Care Home: Bromley Road, 22a

Similar services:

• Ashlong House
• Norbury Crescent (30)
• Edenvale
• Wadham Avenue
• Chatsworth Care - Dawson House
• Cowden Road, 52 - 54
• Townley Road, 2-3
• Chatsworth Care - Tudor Lodge

What the care home does well Residents that we spoke to were generally happy living at the home and with the support they receive from staff. One resident commented that they were happy with staff whilst another said they felt better when they spoke to staff about things. Residents are supported to make their own decisions and staff provide them with information as required to assist them in this. Staff support residents to take part in a range of activities and to be a part of the local community and make good use of local facilities such as shops, pubs, restaurants, leisure centres. Family links are maintained for residents who regularly spend weekends with their families. They are supported to maintain friendships and relationships. Generally residents are encouraged to be as independent as possible and take responsibility for their own personal care and to take part in some house hold tasks. Residents receive healthy and nutritious meals that they are involved in choosing ensuring they get to eat the foods they like. Those residents with culturally specific needs are also met. Residents receive personal support flexibly and in the way they prefer from staff. The home is well maintained and provides a safe, clean and homely environment. What has improved since the last inspection? Service user plans or care plans are now being regularly reviewed and updated at least six monthly to reflect any changing needs. There is also more detail included in these care plans in respect to their personal and social support needs. Risk assessments are more comprehensive and measures to reduce risks are clearly specified. Risk assessments are now being reviewed and updated to reflect any changes and linked in with the care planning process. Health Action Plans (HAP) that outline all service users` health care needs are now in place that identify any measures that need to be taken to address these needs and they are updated on a regular basis to ensure that all health care needs are met. Improvements have been implemented in the way allegations and incidents relating to adult abuse are handled with adult protection procedures being more rigorously adhered to. Resident`s finances have been reviewed and policies and procedures re written in line with advice given by the local authorities that have supported individual service users living in the home. Formal and rigorous monitoring arrangements are now in place for the management of resident`s finances. The Manager told us that an annual training plan has been drawn up with staffsindividual training needs in respect to mandatory training and more specific training to meet the individual needs of service users being assessed. The Manager has implemented a new record of the induction programme provided to newly appointed staff. Staff receive more regular supervision. What the care home could do better: Specific areas identified in this report are, Each resident should be provided with an up to date appropriate contract. Resident`s meetings minutes should indicate who has attended the meetings and what issues have arisen and have been discussed. Sufficient detail needs to be provided in order to ensure a useful record and any agreed actions, by whom and by when also need to be recorded. Photographs of residents should be attached to their Medical Administration Record (MAR) sheets. The Manager is reminded that any incidents that occur must be reported to the Commission for Social Care Inspection using the Regulation 37 reporting format. All the documentary evidence required under Standard 34 of the National Minimum Standards should be gathered for all the staff members at 22, Bromley Road and it should be held on the staff files for review and inspection. Certificated evidence must be gained for all staff and held on file for any who have completed training courses or for any other relevant qualifications including NVQs. The Manager should ensure that all staff be asked to read and discuss the homes policies and procedures in order to increase their awareness of them. Supervision records must be more detailed and include specific discussions about residents progress on their care plan objectives. It is recommended that the Manager be made full time so as to ensure the positive developmental progress that has been achieved continues and so that the "next steps" may be achieved. The Manager must ensure that the home`s quality assurance process be fully developed over the next year as discussed in this report. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Bromley Road, 22a Bromley Road, 22a Catford London SE6 2PT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: David Halliwell     Date: 1 1 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 41 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 41 Information about the care home Name of care home: Address: Bromley Road, 22a Bromley Road, 22a Catford London SE6 2PT 02086906681 02083140300 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mpower Limited Name of registered manager (if applicable) Donna Esther Brodie-Brown Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: 6 can have a mental disorder and 1 can have a mental disorder and be over 65 years This home is registered for 6 persons of whom 6 can have a learning disability, 1 can have a learning disability and be over 65 years Two of the service users maybe over the age of 65 years. Date of last inspection Brief description of the care home 22 Bromley Road is a care home for women and men with mild to moderate learning disabilities, who might also have other support needs, such as certain mental health needs or physical impairments. The overall aim is that of providing care and to empower service users to make informed decisions, leading to fulfilling experiences. The philosophy is that of enabling ordinary living as members of the community, with equal rights and access to employment, training, recreation, housing, health and social Care Homes for Adults (18-65 years) Page 4 of 41 care home 11 Over 65 0 0 11 11 Brief description of the care home services. 22 Bromley Road aims to achieve this by ensuring that the service is based on a thorough assessment of needs and delivered in collaboration with external agencies. Recruitment and training is targeted to enable staff to advance the rights of service users to privacy, dignity, independence, security, civil rights, and choice. The provider is an organisation named: Mpower Ltd represented by one of its directors. The day-to-day running of the home is delegated to a care manager. The premises are a large detached house. It is set back from a busy main road and has a large garden. Recent building work extended the house to provide eleven single bedrooms, 3 with en-suite facilities and to make part of the premises suitable for people using wheelchairs. Care Homes for Adults (18-65 years) Page 5 of 41 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 stars quality rating for this service is good. This means that people who use these services experience good outcomes. Service users said that they like to be called residents. This was an unannounced inspection visit of the service at 22, Bromley Road. The Inspection covered all the key standards and involved a tour of the home and a review of all the homes records. We reviewed 4 of the residents files and 3 of the staffing files and we had formal interviews with the 3 staff concerned, the Manager and 3 of the residents. A completed Annual Quality Assurance Assessment (AQAA) was received prior to the Care Homes for Adults (18-65 years) Page 6 of 41 inspection. No enforcement activity has occurred since the last inspection. There have not been any changes in the ownership or management of 22, Bromley Road, M Power remain the provider agency. The Manager is registered with the Commission for Social Care Inspection as the Manager. 5 new requirements have been made as a result of this inspection and 1 repeat requirement that should be addressed within the new timescale if enforcement action is to be avoided. 4 new good practice recommendations have also been made. Feedback on the requirements and recommendations was fully explained to both the Proprietor and to the Manager at the end of the inspection visit. We found the residents and staff most helpful and they are to be thanked for the assistance that they gave him over the course of this inspection visit. We were impressed by the commitment and enthusiasm of the Manager and of the staff group to work on and improve the quality of the services being provided at 22, Bromley Road. The Manager told us that the cost of a placement at Bromley Road starts at 850 per week and varies according to the level of needs of the resident. What the care home does well: What has improved since the last inspection? Service user plans or care plans are now being regularly reviewed and updated at least six monthly to reflect any changing needs. There is also more detail included in these care plans in respect to their personal and social support needs. Risk assessments are more comprehensive and measures to reduce risks are clearly specified. Risk assessments are now being reviewed and updated to reflect any changes and linked in with the care planning process. Health Action Plans (HAP) that outline all service users health care needs are now in place that identify any measures that need to be taken to address these needs and they are updated on a regular basis to ensure that all health care needs are met. Improvements have been implemented in the way allegations and incidents relating to adult abuse are handled with adult protection procedures being more rigorously adhered to. Residents finances have been reviewed and policies and procedures re written in line with advice given by the local authorities that have supported individual service users living in the home. Formal and rigorous monitoring arrangements are now in place for the management of residents finances. The Manager told us that an annual training plan has been drawn up with staffs Care Homes for Adults (18-65 years) Page 8 of 41 individual training needs in respect to mandatory training and more specific training to meet the individual needs of service users being assessed. The Manager has implemented a new record of the induction programme provided to newly appointed staff. Staff receive more regular supervision. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 9 of 41 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 41 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 11 of 41 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. Prospective residents will receive the information that they need to make a decision about living at 22, Bromley Road. Prospective service users may be fully assured that their needs are assessed and that their individual aspirations and wishes will be taken into account in the assessment process. The Manager will need to ensure that each resident has an individual and appropriate contract with the home. Evidence: A new residents handbook / service user guide has been drawn up that includes appropriate and useful information in an accessible format (pictorial) for the residents. The Manager explained that a copy of the newly developed guide is given to all new residents so that they can easily make reference to it when necessary. A copy was made available for us to see for information. All the necessary and appropriate information about the home has been included in the guide. There was evidence within the residents personal files that we looked at where a form had been signed by residents that acknowledges that they had received a copy of the Care Homes for Adults (18-65 years) Page 12 of 41 Evidence: service user guide and a staff member had gone through this with them to check their understanding of its content. This means therefore that residents and prospective residents have sufficient information available to them to make a choice about where to live and the services they will receive. Since the last inspection 2 new residents have been admitted to the home. We reviewed the files of 4 of the residents including the 2 new residents and found that all had received a full and comprehensive pre-admission needs assessment that was carried out by the senior staff with regards to the needs of the people concerned. The Manager told us that they ensure a needs assessment and care plan is obtained from the referring authorities for each new resident placed at Bromley Road. Evidence of this was seen by us on the residents files. The completed AQAA (Annual quality assurance assessment) also confirms this and says, A comprehensive assessment of the prospective residents needs are undertaken by the Manager, a senior staff member and a Director. The combined information from these sources form a comprehensive information base for each resident from which accurate and relevant care plans can be drawn up. The Manager explained to us that the needs assessment process is about ensuring that staff can meet the identified needs of the prospective resident in that they have the appropriate skills, training and knowledge to enable them to do so. Before agreeing any admission the Manager allocates a key worker to each resident who will work with them on developing the homes care plan and making sure it meets the identified needs. Residents were seen by us to have been involved in the assessment process having had the opportunity to express their wishes and preferences and to comment on their identified needs. Signatures of the residents and dates were seen on the assessment paperwork confirming their involvement in the process. For the new service user that was admitted to the home in August 2008 there was evidence within their personal file that the home had obtained a full needs assessment from the referrer. There was also evidence the home had carried out its own assessment to ensure that the individual needs of the resident could be met. In addition, a six week review of the placement with the placing authority had been held to check how it was going. The report of this indicated that it was going well. Care Homes for Adults (18-65 years) Page 13 of 41 Evidence: This all means that the prospective residents individual needs and aspirations are fully assessed appropriately. At this inspection, having reviewed 4 of the residents individual files, we found that only 2 of the 4 residents had a written contract and these were out of date (2007). It is important that each resident has an up to date, written and costed contract or statement of terms and conditions. This should be signed and dated by the resident and the home. The contract should include the following elements, The room to be occupied The notice period The cost of services not covered by the fees All services and facilities to be provided Policies and procedures that limit personal freedom Rights and responsibilities of both parties Referral to the service user plan and the arrangements for its review and revision. The contract should be in an approriate format so that the resident can understand the details and importance of what the contract states. Efforts should be made to explain the contracts to residents, who should have their own copy of the contract. It is required that each resident be provided with an up to date appropriate contract. Care Homes for Adults (18-65 years) Page 14 of 41 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. Residents may be assured that their assessed and changing needs and personal goals will be reflected in their care plans.They may also be assured that they will be able to make decisions about their daily lives and be enabled to take risks as part of developing a more independent lifestyle with support, as they need it. Evidence: The central focus of the services provided at Bromley Road is on the residents and how their needs, wishes and preferences can be most effectively be met where ever possible. Residents were seen by us (as far as their capabilites will allow) to be involved in the needs assessment and care planning processes. Care plans are based on the needs assessments that had been drawn up both from the referring agencies needs assessment and Bromley Roads own needs assessment. Inspection of the care plans evidenced this and we were impressed with the quality of the care plans seen. They had been clearly divided into sections (relating to the Care Homes for Adults (18-65 years) Page 15 of 41 Evidence: identified needs) with care plan objectives and action plans which addressed the needs and set out identified outcomes with review dates, so that clear monitoring and review could then be achieved. 6 monthly reviews by the care staff team were evidenced on the files and involvement of each of the residents in these reviews was also evident. They confirmed their involvement in the review and care planning process at interview with us. Inspection of the review reports showed that where changing needs of residents had been identified and appropriately revised care plan objectives had been drawn up together with the resident. Key workers were seen to actively provide individual support; to revise the care plans as necessary and to keep the residents informed. The Manager said that formal annual reviews are planned and held with the local authorities and clinical teams and the residents. The residents have their own key workers and the Manager said that residents can choose their key workers if they wish. Residents confirmed that they are happy with their key workers and find them helpful, supportive and friendly. Over the course of this inspection we saw that staff asked residents what they wanted to do and assisted them to make decisions about their daily lives. The Manager told us that residents do have their own residents meetings and that those meetings are minuted. The minutes of these meetings were shown to us by the Manager. The records show that meetings are held monthly. Recording of the meetings however could be improved and it is recommended that minutes indicate who has attended the meetings and what issues have arisen and have been discussed. Sufficient detail needs to be provided in order to ensure a useful record and any agreed actions, by whom and by when also need to be recorded. When this has been achieved it will mean that residents are enabled to make decisions about their lives with assistance as needed. The care planning process includes the use of risk assessments that were seen and inspected on each of the 4 residents files inspected. They are evidently used as a pre admission assessment tool and following admission, being used to assist residents to be appropriately supported to take risks as a part of developing a more independent lifestyle wherever possible. Any identified risks are managed positively to help the residents lead the sort of lives they aspire to as much as is realistically possible. These risk assessments are agreed with the resident and the relevant professionals who both sign the risk assessment form. This all helps residents to be assured that they will be supported to take risks as part of developing a more independent lifestyle wherever this is possible. Care Homes for Adults (18-65 years) Page 16 of 41 Care Homes for Adults (18-65 years) Page 17 of 41 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users may be assured that they will be able to take part in appropriate activities, some of which will be based in the local community. That they will be supported to maintain appropriate personal relationships with family and friends; and that their rights will be respected and their responsibilities recognised in helping them to construct an appropriate programme of activities in their daily lives. Service users are offered a healthy diet and they enjoy their meals. Evidence: There was evidence within personal files from key worker notes and the individual daily monitoring books that residents have been supported by the home to participate in activities inside and outside of the home. A weekly timetable of activities had also been drawn up for each service user. Inside the home one resident spoken to said that they played games with staff and that the home had purchased a karaoke machine Care Homes for Adults (18-65 years) Page 18 of 41 Evidence: that they use. Outside the home, records showed that residents were involved in a range of activities, for example one resident attends college to do maths, English and computers, regularly attended a social club, went swimming, bowling and to bingo. Another resident attends classes at a local education centre to do cookery, creative art and health and fitness. The residents who were both case tracked confirmed this. This all means that residents are able to take part in age and culturally appropriate activities. It was evident from records seen as well as residents who were spoken to and who stated that they regularly go out within the local community, for example to go shopping, to eat at restaurants, cafes and to go to the cinema and attend church. They are supported to use public transport with two service users travelling independently. On the day the inspection was held several residents went out to the day centre where there was a Christmas party and they told us when they returned how much they had enjoyed this experience. They said, we go to the day centre every week and we like it there. We asked the Manager if all the residents were registered to vote and we were told that they are all registered. We were told that 5 residents chose to vote at the last election. Residents are seen to be part of the local community. Evidence from 3 staff who were interviewed and from 4 residents who we spoke to also confirmed that they are supported to maintain contact with family members and to have personal relationships. Relatives are able to visit the home when they would like and some of the residents spend weekends at home with their family. This all means that residents may have appropriate personal relationships. The routines of the home and the house rules do aim to promote independence. Staff told us that some residents who are able are supported and encouraged to do some household tasks such as cleaning and tidying their bedrooms. There is freedom of movement and individual choice. Residents were able to choose how they spent their time, whether to spend time alone in their rooms or to be in the company of others. The Manager told us that some of the residents have a key to their room although others do not. Staff interaction with residents was seen to be warm and respectful. Those residents who we spoke to confirmed that staff do respect their privacy and knock before entering their rooms. Residents rights are respected and appropriate responsibilities recognised in their daily lives. With respect to meals it was reported to us by the Manager that a menu is drawn up each week. Residents are asked on a Sunday for their menu choices so that the shopping list can be drawn up. We were told that residents also help with the weekly Care Homes for Adults (18-65 years) Page 19 of 41 Evidence: shop. This was confirmed by two of the residents we spoke to. The menus were inspected and these did indicate that meals provided were generally healthy and nutritious. Residents spoken to also stated they liked the food and got to eat what they like. For individuals with culturally specific needs these had been met by the home and the home had made attempts to vary the dishes for individual residents after it had been noted at a previous inspection that there had been some repetition of meals. Care Homes for Adults (18-65 years) Page 20 of 41 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. Service users may be assured that they will receive personal support in the way they prefer and require, they may also be assured that their physical and healthcare needs will be appropriately met. Service users are protected by the homes policies and procedures for dealing with medicines. Evidence: Residents who were interviewed at this inspection said that they receive their care in the way they prefer. From evidence given to us in the AQAA and from what we were told by staff and residents, they are able to decide themselves about their daily routines. Staff ensure that care support at Bromley Road is person centred, flexible, consistent and is able to meet the changing needs of the residents. It was confirmed by the staff and the residents that they are able to choose when they get up, when they go to bed, when they have a bath, what they wear and what they will do during the day. A member of staff interviewed, explained how when drawing up the residents Care Homes for Adults (18-65 years) Page 21 of 41 Evidence: activities chart, which is based on the care plan, they work through the programme together in order to gain the residents approval and commitment to the plan and to understand their choices. Activities plans linked with the care plans were seen on each of the 4 residents files inspected. They covered the following areas: external leisure, education, training and hobbies and leisure pursuits within the home. For each of these areas outcomes and goals had been identified by the resident and had been written down so that it was clear what they want to achieve from their individual programmes. The plans were seen to be up to date, having been reviewed on a regular monthly basis. Copies of these plans were seen on the residents individual files. This means that as far as is possible residents do receive personal support in the way they prefer and require. With regards to the health care of the residents the Manager told us that all residents are supported to keep well through accessing appropriate healthcare and associated mental health care support. The AQAA completed by Bromley Road says that there is, Regular monitoring of health for all the residents and prompt intervention isprovided when necessary. All residents have Health Action Plans, their needs are monitored and acted upon promptly. Given the needs of the residents living at Bromley Road this ongoing support is important. The home operates a key worker system to ensure that there is consistency of support provided to residents. Those residents that we spoke to were aware of who their key workers were and there was evidence on the residents files that monthly key worker sessions had been held with them. Residents told us that they were satisfied with the support they had received from staff. Health Action Plans (HAP) have been drawn up for each of the residents and were seen on their files. They are aimed at detailing service users physical and emotional health care needs and had been reviewed and updated appropriately. Information contained within the individual residents files indicated that there had been liaison with health professionals such as GPs, psychologists and psychiatrists and now also with primary health care services such as chiropodists, dentists and opticians. This was confirmed to us by the Manager and by staff who we spoke to. All residents are signed up with local GP surgeries and some are registered with local dentists. The Manager told us that annual health checks do take place for the residents, this was also confirmed by staff who we interviewed. Residents who spoke with us said that they go to see their GPs as and when necessary. They said they prefer not to go to the dentist. The Manager told us that they also see an optician. Care Homes for Adults (18-65 years) Page 22 of 41 Evidence: Forms are in place to monitor residents visits to these healthcare professionals. The units policies and procedures manual contains a policy for medication that includes the procedures that staff need to take in order to ensure the safe administration of medication to residents. 2 members of staff who were interviewed indicated that they were aware of the policy and know what the procedures are when administering medication to the residents. A list of staff signatures was available in the medication records so as to clearly identify the signatures recorded on the Medical Administration Records (MAR sheets). The Manager told us that staff only administer medication to the residents once they have completed training to do with the safe handling of medicines. The Manager said that some residents do self medicate but with supervision, she also said that risk assessments are completed for those residents who self medicate and who are unsupervised. This is welcomed as it should help to minimise any potential hazards for the resident or others. Inspection of the medication records MAR sheets found no unexplained gaps and the Manager explained that staff who administer any medications are required to sign the MAR sheet records immediately after the residents have been given their medications. 2 staff who were interviewed accurately described the appropriate medication procedure as outlined in the homes policy document. In most cases except for the most recent admission, photographs of the residents were attached to the MAR sheets. This is important as it helps to ensure that staff administer medications to the right resident and therefore assist in the protection of residents. It is recommended therefore that the Manager ensures each resident has their photograph attached to their MAR sheets just after their admission to the home. We did a spot audit check on the stock control system and this proved satisfactory with the levels of medications being as stated on the control sheets. A check on the storage facilities for the medication was seen to be appropriate and although controlled drugs are not currently in use within the home there is appropriate provision for doing so i.e. there is a lockable metal cupboard within a locked metal cabinet. The Manager said that Superdrug, the chemists provides quarterly checks on the medication procedures carried out at Bromley Road. Training records provided by the Manager showed that 2 of the 4 staff files inspected received training in 2008 on the Care Homes for Adults (18-65 years) Page 23 of 41 Evidence: safe handling of medications within the home. The Manager told us that all staff have received this training however certificated evidence was not available to be seen to support this claim. It is referred to later in this report under Standard 35, that all staff training received must be supported by certificated evidence. PRN guidance was also seen to be provided appropriately on the medication records. Care Homes for Adults (18-65 years) Page 24 of 41 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. Service users may be assured that their views will be listened to and that they will be protected from abuse, neglect and self-harm. Evidence: The home had included information about the homes complaints procedure in simple language and using pictures in the updated service user guide a copy of which had been issued to all residents and staff had gone through this with individual residents to ensure they understood its content. The Manager also reported how a copy of the homes complaint policy was to be placed in each residents bedroom to make this as accessible to them as possible. Concerns and complaints were addressed monthly as part of key worker sessions with service users. The 4 residents who spoke to us at this inspection all individually confirmed that they feel their views are listened to and acted upon. They said that if they had a complaint they know the procedure to be followed and would do so if they needed to. Staff interviewed said they thought that the residents were all aware of the complaints process and that the whole staff group took any issues raised by residents seriously. We asked the Manager to see the homes complaints record, 4 complaints had been registered in the record book since the last inspection in January 2008. All 4 complaints had been resolved to the satisfaction of the complainants and the homes new complaints policy (updated recently in June 2008) had been followed. Care Homes for Adults (18-65 years) Page 25 of 41 Evidence: A good deal of progress has been achieved in this area since previous inspections that shows that the outcome is that the home learns from complaints in order to improve its service and all the residents know that their complaints and concerns will be listened to and dealt with appropriately. The Manager advised us that the home has a policy for the Protection of Vulnerable Adults (POVA) that is linked in with that of the Local Authority London Borough of Lewisham. We were told that staff have been provided with training and guidance about what actions they need to take if the need arises. We saw the policy in the Units policies and procedures file, the procedures are robust for responding to suspicion or evidence of abuse or neglect and they include a whistle blowing procedure for staff. The Manager is reminded that any incidents that occur in this area must be reported to the Commission for Social Care Inspection using the Regulation 37 reporting format. However training records seen by us for 4 staff whose files were inspected evidenced that only 1 staff member had received recent POVA training from an authorised trainer. However the Manager advised us that all members of staff had in fact received POVA training. The Manager must therefore ensure that certificated evidence is held on every staff file that supports that staff members attendance for the training they have received. POVA training helps to ensure that all staff are up to date with the policies and procedures and other issues to do with the protection of vulnerable adults at Milestone. At the last inspection it was recommended that the Manager ensure an inventory for each resident is kept on the residents files of their valuable belongings. This has now been completed and evidence was seen on each of the 4 residents files inspected. This is welcomed as it will help protect both the residents and staff from abuse. Some concerns were raised at previous inspections about the financial procedures being used at the home and the safety of the residents monies. At this inspection the Manager told us that a new policy and procedure has been drawn up in conjunction with the advice provided by the Local Authority. These policies and procedures cover the requirements and the Manager told us that they have been fully implemented by staff. Residents monies are checked 3 times daily by 2 members of staff including after handover shifts. The Manager regularly checks and also carries out spot checks to ensure that the policies and procedures are being carried out effectively. The Manager reports no problems or discrepancies have arisen with the new procedures. Staff who were interviewed by us also told us that the new procedures are being rigourously Care Homes for Adults (18-65 years) Page 26 of 41 Evidence: implemented. Care Homes for Adults (18-65 years) Page 27 of 41 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. Service users at 22, Bromley Road are able to live in a homely, comfortable and safe environment. The home is also clean and hygienic and well looked after by staff. Evidence: The home is a large spacious detached house that is set back from a busy main road. It is suitable for its stated purpose and was extended to provide eleven single bedrooms, 3 with ensuite facilities and to make part of the premises suitable for people using wheelchairs. The home has ample of communal space with a large well maintained garden that is accessible by a ramp. Overall, the home is decorated and furnished to a high standard and is well maintained. Together with the Acting Deputy Manager we reviewed all areas of the home to assess the quality of the environment and decor. There is generally a comfortable atmosphere and residents bedrooms are individually decorated with input from them with regard to choice of colour and furniture. Those residents that we spoke to about this said they were generally happy with their rooms. The home was found to be clean and hygienic. 6 residents bedrooms were inspected with the permission of those residents. They all told us that they are happy with their rooms and that they like living at Bromley Road. This means that residents live in a Care Homes for Adults (18-65 years) Page 28 of 41 Evidence: homely and comfortable environment. General maintenance throughout the home was seen to be good. The Manager told us that since the last inspection a new handiman has been contracted to carry out all the homes maintenance. Any faults or repairs are noted in the homes maintenance book by staff and they are then attended to by the handiman. No problems were identified with this system at this inspection. The home was seen to be clean and no unpleasant odours were noted. We noted that regular checks at each hot water outlet are being carried out and findings recorded to ensure that hot water temperatures are maintained within the prescribed limits. At this inspection we asked to see the records for checks on water temperatures and the Manager provided the homes records for this. They indicate that regular testing is carried out each week as required and that hot water temperatures fall within the prescribed limits to ensure the safety of the residents. A senior member of staff told us that they regularly review the recording process of water temperatures and ensure that faults are reported immediately where temperatures exceed the prescribed limits so that immediate action is taken to rectify the problem. The Manager showed us the homes infection control procedure, which seems to be working effectively. This means that the residents live in a clean and hygienic home. The laundry area is well laid out and there is an impermeable floor laid down to prevent water ingress and easy cleaning. Laundry is not taken through areas where food is prepared. The home has appropriate sluicing facilities and these were seen by us to be appropriate. Care Homes for Adults (18-65 years) Page 29 of 41 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. Service users are supported by competent staff and by the homes recruitment policy and procedures.Some improvements are still required in the recruitment and training of staff, however service users benefit from well supervised and well supported staff Evidence: The Manager told us that 3 new staff members had joined the staff team at Bromley Road since the last inspection. 4 of the staffing files were inspected and this included 2 of the new staff members. It was reported by the Manager that most of the staff group have now achieved their NVQ level 2 or 3 qualifications and this was confirmed by the staff who we spoke to at this inspection. However certificated evidence of these qualifications was not available for inspection and a requirement is made with reference to this under Standard 35. Residents interviewed told us that staff are approachable and we saw staff taking time to deal with residents questions. The Manager told us that the home has good recruitment polices and procedures in place. The AQAA supports this, it says The home has a well defined recruitment Care Homes for Adults (18-65 years) Page 30 of 41 Evidence: process that is based on equal opportunites and carries out all the required recruitment checks on all new employees. It was reported that the Director, the Manager and the Deputy Manager usually sit on the interview panel for staff recruitment. The Manager also said that the service is working to develop a service user representative who may be able to contribute to the recruitment process. This would be a welcome development and would help to increase participation from the residents in this process. As a part of this inspection we selected 4 staff files including 2 of the new staff members files. Inspection of these staff files showed that most of the appropriate documentation was available for inspection. Information on file showed that Criminal Record Bureau (CRB) checks had been carried out and the relevant information had been stored on the files. However employment contracts were missing from 3 of the 4 staff files inspected. Also a photograph of the staff concerned was not in all cases attached to their staffing files. Appropriate forms of identification such a passport or birth certificate were held on 3 of the 4 staff files, however this was missing for 1 member of staffs file. It is therefore a requirement that all the documentary evidence required under Standard 34 of the National Minimum Standards be gathered for all the staff members at 22, Bromley Road and it should be held on the staff files for review and inspection. There is a structed induction programme that is offered to all new staff and documentary evidence of this was seen in the staffing file review and was also supported by staff who were interviewed. The Induction programme is seen to be comprehensive and covers, Safe working practices The workers role Meeting the needs of service users The homes policies and procedures. The Manager told us that each new staff member has to go through the homes induction programme that usually lasts for about 1 week. One of the new members of staff told us, Induction training was very good. It covered the aims and objectives of the home and also my own role and function within Bromley Road. The AQAA also says, The home has implemented a comprehensive induction training programme which meets all the common induction standards for all new staff and ongoing training that reflect the individual needs of the client group. With regards to improving staff awareness of the homes policies and procedures it is required that the Manager ensures that all staff be asked to read and discuss the homes policies and procedures. This should help increase awareness about the support Care Homes for Adults (18-65 years) Page 31 of 41 Evidence: the policies and procedures offer to staff in different areas of the work within the home. Staff should be asked to sign to say that they have read, had a chance to discuss the policies and procedures with their supervisor in their supervision sessions and would be willing to work within them. The Homes management prioritise training and facilitate staff members to undertake training sufficient to meeting the needs of the residents. The Manager explained that the training programme provides the following courses Care of medicines, 1st Aid, Risk assessment, Health and safety, Fire safety, Manual handling, Food hygiene, POVA, A Learning Disability Qualification. Inspection of the 4 staffing files and the associated training records showed that 2 of the staff had received recent training in most of these areas. However for 1 of the other staff members this level of basic training had not been achieved and for the other who is a very new staff member it will need to be achieved over the coming months. The Manager told us that staff had received more training than is apparent from the training records. However training certificates and other certificated evidence of qualifications being held by staff were not in evidence or available for inspection in all the files inspected. This is very important as it confirms that staff have attended the stated courses. This issue has also been raised earlier in this report and there is now a requirement that certificates are gained for all staff training and other qualifications including NVQs and held on file. Apart from being essential evidence of staff qualifications held it is also valuable for the staff member in that it provides documentary evidence of the training input they have received and helps to document their CVs. The Manager told us that she has introduced a new staff training matrix that identifies future staff training needs and that logs training already undertaken by staff. This is a useful tool in that it will easily inform the Manager what training the staff team have received and where the gaps in training exist. A further positive development in the training field would arise if all staff who have undertaken training are asked to evaluate the experience they have had, how they have benefited from it and how they believe their work with residents may have of improved. A summary of the results of this sort of evaluation could be drawn up, as it would provide excellent feedback on the strengths and weaknesses of the training experience. Feedback to the trainers from the summary should help to ensure more appropriately trained staff at 22, Bromley Road and better care delivered to the residents in meeting their needs. Care Homes for Adults (18-65 years) Page 32 of 41 Evidence: The Manager told us that there is a properly structured staff supervision policy and procedure. Records were inspected and both the policy and the supervision tools cover the areas that are required in order to implement an effective supervision process. Inspection of the supervision records that are held on staffing files showed that staff have received regular and formal supervision. Areas of discussion have been recorded briefly however it is recommended that these records could be considerably improved by being more detailed to include all the issues discussed and that any agreed actions are included in the records. The Manager told us that staff all receive a copy of their supervision notes. This was confirmed by all 3 members of staff who were interviewed as a part of the inspection. It is also recommended to the Manager that the discussions had in staff supervision are expanded to include discussion on specific residents issues and the key working process, monthly reports on progress being made by residents and key workers with care plan objectives. This will mean that all the key and important areas for the review and monitoring of the work being done in the home to meet the needs of both the residents and the staff groups will then be properly met. Care Homes for Adults (18-65 years) Page 33 of 41 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 can be confident that they benefit from a well run home. With the developing quality assurance system they may be confident that their views underpin monitoring and review of the homes developments. Service users may also be confident that their rights and best interests are safeguarded by the homes record keeping policies and procedures. Evidence: The Manager has 5 years overall experience of management experience at 22, Bromley Road. She holds an award in Leadership and Management in Health and Social Care that is the equivalent to the Registered Managers Award at NVQ level 4. The Manager reported that her work as a Manager over the working week covers 3 days and for the remaining time she works as a senior support worker with the residents. It is clear that since the last inspection the Manager has made many considerable improvements in all areas of the running of the home. She demonstrates a good level of competence in the management and running of 22, Bromley Road and the systems that are now in place help to ensure that the home is fit for purpose. Care Homes for Adults (18-65 years) Page 34 of 41 Evidence: However it is recommended that the Manager be made full time so as to ensure the positive developmental progress that has been achieved continues and so that the next steps may be achieved. The residents spoken to by us felt that the home is being well run and evidence seen supports this view. The homes records and administration systems were seen to be in very good order and overall the impression was positive. Interviews with staff reflected a positive and caring approach towards the residents. Residents can therefore be assured that they are benefiting from a well run home. The Manager explained that a residents survey was carried out in 2007 that sought the views of residents on different aspects of the care and support being provided at Bromley Road. We were also told that a new questionnaire is being worked on for 2008. As well as this the Manager told us that there are the weekly and monthly audits of care plans, residents activity plans and residents goal sheets. The Manager carries out checks regularly on administration and recording systems that are used for the running and management of the home, including for example medication records checks, clients financial procedures, healthcare appointments, concerns and complaints, and other health and safety checks. Some further discussion was had with the Manager as to what other elements might be usefully included in order to ensure a complete approach to developing quality assurance processes. Some suggestions were: Questionnaires for relatives and referring professionals seeking their feedback on different aspects of the service. For instance professionals who have referred people to Bromley Road could be asked about the effectiveness of the service in meeting the care plan objectives. Relatives and families could also be asked for their views on different elements of the service and how their relative is being served by it. A review of any accidents that have occurred. Issues raised by residents at their meetings. Issues raised by staff at staff meetings. A summary and analysis of the key points arising from these areas mentioned above could then be used to inform an annual development plan for the home. Different areas or themes could be targeted on an annual basis that over a longer period would inform all the key areas of service provision. It is required that the Manager ensures the homes quality assurance process be fully developed over the next year as discussed. We were shown information to do with relevant Health and Safety legislation. Policies and procedures were also seen for Health and Safety, risk assessment, moving and Care Homes for Adults (18-65 years) Page 35 of 41 Evidence: handling and fire. A fire risk assessment had been carried out in 2007 under a previous manager that identified a number of actions. The Manager said that these actions had been met but thought that a new fire risk assessment could be usefully carried out in 2009. This is supported and should be carried out as advised. Up to date and satisfactory pass certificates were seen for: Boiler & Gas - 1.5.08 Electrical installation for the new extension - 26.9.07 Portable electrical appliances 1.10.08 Fire alarms - 14.7.08 Fire equipment - 1.9.08 Emergency lights - 14.7.08 A water and legionnaires test was last carried out in 2008. Records were seen that confirmed regular tests had been carried out for the: Fire alarm - weekly, last record seen 23.10.08 Accident records were checked. They had been completed appropriately however Regulation 37 notices had not been sent out as required. A visit from the London fire Brigade in July 2008 reported all the fire arrangements as being satisfactory with no requirements or recommendations. A visit from the Environmental Health Officer in May 2008 made a very positive report on conditions at 22, Bromley Road with no requirements or recommendations. At the time of this inspection no fire doors were seen to be wedged. Generally the building appeared to be secure. All of this means that residents benefit from a competently run and accountable management of the services at 22, Bromley Road. Care Homes for Adults (18-65 years) Page 36 of 41 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 37 of 41 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 5 5 It is required that each 01/03/2009 resident be provided with an up to date appropriate contract. In order to meet this standard. 2 34 19 All the documentary evidence required under Standard 34 of the National Minimum Standards be gathered for all the staff members at 22, Bromley Road and it should be held on the staff files for review and inspection. In order to meet the NMS 01/03/2009 3 35 18 Certificated evidence must be gained for all staff and held on file for any who have completed training courses or for any other relevant qualifications. In order to meet the NMS. 01/03/2009 4 35 18 The Manager should ensure that all staff be asked to 01/06/2009 Care Homes for Adults (18-65 years) Page 38 of 41 read and discuss the homes policies and procedures in order to increase their awareness of them. In order to meet the NMS. 5 39 24 The registered person must 01/06/2009 ensure that the quality assurance systems for the home are developed.An effective system where service users views underpin all self-monitoring, reviews and development of the home.Continued noncompliance with this requirement will lead to enforcement action being taken. In order to meet the NMS. 6 42 37 Regulation 37 notices should 01/03/2009 be sent out as required. In order to meet the NMS. 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 7 Residents meetings minutes should indicate who has attended the meetings and what issues have arisen and have been discussed. Photographs of residents should be attached to their MAR sheets in order to aid correct identification. It is recommended that the Manager be made full time so as to ensure the positive developmental progress that has been achieved continues and so that the next steps may be achieved. Supervision records must be more detailed and include specific discussions about residents progress on their care Page 39 of 41 2 3 20 32 4 36 Care Homes for Adults (18-65 years) plan objectives. Care Homes for Adults (18-65 years) Page 40 of 41 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 41 of 41 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!