Care Home: 15 Brooklyn Road

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What the care home does well People living in the home were very happy with their care. They commented positively about the food, their bedrooms, the staff team and how they spent their time. People also said that they felt safe in the home, and were able to say if they were upset and concerned. They reported that staff were good listeners and took notice of what they said. There is a good approach to referral and assessment, helping to ensure that the service should be able to meet the needs of people who move in. The home has a good approach to care planning. People`s needs, goals and wishes are recognised and responded to. Risks are clearly identified and managed, with an emphasis on helping people to lead full lives and to take up opportunities. Staff the knowledge, skills and values that they need to care for the people living in the home. They are supported by a generally sound training programme and good management.People living in the home are offered a high degree of choice, both about dayto-day matters and longer-term issues affecting their lives. They are supported to lead individual lifestyles according to their needs and wishes, and to stay in contact with family and friends. Routines in the home are flexible and based around what the people living there want. People get the help that they need and want with personal care and to stay well. A varied and healthy diet is provided, with people choosing what they eat. People have opportunities for regular exercise. Steps are taken which help to protect people from harm and abuse. The people living in the home feel able to speak up if they are unhappy about something, and are confident that they will be listened to. People are asked what they think about the service and are involved in the day to day running of the home. This includes taking part in selection of new staff. People are happy with their rooms. Bedrooms are personalised according to people`s wishes. 15 Brooklyn Road is clean, homely and comfortable. What has improved since the last inspection? The service is classed as new due to a change of provider. What the care home could do better: Some recommendations are made in the report. In particular, some aspects of the handling of medication could be improved and staff need to have training in fire safety. Some observations are made about how the physical environment could improve. The AQAA noted some areas where the service could be better, providing evidence of a continued drive to assess and improve standards. CARE HOME ADULTS 18-65 15 Brooklyn Road 15 Brooklyn Road Cheltenham Glos GL51 8DT Lead Inspector Mr Richard Leech Key Unannounced Inspection 9 & 10th January 2008 10:00 th 15 Brooklyn Road DS0000070504.V353945.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 15 Brooklyn Road DS0000070504.V353945.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. 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 15 Brooklyn Road Address 15 Brooklyn Road Cheltenham Glos GL51 8DT 01242 581112 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.caretech-uk.com CareTech Community Services Ltd Mrs Gillian Mary Smoday Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 6. Date of last inspection New Service Brief Description of the Service: 15 Brooklyn Road is a detached property in a residential area about two miles from the centre of Cheltenham. It is situated close to local facilities and amenities including a shopping centre, bus services and the railway station. The home is registered to provide care for up to six adults with a learning disability. It is a specialist service for people with autistic spectrum conditions. Each person is accommodated in a single room with a hand basin. There is a large lounge/dining area on the ground floor. There are two shared bathrooms as well as a shower room. The home has a back garden overlooking a local park. Fee levels were reported to range between £1028 to £1913 per week but are negotiated according to individual needs. Prospective service users and their representatives are given information about the home including a copy of the Service Users Guide. Gloucestershire Autism Services were taken over by CareTech during 2007. As a result the service is classed as ‘new’, although it has been running for several years. 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection began on a Wednesday morning, lasting until late afternoon. Another visit was made on the following day from 10:00 to the middle of the afternoon. The service had not been told that there would be an inspection. The registered manager was present during the two days of the inspection. Many of the staff team were met with, as well as everybody living in the home. Some written feedback was also received through survey forms completed by people with an interest in the service. During the visits a range of records were checked. These included selected care plans, risk assessments, medication charts, training records, staffing files and selected policies. General observation of life in the home also took place. All communal areas were looked at along with some of the bedrooms. Before the inspection the manager had completed an Annual Quality Assurance Assessment (AQAA), providing information about the home and how it runs. What the service does well: People living in the home were very happy with their care. They commented positively about the food, their bedrooms, the staff team and how they spent their time. People also said that they felt safe in the home, and were able to say if they were upset and concerned. They reported that staff were good listeners and took notice of what they said. There is a good approach to referral and assessment, helping to ensure that the service should be able to meet the needs of people who move in. The home has a good approach to care planning. People’s needs, goals and wishes are recognised and responded to. Risks are clearly identified and managed, with an emphasis on helping people to lead full lives and to take up opportunities. Staff the knowledge, skills and values that they need to care for the people living in the home. They are supported by a generally sound training programme and good management. 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 6 People living in the home are offered a high degree of choice, both about dayto-day matters and longer-term issues affecting their lives. They are supported to lead individual lifestyles according to their needs and wishes, and to stay in contact with family and friends. Routines in the home are flexible and based around what the people living there want. People get the help that they need and want with personal care and to stay well. A varied and healthy diet is provided, with people choosing what they eat. People have opportunities for regular exercise. Steps are taken which help to protect people from harm and abuse. The people living in the home feel able to speak up if they are unhappy about something, and are confident that they will be listened to. People are asked what they think about the service and are involved in the day to day running of the home. This includes taking part in selection of new staff. People are happy with their rooms. Bedrooms are personalised according to people’s wishes. 15 Brooklyn Road is clean, homely and comfortable. 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. 15 Brooklyn Road DS0000070504.V353945.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 15 Brooklyn Road DS0000070504.V353945.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good approach to referral and assessment, helping to ensure that the service should be able to meet the needs of people who move in. EVIDENCE: In the AQAA the manager described the approach to admissions, including thorough assessment of needs. During the inspection the manager talked through in more detail how the referral and admissions process worked in the service. This included consideration of compatibility and taking into account the views of people already living in the home, as well as an assessment of needs and the gathering of background information. Depending on the assessment, visits may be offered during the daytime and for overnight stays. There was one vacancy at the time of the inspection. Discussion with the manager provided evidence of careful consideration being given to referrals to ensure as far as possible that the service would be able to meet the person’s needs and that they would be compatible with existing residents. Some referrals had been turned down, demonstrating that the service was committed to filling the vacancy appropriately rather than as quickly as possible. The organisation’s referral and admissions policy was seen. 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service has a comprehensive approach to care planning. This results in people’s needs, goals and wishes being recognised and responded to. Risks are clearly identified and managed, helping people to lead full lives. People living in the home are offered a high degree of choice, promoting their autonomy and sense of control over their lives. EVIDENCE: Care planning files for two people were checked. These included photographs and background information. There was also detailed information about how autism impacted on the person and about particular triggers and behaviours and how these were responded to. These were seen to provide thorough information and clear guidance. Care plans were in place covering areas such as personal care, mobility, eating & drinking, beliefs, activities, family and money. These were clear, simple and person-centred, reflecting people’s choices and preferences. 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 10 Some ‘Smart’ goals were in place, providing information about how progress towards particular goals would be encouraged within particular timescales. These had a focus on independent living skills. Care planning files also provided information about how each person communicated. Keyworkers are in place, with responsibilities around care planning, healthcare, family liaison etc. In some cases ‘silent keyworkers’ are in place in recognition of issues that can be created around named keyworkers. This demonstrates how the service adapts to the individual needs of the people living in the home. Some records were seen of monthly keyworker meetings, when care plans, goals and other issues were discussed with the people living in the home. Conversations with staff provided evidence of good knowledge of people’s care plans. Observation provided further evidence of care plans being followed. Care plans placed an emphasis on identifying and respecting people’s choices, whilst also acknowledging some complexities around decision-making related to individuals’ needs and conditions. Observation of life in the home provided evidence of people being offered choice in areas such as how they spent their time, their personal appearance, what they ate and drank, and whether to be alone or in company. People were seen to be very much in control of their lives, with staff facilitating their choices this in an empowering way. Discussion with staff provided further evidence of a commitment to respecting people’s choices. One person had chosen to no longer live in the home. This had been acknowledged and responded to. There was a lock on the fridge door. The manager described the reasoning for this and said that it had been documented. The rationale was accepted, although documentation could not be located at the time. Written information about this restriction has been forwarded to us in the past. There was also information in files about offering people front door keys. The manager was aware of the Mental Capacity Act and had some literature about this in the home. Risk assessments for two people were looked at. The assessment covered key areas, clearly identifying the risks and the strategies used to minimise these. There was an emphasis on supporting the person to take risks as part of leading a full life and taking up opportunities. Discussion with staff provided further evidence of people being supported to take measured risks, such as going to shops independently. Staff described the staged approach to introducing this and the steps taken to manage any identified risks. 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 11 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 excellent. This judgement has been made using available evidence including a visit to this service. People living in the home are supported to take part in a variety of activities in the home and community and to maintain contact with family and friends, promoting their quality of life. The rights and responsibilities of people using the service are respected, helping them to feel valued and included in the running of the home. Meals are varied and reflect people’s choices, enhancing their wellbeing and enjoyment of their food. 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 12 EVIDENCE: During the visits to the home people were observed to be very busy, being offered a range of options for activities. These included going for walks and drives, accessing sensory facilities, attending social clubs and going to cafes, pubs and shops. Daily records for two people were checked for a 10-day period. These provided further evidence of people taking part in a wide range of individualised activities in the home and community both during the daytime and evening. There was reference to public transport being used. Observation and records indicated that there was a clear emphasis on respecting people’s choices, including staying at home if they preferred. Some people living in the home were asked about their activities. They indicated that they were very happy with how they spent their time and that they had plenty to do. A weekend break for some people was being planned in response to their choices about what to do and where to go. Activity planners were seen, covering every day and including evening activities. However, there was also a clear balance between structure and spontaneity with regard to people’s needs and special interests. There were many examples of staff flexibly responding to people’s wishes during the visits to the service. Some staff had been given the task of reviewing people’s activities with a view to making the focus more about promoting independent living skills. Daily records provided evidence of people having contact with family members. People were seen having telephone contact with family. Care plans described how they were supported to maintain contact with friends and family. Survey forms completed by family members provided positive feedback. One person praised the team for the support offered to their relative when unwell. Another said that the service listened and took feedback on board, and that ‘they strive to make life better for everyone’. Feedback was received expressing concern about some issues, such as people’s weights and high use of agency staff. Discussion with the manager showed that she was aware of these concerns and had taken steps to address them, for example by enlisting the help of a dietician and promoting exercise as far as possible. See also ‘staffing’ section. 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 13 People were seen being supported to make phone contact with friends and to invite them around if they wished. Routines were seen to be very flexible in the home, with people having a lie-in if they wished, and choosing when they had breakfast and support with personal care. People were seen to decide where they spent their time and with whom, in some cases electing to go their rooms to listen to music or have a rest. Discussion with staff and observation provided evidence of people being very involved in the running of the home, and of independent living skills being promoted. For example, people living in the home were involved in cooking and food preparation, cleaning, shopping and laundry. The AQAA described how people’s rights were promoted. There was a discussion with the manager about upholding people’s rights and promoting their autonomy, with examples given of how the service had done this despite being confronted with some resistance. People living in the home were seen answering the phone, making drinks for visitors and greeting people at the front door in a very natural manner. The people living at Brooklyn Road were positive about the food and confirmed that they had choice about what they ate. One person described the food as ‘beautiful’. Food records were seen providing evidence of a varied and balanced diet being provided. The manager confirmed that a dietician was now involved with the service, providing guidance about diet and weight. Discussion with staff and documentation showed that recommendations were being taken forward. 15 Brooklyn Road DS0000070504.V353945.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. Appropriate personal and healthcare care support is provided, promoting people’s dignity and wellbeing. Arrangements for the handling of medication are generally sound, although some areas of practice should be improved in order to minimise risk to people living in the home. EVIDENCE: Care plans gave information about people’s preferences on how personal care support was provided, including about the gender of the carer. The service has a policy about intimate personal care. This includes reference to principles such as promoting dignity, independence and choice. Staff spoken with described how they provided personal care support, demonstrating awareness of these principles in action. Staff were observed offering personal care support in a sensitive manner. People were seen to be dressed individually in ways which reflected their personalities. 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 15 Discussion and documentation provided evidence that the service was fully engaged with different professionals from the local Community Learning Disability Team (CLDT). There was evidence of regular liaison and of recommendations being acted upon, for example with regard to care planning, diet and the management of challenging behaviour. Written surveys completed by healthcare professionals provided very positive feedback about the service. Comments included about the management of the service, good communication with the CLDT, support for accessing services in the community, and strategies/plans for managing challenging behaviour. There were also comments about the team’s strong value base and commitment. A comment was seen from a healthcare professional on file stating that, “[service user] has a comprehensive written behaviour support plan”. Individual health action plans were seen, with actions arising for follow-up. Healthcare documentation provided evidence of people being supported to access routine and specialist healthcare in accordance with their needs. In cases where people did not want to attend an appointment there was evidence of appropriate guidance being sought and care plans being generated. Some equipment was seen to be in place in relation to one person’s particular healthcare needs. The manager described actions taken in response to concerns about one person’s health, demonstrating a proactive attitude to optimising people’s wellbeing. Records provided further evidence for this approach. As noted, a dietician was involved with the team. Observation and daily records provided evidence that people using the service were encouraged to take part in regular exercise. Systems for handling medication in the home were checked. Policies and procedures were looked at. These included more general policies, as well as covering areas such as self-administration. Storage appeared to be in order. Products were labelled when opened as necessary. Current medication records were seen. These were generally satisfactory although the following was noted: • • • Several gaps for medication were seen for different people, with neither initials to indicate administration nor code to show other events. A variable dose ‘as-required’ medication had been signed for but there was no indication of the actual dose administered. Although most handwritten entries were signed and counter-signed some entries had no signature. 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 16 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 to enable people using the service to raise concerns and complaints, helping them to feel valued and listened to. Plans to make the complaints process more accessible will be a positive development. Measures are taken which help to protect people from harm and abuse. EVIDENCE: The manager reported that there had been no formal complaints since the service changed ownership. A complaints procedure is in place, although the manager said that work was underway to make this more accessible to the people living in the home. Staff described how different people living at Brooklyn Road expressed dissatisfaction, and talked through how they responded, giving examples. During the visits some people were seen expressing concerns or unhappiness and this was dealt with sensitively, providing evidence of an open atmosphere where people felt able to speak up. Communication passports are in place which include descriptions of how people express different emotions and feelings. 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 17 Some of the people living in the home were asked whether they felt able to raise concerns or to say if they were unhappy about something. They confirmed that they were able to do this and that when they did they felt listened to. Survey forms by people living in the home provided further evidence that they felt able to raise issues and that they were listened to. The manager said that monthly keyworker sessions and regular client meetings were used to gather feedback and people’s views. In a survey form a relative wrote, “if I noticed any way that [the service] could be improved I would be able to approach someone about it”, adding also how much the team listened and took feedback on board. Written surveys by other family members also provided evidence that people knew how to raise concerns and complaints and received a constructive response when they made any comments. People living in the home reported feeling safe. The service has policies and procedures covering adult protection and whistle blowing. Staff spoken with were aware of their responsibilities in this area. They had no concerns but said that they would feel able to report them if they did and that appropriate action would follow. Staff confirmed that they had received training which covered the protection of vulnerable adults. The manager reported that there was an open culture, with staff coming forward with queries, concerns and ideas at times. She described the safeguards in place and the need for constant vigilance. A notification to CSCI in 2007 had provided evidence of adult protection issues being picked up and dealt with appropriately. Other notifications had been made, with the team liaising appropriately with the local Adults at Risk team where necessary. The above notifications included some money going missing from petty cash. The police investigation had not resulted in the money being found. The manager described the measures in place to reduce the risk of recurrence. Samples of financial records provided evidence of these measures being implemented. Incident forms for three people were sampled back to August 2007. These showed that there had been a general decline in the number of incidents of severe challenging behaviour. Where restrictive physical intervention had been used the nature and reason were documented. The manager reviews and signs all incident sheets and was satisfied that physical interventions were used only as a last resort by trained staff and in accordance with care plans and national guidance. Discussion with staff provided further evidence for this. 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 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 generally well maintained environment is provided, promoting people’s comfort and safety. EVIDENCE: All of the shared areas of the home were checked along with some of the bedrooms. People said that they were happy with their rooms, which were seen to be personalised and well furnished. People confirmed that their rooms were warm enough and their furniture comfortable. One person’s room was going to be redecorated shortly after the inspection. One bedroom had been equipped with facilities for making hot drinks as well as a microwave and a fridge to make it more a bed-sit. 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 19 The AQAA described a cyclical maintenance programme being in place. This was confirmed by the manager. It was agreed that some areas would benefit from general freshening up. Some staff felt that it was taking longer to get maintenance work done than in the past. Communal areas appeared to be reasonably decorated and maintained. The manager reported that the lounge was going to be decorated in the near future. The kitchen bin was missing its lid. A replacement was purchased on the day. The washing machine was leaking, despite this having been looked at by an engineer. The manager described the steps that were being taken to ensure that this was quickly resolved. In the meantime people living in the home were included in trips to the launderette, turning the inconvenience into an opportunity for an activity. The telephone in the hallway had a trailing wire. This should be secured so that it is not a trip hazard. A drawer front in the kitchen was becoming loose and should be secured. One drawer front on a cabinet in the lounge had come off entirely and should be repaired. One person was missing a drawer in their room. They said that that staff were aware and were doing something about it. The manager reported that during December 2007 new patio doors had been fitted, along with a new boiler and bathroom floor. An infection control policy was seen. The home was seen to be clean throughout during both visits with routine infection control measures in place. 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have the appropriate knowledge and skills to meet the complex needs of the people living in the home. They are supported by a good training programme. A satisfactory framework for recruitment and selection is in place, helping to safeguard the people living in the home. 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 21 EVIDENCE: There was positive external feedback about the team. This included reference to staff having the necessary skills, not making moral judgements about people’s behaviour and listening to what the clients said. As noted, there was evidence of good links with external professionals and of advice and recommendations being implemented. People living in the home were also positive about the staff team. Two people said that they were nice. Another described staff as kind. In written surveys people also indicated that the staff treated them well. Staff were observed to work in a very individualised way, following care plans, listening and responding to people’s wishes and providing discreet and sensitive support. There was a professional and non-judgemental approach to challenging behaviour resulting from anxieties and other factors. Staff spoken with demonstrated a good knowledge of the needs and conditions of the people they supported. Literature about autism and Asperger’s syndrome were available in the home. The service’s induction includes a session about autism. According to the AQAA about half of the staff team either had or were working towards a National Vocational Qualification (NVQ) in health and social care. Several staff members had also attained LDAF qualifications (Learning Disability Award Framework). The manager and staff reported that there had recently been high use of agency workers, due to short staffing. This was said to be easing through recruitment of permanent staff. It was stated that the same agency workers were generally being used in order to promote consistency. Some agency staff were spoken with during the visits. They confirmed that they had worked a number of shifts in the home and that they were familiar with people’s needs. Coordination of recruitment and selection along with gathering necessary information had been centralised to the Human Resources section of CareTech. Local functions included identifying vacancies and informing Human Resources, shortlisting, interviewing and appointing (subject to confirmation of checks being satisfactory). The manager described how the people living in the home were involved in recruitment and selection. This included being supported to take part in the interview panel, and/or having the opportunity to meet candidates when they visit the home. This is good practice. 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 22 Staffing files contained a CSCI proforma which included information such as when references and the Criminal Records Bureau check were completed. The Commission is in the process of agreeing with the organisation that original documents on staffing files can be stored centrally. In these circumstances we reserve the right to see the original documents at short notice if requested. The manager described the training offered to staff. CareTech provides a quarterly training programme, with courses made available locally in Cheltenham. A copy of the brochure was seen. Discussion with the manager and staff along with training records provided evidence that staff were generally either up to date with, or booked onto, necessary training. Bookings for early 2008 included adult protection, infection control and challenging behaviour (including refresher training). An exception to the above was training in fire safety. Some staff had last had this training as far back as 2004. It is strongly recommended that this training be provided for staff as necessary such that the whole team is up to date. The manager had requested that some more in-depth training about autism be available for staff. This was apparently being looked into. In the meantime a specialist had begun working with the team. Their role included looking at how challenging behaviour was being managed and providing bespoke training and guidance about this area and autism. 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 23 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 well run, promoting positive outcomes for the people living in the home. A sound quality assurance framework is in place, with further improvements planned, providing people with the opportunity to say what they think about their care. Measures are in place to promote the health and safety of people living and working in the home. 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 24 EVIDENCE: The manager was registered with CSCI in September 2006. She has a Certificate in Community Services (Intellectual Disability) from an institute in Australia. At the time of the inspection she had just completed the Registered Manager’s Award and was starting the NVQ level 4 in health and social care. The manager felt that the home was running well and that she received good support from her manager and the organisation. Staff spoken with also felt that the home was running well. They described the manager as hands-on and approachable. In terms of management structure, a new senior staff member had been appointed in December 2007. It was expected that they would take some of the day-to-day pressures from the manager, who would then have more time to dedicate to other managerial tasks. There was positive external feedback about the manager. For example, one person wrote that the manager was very organised and caring. Another described how the manager went out of her way to ensure that people using the service accessed the community. The manager felt that the service could be improved by having a computer available on site at all times and with access to the Internet and email, stating that this would help with communication, research and keeping documentation up to date. The AQAA was very thoroughly completed and selected information in it was confirmed during the inspection. The organisation has a policy about quality assurance, and a template based around the National Minimum Standards. The manager had not yet implemented this in the home, but was planning to do so early in 2008. The manager said that when completed this is forwarded to the quality assurance coordinator for the region and checked through unannounced monitoring visits. An action plan is also written. Some reports from the service development manager made under regulation 26 were seen. These were thorough and taking place regularly, with action plans generated as necessary. Minutes were seen from some recent service user meetings. The manager said that they were looking into putting the minutes into an audio format to make them more accessible. The management team was also said to be developing a range of pictorial policies and procedures. A satisfaction questionnaire for the people using the service was being produced. 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 25 As noted earlier, minutes were seen monthly keyworker meetings, when people living in the home were given the opportunity to talk through how things were going for them on a one to one basis. Minutes were seen from staff meetings, providing evidence of wide-ranging discussion and of external professionals providing input to the team. The service is accredited with the National Autistic Society, and is subject to periodic visits as part of maintaining this accreditation. Staff spoken with felt that their health and safety was generally looked after well. In surveys forms some people had indicated that they did not always feel equipped to manage the levels of physical aggression that they sometimes encountered. The manager said that this had been raised and had resulted in actions such as closer links with the CLDT and booking training in the management of challenging behaviour. In discussion one person pointed out a few areas of health and safety which could improve. They said that they would take these forward with the manager, who they described as approachable and open to suggestions. Records showed that routine health and safety checks were taking place. As noted, a new boiler had just been installed. This had resulted in some high hot water temperatures. At the time of the visits further work was taking place to regulate the temperature of each outlet to reduce the risk of scalding. As noted, fire training was overdue for many of the staff team. The manager was trying to arrange this urgently. 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 26 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 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 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 3 33 x 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 x 4 x LIFESTYLES Standard No Score 11 x 12 4 13 4 14 x 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 2 x 3 x 3 x x 3 x 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/A 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 Refer to Standard YA20 YA24 Good Practice Recommendations Address the points noted in the text about the handling of medication. The trailing wire from the telephone in the hallway should be secured so that it is not a trip hazard. Repair damage to drawer fronts in the kitchen and lounge. 3 4 YA35 YA37 Repair damage to one person’s chest of drawers. It is strongly recommended that appropriate fire safety training be provided for staff such that all team members are up to date in this area. Consider providing a computer for the home which is enabled for Internet and email access. 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA 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 15 Brooklyn Road DS0000070504.V353945.R01.S.doc Version 5.2 Page 29 - 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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