Care Home: Brook House

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What the care home does well People have good plans for their support and are supported to take risks. People`s health needs are being managed well despite the challenges that these present. Staff are responding well to changes in people`s needs and have a good understanding of the people they support. The manager has worked hard to improve the home despite the challenges. He recognises that the home is not appropriate for the long term needs of the people who live there and is working hard to ensure new accommodation is found. What has improved since the last inspection? Records relating to how people make decisions and how the service protects people are up to date and meaningful. There are more regular reviews of people`s needs, including social and emotional needs, with contributions made by people using the service. Complaints are responded to appropriately. The service has pursued re-assessments of people`s needs and has developed more personalised care plans.Brook HouseDS0000065900.V378450.R01.S.docVersion 5.3 What the care home could do better: Continue to prioritise the plan to move to new accommodation Finish the work on care plans so people have a personalised plan to take with them to new accommodation People using the service have varied ages, needs and lifestyles. Because people`s choices are more likely to conflict, it is not always possible for the staff to meet everyone`s choices and decisions regarding their lifestyle. As people change and get older, the current staffing levels and environment of the home will not be enough to meet their needs. While continuing to support people at Brook House, staff must have the appropriate mandatory and specialist training and supervision to meet people`s changing needs. Key inspection report CARE HOME ADULTS 18-65 Brook House 56 Ash Grove Four Pools Evesham Worcestershire WR11 1XN Lead Inspector Emily White Key Unannounced Inspection 19th November 2009 09:00 Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 2 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 Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Brook House Address 56 Ash Grove Four Pools Evesham Worcestershire WR11 1XN 01386 765551 01386 429380 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.macintyrecharity.org MacIntyre Care David Joseph Bunn Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 8 The maximum number of service users to be accommodated 8 2. Date of last inspection 1st December 2008 Brief Description of the Service: Brook House provides residential care for up to eight adults with learning disabilities. It is situated in a quiet residential area of Evesham with access to local facilities. Brook House is operated by MacIntyre Care, The Mencap Society own Brook House. The stated purpose of the organisation is, ‘to be recommended and respected as the best provider of services for people with learning disabilities throughout the United Kingdom.’ The Responsible Individual is Mr William Mumford. The registered manager is David Bunn. Current fees for this service are £567.00 Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The manager sent information about the house to us before we visited. This is called the Annual Quality Assurance Assessment. We visited on a week day, where we met staff and people who live at Brook House. We looked at some records such as care plans and medication and looked at how the house is run. What the service does well: What has improved since the last inspection? Records relating to how people make decisions and how the service protects people are up to date and meaningful. There are more regular reviews of peoples needs, including social and emotional needs, with contributions made by people using the service. Complaints are responded to appropriately. The service has pursued re-assessments of peoples needs and has developed more personalised care plans. Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 6 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 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. Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service supports a variety of people of different ages and lifestyle choices who would be better suited to alternative arrangements to meet their care needs. EVIDENCE: Since the last key inspection one person has moved out of the house and noone new has moved in. There are currently no plans for new people to move to the house as the service is considering a move to alternative accommodation. Since 2007 inspections carried out at the service have identified that Brook House may not be appropriate for the needs of the diverse people who live there, and that assessments of their needs had not been carried out for some time. This year the manager has been successful in arranging reviews for everyone who lives at Brook House. These reviews were carried out in June 2009 by the local authority, to consider whether people would be better having their needs met in alternative accommodation. At the time of the inspection no further action had been undertaken. The manager is aware of what accommodation would suit the different people who live at Brook House and they are involved in this process. For example one Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 9 person has expressed a wish to move to older persons accommodation, and others would like to remain living together in a smaller house. The AQAA tells us that It is difficult under the present circumstances to fulfil the needs of all the people who live in the home because of the different age groups and the differing needs of the people, we have discussed in a personal way the option of moving to two smaller premises. During the past year people living at the service have become older and developed new needs and interests. This is shown from the notifications we have received, is recorded in peoples individual care files and is confirmed by staff and the manager. The manager tells us he will continue to make it a priority that people living at Brook House eventually move to new accommodation that is better suited to their needs and lifestyles. Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a plan of care that the person, or someone close to them, has been involved in making. Staff promote peoples 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. EVIDENCE: Brook House has a variety of records to give information to staff and to help people make decisions and take risks in their daily lives. These include their person centred plan, health action plan, daily diary to take out with them for example to the day centre, a confidential log for monitoring or recording information that cannot leave the home, scrap books, and personal books with photos and newspapers cuttings. Since the last key inspection peoples support plans have been updated to make them more personal to each individual. Although this work has not been Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 11 finished yet, we saw good examples of those who have been finished. We looked at two peoples records. One persons plan has headings such as things people like about me, things that make my life meaningful, and likes and dislikes. There is also information about peoples special interests. Listen to me is a system where the persons key worker can sit with them and find out how they are. It was not clear from records how often these should be, but one person had a listen to me meeting once in 2008 and once in 2009. At this meeting the key worker asks questions about the persons health needs, clothes, health and safety, and what is making you happy/ unhappy at the moment, is there anything you want to change, anything new to try?. Another person whose plan had not yet been set up in this way had had a goal setting meeting with their key worker in November 2009. This shows that peoples needs and choices are being addressed while their care planning records are being updated. Peoples support plans also provide information about how I communicate with you, and provide good detail around peoples preferred routine, meal times, what they need support with, and what they can do independently. Staff tell us that there are a variety of ways they can support people with communication and making decisions. There is a talking book for house meetings, a rota board which shows who is at the house in pictures, and a meal planning board. Most people who live at the home are able to communicate their wishes to staff. However there are some areas where making decisions could be better supported. Because of the varied ages, needs and lifestyles of people using the service, while their decisions may be communicated, it may not always be possible for the staff to meet everyones choices, and peoples choices are more likely to conflict. Some examples of this include: one person using the service is able to use the Makaton sign language, however only one staff member is able to use this. This was raised in this persons review carried out by the local authority. One person has commented in their review that they dislike another resident, and the care plan identifies reasons for this. Another person using the service has expressed distress following the behaviour of another person. Mental capacity assessments have been carried out for one person using the local IMCA service, but these did not include dates for review and it is not clear from the assessments who carried these out. One persons plan states that staff should be aware of where they are at all times. Comments recorded from staff include impossible with 6 other residents and staff cannot watch X 24:7 From speaking to staff and the manager we are confident that they are aware of these issues, however the nature of the service in its present set up often prevents them from being able to support everyones decisions. We received surveys from people living at Brook House. People made positive comments about the staff and the support they receive. Three out of seven Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 12 people said they only sometimes make decisions, but everyone said they are able to do what they want to during the day, evening and at weekends. As there have been significant changes in peoples needs during the past year, this has presented more risks for people using the service. The new care plans provide clear directions for staff to follow which support people to do the things they enjoy. One person has an intervention plan which includes some things I do which may cause upset, some day to day situations and things which may upset me, understanding why I do these things, supporting me through a situation and supporting my well being. There are clear plans for action and information to help staff understand what is happening. In discussion with staff it is clear that they know the people they support well and can refer to the right actions to take. Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16, and 17. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service supports a variety of people of different ages and lifestyle choices who would be better suited to alternative arrangements to suit their lifestyles. EVIDENCE: Following the last key inspection report the home has tried to improve the lifestyle of those who live at Brook House. The AQAA tells us that new and different age appropriate activities have been sought and accessed involving many links to the local community - one lady we support expressed an interest in working in a local shop - she now does this two times a week. One gentleman attends a day centre at his request which is specifically for the elderly group, some of the younger of our clients attend regular discos and social clubs. Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 14 As we have raised previously in this report and earlier key inspections, it is a challenge for the service to provide stimulating and appropriate occupation for a diverse range of people. We talked to people using the service, looked at three peoples daily diaries and spoke to staff about what opportunities there are for maintaining the lifestyle they choose. It is clear that the younger and more active people who live at Brook House are supported to go out shopping and get involved in some nightlife and other activities. Staff say that because these people are more independent and get on well, they are able to go out as a group supported by fewer staff. People are supported to maintain community contacts and relationships through day services, visits with their families and friends, and trips out. These include garden centres, an airfield, a butterfly farm, and meals at the pub. It is difficult to get a very clear picture of the lifestyle of people living at Brook House because peoples daily diaries are not always consistently completed. This is sometimes when people are at day services but also at the weekends. When records are made, they vary between very minimal such as seems fine to more detail about the persons activities and occupation. People living a Brook House who have greater needs and who prefer a quieter life may not always have their choices met. One persons daily diary shows a lot of time spent at the day centre, and at home in the summer house which is in the garden. This persons care files identify particular interests that are not shared with others in the house. Records do not show that these interests are happening, although one staff members says that he regularly supports this person in their interests. This person also has an interest in certain books and newspaper articles. Although people have scrapbooks which have photos, newspaper cuttings and other things they are interested in, these are kept in the managers office and we did not see any evidence that people look at these while they are at home. Staff confirm that although staffing levels are better since two people have moved, there is rarely any time for one to one activity. Staff say that usually there are three people at home with two staff, which means that often all three people go out as a group. Staff say that this is not ideal because of the differing needs and interests of the people living at Brook House. We received some surveys from staff, comments from these include: • More time spent with clients would be more beneficial to them, and make our work seem constructive and useful. • Due to the age differences between oldest and youngest we are limited to activities, some are noisy and others prefer a quieter life. • Needs are changing, some needing care rather than support due to age and illness. We received surveys from people living at Brook House and their representatives. Some comments from people living at Brook House include: Comments from people who live at Brook House include: • I am happy with the routine at Brook House Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 15 • I make sure my room is clean with my keyworker • I go to church • Staff take me on holidays • I like to do my bedroom vacuuming etc • I go to church with my mum and see my family However two people said on their survey • I don’t like it • I want to move Comments from representatives of people living at Brook House include: • More discussions with parents and relatives, at the moment there is one meeting per year • Communication with relatives could be much improved - I was not told when my daughters key worker left • More thought should be given to healthy eating for those who have a weight problem. I feel that if my daughter could be occupied more while at home this would alleviate the problem During our visit we observed that the kitchen is clean, the food cupboards are well stocked and the fridge temperatures and food temperatures are being recorded. There are pictures on a board showing what people are having for their main meal. Breakfast and lunch are not shown in picture format. We talked to one person living at Brook House who told us they like the food, especially sandwiches and hot dogs. Staff tell us that people can choose what they prefer for breakfast and lunch, and each week each person chooses what they would like to eat for a day in the week. Records show a variety of food is available although we note that people frequently choose hamburgers and hot dogs, and could be supported to choose healthier options. The care and support records show us that the two people concerned had gained weight recently. For the younger person this had been raised as a concern. While it is good practice that peoples choices are respected we also note daily records show very few entries relating to exercise. It is important that the home clearly monitors diet and exercise so that people are supported to maintain healthy lifestyles. Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People 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. The manager is aware that as time goes on peoples physical and mental health needs may not be able to be supported at Brook House. EVIDENCE: We received a survey from a mental health professional. This said that people at Brook House usually have the right information about their needs, so they are properly monitored, reviewed and met. The survey also says that the home usually seeks advice and acts on it, manages medications correctly and respects privacy and dignity. A comment includes the service has improved over the last 12 months. Peoples representatives told us through surveys that they would like more communication from the home. Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 17 Following the last inspection report a recommendation was made that staff should make sure that the information in personal support records is consistent so that people using the service get the support they need. Care and support plans have been reviewed and the information we saw in two of the care plans was consistent. We looked at the support plans for one person whose needs have changed in the past 12 months. This persons plan contains a lot of detail about how to support their changing needs. The records show that different professionals have been involved in supporting the home, for example mental health professionals and advocacy. Records also show that staff are monitoring this persons health needs and recording incidents appropriately. We spoke to staff about how they manage the changing needs of the different people who live at Brook House. Staff tell us they are able to manage peoples needs at the present time and show a good understanding of peoples needs. Staff tell us that they have had some training recently which has helped them to understand peoples changing needs, for example dementia. However staff are also concerned for the future as individuals needs increase, for example in mobility and behaviour. Staff told us they are concerned about use of the stairs for some of the older people, and as there are no waking night staff incidents of people being unsettled at night have been difficult to respond to. The AQAA tells us that we will be accessing well woman clinics that have just become available at the local surgery and there are plans for a well man clinic to start shortly. We will continue to ensure that we are proactive in the field of healthcare and diet given the age of some of the people who live here. Following the last key inspection a recommendation was made that people using the service should be supported to be more involved in their own health care and taking their own medications where possible. The home manager responded as follows: Because of the complex needs of individuals who live at Brook House we are unable to support them to self-medicate, with the exception of one person who finds the whole procedure very difficult. She does however deal with her own oral hygiene with prescription toothpaste. Records show that the home is managing changes to peoples medications well, and is getting help from professionals when it is needed. It would be good practice for staff to record dates of opening on boxes of medication to help with auditing, and for information about medications to be included to help staff understand what medications they are administering. Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. EVIDENCE: Following the last key inspection a requirement and a recommendation was made that where complaints are made by or on behalf of people using the service, details of any investigation, action taken and outcome must be recorded, all complaints must be responded to within 28 days, and any action taken to protect people using the service must be recorded so that the service can demonstrate how it is acting in peoples best interests. In response to this the manager told us that Macintyre have a very comprehensive complaints policy which is well documented, however it would appear that the recording fell short of the standard required. I will deal with the current issues retrospectively and will ensure that in future all details are recorded and kept in the complainants personal files, or a reference to where details are recorded is in the file. We saw from records that responses had been recorded to complaints received and the home has improved its recording. The AQAA tells us that we plan to Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 19 record and monitor more of the smaller incidents that take place in our home to see if there is a pattern and act upon those findings. Surveys from people living at Brook House and their representatives tell us that people know who to speak to if they are unhappy. The home has a red card system which staff say people do not use, but they know how to complain. We saw from records that risk assessments relating to the handling of money and money documentations are clearly recorded. We saw that Safeguarding and Protection of Vulnerable Adults training for staff did not appear on the managers training matrix. The manager tells us that four staff have been booked on the training course offered by Worcestershire County Council and this will be recorded. The staff that we spoke to during out visit showed a good understanding of what they need to do to safeguard people using the service. Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to the home to make it more homely. However it is not necessarily appropriate to the needs of people living there now and the long-term aims of the service. EVIDENCE: The last key inspection identified that the house is not necessarily appropriate to the needs of people living there now and the long-term aims of the service. Two people have decreasing mobility, so stairs are likely to become a problem for them without ground floor bedrooms. Staff tell us that although they are able to manage at present, they fell that this will become more of an issue in the next twelve months. The AQAA tells us that we need to make certain areas more accessible to people who use mobility aids, staff to be more aware of this need. Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 21 The AQAA also tells us that displays of photographs, artwork, communication aids such as a pictorial rota and menu board to show those we support who is working later, what is for dinner…the conservatory and garden show vast improvement over the last year - the house is now looking a lot less institutional and more homely. We saw that the house has a lot of picture of people up and more effort has been made to make the hosue more homely. The garden has raised beds and lots of seats, one person who lives at the home has a summer hose which he regularly uses. The AQAA also tells us that a new domestic assistant has been employed and the cleanliness of the communal areas is his responsibility and this is working well. We saw that all areas of the house were clean and tidy. We met the cleaner who confirmed that he works 16 hours per week and cleans all of the communal areas. Staff tell us that when the cleaner is not at work they do the cleaning, however staff say that his employment has helped to free their time. Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. As peoples needs have increased there may not be enough competent, qualified staff on duty at all times to provide safe and appropriate support. Staff do not always get the right training and supervision. People can have confidence in the staff because checks have been done to make sure that they are suitable. EVIDENCE: People using the service tell us they like the staff at the home. Comments include: • The home looks after me • I really like Brook House and all the staff The AQAA tells us that once recruited staff follow a clear induction and probation programme, which lead onto the NVQ and LDQ. Following the last key inspection a requirement was made that the service must be able to demonstrate through staff records that new members of staff receive structured induction training. This is so that staff know how to meet the needs of people using the service. The manager has responded to this and tells us Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 23 that staff induction records form part of their Personal Development Plan which is kept by the staff member and signed off by the manager when completed. I have put in place a checklist of the induction immediate requirements, to be signed off by the manager when completed and kept in their personal file at the home. These will be completed at the same time as the P.D.P and will apply to all new starters and the one person who is part way through induction. One staff member started work at the home since the last key inspection. He tells us he has had an induction and spent three days shadowing other staff. The AQAA tells us that all staff have CRB checks before starting work, and the recruitment policies and procedures ensure all references and qualifications are fully checked. We spoke to the one staff member who has been recruited since the last inspection who confirmed that CRB and references were taken. The manager tells us that Macintyre have re-launched their e-learning programme in February which covers modules in managing learning, communication, food hygiene, values, person centred planning, health action planning, challenging behaviour, risk assessment and complaints, which all form part of an induction. Staff confirm that they have started to use this method of training and keep a record on their personal file at home. Staff tell us that they have had some extra specialist training such as dementia care which has helped them to understand the changing needs of the people they support. This training, as well a safeguarding and protection of vulnerable adults training was not recorded on the training matrix. However the manager tells us that four staff have been booked on the training offered by the local authority. The training matrix also shows that four staff need updates on mandatory training such as infection control and moving and handling, as well as medications and risk assessments. This is confirmed by individual training files, senior staff and the manager, who tells us that the home have not been able to access the qualified person within Macintyre. The manager says he has accessed an external training provider. The AQAA tells us that two part time staff have replaced a staff member who left which has led to an easier, regular, balanced and more flexible staff team. Rotas show that there are three or four staff on duty depending on days and how many people are at home. Staff say that there are usually three staff working, but on a Wednesday there are only two which makes the morning routine and going out difficult. Staff raised concerns about support at night time when there are no waking night staff, and staffing at weekends to support activities. Staff also say that although a cleaner has been employed there is a lot of washing and ironing to do which takes away the time from for example, sitting and reading from the newspaper with people who need support to do this. During our visit we observed that although the two people at home during the day had one to one support, between 4 and 5pm one staff Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 24 member was supporting six people while another took someone to a doctors appointment. Five of these people had returned from day services and were very lively with stories of their day. At this time the staff member was administering medications which was a difficult task for her to achieve and may have posed a risk to some people. Comments from staff surveys include: • Extra staff during the day would provide extra opportunity to go out. Individuals are varied and need varied opportunities. • Could do with more staff at the weekends especially Sunday. • Could do with more time one to one but this getting better as we are trying new things. • A large amount of our shifts appear to be spent doing domestic work and not interacting with people. Staff surveys told us very mixed comments. Some staff say they always have up to date information, other say only sometimes. Some staff said their induction covered what they needed to know partly or not at all, others said very well. Some staff said there are usually enough staff, some said there are sometimes or never enough staff. A survey from a health professional working with the home tells us that the home sometimes has the staff with the rights skills to support people with diverse needs to live the life they choose. Staff tell us that staff meetings are regular and they feel supported to deal with the changing needs of people living at Brook House. Senior staff tell us that the home is starting a new system if supervisions for staff because recently regular supervision has not been happening. One new staff member said that he has had one supervision since starting work at the home. Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the care home because it is run and managed appropriately. The environment is safe for people and staff because health and safety practices are carried out. People’s opinions are central to how the home develops and the manager is continuing to work to find more appropriate accommodation for them. EVIDENCE: The AQAA tells us that the manager has an NVQ4 and Registered Managers Award. The manager has for some time understood that the needs of people living at Brook House have changed and more suitable accomodation should be sought for their needs. The manager tells us that a house has been identified for four people who wish to remain living together but the process has not Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 26 moved on as yet. The home are working with social services to identify suitable accommodation for the others, such as older persons accommodation. In the mean time the manager is ensuring that the home is run in a safe and appropriate way. He has attended training in the Mental Capacity Act and Deprivation of Liberty Standards and has provided this information for staff. The AQAA tells us that the manager checks to quality of the service through monthly health and safety audits, with action plans to follow up on any outstanding issues, monthly management recording (reg 26 area manager visit reports) which checks on areas such as training, medication, finances, and service user plans, reports to CQC, supervision records, annual health and safety audits with clear scoring and action plans, and an area development plan. We looked at a random sample of these records and saw that they are up to date. We looked at health and safety records which show that daily health and safety checks include fridges, medications, and money. We observed the house was clean and safe and staff were acting appropriately. As mentioned under staffing, the training matrix shows that four staff need updates on mandatory training such as infection control and moving and handling, as well as medications and risk assessments. This is confirmed by individual training files, senior staff and the manager, who tells us that the home have not been able to access the qualified person within Macintyre. The manager says he has accessed an external training provider. Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 2 3 2 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 x 3 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 x 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 x 3 x x 3 x Version 5.3 Page 28 Brook House DS0000065900.V378450.R01.S.doc Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA35 Regulation 13 Requirement All staff must receive training updates to meet skills for care specifications on all safe working practice topics. This will ensure that people using the service are supported by staff who understand how to work safely. Timescale for action 19/02/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA2 YA3 YA24 Good Practice Recommendations The manager should continue to make it a priority that the assessed needs of people using the service are followed up and more suitable accommodation is found to meet their needs. As changes in need occur and new accommodation is found, the home should ensure that it maintains regular communication with the families and other representatives of people who use the service. Further consideration should be given to the needs and wishes of people using the service, and staffing levels to DS0000065900.V378450.R01.S.doc Version 5.3 Page 29 2 YA15 3 YA7 YA12 Brook House YA13 YA16 YA33 4 YA17 ensure that lifestyle and emotional well being is maintained. Consideration should be given to supporting people who use the service to maintain healthy diets and opportunity for exercise. To support staff through a period of change and to ensure they can meet the needs of people using the service, the manger should ensure that regular supervision and support is provided. 6 YA36 Brook House DS0000065900.V378450.R01.S.doc Version 5.3 Page 30 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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). 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. 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