Care Home: Briar House

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What the care home does well Briar House continued to provide `homely` care in a clean and well looked after house. It was a large house with two lounges and a dining room, so that if the clients wanted some private time, without using their bedrooms, this was possible.No new staff had come to work at the home since the last inspection, which was over 14 months ago. This meant that the staff knew the clients well, and could support them in the way they liked. One person said "I like all the staff who work here" and another client indicated they also liked the staff. As people did not have much contact with their own relatives, the staff invited them to their own special family occasions so they would get to meet a wider range of people and have a better social life. The staff were good at making sure the people`s physical and mental health needs were met and the clients were happy and in good health. What has improved since the last inspection? A more person centred plan had been written with each client, giving a clearer picture of his or her individual likes and routines. All staff had now done medication training so they would know how to give out medicines safely. A section on homely remedies had been added to the medication policy, but a section on self-medication still needed to be included. The deputy manager had started to do the right training programme with new staff so they would learn how to do their jobs safely and support the clients in the way they liked. There was a policy in place about how new people should be recruited and what checks needed to be made before they started work. This is so that the people living at the home will be supported by the right kind of staff. More training had been provided for the newest member of staff in different health and safety matters so he would be able to support people in the right way to keep them safe. What the care home could do better: Staff files still did not contain the date when the Police check had been obtained and whether or not it was satisfactory. This information was needed to make sure people were not being employed unless they were suitable and not starting work before a check had been done. The complaints procedure that was in the service user guide was not up to date and did not show the right address and telephone number for the Commission for Social Care Inspection. This needed to be updated so that the everyone would know how to contact us if they wished to do so.One part of the flooring in the kitchen was dangerous and whilst tape was stuck over it, this was not satisfactory in the longer term as people could trip up and hurt themselves. From checking the staff training records, it was noted that whilst staff had done all the right health and safety training courses in the past, they needed to do refresher training to keep themselves up to date with new ways of working. CARE HOME ADULTS 18-65 Briar House 186 Bury Old Road Heywood Lancashire OL10 3LN Lead Inspector Jenny Andrew Unannounced Inspection 29th January 2008 09:30 Briar House DS0000025493.V357163.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 Briar House DS0000025493.V357163.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. Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Briar House Address 186 Bury Old Road Heywood Lancashire OL10 3LN 01706 621906 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) Mrs Anna Geraldine Ellis Mrs Anna Geraldine Ellis Care Home 3 Category(ies) of Learning disability (3), Learning disability over registration, with number 65 years of age (1) of places Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home is registered for a maximum of 3 service users, to include: up to 3 service users in the category of LD (Learning Disabilities under 65 years of age). The service should employ a suitably qualified and experienced manager who is registered with the CSCI. One named service user in the category of LD(E) (Learning Disabilities over 65 years of age) may be accommodated within the overall number of registered places. 7th November 2006 Date of last inspection Brief Description of the Service: Briar House is a large, semi-detached house providing care and accommodation for up to three persons with a learning disability. The property provides three single bedrooms, along with two living rooms, and a large dining/kitchen area. There are well-maintained gardens to the front and rear of the property, as well as parking for several cars. The home is situated in Heywood and has good access to local shops and bus routes between Bury, Heywood and Rochdale. The weekly fees are dependent upon the assessed needs of the individual. Extra charges are made for dry cleaning and hairdressing. The owner makes information about the service available upon request in the form of a Service User Guide and Statement of Purpose, which is given to new residents. A copy of the Commission for Social Care (CSCI) inspection report is held in the home. Briar House DS0000025493.V357163.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. This was a key inspection, which included a site visit to the home. The staff at the home did not know this visit was going to take place. The visit lasted five hours. We looked around parts of the building, checked the records kept on the service users to make sure staff were caring for them properly, looked at the way medication was given out and stored and watched how the staff spoke to and supported the people living there. The files of three members of staff were also checked to make sure the right checks were being done before staff started working at the home and that they were receiving training. In order to obtain as much information as possible about how well the home looks after the service users, two service users, one support staff/domestic, the deputy manager and the provider/manager were spoken to. Before the inspection, comment cards were sent out to the service user, staff and relatives/advocates asking what they thought about the service. One service user and three staff questionnaires were returned and this information has also been used in the report. Before the inspection, we asked the manager to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what the management of the home feel they do well, and what they need to do better. This helps us to determine if the management see the service they provide the same way that we see the service. Whilst all the sections had been completed, some sections needed to be in more detail for example, “What we could do better”, “How we have improved” and, “Plans for improvement in the next 12 months”. The Commission for Social Care Inspection (CSCI) has not undertaken any complaint investigations at the home since the last key inspection. What the service does well: Briar House continued to provide ‘homely’ care in a clean and well looked after house. It was a large house with two lounges and a dining room, so that if the clients wanted some private time, without using their bedrooms, this was possible. Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 6 No new staff had come to work at the home since the last inspection, which was over 14 months ago. This meant that the staff knew the clients well, and could support them in the way they liked. One person said “I like all the staff who work here” and another client indicated they also liked the staff. As people did not have much contact with their own relatives, the staff invited them to their own special family occasions so they would get to meet a wider range of people and have a better social life. The staff were good at making sure the people’s physical and mental health needs were met and the clients were happy and in good health. What has improved since the last inspection? What they could do better: Staff files still did not contain the date when the Police check had been obtained and whether or not it was satisfactory. This information was needed to make sure people were not being employed unless they were suitable and not starting work before a check had been done. The complaints procedure that was in the service user guide was not up to date and did not show the right address and telephone number for the Commission for Social Care Inspection. This needed to be updated so that the everyone would know how to contact us if they wished to do so. Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 7 One part of the flooring in the kitchen was dangerous and whilst tape was stuck over it, this was not satisfactory in the longer term as people could trip up and hurt themselves. From checking the staff training records, it was noted that whilst staff had done all the right health and safety training courses in the past, they needed to do refresher training to keep themselves up to date with new ways of working. 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. Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 8 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 Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People’s individual needs were assessed in full, before admission, ensuring staff were able to meet their identified needs. EVIDENCE: All three people had lived at Briar House for ten years, since the home had first been registered. Full care management assessments had been completed in respect of each person, before they had come to live at the home. These assessments had been looked at on previous inspections. The manager also had in place an assessment format that would be used for any future new admissions to the home. A new emergency admission policy/procedure had recently been written. Since the last inspection all three people had had care management reviews, undertaken by a Social Services Department care manager and their needs were continuing to be met at the home. The staff had recently had some training in equality and diversity. Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People were encouraged to be as independent as possible within individual capabilities and enabled to lead fulfilling lives. EVIDENCE: The care plans for all three people were seen. The files contained two care plans, one was problem based and the other, which had been written since the last inspection, was a more person centred plan looking at likes/dislikes, preferred routines and activities. Discussion took place with the deputy manager in respect of expanding on this good practice, to include whether people liked a bath/shower, preferred rising/retiring times, etc. From speaking to one of the people, it was evident that the plan was up to date and being followed. They were kept in the laundry area so that the clients could see their files when they wanted. Each file had a photograph at the front, so that they would be easily recognisable by the clients. Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 11 One person said she could look at her care plan when she wanted and that she felt she received the right care and support from the staff. The person with limited communication skills was seen to interact positively with the two staff on duty and it was clear they understood her needs and had an excellent relationship with her. All three care plans were regularly reviewed. Discussions with one person showed they were able to make decisions and choices regarding their day to day care, dependent upon outcomes of risk assessments. Where choices were restricted, this was recorded on the person’s file, together with the reasons for the action taken. Observations made on the day of the visit, showed the staff to be following the care plan for one person who did not like to get up early. She was supported to get dressed and came down for breakfast at about 10:30am. Individual arrangements were in place with regard to clients’ finances. One person spoken to said the staff gave her money each day to go to work and that she could spend it on what she liked. A solicitor held Power of Attorney for one person. The finances of the people living at the home were checked and found to be in order. At the last inspection, discussion took place about introducing a system whereby at staff handovers, staff signed to say the balance of money was correct. This had still not been introduced but the deputy manager had very recently drafted a form for this purpose, which she showed us, and said she would implement this very shortly. It was noted that receipts for items purchased were not being kept in date or month order. The deputy manager agreed to staple monthly receipts together so that audits could more easily be done. Where risk areas had been identified, assessments were in place, showing what action needed to be taken to reduce the risk area. These had been regularly reviewed and updated. It was noted that whilst all three people were mobile and did not currently need assistance with moving/handling, the ageing process might change this. Even where staff assist people into and out of the bath or shower, a moving/handling assessment must be in place. The manager/provider said she would monitor the situation and implement assessments as and when needed. Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The range of opportunities available for people to pursue educational, community and leisure activities reflected their diversity, social, intellectual and physical capabilities, thus increasing their independence and self-esteem. EVIDENCE: Two clients went out to daytime occupations during the week. One had paid employment at a day centre, working in the café. She said she still liked going but that not as many people were using the café now and so she wasn’t meeting as many people there. The other person attended a day care centre, but as he had already left for the centre, before we arrived, it was not possible to get any update on whether he still liked to attend. The staff did however, confirm that he still enjoyed going there. Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 13 Arrangements for the other person were made on a day to day basis, either going out shopping, for walks or for a drive in the car. If staying at home this person enjoyed knitting, colouring and reading. On the day of the inspection, one of the care workers supported her to go to Morrison’s supermarket and have her lunch out. On her return, she made it very clear that she had really enjoyed her meal of fish and chips. Diaries were in place individually, which recorded particular events of the day. Some activities were recorded in the individual diaries. As on the last visit, it was noted, that for the person who stayed at home during the week, the recordings did not detail all the activities she had done or record places she had visited when out in the car. This should be addressed. Leisure activities noted from recordings in the diary included, going to the cinema, pub, bingo, eating out and shopping. A pool table was in one of the lounges so that one of the clients could have a game of pool in the evenings, whenever he wanted. From speaking to the staff and one of the clients, it was noted that not all weekend outings were recorded and this was why, on some weekends, they did not appear to do very much. It was acknowledged that the age of the clients was such that they did not want to do very much in the evening, except stay in and watch television, DVDs or listen to music. The deputy manager and a support worker had accompanied all three clients to go away on holiday to Blackpool, a place they had been to previously and really liked. One person showed us photographs of her Blackpool holiday. She had been to a show and the waxworks and spoke enthusiastically about these experiences. A male support worker was employed and this meant that he was able to support the male client when going out to public places. From speaking to the clients and staff on duty, it was identified the clients were also very much involved in the staff’s family social events and parties. These events had been written into the daily diaries. Clients’ cultural/religious needs were identified as part of the pre-admission assessment process and recorded on the support plan. One person attended church each week and she said she still enjoyed going and that she was a member of the choir. None of the clients had regular contact with relatives but one person met up with friends and an advocate. This person had made plans the day of the visit to go and see a friend on her return from work. Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 14 Staff encouraged the clients’ to make choices on a daily basis. Discussion with clients and observations made during the visit, identified preferred routines and choices were respected by the staff. The layout of the building enabled people to have their own personal space, even when everyone was at home. The staff on duty interacted well with the residents during their time in the house. It was evident they enjoyed their company. Since the new laws on smoking had been introduced by the Government, one of the residents had had to change his usual preferred practice of smoking next to the patio door in the dining room. The staff were upset about the fact that he now had to smoke outside but when it rained, the staff had an umbrella, which they held over him. The manager said she was going to try and look at different ways of providing a smoking room for him in the future. The staff knew the food likes and dislikes of the three clients and planned the menus accordingly. Inspection of the menu records showed them to be varied and nutritious with fresh fruit and vegetables being regularly eaten. Healthy eating was encouraged by the staff as they were mindful of the need to keep clients’ weight stable. Records showed that weight was monitored regularly. One person enjoyed porridge, toast and jam for her breakfast and had a treat of fish and chips whilst out shopping. Another person said “the food is good” and when the deputy manager asked her who was the best cook, she replied “Gary is”. A full cooked English breakfast was made on a Sunday and one of the clients said she really liked this. Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The health and personal care the people received was offered in such a way as to promote and protect their privacy, dignity and diversity. EVIDENCE: Only a small team of care staff were employed to support the three clients. Not including the owner/manager there were four staff, three female and one male. This meant that staff of the same gender could support both male and female residents. Staff gave each person the individual support they needed, dependent upon the person’s individual abilities. All but one of the staff had worked with the at the home for many years and knew each person’s preferred daily routines. This was evident on the day of the visit. Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 16 All three people were registered with local GP’s. Care plan files had a section that recorded when visits had been made to health care professionals. The files showed that annual health care checks, flu injections, GP, optician and podiatry visits were undertaken as needed. Staff supported residents to attend appointments at surgeries or hospitals. From discussion with staff, it was evident that health care needs were closely monitored with referrals being made to appropriate professionals as necessary such as dieticians, psychiatrist, etc. When any problems were identified, either emotional or physical, the staff knew who to seek help and advice from. A new nutritional policy had recently been put into place but staff had not yet had the chance to read and implement it. Since the last inspection, equality and diversity awareness training had been provided to the staff team. It had also been identified at the last inspection visit, that the most recently recruited support worker had not done medication training. This had been arranged in January and November 2007 and he had also done disability awareness training in October 2007. Following the advice of the pharmacy inspector in 2006, a homely remedies section had been added to the medication policy/procedures. It was noted however, that self medication had not been addressed. The deputy manager said this was because no-one managed their own medication. Whilst this is accepted, it may be that in the future someone may come to live at the home who wishes to self medicate and it is therefore recommended that selfmedication is addressed in the policy. All the staff had done medication training and from checking the medication system in place, it was clear that the policies were being followed. One error had however, been made on the day of the visit when one person’s medication had not been recorded on the medication administration record (MAR), as having been given before she went to work. The deputy manager said this was because she was rushing to get the person off to work. The other MAR sheets had all been signed and the Boots system being used was a safe way of dispensing medication. Drugs were being stored appropriately. Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Staff had received training in protection issues, so they would know what to do if they suspected service users were not being properly treated. EVIDENCE: The Commission for Social Care Inspection (CSCI) have not had to investigate any complaints at the home since the last inspection. The deputy manager confirmed that they had not received any complaints nor had there been any safeguarding investigations. Feedback from the three returned staff questionnaires indicated they knew what to do if a client or relative had any concerns about the home. Each of the care plan files contained a copy of the home’s complaints procedure as did the Service User Guide. It was however noted that the address of the CSCI had not been changed to show the office had moved from Bolton to Manchester, which was some considerable time ago. The deputy manager had in fact altered the information on the computer but had not adjusted the records. She confirmed she would do so and also update the Service User Guide complaint information. When updating the complaint procedure, consideration should be given to making it more user friendly by the use of pictures. Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 18 Staff training records showed that all the staff had received adult protection training so they would know what to do if abuse were suspected and each of the staff files contained a copy of the Rochdale MBC Inter Agency Procedure for the Protection of Vulnerable Adults (POVA). Briar House DS0000025493.V357163.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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. A comfortable, clean, homely environment was provided for the people living there. EVIDENCE: The house was located just outside Heywood town centre and on a local bus route. The home enabled each person to have their own large bedroom and the living accommodation was roomy with two lounges and a large dining/ kitchen being provided. The provider/manager said no specialist aids and adaptations were fitted in the home, as the people living there did not need them. She did, however, indicate that due to the ageing process, she would monitor their mobility and arrange assessments should their physical needs change. Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 20 A brief walk around the home, identified it was clean, hygienic and in good decorative order throughout. At the last inspection, it was identified that a split in the kitchen flooring could be unsafe for clients, although it had been made safer by strong tape being fixed over it. On this visit, the tape had worn off but the deputy manager stuck fresh tape on it to make it safe. The owner/manager was asked when new flooring would be fitted and she said this would be done when a new kitchen was fitted, which she thought would be done in the next 12 months. Given this is a trip hazard, it is strongly recommended that, in the interim, a longer term solution is considered so that people will not be at risk of falling. The dining room table was extremely sticky and any papers put on the table stuck to it. This is unpleasant for people using the table. The domestic/carer said that she cleaned it daily but that the stickiness could not be removed. The provider/manager said she would purchase a new table. Overnight, a large tree branch had part broken off and looked unsafe. During the inspection, the provider/manager made a telephone call for someone to come and make the tree safe. Since the last inspection, a new garage door had been fitted and new taps provided in the kitchen and bathroom. A new shower had also been fitted and some new windows supplied at the top of the house. An Environmental Health visit had taken place in June 2007 when a “Safer Food Business” manual had been left for the staff to complete. A report of their return visit on 1 August 2007 showed that the recommendations made had been complied with. A new infection control policy had recently been written. Disposable gloves and aprons were available. The domestic/carer who was spoken to said there was always a good supply of cleaning products available so that she could keep the house clean. The deputy manager described the procedure they used when soiled linen was carried through to the laundry, as they had to walk through the kitchen to access the laundry facilities. She said any soiled linen or clothes would be put into a bag, which would be sealed. Briar House DS0000025493.V357163.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, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The staff team had the collective skills needed to undertake their roles efficiently and effectively which ensured the needs of the people living at the home were being well met. EVIDENCE: The home was being staffed to meet the identified needs of the people, as agreed with the Social Services Department who were funding the clients’ placements. The rotas were written to take account of what individual clients were doing during the day, evening or at weekends and a member of staff was on sleep duty each night. Feedback from speaking to staff, and from the returned questionnaires, confirmed there were always sufficient staff on duty to meet the individual needs of the people living at the home. From speaking to two of the clients and feedback from the returned questionnaires, it was clear that they got on well with all the staff. One person said “I like all the staff” and another person said, “I like them all but Bernie (deputy manager) best”. Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 22 The staff team was small with only a provider/manager, deputy manager, two support staff and a domestic/support staff employed. Since the last inspection, no new staff had started work, although one person had left. This consistent staffing meant that the residents had built up long-term trusting relationships with the staff. The three returned staff questionnaires indicated they felt they received the right kind of training to enable them to do their jobs well and give the right support to the people living at the home. The deputy manager had attained an NVQ level 3 qualification and was presently doing the Registered Manager’s Award. She had been encouraged to do so by the provider/manager. Information contained on the Annual Quality Assurance Questionnaire was incorrect, as it recorded that 50 of the staff had attained an NVQ level 2 or higher qualification. The provider/manager said she had mistakenly counted the staff member who had left and had thought another of the staff had signed up to do the NVQ level 2 training. The deputy manager said some of the staff were not as keen to register but she was doing her best to persuade them to do so. The provider/manager should ensure that any new staff members she recruits in the future, should only be employed if they are in agreement to do this training. At the last inspection, the newest member of staff had not completed all the required training. From checking this person’s personnel file, this had now been addressed. The “Skills for Care” induction training signing off sheets were in the file showing this training had been done between December 2006 and February 2007. However, the deputy manager could not demonstrate how she had assessed the worker as competent in all the required units and it was recommended that the Skills for Care training booklet be obtained and used when next inducting a new member of staff. The manager/provider had organised in-house training for the newest support worker in respect of equality and diversity, infection control, food hygiene, emergency first aid, fire awareness and safeguarding. The other staff had also benefited from the equality and diversity training. From checking the staff files of the deputy manager and a support worker, it was noted that whilst they had both done all the necessary mandatory health and safety training such as food hygiene, infection control, moving/handling and first aid, these were now out of date and refresher training was needed. The provider/manager said she would arrange for them to do the necessary courses. This was highlighted at the last inspection and the provider/manager must now ensure all mandatory training is up to date so that all three clients will be safely supported by all the staff. Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 23 The recruitment/selection policy had been reviewed and updated since the last inspection to take into account that Criminal Record Bureau checks must be done before new staff start work. From checking the application form, it was noted it needed updating and expanding. The file for the most recently recruited support worker was checked. At the last inspection, it was incomplete and poor recruitment practice evidenced. This had now been partially rectified with an application form having been completed, two written references obtained and a Criminal Record Bureau (CRB) check having been obtained. However, the status, details of the date the CRB was obtained and whether it was satisfactory were not recorded. Evidence of receipt of a Pova First check was seen. Since the last inspection, the deputy manager had started to undertake staff supervision. Evidence was seen on file of staff receiving regular supervision, usually by way of observing practice. As the team is small and the staff regularly met together to discuss issues, this was felt to be satisfactory. Team meetings had also been held on a regular basis and minutes seen evidenced this. Feedback from the three returned staff questionnaires confirmed they all felt they received the right level of support. One person commented, “The support is excellent”. Another person said, “We all work well together as a team” and, another person commented, “We give good care and support to the people living here”. Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The management arrangements in place were satisfactory, ensuring good outcomes for the people living at the home. EVIDENCE: The manager, who was a trained nurse, but had not practiced for a number of years, was also the registered provider. The Annual Quality Assurance Assessment, which she had completed, said “The proprietor is in and out on a daily basis and is kept up to date with everything that is going on in Briar House”. Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 25 The deputy manager said she usually worked at the home for a few hours each morning and the rota recorded when she was there. This was not always on a daily basis but in her absence, the deputy manager, who was currently doing the Registered Manager’s Award, provided management cover. Upon arrival at the home, the deputy manager informed her we were there and she called in so that feedback could be given to her about the inspection. Information obtained from a previous inspection indicated that as she was nearing retirement she did not wish to undertake a formal management qualification. In the light of CSCI guidance, this is acceptable in the short-term providing the home is well managed and suitable arrangements are made for the future. The small team of support staff knew the residents well and gave them appropriate guidance and support. Feedback from clients about their satisfaction with how they were supported was an ongoing process done in an informal, friendly way. Occasionally, when specific issues needed to be discussed, more formal resident meetings were held. The last one had taken place in June 2007 when the topic of summer holidays was raised. In addition, pictorial quality assurance questionnaires were completed with smiley and unhappy faces being used to show what they felt. These were usually filled in every year as it was felt this was enough, given the small number of people living at the home and the fact that staff spoke to each person on a daily basis. In the past, feedback questionnaires were said to have been circulated to relatives and day centre staff but were never returned. The home should also consider obtaining the views of other visiting professionals, e.g., care managers, GP’s, etc. None of the clients’ families had regular contact with the home. Information from the AQAA showed that all the necessary maintenance checks had been done, with the exception of the portable electrical appliances. These were to be checked later in the week. Random samples of records relating to the servicing of fire extinguishers and the gas appliances showed these were up to date. No accidents had been recorded in the accident book. As the book was stuck together and the pages could not be opened, we were unable to check if any accidents had been logged. The deputy manager said there had been no accidents over the last year. At the last inspection, it was pointed out that this book was not the newly formatted type that complied with the Data Protection Act. The home should now, without further delay, obtain the up to date copy as highlighted at the last inspection. Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 x 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 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 x 3 x x 3 x Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 YA24 Regulation 13(4)(a) Requirement The flooring in the kitchen must be made safer until new flooring is fitted so that people will not trip and harm themselves. The registered provider must ensure that details of CRB checks held on the individuals file contain date of receipt and whether or not the check was satisfactory as well as the reference number. (Previous timescale of 30/11/06 not met). Those staff who need it must be given refresher training in all health and safety areas so they will have the up to date knowledge of how best to support people safely. Timescale for action 31/03/08 2 YA34 19 29/02/08 3 YA42 18(1)(c) (i) 31/03/08 Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 28 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 YA9 Good Practice Recommendations All three clients should be reviewed in respect of whether a moving/handling assessment is needed and they should be written and implemented as needed. This will ensure peoples’ safety is upheld. The daily diaries should record social and community based activities that people have taken part in. A self-medication section should be added to the medication policy/procedures so that staff will know what to do if a client wishes to hold their own medication. The complaints procedure in the statement of purpose and service user guide should be updated to show the address and telephone number of the Commission for Social Care Inspection so that people will be able to contact us if they choose. A Skills for Care training booklet should be bought so the manager will know how to assess people thoroughly when they are doing this training. More staff should do NVQ training to increase their knowledge and awareness of how best to care for people. Feedback questionnaires should be circulated to other professionals in contact with the clients and the service to see if they think the service is providing good quality care. A newly formatted up to date accident book should be provided so the home will comply with the Data Protection Act. 2 3 4 YA14 YA20 YA22 5 6 7 8 YA32 YA32 YA39 YA42 Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Manchester Local Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Briar House DS0000025493.V357163.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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