users views are recorded Timescale for action 31/10/05 30/09/05 3. YA39 24 30/03/05 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 Good Practice Recommendations The Brambles I53 I03 s15227 THE BRAMBLES v235553 060705 STAGE 4.doc Version 1.40 Page 18 Commission for Social Care Inspection CPC1, Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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