Care Home: 15 Preston Drove

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What the care home does well The people living at 15 Preston Drove benefit from the support of a dedicated team of staff who at this time of uncertainty have continued to work professionally in their best interests. Management and staff have worked closely alongside advocacy services to ensure the views of residents are appropriately expressed. Staff provide high levels of support to people with complex needs in a way which protects their dignity and respect. The home take a pragmatic approach to obstacles that get in the way of good care and look for alternative ways to ensure that the people living their can continue to do the things they enjoy. What has improved since the last inspection? The home has worked hard to improve the standard of documentation within the home and in particular has developed the care planning system to ensure that each resident has a detailed plan of care that can be easily followed. Some environmental improvements have been undertaken to provide residents with access to a more homely and hygienic place to live. The updating of some guidelines and policies and procedures have made the role of staff clearer and ensure that they follow good practice at all times. What the care home could do better: Due to the proposed plans to re shape this service, only two requirements have been made as a result of this inspection. At the current time, the focus for the home is clearly to support individuals to find suitable future placements where their needs can be fully met. In order to do this, the service must ensure their are sufficient staff on duty on every shift. The Registered Manager must also obtain evidence that each staff member who is working in the home has been appropriately recruited. If 15 Preston Drove were to remain open as a service for people with complex learning and physical disabilities, then other improvements would be necessary. In particular, further upgrades to the environment would be necessary. The home would also need to work closely with residents to develop their person centred plans and set meaningful goals that reflect their aspirations and ensure that they have fuller choice, flexibility and control over their lives. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 15 Preston Drove 15 Preston Drove Brighton East Sussex BN1 6LA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lucy Green     Date: 2 9 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: 15 Preston Drove 15 Preston Drove Brighton East Sussex BN1 6LA 01273555291 01273265623 Roger.Hewitt@brighton-hove.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Brighton & Hove City Council care home 5 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 5 The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning disability - LD Date of last inspection Brief description of the care home The home is registered to support up to five adults who have a learning disability. The home is a detached two-storey building set in the Preston Park area of Brighton. Although the home was not purpose built for people with disabilities, some adaptations have been made to the home that include a passenger lift and accessible bathrooms. Single bedroom accommodation is provided on the ground and first floor. Communal areas consist of a lounge, dining room, conservatory area and a kitchen. A large, rear garden also provides a safe and pleasant area for people to spend time in. More detailed information about the services provided at 15 Preston Drove can be found in the homes Statement of Purpose and Service User Guide - copies of these documents can be obtained directly from the Provider. Care Homes for Adults (18-65 years) Page 4 of 30 Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: he reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term service user to describe those living in care home settings. For the purpose of this report, those living at 15 Preston Drove are referred to as residents. This report reflects a key inspection based on the collation of information received since the last inspection, a site visit and a review of the homes Annual Quality Assurance Assessment (AQAA). The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. The AQAA was completed by the Registered Manager and returned when we asked for it. Care Homes for Adults (18-65 years) Page 6 of 30 From ongoing correspondence with the service and information provided in the AQAA, the Commission is aware that Brighton & Hove City Council as the provider of this service are intending to support the people currently living there to move to alternative placements and change the stated purpose of this service. In light of this situation, the Commission made a decision to conduct a short inspection now and then re inspect the service once the proposed changes have been implemented. As such this site visit was carried out on an announced basis and lasted for three and a half hours on Monday 29th June 2009. The first part of the inspection involved a discussion with the Registered Manager, the Service Improvement Manager for the Council and the person who has been appointed to manage the service once the changes have been effected. During the second part of this visit we had a look around the home and examined some care, medication and staffing records with the Registered Manager in order to provide a statement about performance under each of the outcome areas. We observed the interaction between staff and residents throughout the visit, but were mindful about how the wider decisions for this service are impacting on them. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Despite the formal support systems being in place, the decision to change the stated purpose of this service means that the people who currently live there do not have the choice to remain in their home. Evidence: There are four people accommodated at 15 Preston Drove and despite there being one vacancy, no one new has moved in since the last time we visited. We met with the residents and they all appeared happy, relaxed and interacting positively with each other. There are currently no known compatibility issues with these individuals who have lived together at 15 Preston Drove for a number of years Brighton & Hove City Council are proposing to change the stated purpose of this service and as such processes are currently in place to support the people currently living at the home to find alternative placements. The Service Improvement Manager informed the Inspector that due to the Councils fire safety policy, the people living at 15 Preston Drove can no longer be accommodated in this building. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: The Registered Manager confirmed that each resident has recently received an updated Social Care Assessment and an Independent Mental Capacity Advocate has been appointed to represent their best interests in securing future placements. Copies of the latest assessments were found in the care plan viewed. This is a difficult period for the service and not least because the residents are elderly and settled in their home. As such, many of the staff team do not believe any move to be in their best interests. The Registered Manager has complained to the Council about this decision on behalf of the residents and an external advocate has been sourced to represent the residents as a group. The Registered Manager stated that each resident has access to a copy of the Statement of Purpose, Service User Guide and terms and conditions of their placement. Following on from a wider Council project to improve these documents generally, 15 Preston Drove have been looking at ways of making this information more accessible to the people who live at the home, although in reality these documents are of little relevance to the current resident group if they cannot stay living at the service. During a conversation with the person appointed to take over the running of the service once the changes have been effected, the Inspector highlighted the need to ensure that the admission of any potential resident is planned and undertaken in line with the Care Homes Regulations 2001 and associated National Minimum Standards. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comprehensive care plans ensure people receive high levels of support with dignity and respect, although the focus for future good quality care needs to go further than identifying appropriate accommodation and personal care needs. Evidence: Through discussion with staff and observation of their practices, it was demonstrated that they have positive relationships with the people they support and a good understanding of their needs. The Inspector tracked the care for one resident, which included meeting the resident and a partial examination of their care plan and activity schedule. There was evidence that the care plan had been recently updated and contained detailed support guidelines about daily care routines, healthcare and communication needs. In line with a recommendation from the last inspection, the care planning system has been restructured to make information more accessible and easier to use. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: A person centred plan for this person was also in place which included photos of the types of activities they enjoy and how good support looks for them. The care plan contained a range of risk assessments which evidence the homes attempts to enable the resident to do the things they enjoy. Evidence gathered from documentation and observation of staff supporting residents during the inspection, highlights that the home provides a service where residents are treated with dignity and respect. The uncertainty of the future for the people living at 15 Preston Drove has meant that the setting of goals has become very short term and generic: to find suitable alternative accommodation. If the service were to remain in its current form, this would need to shift and the home would need to develop the person centred process to support residents to more strategically identify and formulate meaningful life goals. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents would benefit from greater opportunities and flexibility to enable them to do things they like when they want to. Evidence: The high support needs of the people living at 15 Preston Drove and current staffing levels are impacting on the choice and flexibility of activities available. Three of the four residents require 2:1 support with personal care and all residents need at least 1:1 support in the community, with staffing levels providing a maximum of four care staff in the morning and three in the afternoon, there is not a lot of scope for flexible lifestyles, with it being impossible for all residents to go out in the afternoon/evening if they chose too. The Registered Manager stated that external activities are planned around the rota and Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: where specific activities occur, for example one resident goes swimming on a Saturday afternoon, then provision is made to bring an additional staff member in. There is evidence that people do participate in things the enjoy, but the times for these have to be structured and factors other than choice affect the outcome. If the service were to remain open, then this area would need to be improved and staffing levels increased to meet the needs and expectations of people using the service. Meals at 15 Preston Drove are prepared according to a menu that is drawn up in consultation with residents to reflect the meals they wish to have. The menu is said to be reflective of individual likes and dislikes and specialist diets, therefore on some days different meals are prepared for different residents. Where there are specialist dietary needs affecting choice, care plans provide guidelines for staff in how to offer appropriate support. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the provision of flexible and respectful personal and healthcare support and are protected by the systems in place to manage medication. Evidence: There was documentary evidence that each resident has a care plan and health action plan which evidences that personal and healthcare needs are being met. It was evident that appropriate referrals are made to external professionals, including GPs, opticians and speech and language therapists. The care plan viewed demonstrated that peoples weights are regularly monitored. Personal care was observed to be being provided in a sensitive and respectful way during the course of the visit. Interaction between staff and residents as support was being provided was noted to be positive and relaxed. Systems are in place to ensure medication is managed appropriately. No residents manage their own medication at the current time. Staff receive appropriate training in the management of medication. Care Homes for Adults (18-65 years) Page 17 of 30 Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from and are protected by, the open culture at 15 Preston Drove and are supported by people who voice their best interests. Evidence: The home has a complaints procedure in place and an accessible copy is available for residents and visitors to access. The home has not received any complaints about its service since the last inspection. As previously reported the Registered Manager is pursuing a complaint on behalf of the residents against the Council decision to change the purpose of the home and thereby serving them notice. Due to the individual communication methods of the people using the service, residents rely heavily on those supporting them to understand and advocate their views and best interests. In light of the ongoing changes, the home is working alongside an appointed Independent Mental Capacity Advocate (IMCA) and group advocate to ensure residents are appropriately represented. Positive interaction was observed between residents and staff during the inspection. Residents are encouraged to express their opinions about the things they like and dislike in their preferred way. The home has a number of systems in place to protect residents from abuse. New staff are employed subject to the necessary checks being undertaken. There are appropriate systems for supporting residents with their finances. The Registered Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: Manager confirmed that all staff have received training in the safeguarding of vulnerable adults and are aware of their roles and responsibilities in this area. In line with a requirement from the last inspection, the home has implemented clear protocols about how staff food and drink are paid for when supporting residents on outings. The Registered Manager confirmed that all such costs are met by the service and not the individual. A review of one persons financial transactions indicated that money was being spent appropriately. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a homely and comfortable environment, but one which would require some adaptation and improvement if their longer term needs are to be met. Evidence: The Registered Manager showed the Inspector around the home which included a tour of residents bedrooms and communal spaces. The four bedrooms currently occupied have been decorated and furnished to reflect the individuals tastes and preferences. Communal areas include the kitchen, dining area and two conservatory areas. There are three adapted bathrooms in total, one of which offers a shower facility. A passenger lift provides level access to the first floor. There is a secure and accessible garden to the rear of the property. Due to the physical needs of the people currently living at the home, there is necessity for a large amount of equipment and specialist aids. If the home were to continue providing the service it does now, environmental improvements would be required and the use of specialist equipment such as hoists would need to be upgraded. The home was found to be generally clean, tidy and hygienic at the time of the Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: inspection. Ongoing maintenance and redecoration must continue to keep the home in a good state of repair. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are good advocates for the people they support, but there are insufficient members of permanent staff to fully meet their needs and lifestyle choices. Evidence: Discussion with the Registered Manager and a review of the rota identified that there are currently insufficient staffing levels to fully meet the needs and lifestyle choices of the group. As detailed in the lifestyle section of this report, the residents at 15 Preston Drove have complex needs and as such require high levels of support with personal care, eating and drinking and accessing the community. At the current time, staffing levels provide a maximum of four care staff in the morning and three care staff in the afternoon/evening. At night there is one staff member awake and another sleeping in. At times when there are only three staff on duty it is only possible for one resident to go out. In addition to the above observations, it was also highlighted that the majority of staff hours worked are by relief staff and not permanent employees. In the month before the visit, 1000 staff hours were provided by relief staff and whilst these support workers have now worked a number of regular shifts at 15 Preston Drove and as such Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: are familiar to the residents, it does not provide the same continuity and allow for the other duties, such as keyworking, to be carried out that the recruitment of permanent staff allows. An examination of the staff files for two staff members who have recently transferred from other Council services identified that the home does not have copies of staff application forms or statement of mental and physical fitness. All other necessary information was found to be in place for these two people. It is required that the Registered Manager take action to ensure all relevant information is available on staff files kept at the home. The Registered Manager confirmed that all permanent staff are up to date with mandatory training and that any gaps in training have been booked. The Inspector reiterates the importance of ensuring all staff are kept fully up to date with both mandatory and specialist training courses and that refresher courses occur in a timely way. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a home that is managed by someone who knows and understands their needs and who is committed to working in the best interests of the people they support. Evidence: Despite the current changes and uncertainty in respect of the future of this service, the Registered Manager has demonstrated that he has continued to work professionally in the best interests of the people who live at the home. The requirements made at the last inspection have been met and a lot of work has been undertaken to generally improve the service. It is however beyond the Registered Managers control to secure improved outcomes for the people using this service at this time. The home has a system of quality monitoring in place with a Council representative conducting regular visits in accordance with Regulation 26. There is also evidence that Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: annual satisfaction surveys are sent out to stakeholders, although at the current time the results of these have not been formally collated and published. The home has various systems in place to ensure the health and safety of the home are maintained. The Inspector sampled some of the records in respect of health and safety as such concluded that the home has satisfactory recording and monitoring systems in place. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 33 18 Regulation 18(1): The 01/09/2009 Registered person must ensure that there are sufficient numbers of permanent staff employed to meet the needs of the people who live at the home. To ensure that service users are supported by sufficient numbers of people to exercise choice and control over their lives. To ensure also that there is continuity of care. 2 34 19 Regulation 19(4): The 01/09/2009 Registered Person must ensure that there is evidence that all the required recruitment documentation is in place for the staff working in the home. To ensure that service users are supported by people who are fit to do so. Care Homes for Adults (18-65 years) Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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