Care Home: Brightlands

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What the care home does well The people living at the home enjoy busy and interesting lifestyles. They are supported to take part in the activities they enjoy and to develop their own skills and abilities. A very full programme of activities is regularly organised in the home and outside in the community. There is a good assessment process in place for people who want to move to the home. If a person wants to move to Brightlands, someone from the home visits them and talks to people who are important to them such as family and other health and social care professionals. The home writes a report called and assessment which includes a lot of important information about the person`s needs. The home uses this information to decide if they can care for this person`s needs. There are clear care plans in place which give good information to staff about how to support the people who live in the home. The home has recognised that not all plans have been written from the service users` point of view. It is now taking action to make sure that everyone who lives at the home has a care plan that is person centered. People are supported to be as independent as possible. They are supported to go shopping and help with household tasks such as washing, cooking and washing up. The people in the home enjoy the meals provided and there is a lot of choice. The menus contain a lot of information about people`s dietary needs. What has improved since the last inspection? Reports from the home owners are now available to the management team. This means that everyone knows what the aims and objectives of the home are and how to work towards them. Peoples` individual choice and diversity are better addressed. If people do not want to take part in an activity their decision not to is respected. One member of staff commented, "It was like a boarding school. It is more relaxed and there are more choices now". Assessments of risk are general rather than specific to the individual person`s needs. The home has identified this shortfall and is now taking action in the person centred planning process to make sure that everyone is treated as an individual. What the care home could do better: The home recognises that there are gaps in staff training programme in the home. However, it has not identified all the specific areas where training is needed. Nor has it taken any action to address these gaps by booking training in these areas which are essential for all people who work in a care home. The home has stated in the information that it gives to potential service users it can care for the needs of people with a sensory impairment or autism. However, the staff team have not had any specific training in these areas and therefore it cannot be certain that they are competent to do so. There are major shortfalls in the processes that the home uses to recruit new members of staff. Sufficient checks are not carried out to make sure that everyone working in the home is safe to do so. The systems in the home to check that peoples medicines are administered correctly do not always work. This means that it cannot be certain that people always receive their medicine as prescribed by their GP. Key inspection report Care homes for adults (18-65 years) Name: Address: Brightlands 77 Main Road Hoo Nr Rochester Kent ME3 9AE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Nicki Dawson     Date: 1 8 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Brightlands 77 Main Road Hoo Nr Rochester Kent ME3 9AE 01634250592 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Clearwater Care (Hackney) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accomodated is 13. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disabilities (LD) Date of last inspection Brief description of the care home Brightlands is a residential care home providing accommodation and support for up to thirteen adults with a learning disability. The house is a large detached property providing bedroom accommodation over three floors. All bedrooms are for single occupancy so that no one has to share. Some people with a physical disability can be accommodated and there is equipment in place to help with their mobility needs. The home has their own transport that can accommodate wheelchair users. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 13 Brief description of the care home The home is conveniently situated for local shops, library, churches, post office, pubs and a sports complex. It has easy access to the Medway Towns. A wide range of activities are provided at home and in the community. The service also runs a seperate day care service for people with disabilities which some of the people that live at Brightlands attend. In the last few months there have been changes to the person who manages the home on a day to day basis and in the ownership of the care home. The deputy manager is managing the home on a temporary basis until the person appointed to manage the home takes up their position at the home in December. The company that owns the home, Clear Water Care (Hackney) is under a new management team. The current fees charged for this service range from £695.45 to £1342.99 per week depending on peoples individual needs. The last key unannounced inspection to the home was on 31st January 2008. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was unannounced, which means that the service users and staff did not know that the inspector was calling at the home. Key unannounced inspections are aimed at making sure that the individual service is meeting the National Minimum Standards and that the outcomes for people using the service promote their best interests. The inspection started at 9.50am and 8 hours. Five people who use the service, five care staff, the deputy manager and administrator were involved in the inspection to gain their views and knowledge of the level of care, provided by the service. The main areas of the home including and some peoples bedrooms were entered, with their permission. A number of records to do with service users care and safety were looked at. It is now a legal requirement for services to complete and return an annual quality Care Homes for Adults (18-65 years) Page 6 of 34 assurance assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. The service returned their AQAA to us within the timescale requested and it contains all the information that we asked for. Survey questionnaires, Have Your Say About, were sent by us to the home before the inspection visit. These comment cards are useful in gaining the views of the people who live and work in the home about the quality of care that is provided by the service. Ten comment cards were sent to people who live in the home and eight completed forms were returned. Five of the ten staff questionnaires were returned. Everyone who responded was positive about the level of care provided by the home. There have been two changes to the service in the last three months. Firstly, there is a new person responsible for the day to day running of the home. This person, the deputy manager, is managing the home on a temporary basis until a permanent manager is appointed. Secondly, the company, Clear Water Care that owns the home, is under new management structure. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The home recognises that there are gaps in staff training programme in the home. However, it has not identified all the specific areas where training is needed. Nor has it taken any action to address these gaps by booking training in these areas which are essential for all people who work in a care home. The home has stated in the information that it gives to potential service users it can care for the needs of people with a sensory impairment or autism. However, the staff team have not had any specific training in these areas and therefore it cannot be certain that they are competent to do so. Care Homes for Adults (18-65 years) Page 8 of 34 There are major shortfalls in the processes that the home uses to recruit new members of staff. Sufficient checks are not carried out to make sure that everyone working in the home is safe to do so. The systems in the home to check that peoples medicines are administered correctly do not always work. This means that it cannot be certain that people always receive their medicine as prescribed by their GP. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving to Brightlands are given the information they need, in a way that they understand, so that they can decide if Brightlands is the right place for them to live. Peoples needs are fully assessed before they move into the home so that they can be sure that they will receive the right type of care. For people to be assured that their assessed needs can be met, a specialist training programme for the whole staff team needs to be further developed. Evidence: All care homes are required to give details about the service that they provide. This is to help people decide if a particular care home is somewhere that they would like to live. The aims and objectives of the home are set out in the document called, The Statement of Purpose. It clearly identifies that Brightlands provides two separate services; a residential care home and a day centre. The role of the commission is solely to look at the outcomes of people who live in Brightlands, the residential care Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: home. The Statement of Purpose needs to regularly reviewed, to make sure that it contains the most up to date information. Currently it does not contain the correct information about who is in day to day charge of the home. The Service User Guide contains details of the services and facilities that are available to the people living in the home. The information in this guide is written in a number of different formats, including the use of pictures, so that it is appropriate for each persons needs. Before new service users are admitted to the home a full needs assessment should be carried out to decide whether or not the home is a suitable place for the person to live. There have been no new people moving into the care home since the last time the home was visited, but new people have attended the day centre. The deputy manager said that the process of assessing someone for the day centre is the same as for admitting someone to the care home. Therefore, one assessment of a day services client and three assessments of people currently living in the care home were looked at in order to assess the suitability of the homes assessment process. It was found that pprospective service users have a full assessment of their needs in which they are fully involved before they are offered a place at the service. This information is used to start the development of an individual plan of care. If the person is funded by the local social services or health authority then a copy of this assessment is also obtained. The Statement of Purpose identifies that the aim of the home is to support people a learning disability with a number of additional disabilities. These are listed in the document as; physical disability, behavioural difficulties, autism and a sensory impairment. However, evidence was found that the home has not identified the need for specialist staff training in all these areas. The staff training matrix shows that all staff have received training in how to move and handle people safely and that three quarters of the staff team have received training or that training is booked in how to support people with behaviours that challenge. The need for staff to be trained in supporting someone with a sensory impairment has not been identified; and although the need for staff training in the area of autism has been identified, there is no evidence that any training has been planed in this specialist area. Therefore, it cannot be certain that the home can meet all the needs of people in its care. In addition a number of people in the service have epilepsy. Evidence was seen that training in supporting a person with epilepsy has been booked for the whole staff team. Statutory requirements have been made with regards to this shortfall. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home benefit from having a plan of care that gives clear guidance to staff as to how to meet their assessed needs. The home is working towards everyone having a care plan that is truly person centred. People are supported to take assessed risks as part of an independent lifestyle and to make decisions in their lives wherever possible. The home has identified some shortfalls in its risk assessment process and is taking steps to address these. Evidence: Each service user should have an individual plan of care that clearly sets out their health, personal and social care needs, together with the staff support that is required to meet these assessed needs. Four care plans were looked at including the plan of the most recent person using the service. It was found that all care plans are comprehensive and identify each persons individual needs and goals. The only exception was one care plan which referred to a behavioural plan to support the needs of one service user, which could not be found. However, staff were able to clearly Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: state how they support this person on a day to day basis. The deputy manager said that the home intends to make plans more person centred. This involves putting the service user in the driving seat and seeing things from their own point of view. Evidence was seen that person centred planning has started for new people who use the service. One such plan contains a risk and life profile which clearly identifies the most important things staff need to know about how to support this person. The plan is written from the service users their point of view. For example, I can go to the toilet by myself, but may need help with my trousers. Staff who were spoken with during the inspection said that care plans are available to them on a daily basis. Four staff who were surveyed said that they are always given up to date information about the needs of people in their care and one person said that they usually are. All care plans should have written plans in place to minimise the effect of any potential risks. For example, moving and handling assessments for people who use equipment are in place. Evidence was seen that the home has identified through its own self assessment process that some assessments of risk are general rather than specific. Evidence was found to confirm this during the inspection. For example, everyone has the same risk assessment in place for undertaking activities in the community, which does not take into consideration peoples individual needs and diversity. It is important that people who live at the home are able to make decisions and choices in their daily lives. The deputy manager said that they have recently undertaken a piece of work to make sure that everyone who lives in the home has chosen the activities that they take part in daily. This was confirmed by one person who lives in the home who said, I dont go ice skating (anymore). I dont like ice skating. Where monies are kept on behalf of people who live in the home, evidence was seen that they are well organised to ensure that monies are spent in the best interests of each individual service user. Evidence was seen that people who live in the home are regularly consulted about life in the home. A service user meeting was held last week and the notes from the meeting are presented in symbol format so that they can be understood more easily for some of the people who live in the home. When people that live in the home were surveyed about whether they can make decisions about what they do each day, seven people said that they always can and one person replied that they sometimes can. Care Homes for Adults (18-65 years) Page 14 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to take part in activities that they enjoy and which meet their needs. People have numerous opportunities for personal development and are well supported to maintain contact with their family and friends. People have their rights promoted and respected and are also aware of their individual responsibilities and are supported to meet these. People are offered a healthy nutritious diet and enjoy their meals. Evidence: The people who live at Brightlands enjoy busy lifestyles that reflect their interests. There is an excellent programme of activities in place that has been designed with Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: service users involvement. The staff rota and daily notes show that these activities include bus rides, foot spa, hydrotherapy, swimming, shopping, bowling, cooking, train rides, arts crafts, horse riding, going to the library, walking, music and trampolining. On the day of the inspection some people were at home cooking chocolate cakes for lunch. In the afternoon some people went swimming and others trampolining. One person who lives in the home said, I like horse riding. When asked if they go horse riding, the person replied, Yes, I do. In the AQAA (annual quality assurance assessment) the home told us that three people who live at the home are doing arts and crafts at a college of their choice and that four people are taking part in a DIY course. On the day of the inspection some service users proudly showed the Christmas pictures and candles that they had recently made that are on display in the conservatory. As well as enjoying busy lives, the home acknowledges in the AQAA that some people choose not to engage in all the activities on offer. They need time to relax watching television and to spend time on their own. This shows that the home is aware of peoples individual needs and diversity. People who completed surveys all said that they can do what they want to do during the day, evening and weekend. A relative who completed part of a survey commented, Could be less repetitive and more adventurous in activities. The home provided evidence that they support people to maintain good links with family. The deputy manager stated that they have recently been involved in supporting one person to go home for Christmas, who has not visited their family home for many years. She spoke of the delight experienced by the service user and their family member when the visit was successfully arranged. During the inspection it was observed that peoples right to privacy within the home is respected. When some service users were showing the inspector around their home, a member of staff reminded them not to talk about other peoples personal affairs. It was noted at the last inspection that people have each been offered a key to lock their room. Staff spoke with service users in a personal and dignified way throughout the inspection. The inspector joined some service users for lunch. It was observed that people who need help to eat are supported discretely. People who can take on more responsibilities are encouraged to do so such as clearing the table and doing the washing up. A seasonal menu has been planned which ensures that there are always choices at mealtimes. The menu planner contains dietary and nutritional information, Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: recipes and a picture of each meal so that people can see what they are cooking and what they are choosing to eat. All this information helps people make healthy and informed dietary choices. Care Homes for Adults (18-65 years) Page 17 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal care and preferences are identified in their care plans. For example, one care plan contains a persons whole morning routine. Let X know you are going to rinse his hair. X can undress himself completely. Peoples health needs are clearly identified together with directions for staff to follow to ensure that they are met. Staff record and monitor peoples health care appointments via a computer system, which alerts them when an appointment is due. Each person who lives in the home has been allocated a key worker who is responsible for monitoring their health care needs and making sure that ongoing medical advice is sought as needed. The home uses a pre-dispensed system for administration of medicines. This system is used to reduce the risk of people receiving incorrect doses or incorrect medication. The person that is giving out the medicine records on a pre printed form the medicine has been given or, if it hasnt been given, the reason why. On examination of this record it was found that there were a number of gaps in recording medicine so that it was not clear if the person had received their medication. None of the medication for this month had been signed in. Evidence suggests that the omission was for this month only and that this information is usually recorded correctly. Without this Care Homes for Adults (18-65 years) Page 18 of 34 Judgement: information an audit trail cannot be kept of all medicines that come into and leave the home. The deputy manager said that the management of medicines in the home is audited monthly. It is recommended that the frequency is increased to ensure safe practice in the home. Evidence was seen that only people who have been formally trained in the safe administration of medication are responsible for giving out medicines in the home. No evidence could be found that these peoples competency in administering medication is assessed on a regular basis. It is required that such a system is put into practice immediately to minimise the risk of any medication errors being made. Evidence: Peoples personal care and preferences are identified in their care plans. For example, one care plan contains a persons whole morning routine. Let X know you are going to rinse his hair. X can undress himself completely. Peoples health needs are clearly identified together with directions for staff to follow to ensure that they are met. Staff record and monitor peoples health care appointments via a computer system, which alerts them when an appointment is due. Each person who lives in the home has been allocated a key worker who is responsible for monitoring their health care needs and making sure that ongoing medical advice is sought as needed. The home uses a pre-dispensed system for administration of medicines. This system is used to reduce the risk of people receiving incorrect doses or incorrect medication. The person that is giving out the medicine records on a pre printed form the medicine has been given or, if it hasnt been given, the reason why. On examination of this record it was found that there were a number of gaps in recording medicine so that it was not clear if the person had received their medication. None of the medication for this month had been signed in. Evidence suggests that the omission was for this month only and that this information is usually recorded correctly. Without this information an audit trail cannot be kept of all medicines that come into and leave the home. The deputy manager said that the management of medicines in the home is audited monthly. It is recommended that the frequency is increased to ensure safe practice in the home. Evidence was seen that only people who have been formally trained in the safe administration of medication are responsible for giving out medicines in the home. No Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: evidence could be found that these peoples competency in administering medication is assessed on a regular basis. It is required that such a system is put into practice immediately to minimise the risk of any medication errors being made. Care Homes for Adults (18-65 years) Page 20 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home have access to a clear complaints procedure that they or their representative know how to use. Staff feel confident to speak out and take action to protect service users, if they have any concerns about their care. Evidence: Details of how people living at the home or their relatives can make a compliant about the service are available at the home. The procedure is available in a number of different formats to help people to understand what they need to do if they want to make a complaint. Service users who were surveyed all said that they know who to speak to if they are unhappy. Staff who were surveyed all said that they know what to do if someone has a concern about the home. The home has a complaints log where any complaints that are made about the service are recorded together with the outcome. On looking at this log it was noted that a record had not been made of how one complaint that was made had been resolved to the satisfaction of the complainant. The home administrator was able to provide this information and it is required that the outcome of any complaint is recorded in full in future. Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: The commission has received one complaint about the service in the last year which was referred to the local authority. The home is currently subject to two safeguarding vulnerable adults investigations. The staff training matrix evidences that three quarters of the staff team have received formal training in how to protect vulnerable adults. Staff who were spoken to during the inspection demonstrated that they would stop any potential abuse taking place and knew how to report it to a more senior member of staff. Care Homes for Adults (18-65 years) Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a safe, clean and comfortable environment that is well maintained. Evidence: Some of the people that live at Brightlands gave the inspector a tour of their home. On the ground floor there is a lounge with a large screen TV, piano and comfortable seating. People who live in the home also have the use of a conservatory which is used as an arts and craft area and a separate dining room. Two bedrooms were entered with the agreement of the people to whom they belong. These bedrooms contained peoples personal belongings and interests and were very spacious. At the last inspection it was recommended that the home audit each persons bedroom contents against National Minimum Standard number twenty six, as not all bedrooms contained lockable storage. There was no evidence that this has been done and it was also observed that not all people are offered two comfortable chairs. All the bedrooms apart from two have ensutie facilities. Equipment has been provided to help with personal care where it has been assessed as required for individuals. Tracked ceiling hoists are fitted for those with identified Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: needs. The home can also provide portable tracking and hoists if required. Other equipment such as shower chairs and toilet frames are all in situ where needed. On the day of the inspection it was found that the home was clean. There is a very well equipped laundry room on the ground floor. It is locked to ensure peoples safety. A service user said that they bring their laundry down to the room with a member of staff who supports them to wash their clothes. The staff training matrix does not identify the need to train staff in how to minimise the spread of infection in the home. Information about the number of staff who have received formal training in infection control was omitted from the AQAA (annual quality assurance assessment). It is required that the home ensures that it is doing all that it can to minimise the spread of any infection in the home. Care Homes for Adults (18-65 years) Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service benefit from a staff team that is flexible in its approach. It cannot be certain that peoples assessed needs are met in a satisfactory way until a comprehensive staff training programme is developed. People are not protected by the recruitment practices within the home which potentially put them at risk of harm. Evidence: The staff rota indicates that there are usually six staff to support service users to get up and ready for their daily activities; three to four staff to support service users in the evening until 9pm and then and one waking and one sleeping in staff. During the day the staffing levels vary according to the needs of the people who live in the home. Staff responded that there was always or sometimes enough staff on duty for them to be able to meet service users needs. In addition there other ancillary staff such as a housekeeper, cook and maintenance person. Information provided by the home in the AQAA (annual quality assurance assessment) is that 50 of staff are trained to National Vocational Qualification (NVQ) level 2 or Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: above. This meets the National Minimum Standards. This award is useful because it helps staff develop good care practices and their skills in working with people who live in a residential care home. Staff files were seen for four new members of staff. Although a statement was made in the AQAA that all people who have started work in the home in the last twelve months have had satisfactory employment checks, it was found that three out of the four files contained serious omissions. Only one verbal reference had been obtained for one person and for two people only one written reference had been obtained. This is a breach of the Care Homes Regulations 2001, which states that, The registered person shall not employ a person to work at the care home unless he has obtained two written references, including where applicable, a reference relating to the persons last period of employment, which involved work with children or vulnerable adults, of not less than three months duration. In addition it was found that one person had started working at the home before they had a protection of vulnerable adults check. This is a breach of the Care Homes Regulations 2001, which state that, The registered person shall not employ a person to work at the care home unless he has obtained details of any criminal offences. Statutory requirements are being made concerning these breaches of regulation to ensure that all members of staff working at the home are suitable to care for vulnerable service users. The home is responsible for making sure that care staff have the skills they need to support the people who live in the home. Evidence was seen that all new care staff receive the appropriate introductory training, which gives them the basic competencies they need to be able to work without direct supervision. In addition to the introductory training, care workers undertake a number of training courses that develop their skills in caring for the people that live in the home. Staff training is an area that has been identified on the homes improvement plan as an area where there are shortfalls. As a result some training has recently been booked in behavioural management, epilepsy and protecting vulnerable adults. The staff training matrix identifies that training has been completed or booked for three quarters of the staff team in first aid, fire and adult protection. Only half the staff team have received training in health and safety. Only a few members of staff have had formal training in food hygiene although many of them are responsible for food preparation in the home. As mentioned previously in this report, there is no evidence that training is planned for staff in the areas of minimising infection in the home, or understanding autism or people with a sensory impairment. It is required that the home plan a rolling programme of training to ensure that all staff are formally training in all areas necessary to the roles that they perform. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: The supervision of care staff is important so that they have the opportunity to discuss care practice, the philosophy of the home and their own development needs. Staff files viewed showed that none of the new members of staff had received any formal supervision. Staff who completed a survey and who were spoken to at the inspection said that said that they knew who to go to if they have any concerns about performing their role in the home. It is required that the home develop a formal supervision programme for the whole staff team. Care Homes for Adults (18-65 years) Page 27 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users lifestyles remain excellent despite a number of significant changes in the staff and management team. People who live in the home and their representatives are regularly consulted about their views of the service. For the health, safety and welfare of service users to be promoted at all times, further action needs to be taken to ensure staff recruitment and training protects and meets the needs of everyone living at Brightlands. Evidence: The registered home manager left the service suddenly in August this year. For the last three months the deputy manager has been in day to day charge of the home, supported by a member of staff from Clear Water Care, the company that own Brightlands. The deputy manager said that a new person has been appointed to manage the service and is due to start working at the home next week. Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: The deputy manager demonstrated that she has a clear understanding of the aims and objectives of the home and it is evident that this has been communicated to the staff team. Staff meetings take place for all care staff to help better communication between everyone involved. Information in the AQAA (annual quality assurance assessment) is that about one quarter of the staff team have left the service in the last year. The person who is responsible for visiting the home on behalf of Clear Water Care has identified from one of his regular visits to the home, that a number of senior staff have left the home recently and that the staff team have been working under difficult circumstances. He has recently identified that staff morale continues to improve. Staff who were spoken to confirmed this on the day of the inspection. They said that even though there had been a number of staff changes at senior level, this has not affected the level of care that people who live at Brightlands receive. One member of staff commented, Staff made it easier for them; and another said of the changes, Service users are a lot happier now as it is less regimented. For the home to run in the best interests of the people who live in it, it is important to have a system in place which regularly obtains the views of service users and visitors about the standard of care that they receive from the home. Evidence was seen that survey questionnaires had been returned last year from care staff, relatives, activity centre staff and care managers. The deputy manager said that surveys are currently being sent out for this years quality assurance. She said that once all surveys had been returned she will looks at all the information, take any action necessary to improve the service and write a report summarising what has been done. A new person has been appointed by the company to visit the service on a regular basis. An improvement plan has been drawn up to identify current shortfalls in the service and an action plan has been developed to address these identified shortfalls. This includes the need for all care records to be reviewed for consistency with service user needs and for staff training to be reviewed and a plan put in place to meet any outstanding needs. However, the improvement plan has failed to recognise the shortfalls in the current way medicines are recorded and major shortfalls in the recruitment and selection of staff that puts services users at potential risk of harm. The training plan for staff has also failed to identify the need to train all staff in health and safety, infection control, food hygiene, autism and sensory impairment. Statutory requirements have been made for the home to address these areas. The deputy manager has told us that there are no people living at the home subject to a deprivation of liberty authorisation under the Mental Capacity Act 2005. The deputy manager made a declaration in the AQAA that all items of equipment in Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: use in the home remain in good working order. Certificates were looked at for moving and handling equipment in the home and showed that this equipment is serviced at the correct intervals. Evidence was seen that the home has an action plan in place to include health and safety visual inspections. The records kept of checks that the home makes to ensure that the water people use for their baths or showers is kept at a safe temperature were also looked at. These records show that for the last ten months the majority of water has been at a temperature that is likely to burn anyone who uses it unsupervised. The home took immediate action to address this serious risk to peoples health and safety to avoid us taking enforcement action. After investigation, the home found they were not recording the temperatures correctly and when they were retested, only one water outlet was at a temperature that presented a risk. This water outlet was put out of action on a temporary basis to keep the person that uses this water safe, until a more permanent solution can be found. Care Homes for Adults (18-65 years) Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 18 The staff training programme must include specialist training for the identified needs of sensory impairment and autism. This will make sure that care staff are appropriately training for the work that they are expected to perform. 18/02/2010 2 34 19 Staff must not be employed at the care home unless satisfactory checks concerning details of any criminal offences and two written references have been obtained. This will make sure that service users receive support from people who have been vetted as fit to do so 18/01/2010 Care Homes for Adults (18-65 years) Page 32 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 35 13 The staff training programme must include training for staff in infection control, food hygiene and health and safety. This will make sure that staff do all they can to minimise the spread of infection in the home and to minimise the risks of any potential harm to themselves or others. 18/01/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 19 The medication records in the home should be audited more regularly. This will ensure safe practice in the administration of medication. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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