CARE HOME ADULTS 18-65
The Brook 303 Leyland Lane Leyland Preston Lancashire PR25 3BP Lead Inspector
Val Turley Unannounced Inspection 24th February 2006 10:40a The Brook DS0000033563.V278136.R01.S.doc Version 5.1 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 Brook DS0000033563.V278136.R01.S.doc Version 5.1 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 Brook DS0000033563.V278136.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Brook Address 303 Leyland Lane Leyland Preston Lancashire PR25 3BP 01772 431466 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) Dawaking Care Ltd Mr Vinod Buldawoo Mrs Erika Ann Catherine Clayton Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Brook DS0000033563.V278136.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service should, at all times, employ a suitably qualified and experience manager who is registered with the NCSC. 1st November 2005 Date of last inspection Brief Description of the Service: The Brook is located on the outskirts of Leyland town centre, and provides 24hour support for up to 6 people with learning disabilities. The Brook offers accommodation on two floors, and all rooms are single. One room has a toilet en-suite facility, and a second has a shower en-suite facility. The communal lounge, dining area and kitchen are on the ground floor. The home has a private patio area to the rear. The Brook DS0000033563.V278136.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second of two statutory inspections to be carried out this year. The inspection was an unannounced one and took place on the 23/02/06. The inspection was undertaken by one regulatory inspector over a period of 4 hours. Files were examined and service users and support staff were spoken to. A tour of the home also took place. As part of the inspection, the inspector used “case tracking” as a means of assessing some of the National Minimum Standards. This process allowed the inspector to focus on one of the service users who stayed at the home. All records relating to this individual were inspected and discussion took place with them. What the service does well:
The home provided a clean, comfortable, well-furnished and maintained environment for both the service users and the support staff. The manager was well experienced and qualified. Staff were presented with a variety of training opportunities, which were relevant to the support needs of the service users. The home had good assessment and admission procedures in place to ensure the needs of the service user could be fully met. Care plans were developed from this information and these included any agreed restrictions on the choices and freedom of the service user. There were risk assessments in place for activities that the service users were involved as well as strategies to deal with any specific concerns regarding the support needs of the service user. The service users were encouraged to make decisions and choices about the way the home was run. The daily routines within the home were relaxed and flexible. Staff spent time talking to the service user and the service user were relaxed in the company of the staff. One of the service user stated that he was happy living at the home and that ‘everything was alright’ there. The staff team had a good awareness of the personal care, social care and health needs of the service users. These needs were addressed sensitively. A number of health professionals were involved in the home and service user were supported to attend health care appointments. Health action plans had been developed for the service user enabling staff to monitor the service users
The Brook DS0000033563.V278136.R01.S.doc Version 5.1 Page 6 health needs. Links with families were also encouraged and supported appropriately. The home had good policies and procedures in place in order to protect service users and to enable any concerns or worries they may have to be addressed. The home had good quality assurance processes in place which took into account the views of the service users, relatives, friends and involved health and social care professionals. Staff received training in safe working practices to ensure as far as possible the safety of the service users. 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 Brook DS0000033563.V278136.R01.S.doc Version 5.1 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 Brook DS0000033563.V278136.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The pre-admission process was in sufficient detail to ensure that prospective service users supports needs are fully assessed before admission. EVIDENCE: The file of a service user who had recently been admitted to the home was examined. The file indicated that a full assessment of the service users needs had been made prior to the admission. As well as the formal assessment processes additional information had been obtained from the Learning Disability Team and information obtained from the previous placement. Introductory visits had been made to the home prior to admission, with a view to making the admission process as positive as possible. A care plan had been developed and this included details of any agreed restrictions on the choices and freedom of the service user. From observation of the service user and supporting staff during the inspection it was evident that these restrictions were understood and agreed by the service user. The service user had not however been asked to sign the care plan to indicate his agreement even though he was able to do this. The Brook DS0000033563.V278136.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 The service users were supported to take responsible risks based on good information enabling them to work towards a more independent lifestyle. EVIDENCE: The service users file examined had risk assessments in place in respect of any activities they were involved in. The risk assessments and the care plan included strategies that had been developed to deal with any specific concerns regarding the support needs of the service user. The service user knew of these strategies and the support staff were heard to discuss these with the service user during the course of the inspection. The home had been aware of the assessed risks prior to the admission of the service user to the home and this information had been considered as part of the admission process. The Brook DS0000033563.V278136.R01.S.doc Version 5.1 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 The daily routines in the home promoted the independence of the service users encouraging them to make choices and decisions. EVIDENCE: During the course of the inspection support staff were observed to interact with service users, including them in conversations and involving them in activities. Service users were able to move freely around the house and were also able to spend time alone if they wished. The service users were comfortable in the company of the support staff and were able to ask for support as they needed it. Information within care plans gave guidance to staff as to the support service users needed to participate in undertaking any household tasks. On the day of the inspection discussion were taking place between service users and staff as to how some of the routine household tasks should be managed without disagreement. The service users were given the opportunity to decide on menus and meals within the service users meetings. The meals were varied and well balanced. None of the service users had any specific dietary needs apart from individual preferences. Mealtimes were observed to be relaxed and unhurried and service users were given assistance appropriately and discretely. Service users were weighed on a monthly basis as a means of monitoring their general health.
The Brook DS0000033563.V278136.R01.S.doc Version 5.1 Page 11 One of the service user stated that he was happy living at the home and that ‘everything is alright’ there. The Brook DS0000033563.V278136.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The support staff had a good knowledge of service users preferences and personal care and health care needs and provided support sensitively and in accordance with their wishes. Medication was well managed in the home although some additional safeguards could be introduced to ensure good practice is maintained. EVIDENCE: The service user file examined gave staff guidance as to the support needed by the service user in terms of personal care. The service users preferences were recorded and the service user confirmed the details recorded. The home had a key worker system in place to ensure as far as possible continuity of care for each of the service users. It was evident on the day of the inspection that the home supported service user to maintain links with family and friends were this was appropriate. One of the service users was visiting his family and another was keen to talk about his family and the regular contact he enjoyed from them. The home received input from a variety of health professionals including a behavioural specialist. Documentation on the service users file indicated that he had been supported to attend a variety of health care appointments. The service user was able to confirm this. The service user also had a health care plan in place, which outlined his health needs and the action taken by the staff team to meet them. The plan also assisted staff to monitor the service users health needs.
The Brook DS0000033563.V278136.R01.S.doc Version 5.1 Page 13 The medication in the home was well managed and with all records having been accurately kept. The service user whose care was ‘tracked’ had signed to give consent to medication being administered by staff. It was recommended that the manager introduce competency checks for staff to help ensure that good practice in the management and administration of medication was maintained. The home had good links with the local pharmacist who was able to offer advice and guidance. The Brook DS0000033563.V278136.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The home had good policies and procedures in place in order to protect service users. EVIDENCE: The home had comprehensive policies and procedures in place, which outlined how complaints would be managed and responded to. The service users guide also contained details of this in a format that was more accessible to service users. The home had not received any complaints in the last twelve months. The home also had a range of policies and procedure in place designed to protect the vulnerable adults in its care. Guidance was provided for staff as to the action they should take if they had any concerns with regard to the safety of a service user or how to manage to any challenging behaviour appropriately. Policies and procedures regarding service users monies were clear with the intention of preventing any confusion or mismanagement. The Brook DS0000033563.V278136.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The home was clean and comfortable and provided a pleasant and safe environment for both the young adults and support staff. EVIDENCE: Standard 24 was partly assessed at this inspection. A recommendation to decorate some areas of the home had been acted upon. The home was clean, well maintained, furnished and decorated. The second lounge was in the process of being refurnished to further improve the standards of the environment and the choice of living areas for the service users. One of the service users was eager to show his room, which he had personalised to reflect his interests and hobbies. The laundry at the home was situated at the rear of the property and its location was such that no laundry needed to be carried through any areas were food was stored, prepared or eaten. The laundry was equipped to suit the needs of the service users. The Brook DS0000033563.V278136.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 The home was continuing to support staff to undertake relevant training and to achieve the expected number of trained staff. EVIDENCE: Standard 32 was partly assessed at this inspection. A recommendation was made at the previous inspection that the home should continue to work towards having 50 of its work force achieve a relevant qualification in care. The manager explained that the home was continuing to work towards this target. Changes in the staff team plus difficulties in enrolling on courses had slowed the process of qualification down. The Brook DS0000033563.V278136.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The home was well managed providing a safe and relevant service for the service users The home had good quality monitoring processes in place, ensuring as far as possible that the views of the service users and others involved in the home were listened to and acted upon appropriately. EVIDENCE: The manager had the relevant qualifications and experience to run the home. She had undertaken additional training over the last twelve months to increase her skills. The home had a variety of quality assurance processes in place. It had achieved the Investors in People Award which is a quality assurance award accredited by an external body. Monthly monitoring visits were made and a report of this was forwarded to the Commission for Social Care Inspection. An internal audit was carried out on an annual basis. There was evidence that reviews were held for each of the service users at least every six months ensuring as far as possible that their needs were met and their views responded to. A survey of service users views on the service had been
The Brook DS0000033563.V278136.R01.S.doc Version 5.1 Page 18 undertaken and the results of this survey and the resulting action plan had been made available in the service users guide. A survey of the views of family, friends and involved health and social care professionals had also been undertaken. The homes policies and procedures had been reviewed in January 2006 ensuring as far as possible that the information and guidance available to staff was the most up to date. Service users were encouraged to become involved in the inspection process and they were keen to provide information about their experiences of living at the home. The home was well maintained with equipment and systems being serviced and tested on an appropriate basis. As many of the staff team were relatively new, they had been booked in for training in safe working practices and policies and procedures in respect of this were available in the home to ensure as far as possible the safety of the service users. It was recommended that a system to monitor any accidents or incidents be introduced with a view to identifying any patterns or trends so that any risks to the safety and wellbeing of service users and staff could be eliminated as far as possible. The Brook DS0000033563.V278136.R01.S.doc Version 5.1 Page 19 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 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 2 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X X X 3 X X 2 X The Brook DS0000033563.V278136.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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. 4. Refer to Standard YA2 YA20 YA32 YA24 Good Practice Recommendations Service users should be encouraged to sign their care plan to indicate their involvement in its development and its review. A competency checklist for staff should be developed in relation to the management of medication in the home. The home should continue to work towards having 50 of care staff achieve an NVQ 2. Accidents and incidents should be monitored to identify any patterns or trends with a view to eliminating any unnecessary risks. The Brook DS0000033563.V278136.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 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 Brook DS0000033563.V278136.R01.S.doc Version 5.1 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
