Inspection on 09/12/08 for The Brandles Residential Care Home

This inspection was carried out on 9th December 2008.

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

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

Other inspections for this house

The Brandles Residential Care... 08/01/08

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 13/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Brandles Residential Care Home 23/25 Birks Drive Bury Lancs BL8 1JA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Bodell     Date: 0 9 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: The Brandles Residential Care Home 23/25 Birks Drive Bury Lancs BL8 1JA 01617976367 01617633833 the.brandles@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Ismat Shafiq Type of registration: Number of places registered: Mr Rufus Fagbadegun,Mrs Christine Fagbadegun care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: That the category of DE is in place for the identified service user only and an application fot the removal of the condition must be made should that service user no longer reside at the Home. 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 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. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 1 6 Over 65 0 0 Care Homes for Adults (18-65 years) Page 4 of 26 Brief description of the care home 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 bedrooms are single with three on the ground floor and 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. Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The home did not know we (the commission) were going to visit. The visit took place over five hours. We looked around the home and at a number of records. To get more information we spoke with all the people living at the home, the owner and a support worker and had lunch with everyone. We requested information from the service before our visit, which was returned to us. This is called the Annual Quality Assurance Assessment (AQAA) and tells us what the home feels that it does well and what needs to be done to improve the service. We received surveys from five people using the service and four from support workers. The responses we received were generally positive about the service. Care Homes for Adults (18-65 years) Page 6 of 26 Care Homes for Adults (18-65 years) Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Before a person moves into the home their needs are assessed so that all concerned can decide whether the home will be suitable for them. Evidence: At our last visit to the home we raised concerns about the staff teams ability to meet the changing needs of a number of people living at the home in an effective and safe way. Since that time two people have moved to different types of services who are better able to meet their needs. One person has moved into the home. They had an up to date community psychiatric assessment and an assessment was also undertaken by the homes owner, who is an experienced former senior psychiatric nurse, before the person moved in. Consideration was given at the time of the assessment to the needs of the people already living at the home and who have done so for many years and the fact that for most of the time there is only one support worker available. Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: The new person had settled quickly gets on well with the other people who live there. They said, I am very happy here. Another person was considering moving into the home. Plans were in place for this person to visit the home before they reached a decision to move in. The owner said that there were no issues at the home and the support worker spoken with confirmed this. Support workers attended a Basic Understanding of Mental Illness course in May 2008. This training was held at the home with an external trainer. This training will help to give the staff team a better understanding of peoples needs. Care Homes for Adults (18-65 years) Page 11 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have support plans and risk assessments in place and are able to make decisions about their lives and receive support when they need it. Evidence: Two peoples care files were examined. Each contained a basic care plan, which included details about their mental health, physical health, medication, personal hygiene, daily living skills, activities and aspirations. The registered manager has received person centred planning training through the local training partnership. Individual daily notes were kept that show what people had been doing. Risk assessments were in place for people and they had been reviewed regularly to check that peoples needs had not changed. The support worker spoken with had a very good understanding of peoples needs, likes and dislikes. She had a strong value base and understood the importance of promoting independence, choice, fulfilment, dignity and rights. She was seen to Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: actively encourage people to be as independent as possible and offering choice at any given opportunity. It was clear from observation that people living at the home decided what they wanted to do each day and some led very independent lifestyles. In a returned survey a support worker stated that they, Supported people to make their own decisions and to be as independent as possible. Some people because of presenting risks needed one to one support to be involved in individual activities outside the home. The support worker confirmed that extra staff time was always made available if people had appointments to attend or a social event planned. Care Homes for Adults (18-65 years) Page 13 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Involvement in activities is promoted and enables people to have access to local community facilities and keep in contact with their families and friends. 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 attend college courses and one person goes to a music group at a local drop in centre. One person attends church on a regular basis with a neighbour. People were seen to be involved in household tasks around the house. The support worker said that people had become more involved in household activities and the staff team worked together to promote independence. Most people were at home during our visit as it was a very cold and frosty day and icy Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: under foot. One person was encouraged not to go out as he was at risk of falling and he decided to go back to bed for a while. Two people went out shopping and on a bus ride. Inside people watched television, videos and DVDs, or listened to music. The group appeared to get on well and chatted to each other in the lounge. One person enjoys using computers and has individual access to the Internet. The group occasionally go out together for meals. There had also been recent trips out to Blackpool and to the bowling alley. One person had been on a Mediterranean cruise with a support worker. Birthdays are celebrated. It was noted in the returned surveys from two people that they ticked that activites were only available, sometimes. Relationships with friends and family are encouraged. During our visit a relative of one person called at the home to deliver a Christmas present for them. There is a close relationship between two people living at the home. Friends were able to visit 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. We have been told previously that this was through personal choice. 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 and the main meal is 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. On the day of our visit people decided that they wanted a chippy lunch and the support worker went to the local shop to get them. Everyone enjoyed them. One person was seen peeling the potatoes for the main evening meal. Care Homes for Adults (18-65 years) Page 15 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to healthcare support and medication practices have improved to protect people from harm. Evidence: People are encouraged to be as independent as possible and manage their own personal care needs with prompts or minimal assistance from support workers. The relationship between the support worker and people living at the home was seen to be very good. Interactions were very frequent, warm, caring and friendly. The support worker was seen to treat people with respect and demonstrated that they had a good understanding of their likes, dislikes and preferred routines. Peoples health care needs appeared to be properly supported. Everyone had a GP and a dentist. An optician and a chiropodist visit the home regularly. A record of all health care appointments is maintained. People are provided with support to attend healthcare appointments if they need it. We looked at peoples medication. A medicines policy provides written guidance for Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: staff. People wishing to self administer their own medicines are supported to do so but most medicines were administered by the staff team. The home had a dossette medication system in place that was supplied by a local pharmacist. We saw that records for the administration of medication were complete and up to date. We were informed that some staff have not yet received medication training and that this was planned for the new year. This training must be undertaken to help ensure the safe handling of medication. A requirement has been made as part of mandatory health and safety training in the staffing section of this report. Care Homes for Adults (18-65 years) Page 17 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know who they can talk to if they are not happy and the staff team had received the training they need to ensure they know what action they must take in the event of an allegation of abuse. Evidence: No complaints have been made about the service either directly to us or to the home. In the returned surveys we received people confirmed that they knew who to speak to if they were not happy and that staff were always available to talk with. No issues of concern were raised during our discussions with people who live at the home. One person in a returned survey stated that they had, No complaints and no worries. Another stated that, The staff here are excellent and I am always listened too. No allegations of abuse have been made to CSCI. A copy of the new local authority safeguarding procedures was available for the staff team to read and use. All the staff team have received training in safeguarding awareness. The registered 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. Care Homes for Adults (18-65 years) Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable and homely with ongoing effort being made to ensure that good standards are maintained. Evidence: The Brandles was seen to be comfortable and homely. There was a good standard of decoration and furnishings, which were domestic in style. 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 a number of bedrooms, which were personalised to individual tastes. Two people in returned surveys commented that they liked their bedrooms. The lounges had recently been decorated. Workmen were in the home fitting new lights to the bathrooms. There were gardens to the front and rear, with a paved patio area. Work has been undertaken over the past year to tidy up the back garden and new fencing has been erected to good effect. There is a pleasant and relaxing view to the rear of the property. The home was clean and tidy. Paper towels and liquid soap had been placed in communal bathrooms to reduce the opportunity for cross infection. One person commented in a returned survey that the home was always Spic and spam. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some members of the staff team need to undertake training to enable them to support people effectively and safely. Evidence: People living at the home said staff looked after them well. There have been a number of changes within the staff team since our last visit. Written duty rosters are kept and were examined. 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 registered manager and four carers, with another carer due to start in the near future. No agency staff were being used. There were two support workers on duty when we arrived at the home as one person had been to an appointment. We were informed that if there was a social event planned or a person had an appointment then extra staffing would be provided. We have previously had concerns about staffing arrangements at the home. It is recommended that the registered manager of the home keeps staffing levels under review. This needs to be done to ensure that there are enough support workers available to meet peoples individual needs and preferences, particularly for those people who need one to one support to take part in activities outside the home. Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: A new support worker in a returned survey commented that they had received two induction sessions and appropriate training before they started. They also said that they worked well together as a team. All the outgoing members of staff held a National Vocational Qualification Level 2 in Care award. Of the new members of staff one person was near to completing NVQ Level 2 and intends to start NVQ Level 3. We were informed that it was planned that the new members of staff will enrol on NVQ Level 2 in the New Year. This needs to be done to ensure that people have access to a suitably qualified team and meet the national minimum standard. Recruitment files were securely held and could not be checked as the manager was not on duty at the time of our visit. To ensure that confidentiality is maintained she was the only person who had access to this information. The owner confirmed that criminal record checks were obtained before a person commenced employment and this was now done by an umbrella body. The owner also said that people living at the home were now involved in the recruitment of support workers. People spent time with prospective support workers and gave their opinions and views about them during the selection process. Their views were considered when making a decision about who to appoint. The last two support workers appointed were done so in this way and people confirmed that they had made the Right choice. The home is a partner member of the local authority Adult Care Training Partnership. Training information could not be accessed at the time of our visit. Information received later from the owner shows that new support workers had received most of the mandatory health and safety training but a number of shortfalls were identified for example medication training. Plans are in place to address these shortfalls through the training partnership. Staff meetings take place on a regular basis and a record is maintained. Staff appraisals and individual formal supervision meetings could not be checked as they could not be accessed at the time of our visit. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home now has a registered manager and is closely monitored by the owners to ensure that it is being run in the best interests of the people who live there. Evidence: The home now has a manager who registered with us in July 2008. The manager has worked at the home for many years and holds the Registered Managers Award. As part of the fit person process it was agreed that the registered manager would also complete NVQ Level 4 in Care to further her knowledge. We were informed by the homes owner at this visit that the training was still in the process of being organised. It is strongly recommended that this training is undertaken. The owner needs to let us know when the training has been completed. The staff training matrix shows that the registered manager had undertaken recent training in the basic understanding of mental illness, common induction standards and person centred care to ensure her continued professional development. The registered manager was on leave at the time of our visit. Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: The owner had not received a copy of the new certificate for the home issued after the managers approval to become registered. He must write formally to us to explain the situation so that a new certificate can be issued. The owner is a very experienced former mental health nurse manager, who visits the home regularly. During our visit he called at the home to give people Christmas cards. He knows the people who live at the home very well. He undertakes monthly unannounced visits to the home and produces a report as required by the law. Resident and staff meetings are held regularly. People living at the home and other stakeholders complete annual satisfaction surveys. We checked the maintenance records for the gas, electrical and fire equipment at the home. All were found to be valid. Regular maintenance checks help to promote the health and safety of people living at the home. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 35 18 The registered person needs 31/03/2009 to ensure that support workers receive all the mandatory health and safety training they require for example medication training. This must be done to ensure that people are supported, safely. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 32 It is recommended that new support workers receive the planned NVQ Level 2 training that they need so that people benefit from a qualified staff team. It is recommended that the registered manager of the home keeps staffing levels under review to ensure that there are enough staff available to meet peoples individual needs and preferences. It is recommended that the registered manager completes NVQ Level 4 in Care to further her knowledge to ensure that people using the service are supported by a suitably qualified person. 2 33 3 37 Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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