Care Home: Brook House Residential Care Home

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What the care home does well Prospective residents/service users are given information to help them make an informed choice about the service. The home has a clear assessment procedure to ensure that prospective residents` needs are assessed and that the home can meet those needs. A comprehensive care plan remains in place for each individual. Care plans include assessment of needs, plans to provide support where required, and evidence of liaison with health and social care agencies in the community. The plans aim to ensure that individuals` needs are met and that they are supported in maintaining their independence. People continue to participate in a variety of social, therapeutic and recreational activities which aim to meet individual needs, improve well-being and establish positive networks of support in the wider community. Guidance and support regarding personal and healthcare support is provided to the people who use the service when required. Arrangements for individuals to maintain contact with healthcare services appear satisfactory and support well-being. Medication is stored securely and administration is accurate, ensuring safety., Needs arising from equality and diversity are met, ensuring that each person`s individual circumstances are taken into account. The home has a procedure in place for responding to, investigating and recording complaints which ensures that issues raised are addressed appropriately. Systems and procedures, including appropriate staff training are in place to ensure the protection of the people who use the service. Brook House is located in a quiet residential area, within reach of local shops, walking distance of Didcot town centre and of public transport. A clean, safe and well maintained environment has been created, providing people with a comfortable and homely place to live, suiting the needs of the people who use the service. Staff have the necessary skills and specialist training to meet individuals` needs. The home has safe recruitment practices in place, which safeguards the people who use the service. The home is well managed and staff work as team, which benefits household members. The service has systems in place to monitor the quality of care and to ensure that standards are being maintained. Health and safety practices safeguard the people who live at Brook House What has improved since the last inspection? Documentation regarding what the home can offer to prospective residents has been reviewed. Health and safety concerns around the temperature of hot water storage, the temperature at hot water outlets, and that of radiator surfaces have been addressed providing a safer environment for all household members. What the care home could do better: All documentation relating to the support needs of the people who use the service should include signatures and dates to uphold the validity of the information. The advice of a pharmacist should be sought regarding the storage and administration of medication especially in relation to handwritten medication administration records. Advice should also be sought regarding staff training in medication administration to ensure the continue health, safety and welfare of the people who use the service. The home has a procedure in place for responding to, investigating and recording complaints which ensures that issues raised are addressed appropriately, however minor amendments should be made to the procedure to ensure that the process is clear and accessible to everyone. Staff job descriptions should b reviewed and amended where necessary so that job descriptions fit with the work staff carry out in the home. A paper copy of the POVA first check should be included within staff files to safeguard the people who use the service. A training needs analysis should be undertaken to develop a training plan for the next year, agree training providers, agree how the programme is to be resourced and integrated into staff induction, supervision, appraisal and development The registered provider should test the temperature of the water at all hot water outlets on a regular basis to ensure the continued health, safety and welfare of all household members. CARE HOME ADULTS 18-65 Brook House Residential Care Home 19 Ockley Brook Didcot Oxon OX11 7DR Lead Inspector Nancy Gates Unannounced Inspection 6th November 2007 10:00 Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brook House Residential Care Home Address 19 Ockley Brook Didcot Oxon OX11 7DR 01235 818926 01235 818926 brookhouse@beeb.net 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) Brook House Residential Care Home Ltd Abigail Reynolds Care Home 4 Category(ies) of Learning disability (0), Mental disorder, registration, with number excluding learning disability or dementia (0), of places Physical disability (0) Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of service users to be accommodated at any one time must not exceed 4. 26th March 2007 Date of last inspection Brief Description of the Service: Brook House is a residential care home for four adults aged 18 or over with a mental illness, learning disability or physical disability. The home is situated in a residential area within walking distance of Didcot Parkway station and local shops. Didcot town centre is less than one mile away. The accommodation is over two floors. The ground floor comprises the entrance hall, office, one bedroom, dining room, kitchen, lounge, small laundry room, cloakroom and conservatory. The first floor accommodates three bedrooms, bathroom, staff sleep-in room and storeroom, shower and WCs. The home has a small garden to the rear of the building and parking for two cars on the front drive. The home does not have a lift and does not facilitate wheelchair access. The service aims to support people in a community based setting with a view towards moving on to independent living in time. The service achieves this through developing individual independent living skills and supporting people to establish contact with a network of other services in the wider community. Fees at the time of this inspection ranged between £700 and £1500 per week. Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of the service was a surprise visit and was a ‘key inspection’. The inspector arrived at the service at 10.00 a.m. on a weekday. The total number of hours spent at the home was 8 hours. The time spent at the home allowed for a thorough look at how well the service is doing. The inspection took into account detailed information provided by the service manager inclusive of information that CSCI has received about the service since the last inspection. The inspector asked for the views of the people who use the service. The inspector also asked the views of others who support the needs of the people who use the service via a questionnaire that the CSCI sent out. All information received by the Commission for Social Care Inspection since the last inspection, about this service was also taken into account when producing the key inspection report. Staff and the people who live at Brook House were very welcoming. The inspector looked around the home including the bedrooms of individuals at their invitation. A number of records were viewed including individuals care plans, staff recruitment records, staffing rotas and maintenance/health and safety records. The inspector looked at how well the service was meeting the standards set by the government. The report includes judgements about the standard of the service. The inspector would like to thank the manager and staff team for their assistance with the inspection. Thanks also to the people who use the service, visitors and all others who shared their experience of this home. What the service does well: Prospective residents/service users are given information to help them make an informed choice about the service. The home has a clear assessment procedure to ensure that prospective residents’ needs are assessed and that the home can meet those needs. A comprehensive care plan remains in place for each individual. Care plans include assessment of needs, plans to provide support where required, and evidence of liaison with health and social care agencies in the community. The plans aim to ensure that individuals’ needs are met and that they are supported in maintaining their independence. Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 6 People continue to participate in a variety of social, therapeutic and recreational activities which aim to meet individual needs, improve well-being and establish positive networks of support in the wider community. Guidance and support regarding personal and healthcare support is provided to the people who use the service when required. Arrangements for individuals to maintain contact with healthcare services appear satisfactory and support well-being. Medication is stored securely and administration is accurate, ensuring safety., Needs arising from equality and diversity are met, ensuring that each persons individual circumstances are taken into account. The home has a procedure in place for responding to, investigating and recording complaints which ensures that issues raised are addressed appropriately. Systems and procedures, including appropriate staff training are in place to ensure the protection of the people who use the service. Brook House is located in a quiet residential area, within reach of local shops, walking distance of Didcot town centre and of public transport. A clean, safe and well maintained environment has been created, providing people with a comfortable and homely place to live, suiting the needs of the people who use the service. Staff have the necessary skills and specialist training to meet individuals’ needs. The home has safe recruitment practices in place, which safeguards the people who use the service. The home is well managed and staff work as team, which benefits household members. The service has systems in place to monitor the quality of care and to ensure that standards are being maintained. Health and safety practices safeguard the people who live at Brook House What has improved since the last inspection? Documentation regarding what the home can offer to prospective residents has been reviewed. Health and safety concerns around the temperature of hot water storage, the temperature at hot water outlets, and that of radiator surfaces have been addressed providing a safer environment for all household members. Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5 Quality in this outcome area is good Prospective residents/service users are given information to help them make an informed choice about the service. The home has a clear assessment procedure to ensure that prospective residents’ needs are assessed and that the home can meet those needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A statement of purpose and service user guide are available to provide information to prospective residents. The statement of purpose provides details of the registered provider and proposed registered manager including details of their qualifications and experience. It provides the staffing structure, information about the service on offer, and details of the complaints procedure. The document states that it should be read in conjunction with the service users’ guide. The service users’ guide includes reference to the statement of purpose, a summary of the service, details of the registered provider and the registered manager as in the statement of purpose, the staff structure, a summary of the Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 10 home’s approach to quality assurance, the complaints procedure, a summary of the ‘terms, conditions and fees’, a summary of the ‘Contract of Residence’, visiting times and confidentiality. The proprietor stated that both documents are to be reviewed in January 2008. Amendments suggested at the previous inspection have been made to both the statement of purpose and service users’ guide. The home is currently registered to provide support to people with mental health needs, to support people with a physical disability and to support people with a learning disability. The proprietor recognises that this is a broad range of diagnostic categories and is proposing to review the support offered at Brook House to specialise in the support and rehabilitation of people with an acquired brain injury and to support people with enduring mental health needs. The accommodation provided at Brook House is described, referring to room sizes in a floor plan attached to the main document. The service users’ guide has been amended to include reference to inspection reports. An assessment of needs is carried out before admission. All places were occupied at the time of this inspection in November 2007. Examination of service user records confirmed that the service continues to have an established referral process with local health and social services. A referral form is completed at an early stage. This gathers information on the prospective resident’s current needs. Completion of a ‘combined assessment pack’ provides further assessment information, assessment of risk and plans to manage risk. This provides the registered provider and registered manager with sufficient information to decide whether the home is likely to be able to meet the referred person’s needs. Documentation provided within the CPA process inclusive of care management information also provides clear descriptive assessment of needs, allowing for clear judgement of need prior to admission. Amendments suggested at the previous inspection have been made to service users contracts to include information regarding the room to be occupied, fees, care plans, the review of care plans and reference to the Care Programme Approach (CPA) in relation to people with mental health support needs. The current scale of fees for this service is £700 to £1500 per week. Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 & 10 Quality in this outcome area is good A comprehensive care plan remains in place for each individual. Care plans include assessment of needs, plans to provide support where required, and evidence of liaison with health and social care agencies in the community. The plans aim to ensure that individuals’ needs are met and that they are supported in maintaining their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans of the four people who live at Brook House were examined. Care plans continue to include a photograph of the individual, a ‘comprehensive assessment plan’ (assessment of needs and assessment of risk), a record of the assessment by the manager, terms and conditions/contract, notes of CPA review and risk management meetings, crisis plan, records of medication, notes of medical and dental contacts, activity diaries, individual menus and correspondence. Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 12 The plans continue to include information regarding the importance of taking prescribed medication, support in personal care, following a healthy diet, agreeing to the current multi-agency CPA plan of care, creating structure around the day and week and the action to be taken in the event of crisis, however not all of the plans were signed and dated by the individual or staff member. Daily notes remain detailed and of a good standard. The care plan forms the basis of the contract between the home and the individual; it is based on an assessment of need, states how staff at Brook House will support the individual and what is expected of individuals. Staff have undertaken “Headway training” specifically relating to the assessed needs of individuals with acquired brain injury. The service has clearly recognised the importance of updating staff knowledge to support identified needs of the people who use the service. An individual who lives at Brook House confirmed that people are supported in participating in home life and in making decisions. This is achieved through activity plans, participating in the cleaning rota, participating in the fortnightly community meeting and in joint activities, and menu planning. Contact details of seven advocacy services in the Oxford area remain available. Risk assessment and management is carried out through the completion of individual risk profiles, information shared between the Community Mental Health Team and the service, individual crisis plans and through the employment of a community psychiatric nurse (CPN) to provide out of hours on call support. Arrangements for managing confidential information are satisfactory. The service user guide includes a confidentiality statement referring to the Data Protection Act 1998. Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good People continue to participate in a variety of social, therapeutic and recreational activities, which aim to meet individual needs, improve well-being and establish positive networks of support in the wider community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Individual’s preferences and wishes in relation to Lifestyle choices are recorded in their support/care plans. The service continues to stress the importance of structure to each person’s day and week. This is particularly important in a service where there is an expectation that in time individuals will move on to more independent accommodation. Staff appeared to have a supportive and positive relationship with the people who use the service, this was confirmed by one individual who stated, “staff are really nice, they take time to talk and help if you need it”. Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 14 An activity diary is written with each individual. Activities recorded include menu planning and shopping, sessions at social, support and rehabilitation groups, working in a charity shop one day a week, working at a work project in Didcot, participating in personal and communal domestic tasks, cooking, trips out to local shops, pubs and the leisure centre. This mix of activities continues to provide structure to individual’s lives, supports participation in communal activities, establishes and maintains links with a network of support services in the community and supports integration with the local community. Three people are in contact with their families. The nature and extent of the contact varied. Established friendships before admission continue to be supported. Visiting is allowed in communal areas and the home’s policy on visiting has been reviewed. The office on the ground floor would be made available to individuals who wish to have a private conversation with a visitor. The daily routine remains structured and the people who use the service are expected to be up for breakfast and to have plans for their day. At the time of this inspection, people were out at various activities, one person returned from a visit with their family. Meals are planned with individuals, each person receiving £25.00 per week for their food. Communal evening meals take place on Wednesdays and Sundays. A roast is always available for Sunday lunch. On other days, each service user makes their own evening meal with support from staff as required. Breakfast is self-service – usually cereals, toast, fruit and beverages. Individuals continue to make their own arrangements for lunch. Lunch may be taken at another service where that forms part of a service user’s programme or in the home. Selections for the evening meal from menus supplied for this inspection were varied and included, ‘Fish, Chips and Peas’, ‘Chilli and rice’, ‘Chicken Curry’, ‘ Spaghetti Bolognaise’, ‘Beef Stew and Dumplings’ and ‘Roast pork with all the trimmings’. People are given the opportunity to develop a healthy and balanced approach to their diet, however individual preferences may not always be considered to be “healthy or balanced”. Reference to a healthy diet is made within care plans and support is provided to ensure that people are given a variety of food options. Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good Guidance and support is provided to the people who use the service when required. Arrangements for individuals to maintain contact with healthcare services appear satisfactory and support well-being. Medication is stored securely and administration is accurate, ensuring safety, however the current system would benefit from a review with a local pharmacist. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Support/care plans detail clear guidance of how residents wish their personal and healthcare needs to be supported. The approach to care for each individual reflect the aims of the admission, the aims and philosophy of the home, the needs and aspirations of the individual and the needs of other people who use the service at the same time. Individuals confirmed that they receive guidance and support when required. Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 16 The people who live at Brook House and the staff continue to comprise of both male and female and people of different ages. The staff group includes a mix of ethnic groups. Each person is registered with a GP. Two individuals were in contact with Community Mental Health Teams (CMHT), the remaining two people having contact with local rehabilitation services. Access to opticians, chiropodist/podiatrist and a dentist is arranged locally as required. A nurse who is a specialist in the management of diabetes continues to provide advice if needed. Specialist mental health services are accessed through the relevant CMHT and other NHS services via the service user’s GP. Physical aids are currently not required at Brook House but can be installed as required The home has a policy governing the administration of medicines. The manager is a qualified nurse (RMN) and is able to appropriately manage the storage and administration of medication. Staff received in-house training from the previous manager; competency is assessed through supervised practice. Staff continue to transcribe the medicines prescribed on to a medicine administration record (‘MAR’ sheet). It is recommended that the dispensing chemist write this on the MAR wherever possible. Two staff should preferably sign handwritten entries. The manager stated that a review of medication would be undertaken in consultation with a local pharmacist. Medication, with the exception of Clozapine, is prescribed by individuals GP and is usually dispensed by a local pharmacist. A copy of the prescription is retained in the home. Clozapine is safely dispensed on a monthly basis by the manufacturer following strict blood monitoring. Medicines are stored in a lockable cupboard in the staff room, which has now been securely fixed to the wall. No medicines required cool storage but the provider said that the home would use a lockable box if required and store it in the refrigerator. Two people continue to administer their own medicines using a dosset box, which they fill weekly. There is a lockable drawer in bedrooms if required. Depot injections are given either at the GP’s surgery or by a CPN in the individual’s bedroom if required. Medication is reviewed at a CPA review or by the individuals GP. Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good The home has a procedure in place for responding to, investigating and recording complaints which ensures that issues raised are addressed appropriately, however minor amendments should be made to the procedure to ensure that the process is clear and accessible to everyone. Systems and procedures, including appropriate staff training are in place to ensure the protection of the people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No formal complaints have been received at the home or at the CSCI since the last inspection. The complaints procedure is outlined in the statement of purpose, service users’ guide and an additional policy. The procedure states that a “service user” who has reason to complain should speak to the staff on duty in the first instance; if it isn’t resolved to the individual’s satisfaction then a written complaint must go to the registered manager and then onto the registered provider. The procedure does not include timescales and should be revised. The procedure correctly states that a complainant may contact CSCI at any stage – although this need not be in writing as stated in the document. Finally, it says that if the matter remains unresolved the ‘next step’ is to write to The Ombudsman. Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 18 The distinction between oral and written complaints in a service of this size remains unnecessary. Requiring an individual to put their complaint in writing may unintentionally discriminate against some people. Whilst an individual, or someone on their behalf, should not be discouraged from making a written complaint if they wish, they should not be required to do so. The proprietor stated that a review of all policies and procedures is to be undertaken in the New Year to ensure that people who use the service receive clear guidance if they wish to raise issues of concern/complaints. People confirmed that they know who to talk to if they’re not happy with something or want to complain, either within a house meeting or individually. The home continues to have a policy governing the protection of vulnerable adults (POVA), which relates to the Oxfordshire Multi-Agency Codes of Practice with regard to the investigation of suspected abuse. Staff have attended local authority POVA/Safeguarding Adults training. Staff are aware of issues surrounding POVA/Safeguarding adults and expressed confidence in the manager and provider to investigate reports of such conduct. The home had a copy of the Department of Health guidance ‘No Secrets’ and now has a ‘whistle blowing’ policy. The staff employed at Brook House are experienced in the care of vulnerable people (adults and children) and had a mature and appropriate attitude to support people who live at Brook House. The home continues to have facilities for supporting people to manage their finances/money if required. Small amounts of cash may be held on behalf of an individual in a small safe. All transactions are recorded. Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good Brook House is located in a quiet residential area, within reach of local shops, walking distance of Didcot town centre and of public transport. A clean, safe and well maintained environment has been created, providing people with a comfortable and homely place to live, suiting the needs of the people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is located in a quiet residential area about 15 to 20 minutes walk from Didcot Parkway station. The town centre is just under a mile away. Regular buses run between Didcot, Abingdon, Cowley and Oxford. There is limited parking to the front of the house. Alternative parking is available on nearby roads. There are local shops and a pub a short walk away and a larger shopping centre in Didcot. Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 20 The entrance hall leads to the office, ground floor bedroom, cloakroom, kitchen, dining room, small laundry room, lounge and conservatory. There is a small garden with seating to the rear of the property. A summerhouse has been erected in the garden and is the only area in which smoking is permitted. Stairs lead to the first floor accommodation, which comprises a landing, staffroom, three bedrooms, bathroom, shower and WC. Bedrooms vary in size. According to information provided by the registered manager one bedroom is under 12 square metres in size. Room sizes are included within a floor plan attached to the statement of purpose and service users guide. None of the bedrooms have en-suite facilities. Some additional support in the form of an external banister, shower seat and cooking aid have been installed after consultation with an occupational therapist. The home provides a pleasant, comfortably furnished and well-maintained building. However, it remains unsuitable for a person with a significant problem with mobility or who requires a wheelchair. The kitchen is domestic in scale. It is equipped with wall and floor mounted storage cupboards, work surfaces, cooker, refrigerator, freezer, dishwashing facilities and small electrical items such as a kettle and toaster. Space is provided in the kitchen for people to store their food. Some drawers are labelled. The kitchen facilities were tidy and in good order on the day of this inspection visit and are considered sufficient for their current use. There is a small laundry room, which is equipped with a domestic washing machine and dryer, which again is considered sufficient for current use. The lounge is comfortably furnished and is sufficient in size for current use. The conservatory is a useful additional room, which provides communal space separate from the lounge and from the distraction of the television. Concerns were raised at the previous inspection regarding water temperatures at hot water outlets and that radiators are not covered or do not have cool touch surfaces. Water temperature regulators have been fitted at all hot water outlets and stored hot water is now temperature controlled at 60 degrees centigrade or above. The surface temperature of radiators can be adjusted at each radiator to suit individual requirements and would be covered if required by individual need. All areas of the home appeared clean and there were no unpleasant odours. It is part of the philosophy of the home that individuals undertake domestic chores. Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 Quality in this outcome area is adequate Staff have the necessary skills and specialist training to meet individuals’ needs, however a training and development plan should be developed to ensure staff skills and competency are up to date. The home has sufficient staff to meet identified needs. The home has safe recruitment practices in place which safeguards the people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Job descriptions are in place for all staff. The job description for a ‘senior care/care worker’ was again examined due to issues raised at the previous inspection. The job description remains unchanged and appears to be based on a health services professional post in a larger organisation and would benefit from review and revision in the context of the aims and objectives of Brook House. Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 22 The home’s recruitment, induction, training and supervision procedures aim to ensure that staff have the necessary qualities and skills for the job. Staff have acquired experience in a care or related setting before taking up employment at Brook House. Information provided by the provider reports that two care staff are registered to undertake the NVQ2. As a relatively new service, it is currently not achieving the standard that 50 of staff have acquired NVQ2, however the proprietor stated that it is expected that the target will be achieved within 2008. All staff continue to be provided with a copy of the General Social Care Council (GSCC) codes of practice upon appointment. Current staffing of three full-time care staff, two part time staff and two bank staff provides two staff in the morning, two in the afternoon and evening and one waking and one sleep-in care staff at night. The home employs a community psychiatric nurse (CPN) to be on-call during the night. This provides additional ‘out of hours’ support to the home. The provider is available at all times. Applicants for posts in the home continue to be required to complete an application form, provide two referees, have an enhanced Criminal Records Bureau (CBR) check, provide information in relation to their medical fitness for the job and attend an interview. Three staff files were examined. All files had a recent photograph of the staff member, completed application form, references, a Criminal Records Bureau (CRB) check, a letter confirming appointment and a contract of appointment. A ‘POVA first’ check is completed before appointment and the results emailed to the home, however a paper copy of the email had not been filed as evidence that the check had been undertaken. A CRB check raised an issue for one employee but the individuals file did not provide greater detail as to the evidence, risk assessment and reasons for the decision to appoint or not. The proprietor took immediate action to ensure that evidence was available to support the decision made. Brook House remains a relatively new service, continuing to develop an approach to staff training and development. New staff continue to follow the ‘Skills for Care’ induction programme. The proprietor has established links with a range of training providers including local social services authorities, commercial providers, local colleges and courses supported by the Learning and Skills Council. Staff have attended in food hygiene, first aid, infection control, health and safety, POVA, challenging behaviour, moving and handling and introduction to working in mental health services. Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 23 An audit of training needs was completed in April 2007, however it does not provide an up to date account of staff training. Recommendations made at the previous inspection regarding the development of a training plan for the next year or 18 months, agreements with training providers, agreements on how the programme is to be resourced and integrated into staff induction, supervision, appraisal and development have yet to be developed and must be considered as a priority to ensure that staff have the appropriate skills to support people at Brook House. The inspector recognises that all staff have undertaken “Headway training” specifically relating to the assessed needs of individuals with acquired brain injury. The service has clearly recognised the importance of updating staff knowledge to support identified needs of the people who use the service. The newly appointed manager is also proposing that all staff attend training regarding the Mental Capacity Act 2005 and how this will impact on the support provided to people within a care setting. A policy remains in place with regard to staff supervision. A contract for supervision has been agreed with all staff. Due to a change in manager, staff have not received one to one supervision for six months. The newly appointed manager has started to re-introduce supervision, aiming for all staff to be supervised every eight weeks. Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good The home is well managed and staff work as team, which benefits household members. The service has systems in place to monitor the quality of care and to ensure that standards are being maintained. Health and safety practices safeguard the people who live at Brook House This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new manager was appointed at Brook House at the end of September 2007. The manager is an RMN qualified to degree level, has been a CPN, is a psychotherapist, has a certificate in Community Mental health and a Certificate Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 25 in Health and Social Care. The manager has numerous years of experience in supporting people with mental health needs and has previously been registered with the CSCI. The manager confirmed that an application for registration would be submitted to the CSCI by December 2007. The home continues to meet a range of needs and to support people in moving on to independent living. The provider continues to be on site every day, can observe how things are going and deal with any problems at an early stage. Regulation 26 reports are completed monthly. Day to day interactions and the fortnightly and monthly meetings with staff and the people who use the service provide ongoing feedback on life in the home. The relationship between staff and the people who use the service was positive and respectful. An individual was very positive about the support offered at Brook House. The home has a policy manual and a list of policies was provided by the manager in the pre-inspection information provided to the CSCI. Policies are dated and were reviewed in April 2007. The registered provider is proposing to review all policies and procedures in the New Year. Policies are readily available to staff and the people who use the service in the ground floor office. Records examined within the inspection were accurate and up to date. A range of health and safety checks continues to be carried out at the home. A health and safety policy is in place. The fire log showed that routine tests are carried out and that maintenance and servicing takes place. Additionally a fire based risk assessment was in place. Contracts for the maintenance of fire equipment are in place. The emergency lighting is tested in the home weekly. There is a designated area for smoking within the home. The manager has sought the advice of the fire service following the previous inspection with regard to a safe method (such as the installation of a fire door retainer) of retaining the kitchen and office doors in the open position when required. The fire service made no recommendation regarding the installation of door retainers. COSHH materials are stored in a locked cupboard and the relevant data sheets are available in a health and safety file. Systems are in place for recording accidents. Concerns were raised at the previous inspection regarding water temperatures at hot water outlets and that radiators are not covered or do not have cool touch surfaces. Water temperature regulators have been fitted at all hot water Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 26 outlets and stored hot water is now temperature controlled at 60 degrees centigrade or above. The surface temperature of radiators can be adjusted at each radiator to suit individual requirements and would be covered if required by individual need. Arrangements for ensuring the safety of gas and electric appliances are satisfactory. There is a business and financial plan for the service and relevant insurance cover is in place. Lines of accountability are clear and an organisation chart is included in the home’s statement of purpose. Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 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 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 28 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. Standard Regulation Requirement Timescale for action 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 YA6 Good Practice Recommendations The registered provider should ensures that all documentation relating to the support needs of the people who use the service include signatures and dates to uphold the validity of the information. The registered provider should obtain the advice of a pharmacist regarding the storage and administration of medication especially in relation to handwritten medication administration records. Advice should also be sought regarding staff training in medication administration to ensure the continue health, safety and welfare of the people who use the service. The registered provider should review staff job descriptions, making amendments where necessary so that job descriptions fit with the work staff carry out in the home. The registered provider should ensure that a paper copy of the POVA first check should be included within staff files to safeguard t he people who use the service. DS0000066262.V349844.R01.S.doc Version 5.2 Page 29 2. YA20 3. YA31 4. YA34 Brook House Residential Care Home 5. YA35 The registered provider should undertake a training needs analysis, develop a training plan for the next year, agree training providers, agree how the programme is to be resourced and integrated into staff induction, supervision, appraisal and development The registered provider should test the temperature of the water at all hot water outlets on a regular basis to ensure the continued health, safety and welfare of all household members. 6. YA42 Brook House Residential Care Home DS0000066262.V349844.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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