Inspection on 08/01/08 for The Brandles Residential Care Home

This inspection was carried out on 8th January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Brandles Residential Care... 09/12/08

The Brandles Residential Care... 04/10/06

The Brandles Residential Care... 09/03/06

The Brandles Residential Care... 04/02/05

The Brandles Residential Care... 15/06/04

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

CARE HOME ADULTS 18-65 The Brandles Residential Care Home 23/25 Birks Drive Bury Lancs BL8 1JA Lead Inspector Julie Bodell Unannounced Inspection 8 & 14 January 2008 09:30 th th The Brandles Residential Care Home DS0000008426.V356630.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 Brandles Residential Care Home DS0000008426.V356630.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 Brandles Residential Care Home DS0000008426.V356630.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Brandles Residential Care Home Address 23/25 Birks Drive Bury Lancs BL8 1JA 0161 797 6367 0161 763 3833 the.brandles@virgin.net 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 Rufus Fagbadegun Mrs Christine Fagbadegun ** Post Vacant *** Care Home 7 Category(ies) of Dementia (1), Mental disorder, excluding registration, with number learning disability or dementia (6) of places The Brandles Residential Care Home DS0000008426.V356630.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 7 service users, to include: Up to 6 service users in the category of MD (Mental Disorder under 65 years of age). Up to 1 service user in the category of DE (Dementia under 65 years) The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The registered person must ensure that all staff working in the home have training in mental disorder that equips them to meet the assessed needs of the service users. That the category of DE is in place for the identified service user only and an application for the removal of the condition must be made should that service user no longer reside at the Home. 4th October 2006 2. 3. 4. Date of last inspection Brief Description of the Service: The Brandles is a small care home providing long term support to people with mental health needs. It is situated in Brandlesholme, a residential area of Bury, and consists of two adjoining (semi-detached) properties that have been converted into one house. The home provides seven places, all in single bedrooms (three on the ground floor, four on the first floor). There are gardens to the front and back, with open fields to the rear. The home is near to bus routes and local amenities, including several shops and a pub. There is onstreet parking available. The Brandles Residential Care Home DS0000008426.V356630.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection, which the home did not know was going to happen, took place over seven and a half hours. The inspector looked around the home and at a number of records. To get more information the inspector spoke to three people living at the home, the acting manager, and a support worker and had lunch with everyone. Due to concerns about the safety of the medication system, a CSCI pharmacist also made a visit to the service. We requested information from the service before our visit, which was returned to us. This is called the Annual Quality Assurance Assessment (AQAA). One survey was returned to us. What the service does well: What has improved since the last inspection? The Brandles Residential Care Home DS0000008426.V356630.R01.S.doc Version 5.2 Page 6 The staff team has recently received some training via CD on the five principles of the Mental Capacity Act. The acting manager has received person centred planning training through the local partnership and other staff members are to attend in the near future. An example of a person centred plan has been drafted by a registered provider but has yet to be fully implemented. Most of the staff team have recently received training in safeguarding awareness to help them understand their responsibilities in protecting people living at the home. Some bedrooms have been redecorated and had new wardrobes fitted. A quality assurance exercise has been carried out, which shows very positive results about the service and the support provided. What they could do better: If the needs of people living at the home change, a formal review with the appropriate healthcare professionals must be carried out to ensure that the service can continue to meet their needs, effectively and safely. The written information about the help and support people want needs to be person centred, detailed and give clear direction to the staff team. The information should make the link to a sound and underpinning value base that shows that the home recognises the importance of areas such as independence, choice, fulfilment, dignity and rights. More opportunities need to be provided for people who need support to be involved in activities outside the home. Clear records need to be maintained to show how often these activities are provided. The home must keep us informed about any event at the home, which adversely affects the wellbeing, safety or protection of any person living at the home. Although comfortable and homely some work is needed to the home to ensure that good standards are maintained both inside and out. Paper towels and liquid soap need to be placed in communal bathrooms and the kitchen area to reduce the opportunity for cross infection. The staffing levels at the home need to be reviewed to ensure that there are enough support workers in place to assist people in outside activities and be able to support people, effectively, if their mental health deteriorates. The Brandles Residential Care Home DS0000008426.V356630.R01.S.doc Version 5.2 Page 7 To benefit the people living at the home what is learnt through this training must be adopted as good day-to-day practice. Shortfalls identified in areas of medication, safeguarding, control of infection, recording and notification suggest that this is not happening. To ensure that the home is well run and complies with the law, we must receive an application from a person who is competent and suitably qualified to become a registered manager. It is strongly recommended that Regulation 26 visits are expanded and more detail is put into the reports to evidence that the registered providers are effectively monitoring the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Brandles Residential Care Home DS0000008426.V356630.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 Brandles Residential Care Home DS0000008426.V356630.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. If the needs of people living at the home change, a formal review with the appropriate healthcare professionals must be carried out to ensure that the service can continue to meet their needs effectively and safely. EVIDENCE: There have been no new admissions to the home since the last inspection. Following discussions with people living at the home, the staff members on duty and observation it was clear that two people were unsettled and there were a number of behavioural management concerns. There was no evidence of an up-to-date CPA or review on either of their care files. This is necessary to give clear direction to support workers as to what action they must take should a person’s mental health deteriorate and what triggers to look for. This information should take into account that lone workers are supporting both the individual and the group of people living at the home most of the time. It is acknowledged that there has been involvement of healthcare professionals. The registered provider has significant mental health nursing experience at a senior level and is involved in assessing the needs of people before they come to live at the home. The staff team has recently received some training via CD on the five principles of the Mental Capacity Act. The Brandles Residential Care Home DS0000008426.V356630.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6 7 and 9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There continues to be a need to improve care plans and risk assessments to ensure that they are person centred and reflect the current needs of people living at the home. EVIDENCE: Two care files were examined. Each contained a care plan, which included details of mental health, physical health, medication, personal hygiene, daily living skills, activities and aspirations. Staff members talk through the plan with the individual, who then signs the plan if they agree. Staff members spoken with had a good general understanding about people’s needs, likes and dislikes. At the last inspection we asked the home to improve care plans and risk assessments. This had not been done. Written information about the help and support people want needs to be person centred, detailed and give clear direction to the staff team. The information should make the link to a sound The Brandles Residential Care Home DS0000008426.V356630.R01.S.doc Version 5.2 Page 11 and underpinning value base that shows that the home recognises the importance of areas such as independence, choice, fulfilment, dignity and rights. The acting manager has received person centred planning training through the local training partnership and other staff members are to attend in the near future. An example of a person centred plan has been drafted by a registered provider but has yet to be fully implemented. This needs to be done as soon as possible. Risk assessments were in place for people but they had not been reviewed for sometime and need to be updated to reflect changing needs. This should be done in line with each individual’s up-to-date CPA or review. Information found at the last inspection within a risk assessment around behavioural triggers was still in place. Support workers were not clear about what was meant and this needs to be removed. Some restrictions were in place around the management of cigarettes to ensure that people smoke cigarettes within their financial means. Individual progress notes are maintained. However when we attempted to audit trail PRN medication against the daily records to see why it had been used, there was not always a clear reason given. We have shared previously with the home our concerns about the use of inappropriate language. A number of incidents were noted in the staff meeting book that need to be looked at. If restrictions are to be put into place then this needs to be done formally with the involvement of the person living at the home and clearly recorded e.g. not being allowed to go out at night for safety reasons, a person having to buy their own coffee because of the amount they drink and what time people were to get up in the morning. It was clear from observation of some people living at the home that they decided what they wanted to do each day and had very independent lifestyles. Some people need one to one support from the staff team to be involved in individual activities outside the home. Clear records need to be maintained to show how often this type of activity and this level of support is provided. There are regular meetings held with people living at the home to ensure that they are involved in planning group activities. The last meeting took place on 05.11.07 and a record of the meetings is kept. The Brandles Residential Care Home DS0000008426.V356630.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. JUDGEMENT – we looked at outcomes for the following standard(s): 11 12 13 14 15 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Most people who live at the home are able to access activities in the community independently, but more opportunities need to be provided for those people who need more support. EVIDENCE: Some people living at the home have very busy lifestyles, which gives them the opportunity for personal development. As well as getting out and about meeting relatives and friends, several people continue to attend a range of weekly art therapy classes, cookery courses and support groups. One person has a NVQ Level 2 in Performing Engineering Tasks and attends college. The financial cost has prevented this person from pursuing any further courses. Two people attend different churches on a regular basis. People were seen to be involved in day-to-day household tasks around the house, which promotes independence. As previously recommended at inspections, the acting manager The Brandles Residential Care Home DS0000008426.V356630.R01.S.doc Version 5.2 Page 13 has supported three people to look for employment in retail and application forms have been completed, but none of the people concerned have been able to secure employment. The acting manager and support workers usually work alone. Concerns have been raised previously with the service that this situation limits the opportunity to undertake rehabilitative work and support people in the community. An improvement in extra staffing made available when people need support to attend appointments or social outings was noted at the last inspection. However rotas suggest that this improvement has not been maintained for people who require one to one support to undertake activities outside the home. Most of the people living at the home have done so for some time and are well known throughout the local community. Some examples of good relations with neighbours were given but some tension with neighbours was also noted due to behavioural issues. Inside the home people enjoy a range of leisure activities. They watch television, videos and DVDs and listen to music. They go out occasionally for meals as a group. Birthdays are celebrated. On Christmas Eve and New Year’s Eve parties were held with a buffet and friends invited. One person went on a cruise supported by a staff member some time ago and is hoping to go on another in the near future. The group went to a hotel in Blackpool for a holiday this year. The hotel was able to cater well for people’s needs and they enjoyed it so much that they hope to go again this year. Relationships with families are encouraged. One person spends part of each week living with a relative and another person spent Christmas with a relative. There is a close relationship between two people living at the home. Some people choose to spend time in their bedrooms while others preferred the lounges. All bedrooms have locks but not everyone has keys. The acting manager has previously advised this was through personal choice and is reviewed regularly. Mealtime arrangements are flexible. The home does not have a fixed menu, but details of what meals people have had are recorded. People have a choice of cereals and toast for breakfast, sandwiches for lunch, with the main meal served in the evening. The majority of the food is home cooked. Meals are decided by consensus on a daily basis. People spoken with expressed satisfaction with the quantity, quality and choice of food available. The Brandles Residential Care Home DS0000008426.V356630.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Medicines record-keeping at the home needs to improve to show that medicines are handled safely, to ensure people’s health is best protected and to keep them safe. EVIDENCE: People are in the main independent and able to manage their own personal care needs with prompts, encouragement or minimal assistance. The relationship between staff members and people living at the home appeared warm, caring and friendly. Staff members were seen to treat people with courtesy and demonstrated a good understanding of their likes, dislikes and preferred routines. However, it was clear from discussion with both people living at the home and the staff supporting people, as well as records that there were times when the atmosphere at the home was tense. This was because of the challenging behaviour occasionally displayed by some people living at the home, which was difficult for support workers to effectively manage alone and therefore negatively impacted on other people living at the home, who wanted a quiet life. Incidents appeared to be happening from The Brandles Residential Care Home DS0000008426.V356630.R01.S.doc Version 5.2 Page 15 teatime onwards and sometimes into the night and on one occasion affecting neighbours, causing them to complain. Most people have an allocated social worker or a CPN, and a psychiatrist, who support people with their mental health needs. It is acknowledged that there has been involvement of healthcare professionals. A GP and a social work manager were visiting a person on the day of the inspection. It was clear from records that this person had had a number of admissions into hospital over the past 12 months. We were not notified of these admissions or about some of the incidents that have happened at the home through Regulation 37 notifications. We must be informed about any event at the home, which adversely affects the wellbeing or safety of any person living there. If we had been kept informed then we may have considered making an earlier inspection visit to the home. It was felt by the acting manager that sometimes other healthcare professionals did not always listen to staff at the home, if they had concerns about people’s emotional wellbeing. People’s general physical healthcare needs appear to be properly addressed, with support provided where necessary to attend appointments. Everyone had a GP and a dentist. An optician and a chiropodist visit the Home regularly. A record of all healthcare appointments is maintained. A medicines policy provided written guidance for staff about many areas of medicines handling in the home but could be expanded to include, for example, more information about supporting safe self-administration, the safe storage of medicines at the home and the handling of controlled drugs. People wishing to self-administer their own medicines are supported to do so but most medicines are administered by care staff. The manager said that all staff complete medicine training before they are allowed to handle medicines at the home and refresher training had been organised for all staff to ensure their knowledge is up-to-date. A sample of medicines was counted for comparison with the records to check that they were given at the prescribed dose. We saw that records for the administration of medication were mostly clearly completed and up-to-date but that records were poor for the receipt of medicines into the home. This meant it was impossible to complete checks to see whether medicines had been administered correctly. In one case records at the home could not account for forty-six tablets. We saw that changes to peoples medicines were mostly clearly recorded but in one case a ‘when required’ dose of medication was not listed on a consultant’s letter. Staff had not noticed or queried the change, so had continued to administer the ‘when required’ dose. It was not possible to tell whether the dose had been ‘stopped’ or not. The ‘when required’ dose had been handwritten on the administration records but not signed, checked and The Brandles Residential Care Home DS0000008426.V356630.R01.S.doc Version 5.2 Page 16 countersigned by a second person. A second check is recommended to help ensure the instructions do match those given by the prescriber, and that any unexpected changes are picked–up and addressed. Thorough recorded checks (audits) were not made by staff to ensure that both medicines records and stock were accurate. Thorough audit is needed to assess and improve the quality of the medication service offered. Medicines were securely stored but there were no arrangements in place for the safe handling of controlled drugs. There were no controlled drugs at the home but if staff need to administer controlled drugs they will need to be kept in a proper (legal) controlled drugs cupboard in order to provide the right level of security; similarly a proper register should be used to help ensure the clarity and security of the controlled drugs records. The Brandles Residential Care Home DS0000008426.V356630.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): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. To protect people living at the home the service must adhere to the safeguarding procedures of the local authority and keep all relevant parties informed. EVIDENCE: There have been no complaints made about the service. People living at the home have an opportunity to raise any issues or concerns that they may have at residents meetings. No allegations of abuse have been made to CSCI. New local authority procedures in respect of the safeguarding and protection of vulnerable adults are in place. Most of the staff team have recently received training in safeguarding awareness and the course is booked for the outstanding support worker to attend the course in the near future. The acting manager has attended the two-day “Safeguarding Adults Investigating Officers” course. Training has been provided through Bury Adult Care Training Partnership on the new policy and procedure. Whilst examining a person’s file it became clear that there had been a safeguarding strategy meeting with a neighbouring local authority. We had not been informed about this matter through either the safeguarding policy and procedure or a Regulation 37 notification. Nor did it appear that the local authority safeguarding co-ordinator had been informed either. This needs to be done to make sure that everyone knows what is happening. The Brandles Residential Care Home DS0000008426.V356630.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): 24 and 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Although comfortable and homely some work is needed at the home to ensure that good standards are maintained both inside and outside the property. EVIDENCE: The Brandles was comfortable and homely. There is a satisfactory standard of décor and furnishings, which were domestic in style but appeared tired in parts. People living at the home have the use of a small dining area, a kitchen, two adjoining lounges, a small smoking area and two bathrooms. We looked at two peoples bedrooms which had recently been decorated and one had had built in wardrobes fitted to good affect. There are gardens to the front and rear, with a paved patio area. The gardens and the building from the outside also appeared tired with some attention needed to fencing particularly at the back of the house. We have requested a The Brandles Residential Care Home DS0000008426.V356630.R01.S.doc Version 5.2 Page 19 rolling plan of maintenance from the registered providers for the home that gives evidence as to what plans for improvement are in place for the coming year. The home was clean and tidy to a satisfactory standard throughout. Paper towels and liquid soap need to be placed in communal bathrooms and the kitchen area to reduce the opportunity for cross infection at the home. The Brandles Residential Care Home DS0000008426.V356630.R01.S.doc Version 5.2 Page 20 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 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staffing levels for the home need to be reviewed to ensure that there are enough support workers in place to enable people to be involved in activities outside the home and effectively support people should their mental health deteriorate. EVIDENCE: People living at the home said staff looked after them well. There is a stable staff team in place. Written duty rosters are maintained and were examined. Staffing meets minimum guidelines set by the previous social services inspection unit in 2002. For the most part there is usually only one member of staff on duty at any one time and that person is also responsible for cooking and cleaning. The current staff team consists of the acting manager and four carers, one of whom is on long-term sick, which has led to agency staff being used on occasion. We had concerns about the adequacy of staffing given some of the challenging behaviour being displayed by some people living at the home. It was evident from both documentation and discussion that support The Brandles Residential Care Home DS0000008426.V356630.R01.S.doc Version 5.2 Page 21 workers, who are lone workers, have been both fearful and struggling to cope at times. It was not clear what the on-call arrangements were in place for evenings and during the night. We have required a review of the present staffing arrangements and the registered providers must evidence why they believe the current arrangements are adequate or state what action they are going to take to improve the situation. The review should also take into account the need to support some people living at the home to enable them to participate in activities outside the home. We were informed that all the staff holds either an NVQ Level 2 or 3, which exceeds the national minimum standards. A recruitment file was examined and found to meet legal requirements. We asked to see the criminal record check for a person who worked briefly at the home recently to reassure us that a new criminal record check had been undertaken by the registered provider to ensure that people living at the home were protected. We were informed that the registered provider kept this documentation at home and it was suggested by the acting manager that in this case the person concerned brought an old CRB check with them. Details about this person’s criminal record check need to be forwarded to us and all criminal records checks kept by the home so that an inspector can examine them and sign them off in accordance with CSCI guidance that can be found on our website. The home is an active partner member in the Bury Adult Care Training Partnership (BACTP), a local authority initiative. Records examined confirm that the registered provider, the acting manager and support workers have received regular training through the scheme. All training is linked to Skills for Care, which is a Government initiative. Training files have been adapted to show continuous professional development. To benefit the people living at the home what is learnt through this training must be adopted as good day-to-day practice. Shortfalls identified in areas of medication, safeguarding, control of infection, recording and notifications suggest that this is not happening. Staff meetings take place on a regular basis and a record is maintained. Staff appraisals and individual formal supervision meetings are taking place at the required frequency and recorded. The Brandles Residential Care Home DS0000008426.V356630.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 and 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. To ensure that the home is well run and complies with the law, we must receive an application from a competent and suitably qualified person to become the registered manager for the home. EVIDENCE: The home has not had an active registered manager since May 2005 due to ill health. This situation has now been resolved and a former registered manager has been providing management cover for some considerable time. Although it appears that the registered provider has had some contact with us, to comply with conditions of registration we must now receive an application for a registered manager. The Brandles Residential Care Home DS0000008426.V356630.R01.S.doc Version 5.2 Page 23 The acting manager has recently completed the Registered Manager’s Award NVQ Level 4 and has also undertaken regular training including, the Safeguarding Investigating Officers course, person centred planning, writing and reviewing policies, Health & Safety in the work place, moving and handling, basic health and safety and medication awareness. The registered provider is a very experienced former mental health nurse manager. A registered provider must ensure that the acting manager has enough time available to her to ensure that the management tasks at the home can be fully completed and good standards maintained. The home now has Internet access and is using a laptop provider by the BACTP to keep updated with CSCI and Skills for Care websites. We discussed the Inspecting for Better Lives processes, including quality ratings, annual service reviews and KLORAs. We also gave the acting manager information about how to download a registered manager’s form from the site and what information was needed to complete the application process. Quality assurance systems are in place. Resident and staff meetings are held regularly. People living at the home and other stakeholders complete annual satisfaction surveys. A registered provider was said to visit the home regularly. He also conducts monthly Regulation 26 visits and produces a report and a copy is forwarded to CSCI. It is strongly recommended that these visits are expanded and are more detailed to evidence that the registered provider is effectively monitoring the home. The inspector checked fire system serving records, which were found to be in good order. Portable electrics were checked on 16.12.07. A gas safety check was undertaken on 12.09.07 and makes comment about the age of the boiler, which has been in place for over 18 years. We looked at the homes electrical certificate for fixtures and fittings, which states that only a 20 inspection was carried out and that some upgrades would be required to fully comply with BS 7671. The acting manager confirmed that all the necessary work had been done. We require the registered providers to confirm this and that a full inspection of the homes electrical fittings and fitments was also carried out. A fire officer visited the home on 08.05.07 and due to lone working and concerns about the unpredictable actions of people living at the home in the event of a fire, recommended a fire drill to simulate a worst-case scenario. The home undertakes fire drills regularly. It was noted also that some people smoke in their bedrooms, which is a potential hazard. Care needs to be taken to ensure that these drills are occasionally done late at night and early morning to ensure that people respond appropriately. The fire system was serviced on 28.11.07 and the homes extinguishers were checked on 18.04.07. The Brandles Residential Care Home DS0000008426.V356630.R01.S.doc Version 5.2 Page 24 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 2 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 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 4 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 2 X 2 X X 2 X The Brandles Residential Care Home DS0000008426.V356630.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES 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 YA2 Regulation 14 Requirement If the needs of people living at the home change a formal review with the appropriate healthcare professionals must be carried out to ensure that the service can continue to meet their needs effectively and safely. Care plans must be person centred with an underpinning value base and give clear direction to members of the staff team. (Outstanding 31/12/06) CSCI must be informed about any event at the home, including safeguarding incidents through local authority procedures, which adversely affects the wellbeing or safety of any service user. Records of all medicines received into and administered at the home must be made to enable the safe administration of peoples’ medicines to be accounted for. That a copy of a rolling plan of maintenance is received from the registered providers that gives evidence as to what plans DS0000008426.V356630.R01.S.doc Timescale for action 31/03/08 2. YA6 YA9 15 13 31/03/08 3. YA23 37 29/02/08 4. YA20 13(2) 29/02/08 5. YA24 23 31/03/08 The Brandles Residential Care Home Version 5.2 Page 26 6. YA30 7. YA33 8. YA34 9. YA37 10. YA42 for improvement to the property are to take place in the coming year. 16 That paper towels and liquid soap are provided in communal bathrooms and the kitchen area to reduce the opportunity for cross infection. 18 A review of the present staffing arrangements must be undertaken by the registered providers confirm that the current arrangements are adequate or state what action he is going to take to improve the situation. 19 That a new CRB check is undertaken by the home before a new employee works in unsupervised capacity at the home to protect people living at the home. Information about the CRB relating to the person identified in the report is also required. Section 11 To ensure that the home is well Care run and complies with the law, Standards we must receive an application Act 2000. from a competent and suitably qualified person to become the registered manager for the home. 13 That the registered providers must write to confirm that a full inspection of the homes electrical fittings and fitments was also carried out and that any outstanding work was addressed to ensure the safety of people living at the home. 31/03/08 31/03/08 31/03/08 29/02/08 29/02/08 The Brandles Residential Care Home DS0000008426.V356630.R01.S.doc Version 5.2 Page 27 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 YA7 YA13 YA20 Good Practice Recommendations Clear records need to be maintained to show how often, individual activities are provided for people who are dependent on one to one support outside the home. To ensure that people who are dependent on one to one support can become involved in individual activities outside the home, appropriate staffing levels need to be provided. Written audits of medication handling should be completed to help ensure the quality of the medicines service. The medicines policy should be reviewed and expanded to offer more complete guidance for staff handling medication. Handwritten entries on the medication administration records should be signed, checked and countersigned. To benefit the people living at the home what is learnt through this training must be adopted as good day-to-day occupational practice. The registered providers must ensure that the acting manager has enough time available to her to ensure that the management tasks at the home can be fully completed to ensure that good standards maintained. It is strongly recommended that Regulation 26 visits are expanded and are more detailed to evidence that the registered providers are effectively monitoring the home. That consideration is given to replacing the home’s central heating boiler that is over 18 years old. Fire drills at the home simulating a worst-case scenario continue to be carried out particularly during the evening and towards night time. 4. 5. YA35 YA37 6. 7. 8. YA39 YA42 YA42 The Brandles Residential Care Home DS0000008426.V356630.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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