Care Home: Brambletye

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What the care home does well The home make sure that there are lots of things that people like to do, so that they do not get fed up or bored with their lives. The service makes sure that peoples` rooms have lots of equipment and special things so that they are as comfortable as possible. Peoples` rooms suit them very well and they meet any special needs they have. The house looks lovely and is kept very clean and tidy, it is a comfortable and pleasant place to live. The garden is very nice, so that the people who live in the home enjoy using it. What has improved since the last inspection? People have more things to do, during the day. People are helped to use the garden alot more than they used to. The home makes sure that staff who want to work there are properly checked to show that they can look after people properly and will not do them any harm. What the care home could do better: The home have very good ways of writing down how staff must help them with things, but staff must do what it says and make sure they `listen` to what people are trying to tell them. The home must make sure that people are helped to do as much as they can for themselves, but it must be done as safely as possible. The home must make sure that they look at what is wrong with people (if they feel ill), find out why and work out how to try to stop them being ill again. They must write down when people go to see Drs., nurses and other people who help them keep healthy so that they know when and how to help them to stay feeling as well as possible. The home must write down the ways that they help people to behave in a good way, so that they know how staff are going to help them if they are causing themselves or others to be upset. Staff must give people their pills as they are told to so that people have the right pills at the right time to keep them as well as possible. The home must look at what is written down about how and when it uses wheelchairs for some people, to see if this is the best way of doing things. The service must make sure that it has a good manager who works in the home alot so that they can do all the things that are needed. The home must make sure that people are kept safe at all times by looking at and writing down how to try to stop accidents and incidents happening again. They must make sure that staff do not try to do things that are not safe for them or for the people who live in the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Brambletye New Mill Road Finchampstead Berkshire RG40 4QT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kerry Kingston     Date: 1 4 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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: Brambletye New Mill Road Finchampstead Berkshire RG40 4QT 01189734539 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.new-support.org.uk Dimensions (NSO) Ltd The registered provider is responsible for running the service care home 5 Name of registered manager (if applicable): Type of registration: Number of places registered: 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 5. The registered person may provide the following category of service only:Care Home only - Code 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 Code LD Date of last inspection Brief description of the care home The house is owned by the Maidenhead/Windsor Housing Association, and the care is provided by Dimensions (NSO) Ltd. The home is registered to provide accommodation for up to five service users who have learning disabilities, but there are only four available bedrooms. Presently, only three service users are accommodated. The home is in a very rural location, not on a public transport route. It is situated Care Homes for Adults (18-65 years) Page 4 of 30 5 Over 65 0 Brief description of the care home approximately five miles from Wokingham Town Centre, with Bracknell and Reading also within a short distance. The home has its own adapted vehicle and service users are able to use taxis if necessary. All accommodation at the home is on the ground floor. There is spacious communal accommodation and a large garden that is accessible to all service users. There are four bedrooms, one room has an en-suite shower room and one room has a lounge area and en-suite bathroom. The fees at this service are £1617.61per week. There are additional charges for toiletries; hairdressing; clothing and other personal effects the service users might wish to have. 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: one star adequate 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: The last inspection on this service was completed on the 25th September 2007. This is a report for the key inspection, which included a routine unannounced site visit to the service. This took place between 10.30 and and 6.30 pm on the the 14th September 2009. The information was collected from an Annual Quality Assurance Assessment, a document sent to the service from the Care Quality Commission and completed by the acting manager (no longer in post.) Surveys returned to us by people who use the service, peoples families completed them on their behalf as the three people who live in the home are unable to use written communication. Discussions with two senior staff members on duty and the manager, took place. People who use the service are unable to communicate with people who do not know them so observation of people and their interactions with staff took place during the visit to the home, which included a meal time. Care Homes for Adults (18-65 years) Page 6 of 30 Reviewing records of the people who use the service and other records and procedures was also used to collect information on the day of the visit. All information received by the Commission since the last inspection, about this service, was also taken into account when producing this inspection report. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The home have very good ways of writing down how staff must help them with things, but staff must do what it says and make sure they listen to what people are trying to tell them. The home must make sure that people are helped to do as much as they can for themselves, but it must be done as safely as possible. The home must make sure that they look at what is wrong with people (if they feel ill), find out why and work out how to try to stop them being ill again. They must write down when people go to see Drs., nurses and other people who help them keep healthy so that they know when and how to help them to stay feeling as well as possible. The home must write down the ways that they help people to behave in a good way, so that they know how staff are going to help them if they are causing themselves or others to be upset. Staff must give people their pills as they are told to so that people have the right pills at the right time to keep them as well as possible. The home must look at what is written down about how and when it uses wheelchairs for some people, to see if this is the best way of doing things. The service must make sure that it has a good manager who works in the home alot so that they can do all the things that are needed. The home must make sure that people are kept safe at all times by looking at and Care Homes for Adults (18-65 years) Page 8 of 30 writing down how to try to stop accidents and incidents happening again. They must make sure that staff do not try to do things that are not safe for them or for the people who live in the home. 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 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 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home will make sure that anyone who wants to live in the home is properly assessed so that they can be sure that they can meet their needs. They will also make sure that the person will be able to live happily with those people who are already resident. Evidence: There have been no new admissions, since 2006 when the three people who are currently in residence were admitted. They were properly assessed prior to admission and have regular reviews. The home is registered for five, but has only four bedrooms since improvements to the building were made in 2006. There are three people in residence as one person died in 2008. The spare bedroom is currently being used as a sensory room, it is a limited space and the manager advised that there are no plans, currently to admit anyone else to the home. The admissions procedure was not seen but the manager was clear that she would ensure an individual introductory and admission programme was developed, if and when another resident was felt to be suitable for admission to the home. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: The Statement of Purpose needs to be up-dated to reflect the current situation, to include the number of people living in the service and management details. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples changing needs are assessed and incorporated into good quality and detailed plans of care, however staff do not always adhere to them. Peoples plans of care describe how they make decisions and express their choices but they are not always supported to do so, as their decision making is not always noted and acted upon by staff. Risk assessments are very detailed and of good quality but it is not clear if they are followed, to ensure peoples indpendence and safety, as they do not always match the plans of care. Evidence: Plans of care for all three people who live in the home were seen, they were of good quality and detailed. They included excellent communication profiles and support plans, so that staff could interpret peoples behaviour and knew how best to assist them. However on the day of the visit, staff were observed to be not following/taking account of the care or communication plans, for instance one person was left unsupervised with one of his brakes off when the care plan clearly specified that they Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: should not be left unsupervised unless brakes were applied. Staff explained that the person could move the wheelchair with or without brakes on and that the care plan was out of date, the person did not need supervision, as noted on the care plan. An observation was also made that a staff member did not correctly interpret someones communication when they appeared to be expressing (as described in the communication profile) that they did not want a particular activity. Another staff member eventually rectified this and the individual appeared to communicate (as per communication profile) that they were much happier and enjoying the new activity. The last reviews for individuals were held in November 2008, the results of the reviews are transferred to a PATH, which is a system used by the organisation to plan the future for individuals and the home, however the PATH seen was not detailed and it was not clear what future plans, goals or aspirations, it represented. The manager booked reviews on the day of the visit. Plans of care included descriptions of how people make decisions and express their choices,such as what they would like to do, but during the day of the visit not all staff adhered to the plans. Risk assessments are of good quality and detailed but do not relate to possible deprivation of liberties/or using restraint. This relates to safety risks versus the use of two straps on wheelchairs, the use of wheelchairs for ambulant people and the use of harnesses in the minibus. Risk assessments did not necessarily correspond with care plans, for instance a swimming care plan noted that at a particular point staff to attempt a two person lift from the swimming pool steps, the lifting/handling risk assessment did not reflect this advice. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given opportunities to take part in interesting and rewarding activities and are to take part in the community. People are encouaraged and supported to maintain relationships with family and friends. Interactions between staff and people who use the service is not of a consistently high standard. People are offered meals in ways that are appropriate to their needs. Evidence: The AQAA noted that a new activities programme had been developed and people had more opportunity to access the community. Daily notes seen included detailed descriptions of any activities undertaken and if people enjoyed them. There were examples of people going shopping, using the sensory room, going to the day centre, attending an evening social club, visiting a garden centre, cafe, country park, pub, art Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: and craft group, library and cinema. Visits from relatives and friends were also noted. The home has its own vehicle, it is in a very rural location and is not on a public transport route, staff advised that the availability of drivers can sometimes limit community activities. The home provide many individual activities but one staff member commented, we could make sure that people have more individual activities as they are sometimes teamed up to do activities together, peoples needs and ability levels are very diverse. One person has been away on a holiday on a 1:1 with a member of staff. Each person has an individualised activity programme and an extra staff member is often provided during the day to ensure people can have the 1:1 support that they may need to participate and access activities. The home is beginning to make good use of the garden, they have installed a trampoline and are growing some of their own produce. One bedroom has been turned into a sensory room and it is well used by people, who choose either sensory stimulation or some calm and quiet. The three people who live in the home have regular contact with their families, family members visit them and they visit their families. This is encouraged and supported by the staff of the home. Peoples behaviour is observed to see if they wish to join in or are enjoying activities that they are participating in. Some staff did not interact very often with people and some staff then used a patronising and child like method of communication. Family members completed surveys on behalf of the people who live in the home and most responses about the standard of care were positive, some comments included, a good service, the home is excellent and the home seems ok, one survey commented that not all staff have the communication skills to reassure me andmake me feel comfortable when attending to my personal needs (although most do). Menus were not seen, only one person has an ordinary diet, one person has a soft diet and another is fed via a tube. Food appeared to be of good quality and all the necessary instrcutions for peoples special diets were detailed in plans of care and health records. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home meet the personal care needs of the people who live there very well. Peoples health needs are met but records do not always show how they have been met and how their health is to be safeguarded, in the future. The homes robust medication policy and procedure is not always followed by staff, some staff are not knowledgeable about all aspects of medication administration and storage. Evidence: Plans of care and support plans for all three people were seen, they were detailed and of good quality and included peoples preferences and choices. The Communication profile notes how people make their views and choices known. It was noted, on the day of the visit that the behaviour cues, as described in the communication profile were not always listened to and acted upon, by staff. A PATH review (the organisations method of future planning) was seen for one person, it did not include enough detail about what the future plans/goals were or how they were to be achieved. Each person has a health booklet that describes their health and their health needs in Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: detail. It is also carefully noted how people act if they are feeling unwell and what staff should do under these circumstances. One person developed a skin condition, in March 2009, which should have been investigated and monitored, there is no evidence of any action that was taken, especially any to minimise/prevent the risk of recurrence of the condition. Health records were not up-to-date or detailed enough to give an easy to follow picture of peoples visits to health professionals and if any follow up appointments were required and attended. There are no behavioural guidelines in place to assist those people who may behave in a way that they and others find difficult, which may impact on their mental health and emotional well being. The home has a robust medication procedure and policy and only staff who have received training and have been assessed as competent, are able to administer it. However although there are guidelines for the use of medication prescribed to be take as necessary, it was noted that one person had two medications prescribed for the same condition, one staff member spoken to was not clear about which medication to use.The manager said that she would immediately seek a medication review for the individual and remove the excess medication (neither medication has been used for over six months.) There has been one potentially serious medication error in the past few weeks, which has not been investigated, as yet. It is not clear if the necessary steps were taken to ensure the safety of the person who takes the medication although they have suffered no harm. Staff spoken to were not very knowledgeable about how to operate with controlled drugs but the manager knew what was needed. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a comprehensive complaints procedure and tries to put in place methods of listening to the people who use the service. The recording of complaints is not detailed enough to make it clear what the outcome of the complaint is. Staff know how to protect people from abuse but the lack of behavioural guidelines, that have been sanctioned by a behavioural specialist, could potentially put people at risk from physical or emotional abuse. Evidence: The home has a comprehensive complaints policy and procedure, which is produced in a simplified format. The people who live in the home are not able to use the formal complaints procedure without assistance, except by making it clear by their behaviour that they are not happy. Plans of care note how people will show that they are not happy and if they have problems or concerns. The AQAA noted that the home has received three complaints in the last 12 months, these were recorded but did not contain much detail and it was not clear what action had been taken, by whom and the final outcome of the complaint. Two complaints were about someones behaviour adversely impacting on others and one was about staff not noticing a health condition affecting an individual. There was no record of the safeguarding referral noted on the AQAA, staff were unable to confirm if a referral had been made in the last year, or not. Safeguarding policies and procedures for the Local Authority are available in the staff office but they are not Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: displayed. Staff were able to confirm that they had received safeguarding (protection of vulnerable adults training) and described how they would deal with an abusive situation that had been brought to their attention. They confirmed that they knew how to and would protect the people in their care, however one person did not appear to be clear about the whistle blowing policy and another was not clear about where to go outside of the organisation, if necessary. Plans of care include vulnerability assessments and detail how to keep people safe and what they might be vulnerable to. The home does not use physical restraint and no restraint incidents are noted, however they use a wheelchair for someone who is fully ambulant (in the community) this has two straps lap and chest and a harness is used in the minibus. A staff member also described how staff have to block someone who may try to run off.There was a discussion with the manager about restraint and staff identifying when they are restraining someone, even if it is for their safety. Staff have been trained in a behavioural control techniques but this training did not include the use of physical restraint (according to two members of staff) although the manager felt that it did. No behavioural plans were evident to assist those people who have behaviours that they and others find difficult. Two staff said that they did not have any knowledge of specific behavioural guidelines and did not follow any, they did what they felt to be right for the individual. The use of the wheelchair and straps is not recognised as a possible restraint and has not, apparently, been examined with regard to the Mental Capacity Act (Deprivation of Liberties). The home keep only a small personal allowance for the people who live there, all have parents as appointees. Financial records were not looked at, during the inspection visit, but the manager advised that receipts and records are kept according to the organisations robust financial policies and procedures. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The house is kept to an excellent standard of cleanliness and is very comfortable. It is designed and adapted specifically to meet the diverse needs of the individuals who live there. Evidence: The home is a large spacious building with all rooms on the ground floor. One person has their own flatlet consisting of sleeping accommodation, bathroom and sitting area. There is a large sitting/dining room which has good quality furnishings and fittings and looks very homely. There is a large rear garden with plenty of parking space in front of the house. The garden is well used and includes a trampoline and herb garden, for use by the people who use the home. Bedrooms are individualised reflecting peoples special needs, choices and tastes. The home offers excellent accommodation with all the necessary equipment and fixtures to meet the needs of the people who live there, individually and as a group. The home was very clean and tidy on the day of the visit and there appeared to be excellent standards of hygiene in all areas of the home. All staff are trained in infection control and are provided with the necessary equipment to ensure infection control procedures are followed. Care Homes for Adults (18-65 years) Page 21 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. The home have enough staff on duty to meet the needs of the people who live there. The permanent staff team is very small, they work long shifts which may not be in the best interests of the people who live there. Evidence: The home operates with a minimum of two staff per shift, three staff are available when activities/outings are planned. One person has 1:1 staffing allocated five times per week for four hours each session, to enable them to participate in activities. Staff routinely work 14.5 hour days, necessary because of a shortage of permanent staff available to work in the home. Staff and the manager felt that this shift pattern was normal but the area director said that it was not usually used within the organisation. There are currently only four permanent staff, three day staff and one night staff. Two newly appointed staff are not available to commence working in the home, at this time and there are currently two advertisements for two more permanent staff. Shortfalls in staff are dealt with by the use of bank staff (five staff on the bank) and agency if necessary. The home has a major problem retaining and recruiting staff, explained by the rural location, no public transport and relatively low wages. During 2008 there were several staff issues that further reduced staffing numbers. The requirement from the last inspection to have evidence that people are safe to Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: work with the people who live in the home has been, largely met. There remain some areas where more attention to detail is needed, that is to be careful about gaps in employment history and to take care who supplies the references. One staff members references were both supplied by colleagues, rather than a manager. The manager advised me that she has made changes to the staffing of the home, following the inspection visit. Two of the four staff have NVQ 2 or above and training records showed that staff complete health and safety and other training as necessary. They also attend specific courses that are to meet the needs of the individuals in their care, such as PEG Feeding, epilepsy and challenging behaviour. Care Homes for Adults (18-65 years) Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not have a full time or registered manager. The home looks at the quality of care it provides on a regular basis but the system has not identified some areas of care that need to improve. People who live in the service are, generally kept safe although there are some areas that need to be improved to ensure people are kept as safe as possible. Evidence: The registered manager left her post in December 2008, an acting manager was in post for several months but left approximately three months ago. The home has an acting manager who is the registered manager for another home, and is currently overseeing both services. There is no set pattern for her presence in Brambletye. The acting manager advised that she has begun the process of registering with CQC to be the manager of Brambletye. The manager described a new system of Senior management support being used by the organisation which no longer uses service managers. This means that the registered and acting managers are directly supervised by the area directors. The acting manager felt that it was working well and she still feels she is well supported, in her role, from head office. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: The home has various Quality Assurance processes including monthly visits from a senior staff member who complete reports on the outcomes of their visits, an annual quality audit by the organisations quality auditor and quarterly quality checks by the senior manager responsible for quality . An audit is also occasionally completed by a person who uses services in another part of the organisation. An annual development plan is formulated for the home. This is called a PATH and is a simple to read document which notes what the home is going to do in the year and with what aims and objectives. This work has not been completed for Brambletye this year (2009). Resident views are sought but mainly interpreted by their behaviour and the use of an advocate and parental involvement. The AQAA noted, and the manager confirmed that all Health and Safety checks are completed as necessary, these include water temperatures, fire checks, electrical and boiler checks. The home keep incident and accident forms which are completed, as necessary, but do not include how they intend to minimise risk of recurrence. There has not been a regular audit of accidents and incidents, by a manager, for some months. The home have comprehensive safety at work risk assessments but they do not always match peoples individual risk assessments and plans of care, such as lifting someone from the swimming pool steps. Care Homes for Adults (18-65 years) Page 25 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 26 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 6 15 Staff must adhere to plans of care, including the communication profiles. To ensure that they are meeting peoples current needs and are listening to them. 01/11/2009 2 19 12 People must have detailed behavioural guidelines in place, if necessary. To support them to keep mentally and emotionally healthy, and as safe as possible. 01/11/2009 3 19 12 To investigate and monitor 05/10/2009 any unusual health conditions, produce a plan to minimise the risk of recurrence and keep Health records up-to-date. To ensure people are supported to keep as healthy as possible. Care Homes for Adults (18-65 years) Page 27 of 30 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 4 20 12 All staff must follow the homes medication administration policies and procedures, at all times. To ensure that medication is given to people, safely and their health is not compromised by medication administration errors. 01/10/2009 5 23 13 To review the use of 21/10/2009 wheelchairs and straps for ambulant people to ensure they are not being used as restraints and compromising peoples liberties. To check that if restraint is being used, it is necessary, alternatives have been considered and it has been properly sanctioned. 6 23 13 To ensure that staff understand all aspects of safeguarding, including whistle blowing and who to approach outside of the organisation, if necessary. To improve their ability to protect the people in their care. 01/11/2009 7 37 8 To review the amount of time allocated to the management of the service. So that people can be 21/11/2009 Care Homes for Adults (18-65 years) Page 28 of 30 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 assured that the home is properly managed and any necessary improvements will be made. 8 42 12 Accident and incident forms 21/10/2009 must be auditted and notes made to show how the service is minmising the risk of recurrence. So that people are protected from harm and they are kept as safe as possible. 9 42 12 Risk assessments must 21/10/2009 reflect Health and Safety at work assessments and support and match peoples plans of care. To make sure that the safety of people who use the service and of staff is not compromised. 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 1 22 To include detail in the complaints records, so that the outcome of the complaint and what action has been taken is clear. To review how the effect of the staffing shortages, on the people who use the service, can be minimised and if the current shift patterns are appropriate for the provision of good and consistent care, throughout the day. 2 33 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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