Care Home: Brambledown Road (44)

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What the care home does well The home provides people who plan to use the service and their representatives with the information they need so that they can make an informed decision about whether or not to use the service. This is done in a clear way. People are able to attend appropriate social and leisure activities so that they can maintain community presence and exert reasonable control over their participation and opportunity to follow their chosen lifestyle. Appropriate arrangements are made so that people have regular contact with their friends and families. The people can be assured that they receive support in the way they prefer and that their individual and unique support needs require. The service also demonstrates a commitment to continually seek ways to maintain and improve upon the quality of the service that is offered. What has improved since the last inspection? There were views expressed in feedback from at least two of the people who live at the service and some relatives prior to the last inspection about complaints and variable service quality. The service has subsequently explored those views and established clarity with those who raised these questions. The actual hours of duty are included on the staff rota to ensure that a fully accurate record is kept. What the care home could do better: There are no requirements or recommendations as a result of this inspection. The service has taken action in response to any previous requirements or recommendations that have been made, and is demonstrating a commitment to quality improvements. Should this work, and the success that it has achieved, be maintained then the service is well on the way to their goal of possibly achieving an excellent rating in the future. The actual hours of duty are included on the staff rota to ensure that a fully accurate record is kept. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Brambledown Road (44) 44 Brambledown Road Wallington Surrey SM6 0TF     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: James Pitts     Date: 1 5 0 5 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 27 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 27 Information about the care home Name of care home: Address: Brambledown Road (44) 44 Brambledown Road Wallington Surrey SM6 0TF 02086471325 02086471325 brambledown@independencehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Independence Homes Limited care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 7 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home 44 Brambledown Road is a registered care home, providing personal care and accommodation for up to seven adults with learning disabilities, specialising in providing a service to people who also have epilepsy. Six people are currently living at the home. Brambledown Road is owned and managed by a private organisation who have three other similar services in the local area. The home is situated in a residential area of Wallington, close to public transport, shops and leisure facilities. Accommodation is provided over two floors. Seven single bedrooms, which Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 7 Brief description of the care home have a wash hand basin. There is a communal lounge, dining room, laundry and kitchen. A conservatory, at the rear of the building, is mainly used as a staff office. The garden has a patio area, a brick barbeque, an area of lawn, a path, mature trees and bushes, a shed and a side access gate. There is some off street parking at the front of the building. The fees are varied and depend on the package of care individuals receive. Information about fees is included in the contract of residence. Inspection reports and details of the CSCI are available. Care Homes for Adults (18-65 years) Page 5 of 27 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 health care support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means people who use this service experience good quality outcomes. The charge for the service is presently between £925 to £2150 per week. This visit took place during the daytime and most of the people who live here were around for parts of the day. One person spoke about their specific positive view of the service and about their interests and activities. Everyone was also provided with a questionnaire before the visit took place and everyone replied. Three people who added a comment to whether they know how to make a complaint did so by either naming specific staff who they would go or saying I will tell the staff. Another person who made an additional comment when asked if they would like to tell us anything else said I would like to stay here all my time. Care Homes for Adults (18-65 years) Page 6 of 27 In addition to the questionnaire feedback and conversations with people who us the service, discussion was also held with the manager, a staff member and a visiting engineer who carries out a lot of work at this home and others that are operated by Independence Homes Ltd. We also examined samples of standard policies, procedures and required records that have to be kept. The AQAA, Annual Quality Assurance Assessment, notifications made to the Commission and other relevant data was also considered. 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 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care 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 9 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service and others are told what the home does and how it will do it. The service user guide is written in a way that maximises the opportunity for each person who uses the service to have this in an accessible format. The people who use the service can continue to feel confident that the home will only care for people that the staff are trained and able to care for. Evidence: We looked at the most recent versions of the statement of purpose and service user guide. These are both presented in word and picture formats that make them as accessible as possible for those who either use, or are planning to use, the service, as well as other stakeholders. No new people have come to live at the home since the previous key standards inspection, although someone is coming for a trial stay in the near future. It should be noted that previous inspections have found the referrals, assessments and admissions process to be very well managed. This maximises the opportunity for successful Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: permanent placements to occur which benefits both the people who currently use the service and anyone new who may wish to live at Brambledown. Care Homes for Adults (18-65 years) Page 11 of 27 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. The people who use this can feel confident that the staff remain knowledgeable about what they need and how best to support each person. They can continue to feel assured that the staff will try their best to make sure that each person who lives at the home is allowed to live the sort of life that they choose.The people who use this can feel confident that the staff remain knowledgeable about what they need and how best to support each person. They can continue to feel assured that the staff will try their best to make sure that each person who lives at the home is allowed to live the sort of life that they choose. Evidence: We looked at two care plans in detail during this visit. These included the most recent review of both the placement and the actual day to day care and support needs. These plans continue to be written in a way that makes it look as though these are about what the individual service user thinks as the words that are still often used are in the first person, using words like I and me. Physical care support, activities of daily living, social and leisure activities and the right to adhere to personally held values and Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: beliefs are reflected in each care plan. Reviews occur and care plans are updated as and when necessary. Consultation with the people who use this service continues to be evidenced by means of notes by keyworkers about their views. Each persons individual case file includes risk assessments that tell staff and other people about anything that may harm anyone who lives here and anything that the person might do that might pose a risk of harm to themselves. Copies of risk assessments are kept and cover a variety of situations from accessing community facilities to learning skills and activities within the home. Risk assessments continue to be reviewed regularly, and the system for risk assessments is in line with the guidance issued by the Health & Safety Executive. The registered provider has very clear procedures for staff about making sure that the personal information of the people who live here remains confidential. These procedures are designed to ensure that information is not shared with anyone who does not have a right to know and are diligently adhered to. Care Homes for Adults (18-65 years) Page 13 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can feel confident that the staff of the home will provide opportunities for everyone to develop their personal and social skills. This includes active support for each person to participate in the community both in terms of the activities of daily life and leisure interests. The opportunity for each person to develop and maintain personal and family relations is also offered and is actively supported by the staff team. Evidence: The people who use this service continue to be supported to make use of a wide range of community based facilities. These can be anything from regular shopping trips for food for the home or personal shopping and attendance at local clubs or other activities. The home has a people carrier that can be used although this does not prevent the use of public transport where circumstances allow. A social activities programme is compiled for each person. One has fourteen hours one to one input per Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: day which is funded by their placing authority. The staff team continue to be able to demonstrate a clear understanding of the cultural and religious practise preference that each person who uses this service chooses to adhere to The staff group continue to encourage and support the maintenance of relationships with family members and virtually all of the people who live here do have at least some family contact. There is an open visitors policy. Family and friends are invited to social events at the home as well as reviews. The home has a key worker system and it is part of the key worker role to keep family members informed of progress made, where appropriate. Visitors can be seen in the communal areas or bedrooms if it is thought to be appropriate and safe to do so. The daily routines of the home continue to be flexible within reason. Staff were again seen to interact appropriately with those who use this service. The people who live here have the freedom to make their own choices about where they spend time in the home and whether they wish to be alone or in company. The home has all appropriate policies and practises on maintaining dignity and rights and has expanded upon this with the recently published guidance regarding the Mental Capacity Act. Individual preferences for the food that people like to eat are given due consideration. The menus show that appropriately varied and nutritious meals are available. Diets and menus are reviewed with the input of a dietitian who is employed by the registered provider. Where an individual may have complex dietary needs the staff team have the necessary written guidance and awareness about managing nutritional intake. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and health care 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. The people who use this service can remain confident that they will get the right support to take care of their personal and health care needs. Anyone who needs to take medicine regularly to help them stay well will get the proper support from staff to make sure that this happens safely. Evidence: The methods of supporting each individual continue to be clearly written down in a way that focuses on the unique preferences and personality of each person. The people who live here continue to make use of the range of community health services. Each persons unique and detailed health care support needs continue to be reflected in his or her care plan. A full medical profile is compiled which outlines the reason for prescription medicines and any risks that might arise about the use of the particular medication. The outcome of all medical appointments is also written down after they occur and a health care feedback form is completed. This is designed not only to provide detail of the appointment outcome and / or treatment but also details about the quality of the interactions with health care professionals. Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: All service users who live here have been identified as possibly needing to take rectal diazepam as an emergency measure should they suffer repeated and frequent seizures. The acting manager stated that it had never been known to be necessary to administer this medication. It should be noted, however, that staff remain aware, through training, of its use and of what they must do should the need ever arise. Risk assessments continue to indicate that none of those who live here are able to take their medication without the staff supporting them. The home has detailed written policy and procedure guidelines for the handling and administration of medication. All staff members responsible for administering medication have been trained to do so. Care Homes for Adults (18-65 years) Page 17 of 27 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. The people who use this service can feel confident that the staff team at the home know what to do if there are complaints or concerns about abuse. The home has clear guidance for staff about the procedures to be followed in either of these circumstances, and respond appropriately to any concerns that may be raised. Evidence: The people who live here, and other stakeholders, are given clear information about how to complain and what happens when they make a complaint. Given the views expressed in feedback prior to the last inspection the home clarified with all service users their understanding of the complaints procedure. Three complaints have been made in the last year by a relative of one of the people who uses this service, with specific reference to their safety and addressing care needs. These concerns were fully investigated using both safeguarding procedures and locally managed complaints protocols. No evidence of abuse was identified. It is positive to note that even though abuse had not occurred these concerns were taken seriously by Independence Homes. They were seen as an opportunity to review the operation of the home and to examine if there were any learning points that could be used to make further quality improvements to the service. There is clear written information for staff about what to do if they think that anyone who lives here is being hurt or abused by another person, or if an allegation is made. Care Homes for Adults (18-65 years) Page 18 of 27 Evidence: All staff complete training in the protection of vulnerable adults as part of their standard induction when they are first employed and have to complete refresher training at regular intervals. Care Homes for Adults (18-65 years) Page 19 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can feel confident that they are living in an efficiently well maintained home. The home is also kept clean and hygienic. Evidence: The People who use the service have a single bedroom and access to a lounge, dining room, and large garden. Bedrooms are personalised to the individuals taste and all have a monitor to enable staff to hear if individuals have a seizure and respond appropriately. The registered provider has invested a substantial amount of money with two specialist engineering companies and purchased a more effective and discreet way of using an alarm system, which is now in use. A bathroom and lavatory are located on the ground floor with a bathroom and separate shower cubicle on the first floor. The state of repair and decoration of the home is generally good and it is positive to note that repairs and refurbishments continue to be planned in a way that means that an acceptable standard is maintained. The Kitchen was completely replaced last year. Redecoration has occurred in areas that required it and there is also new lounge furniture as well as some new furniture for bedrooms. The house continues to be kept clean and hygienic. Care Homes for Adults (18-65 years) Page 20 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can feel confident that there is a committed staff team to meet their needs and that these staff are safe people to support them. Evidence: The staffing rota continues to show that on average three members of staff on duty during the day with one member of staff on waking night duty. The reduction from also having a member of staff sleeping in was a cause of anxiety for some relatives when this was introduced. The service is able to show that there had not been a need for an additional member of staff on overnight, as this resource had never been known to actually be required. The new epilepsy alarm monitoring system and the on call arrangements were risk assessed by Independence Homes, the result of which states that on call back up systems should provide for the necessary emergency response should a situation arise. The staffing levels continue to provide for the necessary support, which creates the opportunity for supporting people to participate in leisure and social activities and generally be involved in the wider community. It is recommended as a result of the previous inspection that actual hours of duty are included on the staff rota to ensure that a fully accurate record is kept, this now happens. The registered provider has previously made organisational improvements to the recruitment process, which continues to achieve the necessary standards required to safeguard the people who use the service. Staff all receive an induction to not only Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: the organisation and service but this also includes safety and communication awareness training where necessary for any of the people who use the service. We looked at recruitment records for two newer members of staff and each of these showed that proper procedures were followed. The staff team continues to have access to a comprehensive training and development programme. Appraisals are also carried out in order to evaluate performance as well as identify training needs for the coming year. Of the staff team 5 permanent staff, equalling around 62 percent, have already achieved NVQ Level 2 or above. The home therefore achieves the current 50 minimum that is required. A monthly pre planned supervision schedule was put into place not long before the previous key standards inspection. This has had the desired effect in assisting to quickly identify if any staff are not achieving the monthly frequency of supervision that the registered provider expects. Even if monthly supervision does not always occur, the service is able to show that the required minimum of six supervisions per calendar year is now being achieved. Care Homes for Adults (18-65 years) Page 22 of 27 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. The people who use this service can feel confident that they are living in a home that has effective management oversight and that their best interests are given due consideration in the planning and development of the service. Evidence: The registered manager vacated their post earlier this year and a senior company manager took over as acting manager. A new manager has been recruited and, pending final background checks, is expected to commence in post shortly. Independence Homes have provided a written agreement to the Commission that an application for registration of this person will be made after an initial three month probationary period. Monthly visits under Regulation 26 are occurring and copies of the reports of these visits are being kept at the home for reference purposes. Given the viewpoints that were expressed about the variable quality of service by some relatives prior to the last inspection Independence Homes has spent considerable effort exploring these views with them and not least in respect of the concerns about changes to the service. A Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: copy of a business and development plan was provided to us at this inspection and this covers the necessary areas that should be considered. The necessary health and safety checks have all been completed and fire alarms are being tested at regular intervals. During the site visit there were engineers present who were carrying out a portable appliance test. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 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 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 26 of 27 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. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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