Care Home: 27 Brockleaze

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What the care home does well There was a statement of purpose and each person was given a copy. The statement of purpose contained all the required information about the service so that people and their representatives would know what to expect from the service. People`s needs were assessed before they moved into the home so that their needs could be met. Each person had a service user charter, which contained information about services provided. Most of people`s abilities, needs and goals were reflected in their individual plans. Work was taking place to make the plans more person centred to make sure that all people`s needs were met. Each person had had a person centred review and actions had been identified following the reviews. These were monitored every two months to make sure they were carried out. People were supported to make decisions about their lives and what they wanted to do. Each person had a series of risk assessments. They benefited from the approach that was taken to managing risk, which promoted their independence. People were provided with a range of activities and opportunities and used local community facilities. These included the shops, cafes, pub, leisure centre and swimming pool. People were able to maintain and develop appropriate relationships with family and friends. People were involved in the routines of the home such as food shopping, dusting and vacuuming. People were offered a variety of meals and enjoyed their food. People received the support that they needed with their health and personal care. Each person was registered with a GP and saw other healthcare professionals such as the dentist and optician. People were generally protected by the way in which their medication was being managed. People are protected by the home`s policies and practices about complaints and protection. There was a complaints procedure in words and pictures. There had been no complaints since the last inspection. There was information about the procedures for safeguarding vulnerable adults and staff had received training about prevention of harm. The accommodation was meeting the people`s needs. People lived in homely, clean and comfortable living rooms. The living room and dining room were decorated and furnished in a homely way. Each person had their own bedroom which was individually decorated and furnished. People were supported by sufficient numbers of staff, who were appropriately trained and competent to meet their needs. There were usually two members of staff on duty and there were extra staffing hours so that one person could have one to one support from staff. Staff had a range of training and their training was updated. Staff had all the necessary checks before they started work so that people were protected by the home`s recruitment practices. The home was managed by a person who was suitably qualified and experienced and had been judged to be a fit person to run the home. There was a process to review the quality of the service so that the home was run in people`s best interests. An action plan had been produced to develop the service in 2009 to 2010. The health, safety and welfare of the staff and the people who lived in the home were promoted. What has improved since the last inspection? We made another requirement that the manager must apply to become the registered manager. The manager had applied and been approved as a fit person to run the home. They had made several improvements to the service since the last inspection. Each person had been provided with a service user charter and information about the things that were not covered by the fees. There was also information about the additional things they would have to pay for including the arrangements for paying for meals out. This showed people and their representatives what to expect from the service. One person had had new support plans produced to make sure that their needs would be met. Some of the plans were dated so that staff would know which information was up to date. All the support plans had been reviewed so that they would be up to date and continue to meet people`s needs. Improvements had been made to the recording and administration of medication to show that people were getting the right medicines at the right time. Some improvements had been made to the accommodation. The dining room had been repainted. There were new curtains in the living room and dining room and new flooring had been laid in the dining room and corridor by the bedrooms. We made a requirement at the last inspection that there must be a quality assurance system in the home and a report of the findings of the recent survey must be sent to CSCI. This had been addressed. There was a process for assessing the quality of the service. Surveys had been sent out and a report and an action plan had been developed from the findings. A copy had been sent to CSCI. This meant that any developments were based on the views of people`s representatives and were in people`s best interests. What the care home could do better: Each care plan should be dated so that staff can tell which information is up to date and when it needs to be reviewed. A record must be kept of food provided for people in sufficient detail to show whether the diet is satisfactory, in relation to nutrition. So it is possible to tell whether people are getting a balanced diet. A cupboard should be obtained that complies with the new regulations for storing controlled drugs. This will make sure that if someone is prescribed a controlled drug it can be stored safely. Some changes need to be made to the recording of medication to make sure that people receive their medication in the right way. Improvements were being made to the bathroom the month after the inspection so that people would benefit from living in a more comfortable environment. CARE HOME ADULTS 18-65 27 Brockleaze 27 Brockleaze Neston Corsham Wiltshire SN13 9TJ Lead Inspector Elaine Barber Unannounced Inspection 27th February and 26th March 2009 10:45 27 Brockleaze DS0000028367.V374705.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 27 Brockleaze DS0000028367.V374705.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. 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 27 Brockleaze Address 27 Brockleaze Neston Corsham Wiltshire SN13 9TJ 01225 811902 01249 765530 alison.wright@unitedresponse.org.uk www.unitedresponse.org.uk United Response 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) Miss Alison Wright Care Home 3 Category(ies) of Learning disability (3), Physical disability (3) registration, with number of places 27 Brockleaze DS0000028367.V374705.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 needs on admission to the home are within the following categories: Learning disability (Code LD) - maximum of 3 places Physical disability (Code PD) - maximum of 3 places The maximum number of service users that can be accommodated is 3. 2. Date of last inspection 16th September 2008 Brief Description of the Service: 27 Brockleaze is run by the national organisation, United Response. The home provides care and accommodation to three people with learning disabilities, who are aged between 18 and 65 years. The home is in a rural location in Neston, which is a village near to the towns of Corsham and Chippenham. 27 Brockleaze is a detached bungalow in its own grounds. Each person has their own bedroom. There is a bathroom and a shower room. The communal areas consist of a lounge and a dining room. There is a kitchen and a separate utility room with laundry facilities. The home has a large garden and a parking area for several cars. One staff member sleeps in at night and there is at least one staff member on duty during the day. The range of fees at the time of this inspection was between £1375.02 and £1508.90. Information about the home is available in a ‘Statement of Purpose’. Copies of inspection reports are available from United Response. They are also available through the Commission’s website at: www.cqc.org.uk 27 Brockleaze DS0000028367.V374705.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. We visited the organisations offices to look at the recruitment records on 27th February 2009. We made a visit to 27, Brockleaze on 26th March 2009. The manager was present throughout this visit. Before out visits the manager sent us an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how they are performing. It also gave us some numerical information about the service. We met with three people who lived in the home. We met with three staff members on duty during the day, to obtain their views about the service. We also observed interactions between the staff members and the people who lived in the home. We looked at various records and documents during the visit. These included care plans, risk assessments, health care and arrangements for managing medication, activities, complaints, staff recruitment and training. We looked at systems such as health and safety and quality assurance and also the accommodation. During the visits we assessed all key standards. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and take into account the experiences of people who live in the home. What the service does well: There was a statement of purpose and each person was given a copy. The statement of purpose contained all the required information about the service so that people and their representatives would know what to expect from the service. People’s needs were assessed before they moved into the home so that their needs could be met. Each person had a service user charter, which contained information about services provided. Most of peoples abilities, needs and goals were reflected in their individual plans. Work was taking place to make the plans more person centred to make sure that all peoples needs were met. Each person had had a person centred review and actions had been identified following the reviews. These were monitored every two months to make sure they were carried out. People were supported to make decisions about their lives and what they wanted to do. Each person had a series of risk assessments. They benefited from the 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 6 approach that was taken to managing risk, which promoted their independence. People were provided with a range of activities and opportunities and used local community facilities. These included the shops, cafes, pub, leisure centre and swimming pool. People were able to maintain and develop appropriate relationships with family and friends. People were involved in the routines of the home such as food shopping, dusting and vacuuming. People were offered a variety of meals and enjoyed their food. People received the support that they needed with their health and personal care. Each person was registered with a GP and saw other healthcare professionals such as the dentist and optician. People were generally protected by the way in which their medication was being managed. People are protected by the home’s policies and practices about complaints and protection. There was a complaints procedure in words and pictures. There had been no complaints since the last inspection. There was information about the procedures for safeguarding vulnerable adults and staff had received training about prevention of harm. The accommodation was meeting the peoples needs. People lived in homely, clean and comfortable living rooms. The living room and dining room were decorated and furnished in a homely way. Each person had their own bedroom which was individually decorated and furnished. People were supported by sufficient numbers of staff, who were appropriately trained and competent to meet their needs. There were usually two members of staff on duty and there were extra staffing hours so that one person could have one to one support from staff. Staff had a range of training and their training was updated. Staff had all the necessary checks before they started work so that people were protected by the homes recruitment practices. The home was managed by a person who was suitably qualified and experienced and had been judged to be a fit person to run the home. There was a process to review the quality of the service so that the home was run in peoples best interests. An action plan had been produced to develop the service in 2009 to 2010. The health, safety and welfare of the staff and the people who lived in the home were promoted. What has improved since the last inspection? We made another requirement that the manager must apply to become the registered manager. The manager had applied and been approved as a fit person to run the home. They had made several improvements to the service since the last inspection. Each person had been provided with a service user charter and information about the things that were not covered by the fees. There was also 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 7 information about the additional things they would have to pay for including the arrangements for paying for meals out. This showed people and their representatives what to expect from the service. One person had had new support plans produced to make sure that their needs would be met. Some of the plans were dated so that staff would know which information was up to date. All the support plans had been reviewed so that they would be up to date and continue to meet peoples needs. Improvements had been made to the recording and administration of medication to show that people were getting the right medicines at the right time. Some improvements had been made to the accommodation. The dining room had been repainted. There were new curtains in the living room and dining room and new flooring had been laid in the dining room and corridor by the bedrooms. We made a requirement at the last inspection that there must be a quality assurance system in the home and a report of the findings of the recent survey must be sent to CSCI. This had been addressed. There was a process for assessing the quality of the service. Surveys had been sent out and a report and an action plan had been developed from the findings. A copy had been sent to CSCI. This meant that any developments were based on the views of peoples representatives and were in peoples best interests. What they could do better: Each care plan should be dated so that staff can tell which information is up to date and when it needs to be reviewed. A record must be kept of food provided for people in sufficient detail to show whether the diet is satisfactory, in relation to nutrition. So it is possible to tell whether people are getting a balanced diet. A cupboard should be obtained that complies with the new regulations for storing controlled drugs. This will make sure that if someone is prescribed a controlled drug it can be stored safely. Some changes need to be made to the recording of medication to make sure that people receive their medication in the right way. Improvements were being made to the bathroom the month after the inspection so that people would benefit from living in a more comfortable environment. 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 8 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. 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 9 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 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5 Quality in this outcome area is good. People had information about the service and each person had a service user charter so that they and their representatives would know what to expect from the service. People’s needs were assessed before they moved into the home so that their needs could be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at three personal files. We saw that each person had a copy of the statement of purpose in their file. This contained all the required information about the service provided. Two people had lived at 27 Brockleaze for several years. A third person had moved in just before the inspection in September 2007. Standard 2 was met when it was assessed at the inspection in 2007, and nobody had moved into the home since then. The person who had moved in more recently had a new intimate and personal support assessment in January 2009. We saw that each person had a service user charter in their file. This was an agreement between the home and the organisation about the service to be 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 11 provided. We made a requirement at the last inspection, and the one before, that each person must have a statement of their terms and conditions or a contract with the home. This had been addressed. There were letters in the personal files, which showed that the manager had tried to find a representative to sign the charters as representatives of the people. However, they had not been successful in finding an appropriate representative. We noted at the last inspection that the information that we saw about the home did not include a list of items that people at the home would have to pay for out of their own money, because they were not covered by the fees. We saw that there was new information in each persons file about the things that were not covered by the fees. There was also information about the additional things they would have to pay for including the arrangements for paying for meals out. 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 12 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 and 9 Quality in this outcome area is good. Most of peoples abilities, needs and goals were reflected in their individual plans. Work was taking place to make the plans more person centred to make sure that all peoples needs were met. People were supported to make decisions about their lives and what they wanted to do. They benefited from the approach that was taken to managing risk, which promoted their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We made a requirement at the last inspection that care plans must be consistent in the home, up to date and reviewed at least at six monthly intervals. This had been addressed. We also made a recommendation that each care plan should be dated so that staff can tell which information is up to date. This had been partly addressed. We looked at the care plans for the three people who lived in the home. One person, who did not have a care plan at the last inspection, had a series of support plans for personal care, 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 13 which were not dated and had no date for review. They also had support plans for behaviour and communication which had dates of reviews recorded. There was information about their likes and dislikes. The two other people had a series of support plans and the review dates were recorded on the plans. We saw that each of the three people had had a person centred review in December 2008. The actions identified at these reviews were written into an action plan for each person and these were monitored every two months and progress was recorded. The manager told us that they were going to move on to the next step and develop person centred plans. We saw that information about some limitations and restrictions was included in people’s individual plans. For example, one person did not have a lockable storage facility in their bedroom, or a lock on the door, and the reasons for this were recorded. Other information had been recorded about people’s likes and dislikes, their relationships, and about how they could experience choice and decision making. This helped to ensure that staff were aware of people’s individual needs and provided support in a consistent way. There was guidance for staff about the support that people needed in areas such as money, managing behaviour, and communication. We noted that each person had a series of risk assessments for example about travelling in the care, travelling on public transport, going on holiday and bathing. These included the benefits to the person of taking the risk. The dates were recorded when the risk assessments were reviewed. 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 14 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, 14, 15, 16 and 17 Quality in this outcome area is good. People were provided with a range of activities and opportunities and used community facilities. People were able to maintain and develop appropriate relationships with family and friends. People were involved in the routines of the home. People were offered a variety of meals and enjoyed their food. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One member of staff told us that each person had some day time activities. We saw records about these in the files. One person went to a resource centre on a regular basis. Other people went to resource centres for different sessions during the week. A member of staff told us that when people were not at the resource centre staff took them out for example to the pub, to a café, the swimming pool, gym and health suite. During our visit a member of staff was arranging for two people to go to the health suite in the evening. 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 15 We looked at the diaries, which contained records of daily activities. We saw that during the last month people had had varied activities. One person attended the resource centre, went to the pub, swimming (several times), drew, went to the café, food shopping and to the gym. A second person went to two resource centres, played skittles, walked around the shops, vacuumed the lounge, helped prepare lunch, went for a walk, went to a café and went food shopping and clothes shopping. The third person went horse riding, spent the day in the garden, went for a walk, went to Bradford on Avon and for a walk, had tea in the tea rooms, listened to music, went to college, went food shopping, went shopping in Corsham and went swimming. On the day of our visit we saw people watching TV and two people went to the pub for lunch. One person chose to have one to one time with a member of staff. Another person went to their day service in the afternoon. A member of relief staff told us that one person liked to go to the Roman Baths and have a meal out in Bath. Staff told us that each person had a holiday with staff support and one person also had a holiday with a friend. The manager and two members of staff told us that one person saw their parents regularly, and sometimes saw their sister, and another person saw their family regularly. They said that one person saw a friend and went on holiday with them and they also went out for a drink sometimes with a person from another house run by United Response. We saw that there was information in peoples files about their contact with family and friends. The manager told us that one person would do most tasks around the house including vacuuming their room and mopping the floors. She said that another person would wipe up after meals and vacuum. We saw several occasions in the diary when this person had helped with the vacuuming and other chores, put the washing out and went shopping for food with staff support. The manager said that the third person was less involved in the jobs around the house. She said that the person would be around staff when they were doing jobs but did not get very involved. We saw in the diaries that there were entries stating that people had enjoyed their meals. We looked at the menu and saw that a variety of meals were served. However, the record was not very detailed so that it was not possible to tell if a balanced diet was being served or whether people had five portions of fruit and vegetables a day. 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 16 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 and 20 Quality in this outcome area is good. People received the support that they needed with their health and personal care. People were generally protected by the way in which their medication was being managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we looked at the individual plans we saw that they included details of the personal support that people needed. The plans covered a range of areas such as bathing, toileting, foot care, dressing, and eating and drinking. We saw evidence that these plans had been reviewed. We saw information on people’s individual files that showed how they wished to be supported. Risk assessments had been undertaken in areas such as shaving, medication, and the use of sun cream, so that support could be provided in ways which people preferred, and reduced the risk of them being harmed. 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 17 We saw that each person had a medical profile. This recorded information about any health needs that they had and the health practitioners that they saw. Each person was registered with a GP and they had access to other health care professionals including the dentist, optician and psychiatrist. Appointments and health reports were being recorded in people’s individual files. We saw that one person had a new medical profile in November 2008. The dates were recorded when another persons medical profile was reviewed. The third person had a profile which included information entered in October 2008. However, the profile was not dated and there was no date recorded when it was due to be reviewed. Information about people’s medication was included in their support plans and personal records. All the support plans for medication had been reviewed during the last year. Medication was stored appropriately in a metal cabinet. There were no controlled drugs. A monitored dosage system was used and a record was kept of medication received into the home and of its administration on the medication administration record (MAR) sheets. There were records of medication returned to the pharmacist and a weekly stock take of medicines. Some medication was prescribed for administration on a PRN (‘as required’) basis and there were guidelines about when and how this was to be given. There was an agreement with the GP about which homely remedies could be given to each person. When we looked at the MAR sheets we saw that they were on the whole appropriately recorded. Staff signed the record after they had given medication to a person and they had taken it. The instructions for giving some medication were recorded on the MAR sheets as directed. A member of staff had written in the directions as originally given by the GP and signed the entry. However, on one persons MAR sheet the directions for a cream had been changed from three times daily to twice daily by a member of staff. They had neither signed or dated the change so that it could be cross-referenced with directions from the GP. The directions for a suspension had been changed from four times daily to as required and there was no signature or date recorded. We have received a notification about a medication error since the last inspection. The manager explained how they had managed the situation and it had been dealt with appropriately. 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 18 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 and 23 Quality in this outcome area is good. People are protected by the home’s policies and practices about complaints and protection This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw that there was a complaints procedure in words and pictures in each persons file. People would need the support of a representative or advocate to make a complaint. The manager told us that there had been no complaints since the last inspection. There was a procedure about protecting people from abuse, and information about the local multi-agency safeguarding adults procedure. The staff training records confirmed that staff had received training about the prevention of abuse and this was updated. Staff had been given copies of the ‘No Secrets’ booklet, which summarises the local procedure for safeguarding vulnerable adults. There had been no safeguarding referrals since the last inspection. People did not manage their own personal money and they received support with this from the staff team. We looked at examples of the records that were being maintained. Transactions involving people’s money were being recorded and two staff initialled the entries. Receipts were being kept and there was a system of auditing. 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. The accommodation was meeting the peoples needs. People lived in homely, clean and comfortable living rooms. Improvements were being made to the bathroom so that people would benefit from living in a more comfortable environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 27 Brockleaze is in a rural location, but there are towns within easy travelling distance that people go to for most of their day to day activities. 27 Brockleaze is a bungalow, so all the accommodation was on the ground floor. Each person had their own room. There was a bathroom and a shower room. The communal areas consisted of a lounge and a dining room. There was a kitchen and a separate utility room with laundry facilities. There was a good sized space for cars, and for people who like to spend time outside. 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 20 The accommodation has been improved through redecoration in recent years, which has given it a more homely appearance. The bedrooms, living room and dining room had been redecorated. There were new curtains and there was new flooring in the dining room and corridor by the bedrooms. The carpet in one person’s bedroom had been replaced. The utility room had been plastered, decorated and had a new floor covering had been laid. The accommodation generally looked homely, clean and tidy. Laundry was washed in the utility room where there were a washing machine and tumble drier. We saw that cleaning materials were kept in a locked cupboard in the utility room, so that they would not be a hazard to the people who live at the home. We reported at the last inspection that the bathroom was in need of some attention. The manager told us that a new bathroom was planned and work was to start the following month to refit the bathroom. The boiler was to be replaced at the same time. 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Quality in this outcome area is good. People were supported by sufficient numbers of staff, who were appropriately trained and competent to meet their needs. People were protected by the homes recruitment practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We spoke to three members of staff. One member of staff told us that there are four permanent members of staff and vacant hours are covered by relief staff and regular agency staff. A relief member of staff told us that there were usually two members of staff on duty. A permanent member of staff said that there were fifteen extra hours for one person to have one to one support. This meant that on the morning of our visit there were three members of staff on duty. We looked at the rota and this showed that there were usually two members of staff on duty and one member of staff sleeping in. There were extra staff for fifteen hours a week to support one person. 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 22 The manager told us that two members of staff had a National Vocational Qualification (NVQ) at level 2. A member of staff told us that the training was very good and was updated. We went to the office to look at the recruitment and training records. We looked at the training records of three new members of staff. They showed that staff had an induction using the common induction standards. They then had a range of basic training including training about moving and handling, medication, challenging behaviour, ‘the way we work’, a course about the ethos of the organisation, first aid, prevention of harm, health and safety and equality and diversity. There was also training about epilepsy and autism. The training was regularly updated. We looked at the recruitment records of three new members of staff. All three staff had completed an application form with a declaration that they had no offences. Two written references and Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks were obtained before they started to work with people. One person had a copy of their passport, one had a copy of their birth certificate and the other had copies of their birth certificate and driving license as proof of identity. 27 Brockleaze DS0000028367.V374705.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. The home was managed by a person who was suitably qualified and experienced and had been judged to be a fit person to run the home. There was a process to review the quality of the service so that the home was run in peoples best interests. The health, safety and welfare of the staff and the people who lived in the home were promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager had a CG 325/3 Advanced Management in Care qualification and was undertaking National Vocational Qualification (NVQ) Level 4 in management. She had applied to become the registered manager and had recently been approved as a fit person to manage the service. She was supported by a management structure in the organisation. 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 24 We made a requirement at the last inspection that there must be a quality assurance system in the home and a report of the findings of the recent survey must be sent to CSCI. This had been addressed. There was a process for assessing the quality of the service. Questionnaires had been sent to relatives and relevant professionals. A report of the findings from the survey had been produced and an action plan had been developed for 2009 to 2010. A copy of this had been sent to the Commission. The manager provided information in the AQAA about the quality of the service. It was clear and provided the information that we needed. It told us what the service does well, what has improved since the last inspection and what improvements they planned in the next twelve months. A number of individual risk assessments and more general risk assessments about safe working procedures had been recorded. A risk management manual had been produced by United Response. Arrangements were in place for the training of staff in moving and handling, fire safety, first aid, food hygiene and infection control. A monthly safety inspection of the home was carried out by staff. Fridge and freezer temperatures were taken and recorded. Hot water temperature regulators had been fitted to all hot water taps except the kitchen. These were regularly serviced. There was a health and safety policy and a health and safety handbook was available to the staff team. This detailed the action to be taken in order to comply with the relevant regulations. There were Control of Substances Hazardous to Health (COSHH) assessments and a range of safety checks. These included portable appliance testing, servicing of the boiler, taking of hot water temperatures, vehicle checks, cleaning of the shower head and fire safety checks. The boiler was due to be replaced. There was fire instruction for staff. 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 X 4 X 5 3 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 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 26 No 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. 1. Standard YA17 Regulation 17 Requirement A record must be kept of food provided for people in sufficient detail to show whether the diet is satisfactory, in relation to nutrition. Timescale for action 30/04/09 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. Refer to Standard YA6 Good Practice Recommendations Each care plan should be dated so that staff can tell which information is up to date. Recommendation carried forward from previous inspections. 2. YA20 When hand written entries are made to the medication administration records the member of staff making the entry should sign and date the record and another member of staff should sign to witness the record. This is so that the change can be cross-referenced with directions from a health professional and people receive their medication in the right way. 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 27 3. YA20 The registered person should obtain a controlled drugs cabinet which complies with the current storage regulations for controlled drugs, the Misuse of Drugs (Safe custody)(Amendment) Regulations 2007 so that any controlled drugs that are prescribed can be stored safely. 27 Brockleaze DS0000028367.V374705.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West 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 27 Brockleaze DS0000028367.V374705.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. 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