Care Home: Brickfield Road (39)

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What the care home does well Feedback received from the vast majority of the people who use the service, some of their relatives, and staff who we either met or completed surveys about the home were in the main very positive. Typical comments included "I am happy in my new home", "my loved one eats very well at Brickfield Road", and "the home is managed very well". We feel the service is particularly good at ensuring significant time and effort is spent making admission to the home is personal and well managed. All new residents receive a full comprehensive needs assessment before admission, which is carried out by suitably experienced staff with skill and sensitivity. The service is also highly efficient at obtaining a summary of any assessment undertaken through care management arrangements and before an admission is agreed the service carefully considers whether or not the prospective new resident will be compatible with the people who already live there. Finally, prospective people who use service are always given the opportunity to spend time in the home before an admission is agreed in order to enable them to get to know the other residents and staff. Staff are good at supporting the people who use the service to lead purposeful and fulfilling lives as independently as possible. People using the service are actively encouraged to make their own informed decisions and have the right to take risks in their daily lives. Residents are also continually consulted on how the service runs and are able to influence key decisions in the home. The manager is highly competent to run the home and meets its stated aims and objectives. The manager was able to describe a clear vision for the home and demonstrated good people skills. Members of staff see the manager as an effective leader. What has improved since the last inspection? Since the homes last inspection the manager has introduced a new complaints record and has ensured any complaints made about the homes operation are fully investigated and responded too in a timely fashion (i.e. within 28 days). This ensures the people who use the service are listened too. Records showed that staff are committed to ensuring behaviours that challenge the service are dealt with appropriately and that psychotropic as required medication and physical intervention techniques are only ever used as a last resort. Staff have not used any physical intervention techniques to deal with incidents of challenging behaviour for the past year. This ensures the people who use the service are kept safe from abuse. The home has installed a new washing machine and new flooring has been laid in the kitchen. 50% of the homes staff have now achieved a National Vocational Qualification in care and another 25% are currently studying for this award in Line with National Minimum Standards. This ensures the people who work at the home are suitably qualified to meet the needs of the people who use the service. The manager has also enrolled on a suitable NVQ (Level 4) course in Management as required in the homes last inspection report and has recently undertaken a `fit` person interview with the Commission to become the homes registered manager. This ensures the manager is suitably qualified to run the home. The results of satisfaction surveys completed by the homes major stakeholders have been published and are available for any interested parties to view on request. This ensures the views of the people who use the service are taken into account when the providers consider ways to improve the service provided. The fire risk assessment of the building was updated in May 2007. This ensures the people who use the service are kept safe. What the care home could do better: All the positive comments made above notwithstanding their remains a number of significant areas of practice that the proprietor must take action to improve the lives of the people who use the service, as well as keep them safe: All the people using the service must be supplied with an up to date costed contracts that set out their terms and conditions of occupancy, which includes details about fees payable for services provided, and arrangements for the payment of such fees. This will ensure people who use the service and their representatives are clear about what facilities and services they can expect to receive and how much they will be charged for them. The home ensures any limitations on freedom and choice are always made in the person`s best interests, but the manager must improve these arrangements to ensure any agree restrictions are fully documented and reviewed on a regular basis (e.g. Locking the kitchen door at certain times of the day). All the uncovered radiators in the home must be reassessed for the risk they present all the new people who have been recently moved into the home. This will ensure the safety of the people using the service. All new members of staff must participate in a fire drill and sufficient numbers of staff who provide personal care in the home must receive infection control training. The manager must undertake training to up date her knowledge and skills regarding the provider`s new arrangements for safeguarding the finances of people who use the service. CARE HOME ADULTS 18-65 Brickfield Road (39) 39 Brickfield Road Thornton Heath Croydon Surrey CR7 8DS Lead Inspector Lee Willis Key Unannounced Inspection 21st November 2007 12:00 Brickfield Road (39) DS0000028229.V339042.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 Brickfield Road (39) DS0000028229.V339042.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. Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brickfield Road (39) Address 39 Brickfield Road Thornton Heath Croydon Surrey CR7 8DS 0208 764 9112 0208 764 9127 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) www.caremanagementgroup.com Care Management Group Ltd (trading as CMG Homes Ltd) Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st August 2006 Brief Description of the Service: 39 Brickfield Road is owned by Care Management Group, a specialist provider of care homes for adults with learning disabilities and challenging behaviour. Personal support can be provided for up to six adults of either gender. Pat McGarry remains the acting manager of Brickfield Road where she has been in operational day-to-day control since June 2006. Pat has recently undergone a ‘fit’ person interview with the Commission and is waiting to find if she is now the homes registered manager. The home is a modern detached bungalow, which is situated on a residential street in Norbury and is within easy walking distance of a local parade of shops and Norbury town centre. The home is also quite near several main line bus routes and a train station with good links to central Croydon and London. The home has its own vehicle. The bungalow comprises of six single occupancy bedrooms; a main lounge; dining room; separate private/visitors room; two baths and a shower unit; kitchen; laundry room; and office. There is also an enclosed courtyard at the rear of the property that has a well-maintained lawn and patio area. People who use the service and/or their representatives have access to copies of the homes Statement Of Purpose, User Guide, CSCI inspection reports, and their terms and conditions of occupancy. These documents contain all the information people need to know about what facilities and services the home provides. The average cost of each placement currently stands at £1,500 per week. Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. From all the available evidence gathered during the inspection process the Commission for Social Care Inspection (CSCI) has judged the service as having significantly more strengths than areas of weakness. Key standards are generally met and the management have a good track record of responding well to issues identified in its inspection reports. We spent five hours in total at the home. We spoke to four people who currently use the service, including two people who recently moved in, the acting manager, the relatively new deputy manager, and two support workers. We looked at records and documents, including the care plans for three people who live at Brickfield Road and the home’s User Guide. The remainder of this site visit was spent touring the premises. Five people who use the service, two of their relatives, and one member of staff completed our ‘have your say’ surveys about the home. The manager also completed a Pre-Inspection Questionnaire. What the service does well: Feedback received from the vast majority of the people who use the service, some of their relatives, and staff who we either met or completed surveys about the home were in the main very positive. Typical comments included “I am happy in my new home”, “my loved one eats very well at Brickfield Road”, and “the home is managed very well”. We feel the service is particularly good at ensuring significant time and effort is spent making admission to the home is personal and well managed. All new residents receive a full comprehensive needs assessment before admission, which is carried out by suitably experienced staff with skill and sensitivity. The service is also highly efficient at obtaining a summary of any assessment undertaken through care management arrangements and before an admission is agreed the service carefully considers whether or not the prospective new resident will be compatible with the people who already live there. Finally, prospective people who use service are always given the opportunity to spend time in the home before an admission is agreed in order to enable them to get to know the other residents and staff. Staff are good at supporting the people who use the service to lead purposeful and fulfilling lives as independently as possible. People using the service are actively encouraged to make their own informed decisions and have the right to take risks in their daily lives. Residents are also continually consulted on how the service runs and are able to influence key decisions in the home. Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 6 The manager is highly competent to run the home and meets its stated aims and objectives. The manager was able to describe a clear vision for the home and demonstrated good people skills. Members of staff see the manager as an effective leader. What has improved since the last inspection? What they could do better: Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 7 All the positive comments made above notwithstanding their remains a number of significant areas of practice that the proprietor must take action to improve the lives of the people who use the service, as well as keep them safe: All the people using the service must be supplied with an up to date costed contracts that set out their terms and conditions of occupancy, which includes details about fees payable for services provided, and arrangements for the payment of such fees. This will ensure people who use the service and their representatives are clear about what facilities and services they can expect to receive and how much they will be charged for them. The home ensures any limitations on freedom and choice are always made in the person’s best interests, but the manager must improve these arrangements to ensure any agree restrictions are fully documented and reviewed on a regular basis (e.g. Locking the kitchen door at certain times of the day). All the uncovered radiators in the home must be reassessed for the risk they present all the new people who have been recently moved into the home. This will ensure the safety of the people using the service. All new members of staff must participate in a fire drill and sufficient numbers of staff who provide personal care in the home must receive infection control training. The manager must undertake training to up date her knowledge and skills regarding the provider’s new arrangements for safeguarding the finances of people who use the service. 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. Brickfield Road (39) DS0000028229.V339042.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 Brickfield Road (39) DS0000028229.V339042.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, 3, 4 & 5 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s needs are fully assessed prior to admission so the individual, their representatives, and the home can be sure the placement is appropriate. The homes current arrangements for charging service users for the facilities and services provided are not particularly transparent and will need to improved to enable people to make more informed decisions about whether or not they are getting value for money. EVIDENCE: “I’m quite pleased with the home” and “I’m happy here” were typical comments made by some of the people who had recently moved into the home. In completed surveys, 100 of the people who use the service said they were asked if they wanted to move into Brickfield Road and that they had received enough information about the home in order to decide if it was the right place for them. One person said their relative had come with them to look at the home and “was happy with what they saw”. Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 10 Documentary evidence produced on request showed that the needs, strengths, and wishes of all four of the people who had recently moved in together, having transferred from another CMG home, had been thoroughly assessed by the homes manager before anyone was admitted. Having examined the admissions process for two of these individuals, case tracking confirmed good practice. The manager demonstrated an extremely good understanding of the importance of assessing whether or not a prospective new service user would be compatible with the others already living in the home. The manager also provided us with two excellent examples of occasions when she felt it had been necessary to decline referrals on the grounds that they would have a destabilising affect on the home because they were not ‘compatible’ with the existing service user group. The manager told us in order to assess the compatibility with the other service user already living in the home she had visited all the new referrals in their former home and had made sure they each had the opportunity to visit Brickfield Road to meet the other service users and staff. The two files being case tracked revealed these individuals had visited the home with their relatives and professional representatives on two separate occasions to have a meal and in one instance stay over night. The manager has exceeded National Minimum Standards by producing a detailed report of the outcome of these introductory visits, in addition to obtaining copies of the new referrals care management assessments from the relevant funding authorities. As previously mentioned in this report written admission documentation was excellent and included a copy of the care management assessment. Initial assessments undertaken by the home were sufficiently detailed to enable staff to meet the personal, social, and health care needs of all new service users. In addition to this all the new placements are continually reviewed on a weekly basis until the formal ‘trial’ period of residency is carried out involving the service user, their relatives and care manager, a practice that exceeds National Minimum Standards regarding admissions. The manager told us when someone comes to live at the home, they are provided with a contract. However, only one contract could be produced on request for the two individuals who care was being case tracked. The document also lacked detailed information about what service users, their representatives could expect to be charged for facilities, and services offered including so called ‘extra’ services that are not covered by the basic cost of each placement. Each person placed at the home must have an up to date and costed contract that sets out his or her terms and conditions of occupancy. Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 11 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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans reflect what is important to the individual, their capabilities, and what support they need to achieve their personal aspirations. The people who use the service are encouraged to participate in the day-today running of the home and consulted about important decisions that affect their lives. In the main people who use the service are protected by the homes arrangements for assessing and management risk which promotes their independence and choice. EVIDENCE: We looked at the care plans for three people living at the home. The plans were person centred and tended to ‘celebrate’ an individuals life experiences, as well as setting out clearly how their current personal, social, and health care Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 12 requirements and wishes were to be met through positive interventions. One relatively new member of staff told us the care plan format used in the home was a good working tool that enabled them to deliver the support required by the people using the service. The plans viewed also contained a lot of individualised information to help staff deliver person centred care. Many actions recorded were very specific. For example when looking at personal care needs, one care plan stated what time this particular individual preferred to have a bath, and the gender of staff required to provide their personal care. One member of staff met was able to describe the care plan for the person they keyworked whose care we were case tracking. This knowledge means that service users can be confident that they will get support from people who understand their care needs. As previously mentioned in this report the manager was fully aware of the importance of capturing good information about people before they move in. Care plans viewed were clearly generated from information obtained during the admissions process, and included detailed information about peoples backgrounds and life histories. The manager told us new plans for all four of the people who had recently moved in would be in placed by 2008. Progress on this matter will be assessed at the homes next inspection. The home ensures that people who use the service are consulted on a regular basis to gather information about what they ‘want’. Minutes of service user meetings revealed that are held on a monthly basis and are well attended by people using the service. In completed surveys, 75 of the people who use the service said carers ‘usually’ listened and acted upon what you said, while the rest said ‘sometimes’. No one said carers never listened to them. It was positively noted that feedback about what action has been taken to deal with points agreed at the previous meeting are always discussed at the beginning of next meeting. One person who uses the service told us they “liked attending these meetings”; while another said “they were useful”. The two care plans being case tracked included comprehensive risk assessments. The manager told us he had a positive approach to addressing safety issues. Risk management strategies sampled at random had clearly been developed in the context of supporting people who used the service to take ‘responsible’ risks as part of structured programme to promote their independent living skills and life choices. One member of staff spoken with at length demonstrated a good understanding of the homes dealing with challenging behaviour policy and was very clear what they should do when confronted with such incidents, both at the home and in the wider community. Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 13 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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A good range of activities within the home and community mean the service users have various opportunities to participate in stimulating and motivating activities. People who use the service are actively encouraged to participate in household chores to enable them to maintain and develop their independent living skills. The homes arrangements to enable service users families to continue there involvement in their loved ones lives and are kept informed about all social, leisure and recreational activities they participate in remain satisfactory. Dietary needs and preferences are well catered ensuring the people who use the service are provided with daily variation, choice, and nutritionally wellbalanced meals. Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 14 EVIDENCE: Several carers spoken with about activities told us they routinely supported people who used the service to participate in a wide variety of social and leisure activities of their choice and were very clear that this was an important part of their role. We saw a number of instances over the course of this inspection where people who used the service were being actively encouraged by staff to get ready to attend sessions at various day centres, or go shopping. Staff also seemed to have time to talk and interact with the service users. It was positively noted that staff roles, shift patterns, weekly activity schedules and care plans all take the social needs and wishes of the individual into account (i.e. person centred) and are not just ‘task’ based. Records also revealed service users lead very active and fulfilling lives. Typical comments from people living at the home included “I can usually do what I want most of the time” and “I go out a lot”. Staff spoken with demonstrated a good knowledge about what person centred care was and told us they received sufficient support from the manager to implement this approach. A member of staff who had a lot of experience working in other CMG homes told us “the manager at Brickfield Road was very good at encouraging people who lived at the home to maintain their community links by supporting them to shop and go out locally”. Care plans inspected contained detailed programmes designed to encourage people who used the service to maintain and develop their independent living skills. One person who used the service was observed loading the dishwasher during this visit while another individual told us they were responsible for setting the dinning room table each day ready for main meals. The manager told us the home continues to operate an open visitors policy without restrictions. One person who uses the service told us they were planning to visit their relative that evening to watch the football. This individual’s daily diary notes revealed this was a regular occurrence and that they are actively encouraged to maintain their independent living skills and travel on public transport without staff support. The manager told us that since the smoking ban came into force in England the home no longer has a specific area for smoking. The manager is aware that smoking rooms are still permitted in residential care homes providing certain conditions are met. As at least one person who lives at the home still smokes it was agreed that the possibility of reinstating the smoking room or having a covered area in the garden for this purpose should be discussed at the homes next service user meeting. The outcome of this discussion will be assessed at the homes next inspection. Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 15 During the course of this inspection it was noted that the kitchen door remained unlocked although the manager told us this area is restricted to people who use the service from time to time to prevent food stocks being ‘pilfered’. An assessment detailing a management strategy to minimise this identified risk needs to be drawn up and alternative ways to deal with this matter considered with the people who use the service rather than just imposing this limitation on their freedom of movement/access. Main meals displayed on weekly menus were varied and nutritionally well balanced. One person spoken with told us the “meals were alright” and that there favourite food of ice cream was often served. During lunch it was noted that three people who were at home at that time choose three different fillings for their sandwiches, including cheese, ham and tuna. Staff on duty told us people who use the service are actively encouraged to help plan the forth-coming weeks menu every Sunday. Detailed records of all the food eaten by service users is maintained by staff to help them monitor diets. These records also revealed people who use the service have the option of choosing alternative meals if they do not ‘fancy’ the one published on the menu on any given day. The manager told us she is very keen for main mealtimes, especially in the evenings and at weekends, to be positive social occasions that enable all the people who live at the home to sit down together and interact with one another and staff on duty at the time. Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitably robust arrangements are in place to ensure the people who use the service receive personal support in the way they prefer and require, and that their unique physical and emotional health care needs are continually recognised and met. Policies and procedures for handling medication are sufficiently robust to keep the people who use the service safe. EVIDENCE: All the people using the service met at various times throughout the course of this inspection were appropriately dressed for the season in well-maintained clothes. As previously mentioned in this report the daily notes kept by staff contained good quality and very useful information regarding every aspect of service users lives, including peoples unique health care needs. These records showed Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 17 that two people who had recently been admitted to the home had both seen a GP and chiropodist since moving in. One member of staff spoken with demonstrated a good understanding of the personal and health care needs of the individual they had been assigned to keywork. One member of staff told us they thought the relatively new health care action plans were an excellent tool for tracking the outcome of appointments service users had with various health care professionals. Staff maintain detailed records of all the accidents and significant incidents involving the people who use the service. These records showed that there had been only one major accident and one significant incident in the past six months, which had both been appropriately dealt with by staff on duty at the time. None of the service users have been admitted to hospital in 2007. Both these events were reported to the Commission in a timely fashion without delay. The home has policies in place for handling medication. The manager was very clear what constituted good practice in this area and there was documentary evidence to show that staff administer medication to people living at the home safely. No recording errors were noted on medication administration (MAR) sheets sampled at random. These records reflected current medication stocks held by the home on service users behalves, which were securely stored in a locked metal cabinet in the office. The manager told us ‘as required’ (PRN) medication is currently held by the home on a service users behalf and that there are clear protocols for its use. Staff spoken with were clear when and how this type of medication should be administered, and who must authorise its use. Staff were also aware that psychotropic PRN medication should only be used as a last resort when dealing with behaviours that challenge the service when all other de-escalation techniques have failed. Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes complaints and adult protection protocols and sufficiently robust and understood by staff to ensure service users feel safe and listened to. EVIDENCE: Records are kept of any concerns or complaints received and we saw these were well maintained. The manager confirmed two formal complaints had been made about the homes operation since it was last inspected. Records showed the providers had investigated these complaints and had responded to the complainant within 28 days regarding their findings. One of these complaints was later withdrawn, and the other partially substantiated. In completed surveys, 100 of the people who use the service said that they knew who to speak to if they were not happy with anything at the home, and how to make a complaint. One person said “I talk to my keyworker if I am worried about something”. The homes complaints procedure is conspicuously displayed in the home and is part of the guide for the people living there. The procedure is also available in an easy to read format. Documentary evidence was produced on request to show that all the homes care staff have received mandatory training that teaches them how to recognise, prevent, and report abuse as and when required. One allegation of abuse has been made within the home since it was last inspected and this was Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 19 referred to the local authorities safeguarding adult’s team. The incident was appropriately documented and dealt with by staff on duty at the time. Specific management guidelines have been developed to minimise the risk of a similar incidents reoccurring. Staff spoken with demonstrated a good understanding of how to deescalate and deal with such incidents. Records confirmed that there have been no more incidents of aggression involving this individual or use of physical intervention techniques in the home to deal with challenging behaviour. The home keeps a record of all the financial transactions taken on behalf of the people using the service, which matched the balance individually stored for them. The storage facility is secure, receipts are kept of all goods, and services purchased on service users behalves. Monthly visits carried out by the homes Regional Operations Manager showed all the monies looked after by the home on service users behalves is routinely audited. Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 20 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, 26, 27, 28 & 30 People who use the 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 condition of the décor, fixtures, and fittings in this care home means the people who use the service live in a relatively homely and comfortable environment. Overall the homes arrangements for controlling infection are sufficiently robust to ensure the people who use the service are kept safe, although more staff need to refresh their infection control training. EVIDENCE: We saw that the home generally provides a pleasant, comfortable, and wellmaintained place for people to live. All the furnishings and fittings are of relatively good quality and domestic in appearance. Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 21 We are aware that based on individually assessed risk it was deemed unnecessary to cover all the homes radiators in the past. However, with so many new service users admitted in the past six months the home will need to review the risk uncovered radiators present all the new people who now live at Brickfield Road. One person who uses the service told us they were “pleased with their new bedroom.” The two bedrooms viewed were adequately furnished and personalised with a wide variety of the individual service users possessions, including ornaments, electrical home entertainment equipment, pictures, and photographs. One bedroom contained a fridge, which the person who occupied this room said was very handy for keeping their food fresh. The temperature of hot water emanating from the bath and shower facility was found to be a safe 42 degrees Celsius when tested between 15.40 and 15.50. Staff appropriately maintain a record of all the hot water temperatures emanating from the homes water outlets on a weekly basis. The manager told us all the homes baths and showers facilities have been fitted with fail-safe thermostatic mixer valves that prevent hot water temperatures exceeding a safe 43 degrees Celsius. During a tour of the premises it was noted that the home looked very clean and tidy throughout. Since the homes last inspection new flooring has been fitted in the kitchen. As required in the homes last inspection report the faulty washing machine has been replaced with a new model that is capable of washing soiled laundry at appropriate temperatures in line with good infection control standards. Staff met demonstrated a good understanding of the homes arrangements for disposing of clinical waste and how to appropriately control infection in the home, although documentary evidence revealed that insufficient numbers of staff have refreshed their training in this important area of practice. Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, sufficient numbers of very experienced and competent staff are employed on a daily basis to support the needs, activities, and aspirations of the people who live at the home. The homes recruitment procedures are sufficiently robust to minimise the risk of service users being harmed by people who are ‘unfit’ to work with vulnerable adults. EVIDENCE: We saw that staff were caring and that they always spoke to the people using the service in a polite and respectful manner. Care staff we spoke with demonstrated that they saw meeting the social and emotional care needs of the people who used the service as an important part of their role as carers. Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 23 In surveys completed by the people who use the service, a third said staff always treated them well, while the rest said either usually or sometimes. No one said staff never treated them well. Typical comments made by the people who use the service during the visit, included “staff are very nice here”, “they help me make tea”, and “staff are alright most of the time”. On arrival it was noted that sufficient numbers of support staff, which included the homes acting and deputy managers, were all on duty. This number matched the duty roster for that day and was adequate to meet the assessed needs of all the people currently residing at the home. At night the home continues to employ two waking night staff. In the past 16 months the home has experienced an usually high turnover of staff, although we accept the managers comments that this can be directly linked to the high number of people who used the service leaving in this period. It was also positively noted that a number of staff who previously worked at the care home all four of the new admissions used to live at transferred over with them to make the move as smooth as reasonably practicable. The staff files for three of the homes most recent recruits were selected at random to inspect in more depth. Each of these files contained a job application form stating their full employment history; two written references; an up to date Criminal Records Bureau and Protection of Vulnerable Adults checks; statement of health; photographic proof of their identity; Home Office approved work permits/visas (where applicable); and any disciplinary action being taken against them. Staff spoken with told us they had all received a thorough induction before being allowed to commence working at the home and contained to be supervised at regular intervals. Documentary evidence was produced on request to show the induction process is linked to Skills for care and covered safe working practices, worker role, and the needs of the people using the service. It was positively noted that anyone failing to successfully pass his or her probationary period of employment would be required to complete another six months. Staff have access to a very good programme of training. The manager has completed a thorough assessment of her relatively new staff teams strengths and training needs. Documentary evidence was provided on request to show that sufficient numbers of staff had received up to date training in fire safety, manual handling, first aid, food hygiene, and Dignified management of conflict training. One member of staff spoken with at length was very clear what action they would need to take in the event of the fire alarm being sounded. This member of staff was also very clear about their roles as a support worker and knew what was expected of them. Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 24 Since the homes last inspection it was positively noted that over two thirds of the current staff team have either already achieved an NVQ Level 2 or above in care or are enrolled on a suitable course, which the manager told us three more staff hope to have completed by the end of 2008. Progress made on this matter will be assessed at the homes next inspection. Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 25 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, 38, 39 & 42 People who use the 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 have confidence in the care home because a suitably competent management team runs it. People know that their opinions are central to how the home develops and reviews their practice because there are good quality assurance systems in place. Overall, the homes fire safety arrangements are sufficiently robust to keep the people who use the service, their guests, and staff safe (so far as reasonably practicable), although all new staff who have yet to participate in a fire drill need to do so as a matter of urgency. Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 26 EVIDENCE: The acting manager was able to describe a clear vision for the home as well as sound understanding and application of ‘best practice’. Skills the manager has include strong leadership of staff and being responsive to the needs of the people who use the service. Typical comments from staff about the manager included “very approachable”, “ always supportive”, and “very service user focused”. The manager is still not registered with the Commission or suitably qualified to run a residential care home for adults with learning disabilities. However, Pat McGarry was able to produce documentary evidence on request to show she has now enrolled on a suitable NVQ level 4 courses. Furthermore, the Commission has now received her manager’s application form and a date set for a ‘fit’ person interview to take place. The manager ensures her staff team follow the homes financial policies and procedures, although she has yet to attend CMG’s new managing service users monies training. In light of recent problems experienced by the provider regarding the handling of service users finances it is essential the manager receive this training. The people who use the service must be able to trust the home implicitly in the handling of their money. The homes relatively new deputy manager also demonstrated she had considerable knowledge and experience of helping to run a care service for adults with learning disabilities. The homes manager and deputy work well as a team. The deputy manager told us she is very keen to enrol on an NVQ Level 4 course in management in order to improve her knowledge and skills. Progress made on this matter will be assessed at the homes next inspection. Minutes of staff meetings revealed that seven had been held since the beginning of the year, which exceeds National Minimum Standards regarding their frequency (i.e. At least six a year). These meetings were always well attended by staff and covered a wide variety of topics, including the needs of the new service users, any compatibility issues with the existing group of residents, and worker roles and responsibilities. As previously mentioned in this report there are also regular meetings for people living at the home and we also saw lots of examples of staff taking their time to answer individuals questions. A formal quality management system is operated at the home to regularly look at all areas of the service. The home continues to seek the views of service users, their relatives, and professional representatives about the standard of care provided at the home through the use of surveys. The results of completed surveys are then published in an annual report, which is made available to any interested parties, including the Commission, on request. Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 27 The homes Regional Manager continues to visit the service at least once a month to carry out ‘spot’ checks and the subsequent reports regarding his findings are kept in the home as required. In addition to these visits the providers have introduced quarterly visits that are carried out by members of their quality assurance team. A copy of the homes latest internal quality assurance report was not requested on this occasion, but the manager told us these reports are proving useful tools for continually improving and development the service. A comprehensive fire risk assessment of the building was undertaken in May 2007 and was made available on request. The homes fire records revealed that the fire alarm system is tested on a weekly basis and fire drills are undertaken at least once a quarter in line with good fire safety guidance. However, the record of fire drills showed that only one new member of staff had participated in a fire drill since commencing their employment at the home. The manager was reminded that all staff should participate in at least one fire drill every six months. Fire doors tested at random all closed flush into their frames when released. Up to date Certificates of worthiness were made available on request to show that suitably qualified engineers had checked the homes electrical wiring, fire alarms, fire extinguishers, and water tank for legionella. During a tour of the kitchen it was noted that all items of food were correctly stored in line with basic food hygiene standards. A set of multi-coloured chopping boards was also found for the safe preparation of food. The home monitors and records the temperatures of fridges and freezers. COSHH products are securely locked away out of harms reach. Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 28 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 4 3 3 4 4 5 2 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 2 25 X 26 3 27 3 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 4 3 X X 2 X Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 29 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5(1)(ba), (bb), (bc) & (c) Requirement All the people using the service must be supplied with an up to date and signed contract that sets out their terms and conditions of occupancy, which includes details about the fees payable for services provided, and arrangements for the payment of such fees. This will ensure people who use the service are clear about what facilities and services they can expect to receive and how much they will be charged for them. Timescale for action 01/01/08 2. YA16 12(2) (3) & 17(1)(a), Sch 3.3(q) The practice of restricting when 01/01/08 people who use the service can access the kitchen must be reviewed and alternative arrangements considered. The views of all the people who use the service and their professional representatives must also be sought. Any professionally agreed restrictions placed on service users freedom of movement must be included in care plans. Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 30 3. YA24 13(4) Radiators in the home must be assessed for the risk they present the people who use the service and include the action to be taken to minimise any identified risk. This will ensure the safety of the people using the service. Up to date infection control training must be given to all those people who work at the care home. This will ensure the safety of the people who use the service. The manager must undertake training to up date her knowledge and skills regarding the providers new checks and balances for managing service users monies. All new staff who commence working at the home must be involved in a fire drill as soon as reasonably practicable (we recommended within the first three months of their employment). This will ensure the safety of the people using the service. 01/01/08 4. YA30 13(3) & 18(1) 01/03/08 5. YA37 9(2)(b)(i) 01/02/08 6. YA42 23(4)(e) 01/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Brickfield Road (39) DS0000028229.V339042.R01.S.doc Version 5.2 Page 32 - 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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