Inspection on 08/11/06 for The Briars

This inspection was carried out on 8th November 2006.

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

The inspector found 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

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Briars Naas Lane Lydney Glos GL15 5AS Lead Inspector Mr Richard Leech Key Unannounced Inspection 8 & 9th November 2006 13:30 th The Briars DS0000067090.V317796.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 Briars DS0000067090.V317796.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 Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Briars Address Naas Lane Lydney Glos GL15 5AS 01594 844728 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) www.brandontrust.org The Brandon Trust Mrs Elizabeth Buckley Care Home 5 Category(ies) of Learning disability (5), Physical disability (2) registration, with number of places The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26/04/06 Brief Description of the Service: The Briars is a large, detached house providing care and accommodation for up to five adults with learning disabilities, some of whom may also have physical disabilities. It is close to the centre of Lydney. The home provides transport to enable residents to access local services and amenities. There is 24-hour staffing cover. Service users are accommodated in single rooms on the ground and first floors. The Brandon Trust runs the home, having taken over from the previous service provider in April 2006. Prospective service users and others involved in their care are offered information about the home including copies of the Statement of Purpose and Service Users Guide. Up to date information about fee levels was not obtained during this visit. The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection began on a Wednesday afternoon for about three hours, continuing on the following day from early afternoon to about 19:30. Five of the staff team were met, and the manager was present for the second day. All of the service users were met with on both days. During the visits various documents were checked including examples of care plans, risk assessments, medication charts, daily records and staffing files. Some staff were spoken with in-depth and time was also spent with the manager. Some general observation of life in the home took place and the premises were inspected. Before the visit survey cards were sent out to staff and to other people involved in service users’ care, providing considerable written feedback. What the service does well: Good local procedures and practices are in place around referrals and admissions, increasing the likelihood that appropriate admissions will be made. Arrangements for care planning and risk assessment are generally good, though there is potential for further development. Service users are supported to make choices. They lead full lives, accessing a range of activities in the home and community. They are also enabled to maintain and develop relationships with family and friends. A varied and balanced diet is offered to service users, promoting their health. People’s personal care needs are met in an individual and sensitive manner. Good arrangements are in place around the handling of medication. Staff are skilled at communicating with service users and at recognising their wishes and feelings. Support is provided by a skilled and caring staff team. The manager has a sound understanding of requirements around recruitment and selection, thereby helping to protect service users. Measures are in place which help to protect people living in the home from harm and abuse. The Briars provides a clean, homely and comfortable. Service users’ rooms are personalised according to their needs and interests. The home is being well managed through a difficult period of change. The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Documentation is available about the home although there is scope for improving this in order that prospective service users have up to date information about the service. Good arrangements are in place around referrals and admissions, increasing the likelihood that appropriate admissions will be made. EVIDENCE: The Statement of Purpose and Service Users Guide were checked. They have been updated to include some information about the new service provider. However, there is still reference to the previous provider and to their complaints procedure. It was agreed that they needed review and that this was a good opportunity to make the documents more attractive and user-friendly such as by adding photographs. At the time of the inspection the home had one vacancy. Staff were aware of referrals, and there was reference in the communication book to the procedure that was to be followed around admissions. The manager had drafted an assessment tool to complement other assessment and background material provided in respect of referrals. She had also written a local procedure for admissions and a profile of the kind of referral which may be appropriate for The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 9 the home in terms of the service provided and compatibility with current service users. The Brandon Trust’s overall admissions procedure dated from 2000 and should be reviewed and updated, for example to fully take into account and reflect the National Minimum Standards. The Briars DS0000067090.V317796.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 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Reasonable arrangements are in place around care planning, although there is potential for further development to promote consistency and best practice. People’s choices are ascertained and respected as far as possible, helping to empower service users to take control of their lives. Arrangements are in place to assess and manage risks, promoting service users’ safety with minimal restrictions and limitations. EVIDENCE: Two care planning files were checked in detail. Care plans were seen to have clear aims and to generally be regularly reviewed (though some had not been reviewed since April 2006). They covered areas such as daily routines, personal care, activities, communication, eating & drinking and family relationships, providing clear guidance for staff. Plans were available describing in detail the approach to challenging behaviour, including triggers, how to keep The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 11 people safe and the use of de-escalation techniques. ABC charts provided evidence of staff managing complex situations using these techniques. Staff spoken with were able to describe how they managed challenging behaviour. There was a discussion with the manager about consistency of approach and adherence to care plans. The manager described steps being taken to promote consistency. Some care plans were becoming harder to read due to hand-written additions and would benefit from retyping. Some plans were not dated. The manager said that daily records were likely to change in the New Year, with each person having their own daily diary. She said that she had spoken to the team about improving record keeping, such as by avoiding entries like ‘as care plan’. It is understood that the Trust will shortly be introducing a new person-centred planning format. Some staff had recently attended training about person centred planning and were due to cascade this learning to other members of the team. Although the plans in place could be described as ‘person-centred’, adopting new tools and practices may help to further promote person-centred philosophy and practice in the home. Care plans included reference to respecting people’s choices where possible, such as around which team member they wished to support them for personal care. Staff described how people living in the home were offered choices, such as around food, activities and daily routines. People were seen being offered choices during the inspection. Standard 7.5 indicates that where support around management of finances is needed the reasons for, and manner of, support are documented and reviewed. There were individual protocols around spending, but these did not fully describe why there was a need for support in this area and what that would consist of. Restrictions and limitations were seen to be documented and reviewed, such as around not having access to room keys, the front door being locked and menus not being entirely based on service users’ choices for reasons related to health promotion. Examples of individual risk assessments were checked. These were seen to cover significant risks and to describe how this would be managed. The manager said that a general review would take place of risk assessments, including whether there may be a better format/approach. Some ambiguities were raised, for example one person’s bathing risk assessment said, ‘if left, check his safety regularly’. It was agreed that ‘regularly’ could be interpreted in very different ways. It is understood that the Trust is currently reviewing the risk assessment tools and procedure (the latter dating from 1996). The Briars DS0000067090.V317796.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): 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate support is provided for people to take part in activities which reflect their needs and interests, both in the home and community. Service users are also supported to maintain and develop contact with important people in their lives. Service users are respected and valued as individuals. People living in the home are offered a varied and balanced diet, promoting their health and wellbeing. EVIDENCE: Daily records provided evidence that service users were being supported to access individual activity programmes which corresponded to their needs and interests. Activities included attending day centres, going to social evenings, The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 13 trampolining, trips out to local place of interest, attending church and using facilities such as the cinema and take-aways. Care planning files included information about people’s activities. There was also a photo board in the kitchen with information about what people were doing each day. All service users had been out on activities on both days of the inspection. This included going to day centres and having a community day (on this occasion consisting of visits to local towns and having a meal out). Staff spoken with described people’s activities and felt that people had enjoyable and meaningful programmes. The home had one vehicle. Some staff felt that a second should be provided. The manager said that there were no plans to provide a second vehicle but that this would be reviewed when a fifth service user moved in. Staff also described efforts to support service users to develop and maintain relationships with family members and friends. Survey cards provided positive feedback from family, including that they could visit whenever they wished and that they were kept well informed. Staff described flexible routines operating in the home, such as the times people went to bed and when people had a drink or snack. This corresponded to care plans and to observation over the two days. Staff also described the importance of consistent routines for some people. People living in the home were seen to move around freely and to treat the Briars very much as their home. A survey card from a relative provided further evidence to back up this impression. Staff were seen to be respectful and sensitive to people’s individual needs and wishes. Service users were also seen to be involved in household routines where possible, such as recycling and putting out the bins. Menus and records of food consumed provided evidence that people living in the home were offered a varied, balanced diet including fresh ingredients. The kitchen (including fridges and freezers) was reasonably wells stocked. Staff described how service users were offered choice around food and drink. A meal was observed. People ate together in a relaxed atmosphere and appeared to be enjoying their food. Some staff expressed concerns about the food budget (out of which cleaning products were also purchased). However, no evidence was found that the quality and quantity of food was being affected. The manager said that there was some flexibility in budgets and that if problems were identified a case could be made to the Trust for additional support in this area. The Briars DS0000067090.V317796.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 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ personal care needs are met, enhancing their dignity and wellbeing. People’s healthcare needs also appear to be met, although more thorough planning and documentation in this area based on current best practice should help to further ensure that people maintain optimal health. Good arrangements are in place for the safe handling of medication, although there is scope for some development in this area to further promote safety and best practice. EVIDENCE: Care plans provided guidance about the personal care support each person required, including reference to people’s preferred routines and to respecting their choices. Staff spoken with demonstrated awareness of people’s needs and wishes in this area, and of issues around people’s privacy and dignity. A comment care from a relative described how their family member was always treated with respect and offered privacy. The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 15 Healthcare notes for two people were looked at in detail. These included evidence that people were accessing a wide variety of routine and specialist services according to their individual needs. In some cases there has been difficulty supporting people to access routine check ups. However, staff had succeeded in supporting one person to have a dental examination in May 2006 after a gap of several years. The dentist was recorded as saying that staff were to be commended. It had not yet been possible to support the same person to have their eyes checked. There had been a domiciliary optician’s visit in July 2004 but this was unsuccessful. The optician had recommended arranging a further ophthalmological opinion in hospital in relation to a condition that the person experiences. The person’s health action planning assessment had not been completed, although the summary/action plan had. No reference could be found to the strategy for promoting the person’s eye health, although staff were able to describe how they monitored this area. There also appeared to be no reference on file to how the person was supported with foot care (staff reported that they cut service users’ toenails). Another service user’s health action planning assessment was largely completed (although the summary/action plan was not). However, the manager agreed that some entries were ambiguous, such as ‘as needed’ being recorded in the section for dental care with no reference to monitoring, whether the dentist had recommended a particular frequency of check up, how it would be recognised that attention might be needed etc. They were recorded as having a ‘hearing impairment’ but no further information was given. An entry stated ‘can self-harm’ without giving any more information. Certain health checks were ticked as having been done but with no dates alongside. The same person had a partially completed hospital assessment. This work should be concluded. The manager agreed that the health action planning format offered a good opportunity to further record issues and plans around how people’s healthcare needs were met, and that documentation in this area should improve. Whilst overall outcomes appeared to be good, further planning and recording in this area should help to enhance this. One person’s weight records indicated that they had been weighed in October 06, May 06 and September 05. Although their weight was stable, given how low the person’s weight was it is recommended that this be done more frequently. The health action plan stated that this was done monthly but this was not correspond to recordings. The manager said that this was being addressed through the person’s day centre. The Trust’s medication policy dated from 2000 and was marked as pending review. It included reference to the Registered Homes Act. This review should The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 16 be done as soon as possible since a variety of new guidance has been generated since then. The manager had written some local procedures. Protocols for ‘as required’ medication and other information such as about each person’s medication were seen on file. Medication storage and recording appeared to be in order, although it was suggested that the allergy section on the MAR chart be completed (even if with ‘none known’) and medicines for external use should be physically separated from internal medicines, such as on separate lower shelves in the main medicines cupboard (see 2004 Gloucestershire PCT guidance). One cream was kept in a plastic container in the fridge. The manager and staff felt that this was safe. The manager said that she would check if there was written risk assessment and, if not, produce one. Staff demonstrated awareness of some changes to practice following a recent medication error, providing evidence of a culture where mistakes were treated as learning opportunities for improvements in practice. The manager reported that most staff had undertaken MDS training and updates from the supplying pharmacy, and that all staff had completed a college course in the safe handling of medication. The Briars DS0000067090.V317796.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 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for managing complaints, although aspects of policy need review in order that people have the information that they need. Systems are in place which help to protect service users from harm and abuse. EVIDENCE: The Trust’s complaints procedure dates from 2003 and consists of a text and symbol version. It is understood that the latter is going to be reviewed to make it more accessible. The home has kept copies of the procedure used by the previous provider in the meantime, such as in the Service Users Guide. The procedure requires review since there are no contact details for CSCI included. Staff spoken with were able to describe in detail how people living in the home expressed dissatisfaction and unhappiness, and talked through how they responded, giving examples. This sensitivity was observed during the inspection. A survey card from a relative expressed confidence that the staff could tell when their family member was unhappy. The Trust has a thorough adult protection procedure dated 2005. There is a whistle blowing policy dating from 2000. In line with a recommendation from the last inspection, the manager and staff reported that most of the team had recently attended training about the protection of vulnerable adults. Staff spoken with demonstrated an understanding of abuse and the indicators that it The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 18 may be taking place, along with their responsibilities if they were concerned about something. They expressed confidence in the arrangements for reporting and investigating concerns. Samples of financial records for two services were checked and appeared to be in order. The manager said that there were balance checks after each transaction, and that she had introduced new procedures around the handling of service users’ money. Some receipts were not numbered. The manager was aware of this and said that she had reminded staff to number receipts. There were also many ‘petty cash vouchers’ where staff had not obtained a receipt for a transaction. Whilst it is accepted that on some occasions it will not be practical to get a receipt, this should be done wherever possible. The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 19 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A clean, homely and comfortable environment is provided, promoting service users’ quality of life. EVIDENCE: All communal areas and three of the four occupied bedrooms were checked during the inspection. The Briars was seen to be clean, homely and comfortable throughout, with service users’ rooms being attractively decorated and personalised. The dishwasher had broken down around the time of the visit. There had been some initial confusion about whose responsibility it was to repair this, although this appeared to have been resolved and arrangements were being made for the work to be done. The home had one vacancy at the time of the visit. It had not yet been decided whether the ground or first floor room would be used. The manager said that The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 20 the room which was not used as a bedroom was likely to be converted into a communal area. Some staff spoken with described infection control measures in the home. The manager said that she is hoping to review and further improve infection control practices. The most recent (2006) guidance about infection control in care homes was pointed out. This is available through CSCI’s website. The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 21 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, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Support is provided by a skilled staff team, helping to ensure that service users’ needs are met, although the team would benefit from further specialised training. The manager has a sound understanding of requirements around recruitment and selection, thereby helping to protect service users and reducing the likelihood of a repeat of past shortfalls. EVIDENCE: Staff were observed providing skilled, individualised support throughout the inspection, treating service users with respect. The people living in the home in turn appeared comfortable and relaxed with the staff. Staff appeared able to communicate effectively with service users and to understand what was being conveyed to them, in accordance with communication guidance on file for each person. A form of ‘intensive interaction’ was briefly observed, using music as a medium for communication and enjoyment. The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 22 The manager felt that total communication techniques were being practiced regularly by all staff, but that there was a need to better evidence and record this. She was planning to attend a meeting about total communication in the near future. A senior member of the team was likely to be going on a week’s secondment to another of the Trust’s homes with a strong track record in applying total communication. The manager said that the Community Learning Disability Team (speech and language therapy) may be engaged as part of bolstering the total communication practices in the home, and that further training may be provided for the staff. These plans would be a positive development for the staff team and people living in the home, and are welcomed as good practice. Progress in this area will be considered as part of future inspections. Staff described good links with external support, such as health and social care professionals in other agencies. Further evidence for this came from written notes and correspondence on file. A survey card from a relative described the staff as ‘excellent’. Discussion with the manager and staff provided evidence that over 50 of the staff had achieved NVQ in health and social care to at least level 2 (level 3 in many cases) and that there was an ongoing NVQ training programme. The manager said that no new staff had been recruited since the last inspection. She said that staffing files had been quite disordered and that she was gradually sorting these. An audit of missing documentation had already been completed. Two staffing files were checked. One of these was missing both references and the application form also appeared to be absent. In view of the time elapsed since recruitment took place it was agreed that a requirement would not be made about this, but that the manager would try to track down the documents. The manager described the steps that she takes when recruiting staff, demonstrating a sound awareness of the relevant National Minimum Standards and Care Homes Regulations. As noted, there had been some recent training about personal centred planning and the protection of vulnerable adults. Many staff reported having just attended an intensive period of training covering all of the ‘mandatory’ elements as well as health and safety and COSHH. The manager said that remaining staff would attend this training early in 2007 and that following this she would arrange more service-specific training including input about autism and epilepsy. This should be taken forward. Some staff expressed concern about the lack of training about service users’ conditions and specialised needs. Given a recent incident of challenging behaviour there may also be a need for further input around the management of violence and aggression. The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 23 Discussions with the manager and staff indicated that morale had been fairly low among the team. This was attributed to some issues around terms and conditions, secondments, sickness and other factors. Some staff felt that changes in the staff team related to covering other homes had contributed to more unsettled behaviour from some service users. Partly as a result of these issues the manager had arranged for senior members of the Trust to attend a staff meeting in the near future. The manager described other ways in which she was trying to promote the team’s cohesion and morale. Staff surveys indicated that team members generally felt that they worked well together and provided high quality care, though some concerns were noted as expressed elsewhere in the report. The manager said that the handover process had been formalised more, though she intended to relaunch the procedures, considering that they had begun to slip again. The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 24 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 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is going through a time of change, creating some stresses. However, the home is well run, promoting positive outcomes for service users. Systems are in place which help to monitor and improve the quality of the service provided. Health and safety in the home is promoted, although there is scope to improve aspects of this in order to further safeguard people’s wellbeing. EVIDENCE: The manager has been a registered manager in another home and has many years’ experience of managing services for people with a learning disability. She has achieved an NVQ level 4 in management and was due to complete the Registered Manager’s Award towards the end of 2006. During the registration The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 25 process a case was put forward for exemption from taking NVQ4 in health and social care or equivalent on the grounds of previous qualifications. This was accepted. Staff felt that the manager was approachable and supportive. Some people felt that various pressures meant that the manager was not able to devote enough time to management tasks as opposed to hands-on care. Quality assurance was discussed. The Trust has devised some quality standards and home managers were asked to complete a self-audit which would in turn be checked by their line manager. The manager said that this had been a useful exercise which had indicated that the team was good at delivering appropriate care but less good at documenting and evidencing this. It is understood that the quality standards are to be reviewed. Regulation 26 reports are being forwarded following monthly visits by representatives in the Trust. Minutes from staff meetings provided evidence of wide ranging discussions taking place regularly. It was agreed that one aspect of quality assurance which should be considered was about widening the sources of feedback and, in particular, considering other ways to seek service users’ views. The manager said that this would be raised in a staff meeting. The Trust has comprehensive health and safety policies. Staff spoken with generally felt that health and safety in the home was well managed. Some staff described having recent training in health and safety. One person’s bedroom door was propped open. The manager said that a case had been made for a self-closing device to be installed. It was agreed that the door must not routinely be propped open and that a self-closing device should be fitted if the service user had a preference for keeping their door open. Some staff commented on specific areas of health and safety, notably that: • • The adapted bath should have a manual override for emergencies. There were some difficulties with the accessibility of the vehicle, particularly for one service user. These were discussed with the manager. It was agreed that they should be considered in consultation with the Trust’s lead health and safety officer. A long-standing requirement about a fire safety issue in the kitchen had been met. The fire logbook provided evidence of testing of fire alarms and emergency lighting at regular intervals. However, the most recent drill was recorded as 13/04/06. These should be conducted more often. The manager had some ideas for testing different aspects of the fire procedures through drills. The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 26 The manager said that the fire risk assessment had been reviewed in April 2006, in line with recent changes to fire safety legislation. Portable appliances had been checked for safety in September 2006. Fridge and freezer temperatures were sampled and were recorded as being within an acceptable range. Hot water temperatures were being regularly tested, although the recording format had been very scrappy (in one case on the back of an envelope). The manager said that a new printed template had been devised. Regarding the risk from legionella the manager said that she would obtain information from the Health and Safety Executive specific to care homes and would write local procedures accordingly. The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 3 x 3 x x 2 x The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO 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 YA22 Regulation 22 (7) Requirement The complaints procedure must include the name, address and telephone number of CSCI. Timescale for action 28/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA1 YA2 YA6 Good Practice Recommendations Review and update the Statement of Purpose and Service Users Guide. Consider ways of making the documents more accessible such as by adding photographs. The Trust should review and update the admissions policy dating from 2000. Aim to retype care plans where hand-written changes are beginning to compromise clarity. Ensure that all care plans are dated and regularly reviewed. Take forward person centred planning within the home, as well as planned improvements to daily recording. Where support around management of finances is needed the reasons for, and manner of, support should be DS0000067090.V317796.R01.S.doc Version 5.2 Page 29 4 YA7 The Briars 5 YA19 documented and reviewed. Further develop health action planning in the home in conjunction with external professionals as relevant. Include consideration of how to monitor and manage complex healthcare issues such as those described in this and previous reports. Add more detail/information as necessary (see examples in text). Complete each person’s hospital assessment. 6 YA20 Ensure that people are weighed at suitable intervals. The Trust’s medication policy dated 2000 should be reviewed as soon as possible to take into account the National Minimum Standards as well as other relevant guidance such as from the Royal Pharmaceutical Society and Royal College of Psychiatrists. The allergy section on the MAR chart should be completed (even if with ‘none known’). Medicines for external use should be should be stored in a separate locked cupboard or be physically separated from internal medicines on separate lower shelves in the main medicines cupboard if possible/practical. Obtain receipts wherever possible for transactions involving service users’ money, using petty cash vouchers only in exceptional circumstances where it is not possible to obtain a receipt. Take forward plans to further promote ‘total communication’ in the home, such as through the ideas discussed during the inspection. Provide more service-specific training for staff relating to service users’ conditions and specialised needs, such as about autistic spectrum conditions and epilepsy. Consider also whether there is a need for further training about the management of challenging behaviour. Consider the two health and safety issues raised by staff during the inspection (about the adapted bath and the vehicle), consulting with the Trust’s health and safety officer to decide whether any action needs to be taken. Conduct fire drills more frequently. 7 YA23 8 9 YA32 YA35 10 YA42 The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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. Extracts may not be used or reproduced without the express permission of CSCI The Briars DS0000067090.V317796.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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