Care Home: Brookhaven

What the care home does well It was pleasing to establish that the home had appropriately addressed all eight requirements made at the last key inspection, therefore improving the standard of service provided for the people living at Brookhaven. The plans of care were very detailed, being generated from the initial assessment of needs and providing staff with very clear, person centered information about how care and support was to be provided for each person using the service. The home supported people living at Brookhaven to make informed decisions about the routines of daily life and they were able to experience a private and dignified lifestyle, which matched their expectations. The policies and procedures in place at the home protected those living there from abusive situations and systems were in place to ensure that complaints were well managed, so that anyone wishing to make a complaint was confident that they would be listened to and appropriate action taken. Brookhaven was comfortable, hygienic and well maintained providing a pleasant place for people to live and people`s bedrooms were individualised. Those living at the home were able to be involved in the selection of decor and furnishings and some residents had been involved in decorating some areas of the home. People living at Brookhaven were well protected by the recruitment practices adopted by the home and their needs were consistently met by the skill mix and competence of the staff team. The health and safety of those living at the home was well protected and systems were in place so that the quality of service provided could be closely monitored. What has improved since the last inspection? Improvements had been made in the pre admission process, so that the needs of people wishing to move into the home had been thoroughly assessed before a placement was offered to them, so that the staff team were confident that they could provide the care and support required by each individual. Improvements had also been made to the care planning process, so that the plans of care clearly identified all the personal care needs of people living at the home and clear guidance was recorded to show how these needs were to be fully met. People living at the home or their relatives were now being given the opportunity to be involved in the planning of their care, including controlled risk taking, so that they could decide how they wished their care to be delivered. The wishes and feelings of those living at the home were being respected by the staff team and they were allowed freedom of choice and expression by being able to change their minds about decisions previously made, if they wished to do so. Better information was recorded in the plans of care about people`s health care, so that staff were provided with clear guidance about how these needs were to be best met. Improvements had been made to the provision of activities, in accordance with people`s needs, by the employment of an activities co-ordinator who along with the staff team were allowing people living at the home individualised activity plans tailored to their own needs and preferences. Massive improvements had been made to the premises, in order to upgrade and modernise the environment for the people living at Brookhaven. The home was clean, hygienic and well maintained, with new furniture, fixtures and fittings in some areas, including floor coverings and soft furnishings, providing pleasant and safe surroundings for those living at the home. The training programme had been extended to incorporate specific training for staff, in accordance with the individual health care needs of those living at the home, so that the staff team could provide the care and support required by every one living at the home. Systems had been introduced to allow thorough monitoring of the quality of service provided, so that any strengths could be recognised and developed and any areas for improvement could be addressed in a timely fashion. What the care home could do better: A risk management tool could have been used, so that any potential risks were recorded separately from the plans of care, so that the level of risk was clear and better guidance could have been provided for staff about how individual potential risks could be best managed. The care plans could have better reflected how the social care needs of people were being met and could have shown how people were supported to maintain their leisure interests whilst living at the home. Hand written entries on the Medication Administration Records could have been consistently signed, witnessed and countersigned in order to reduce the possibility of any transcription errors. It is recommended that the programme of modernisation and upgrading continues throughout the home, so that the whole environment is of the same high standard. A representative of the organisation could have continued to prepare a written report each month following their unannounced visit to the home, so that the provider can form an opinion of the standard of service provided at the care home. The views of stakeholders in the community could have been sought in order to obtain their views about how goals are being met for those living at the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Brookhaven Gough Lane Bamber Bridge Preston Lancashire PR5 6AQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Vivienne Morris     Date: 0 1 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Brookhaven Gough Lane Bamber Bridge Preston Lancashire PR5 6AQ 01772315894 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): jon.whitton@optimacare.co.uk Optima Care Limited Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: This home is registered for a maximum of 34 service users to include: Up to 6 service users in the category of DE - (Dementia). Up to 34 service users in the category MD (Mental Disorder excluding learning disability or dementia). Date of last inspection Brief description of the care home Brookhaven provides accommodation for up to 34 adults, aged between 18 years and 65 years, who are suffering from mental health problems. The home is registered for a small number of places for older people with a diagnosis of dementia. However, the home is no longer admitting people of 65 years of age or above. The accommodation is provided on two levels served by a passenger lift. The majority of bedrooms are single, although a few double rooms are available for those wishing to share facilities. People Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 0 6 34 Brief description of the care home moving into Brookhaven are able to take their own furnishings to the home and are encouraged to retain their personal possessions. Although only a small number of rooms currently have en-suite facilities, toilets and bathrooms are located at convenient intervals throughout the home. A variety of lounges and a large dining room are provided, although people have the choice of dining within the privacy of their own rooms, if they choose to do so. Brookhaven is conveniently situated on the outskirts of Bamber Bridge and is easily reached by road and public transport, with the motorway network being close by. The range of charges at the time of this site visit ranged from £478:30 to £2162:00 per week. Additional charges were being incurred for hairdressing, toiletries, clothing, outings and personal luxuries. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of Brookhaven took place on 2nd July 2009. The quality rating for this service is two star. This means that people who use this service experience good quality outcomes. The site visit to Brookhaven formed part of the inspection process and was conducted over one day in June 2010. It was unannounced, which means that the managers, staff and people living at the home did not know it was going to take place. During the course of the site visit, discussions took place with those living at the home, staff and managers. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation and all communal areas were seen. We received comment cards back from ten people who worked at the home and ten people living at Brookhaven. Some comments made by the people involved in our Care Homes for Adults (18-65 years) Page 6 of 33 survey are incorporated in to this report. Every year the provider completes a self assessment, known as an AQAA, which gives information to the Commission about how the service is meeting outcomes for the people living at the home and how the quality of service provided is monitored. It also gives us some numerical information about the service. Some of this information from the AQAA is incorporated in this report. We observed the activity within the home and tracked the care of three people during the site visit, not to the exclusion of other people living at Brookhaven. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service over a period of time from a variety of sources. The Care Quality Commission had not received any complaints about this service since the last inspection. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? Improvements had been made in the pre admission process, so that the needs of people wishing to move into the home had been thoroughly assessed before a placement was offered to them, so that the staff team were confident that they could provide the care and support required by each individual. Improvements had also been made to the care planning process, so that the plans of care clearly identified all the personal care needs of people living at the home and clear guidance was recorded to show how these needs were to be fully met. People living at the home or their relatives were now being given the opportunity to be involved in the planning of their care, including controlled risk taking, so that they could decide how they wished their care to be delivered. The wishes and feelings of those living at the home were being respected by the staff team and they were allowed freedom of choice and expression by being able to change their minds about decisions previously made, if they wished to do so. Better information was recorded in the plans of care about peoples health care, so that staff were provided with clear guidance about how these needs were to be best met. Care Homes for Adults (18-65 years) Page 8 of 33 Improvements had been made to the provision of activities, in accordance with peoples needs, by the employment of an activities co-ordinator who along with the staff team were allowing people living at the home individualised activity plans tailored to their own needs and preferences. Massive improvements had been made to the premises, in order to upgrade and modernise the environment for the people living at Brookhaven. The home was clean, hygienic and well maintained, with new furniture, fixtures and fittings in some areas, including floor coverings and soft furnishings, providing pleasant and safe surroundings for those living at the home. The training programme had been extended to incorporate specific training for staff, in accordance with the individual health care needs of those living at the home, so that the staff team could provide the care and support required by every one living at the home. Systems had been introduced to allow thorough monitoring of the quality of service provided, so that any strengths could be recognised and developed and any areas for improvement could be addressed in a timely fashion. 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. Care Homes for Adults (18-65 years) Page 9 of 33 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of people are thoroughly assessed before they move into the home, to ensure that the staff team can provide the care and support required by each individual. Evidence: We tracked the care of three people living at Brookhaven and found that very detailed information had been gathered about their needs, from a wide range of sources, before they were offered a place at the home. This ensured that the staff team could collectively provide the care and support required by each individual. One of the people whose care we tracked told us of her stepped admission to the home, which allowed her to integrate gradually into life at Brookhaven, which we considered to be very good practice. Her current stay at the home was planned for one month. She told us, I love it here and I cannot wait to move here permanently. The homes self assessment showed what the service does well in relation to peoples needs being assessed, with some examples of how this is achieved. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents assessed needs are recorded in a plan of care and they are supported to make informed decisions about the routines of daily life within a risk management framework. Evidence: There was a plan of care in place for each of the three people whose care we tracked during our site visit to Brookhaven. We found that the care plans had been generated from the information gathered before people were offered a place at the home, so that all their assessed needs were considered when planning their care. The plans of care examined had been developed with the involvement of those living at the home, so they had some input into the care and support provided. They were all extremely detailed and very informative, providing staff with clear, person centered guidance about how the individual assessed needs of people were to be best managed. Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: The care plans had been regularly reviewed and any changes in needs had been reflected extremely well, so that staff were provided with current information about the assessed needs of those living at the home. We surveyed at random, ten staff members, who all responded to our questionnaire. They all said that, in general, they were given up to date information about the needs of people they supported. It was quite clear that those living at Brookhaven were able to make decisions about their daily activities within a risk management framework, as detailed in their plans of care. During our visit to the service we observed on numerous occasions staff enabling people to make their own decisions about what they wished to do. It was pleasing to see one person being supported to change his mind about a decision he had previously made. The home had significantly progressed toward providing very individualised support for people, using an holistic approach to care. Eight of the ten comment cards received from people living at Brookhaven indicated that they were able to decide what they wanted to do at all times of the day. When asked what the service could do better the manager wrote on the homes self assessment, Increase support to clients to facilitate them managing their finances. Increase the level of risk taken following risk assessment of activity. We need to continue to further develop our confidence in allowing people to take calculated risks. Those living at the home looked happier and were more conversant. They also showed a feeling of ownership toward the extensive improvements made, which demonstrated their involvement in the operation of their home. Although risks were being managed well and plans of care showed that any potential risks had been identified and strategies implemented to reduce the possibility of harm, there were not always separate assessments conducted to show the level of risk and how this conclusion had been reached. Two people living at the home had a recognised assessment tool in place, but this did not show how identified risks could be best managed, although this information was well documented in their plans of care. Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those living at the home are able to experience a private and dignified lifestyle, which matches their expectations in relation to social care, leisure activities and hobbies, both inside the home and within the local community. Evidence: The policies, procedures and practice guidance focused on people being in control of their lives. The home had appointed an activities co-ordinator and an Occupational Therapist was part of the on site multi - disciplinary team. Together they were responsible for creating meaningful activities and experiences, both in the home and wider community, to encourage people to continue their interests and hobbies whilst living at Brookhaven. People living at Brookhaven were able to enjoy a full, stimulating life style with a variety of options to choose from. The home had considered peoples interests and Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: abilities when planning routines of daily living and arranging activities, by the introduction of individualised activity programmes in accordance with the individual wishes and choices of those living at the home. We were pleased to see that massive improvements had been made to improve the lifestyle of people living at Brookhaven. The environment has been extensively upgraded to make comfortable, modern surroundings for those living at the home. A skills kitchen had been installed so that residents could make their own meals and snacks if they wish to do so. Two residents ate cultural diets and they were supported by enabling them to budget for, shop and prepare their own meals in order to promote their independence by maintaining their existing skills and teaching them new skills. One person was being taught by a staff member from the same cultural background how to prepare and cook his meals, which was considered to be very good practice. We observed a small group of people enjoying a game of Bingo, which was being led by one of the people who lived at the home. Participation in leisure activities was being measured by use of the ROMA (Record of Meaningful Activity) tool, which recorded the level of participation by each person to promote independence. The home has now become pro-active in the provision of individualised activity programmes, which was pleasing to see. The environment was more lively and vibrant, providing stimulating surroundings for people to live in. People living at the home were in the process of decorating the activity room and one person who used to be a plumber by trade, had removed the sink and was waiting for a new one to arrive so that he could install it. Activities also linked to the local community by one person attending the Caribbean club in town on a regular basis. People were given the same opportunities to join in life at the home and within the community. One person was eager to show us some of her art work, which was excellent. She also expressed an interest in numerical and literacy skills. Discussions took place about the possibility of her enrolling at college once she becomes a permanent resident at Brookhaven. One resident was in the process of joining a local leisure center and another had obtained his basic food hygiene certificate because he enjoys cooking and cooks his own meals several times a week. The home was planning to move forward to enable people to start voluntary work within Brookhaven and in the local community. There was a lot of evidence available to demonstrate that both age related and cultural activities were taking place. Posters in the reception of the home showed a variety of Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: planned cultural activities and we were told that religious ministers visited the home and people were supported to maintain their religious beliefs whilst living at Brookhaven. People were seen going out in to the community either alone or accompanied. Care records showed that people were supported to maintain personal relationships after they moved into Brookhaven and that people were helped to write letters and ring friends and family if they wish to do so, therefore maintaining links with the wider community. People spoken to told us that they were able to choose what they did each day and that the daily routines were reasonably flexible. Records, policies, procedures and practices showed that the promotion of independence was an important aspect of life at Brookhaven. Policies and procedures showed that those living at Brookhaven were respected and that their privacy and dignity was maintained at all times. This was also reflected within the plans of care, so that staff were provided with guidance about respecting the people living at Brookhaven. Induction records showed that new staff were instructed about the importance of maintaining peoples privacy and dignity and staff were overheard speaking to people with respect and on the same level, which was pleasing to hear. The dining room was pleasantly decorated and tastefully furnished, making it a comfortable place in which to eat. Dining tables were nicely presented with condiments available on each table so that people could help themselves, in order to promote independence. The menu of the day was displayed on the notice board to remind people of the choices of meals available and the meals served at lunch time corresponded with the menu of the day so that people got what they had ordered. However, we also saw that alternatives to the menu were served as requested. One resident had obtained a basic food hygiene certificate because he cooked his own food, which will be updated as required. It was evident that the home was building on peoples strengths in order to promote choice and independence. However, this could have been better reflected in some of the care plans seen. We were shown the evidence based system used in order to monitor and audit activities provided, including activities of daily living. When asked how the home had improved in the last twelve months the manager wrote on the pre admission assessment,We are better able to facilitate a greater Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: number of family and friend visits through provision of a private visiting room. We have continued to adopt the recovery model as a central philosophy of care and rehabilitation within the service. There is a greater level of choice of activities available to the clients. Care Homes for Adults (18-65 years) Page 18 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home receive appropriate personal and health care support and the administration of medications is in general, well managed. Evidence: We tracked the care of three people living at Brookhaven. We found that all their personal and health care needs were well recorded in their individual plans of care. It was very pleasing to see that an on site Multi Disciplinary Team (MDT) had been formed, so that people living at the home had prompt and easy access to a wide range of professional people to ensure that their personal and health care needs were being fully met. An MDT meeting was in progress at the time of our visit where the needs of people were being discussed, to ensure that the right care and support was being provided. Care Programme Approach (CPA) meetings had also been recorded in individual files, showing that peoples needs were being reviewed on a regular basis to ensure that any changes were appropriately addressed. One person living at the home was eager to show us a scrap book she had developed, with support, which explained all her needs in her own words and how she wished these needs to be met, so that staff were fully aware of what she wanted as an Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: individual. During the time of our visit we had the opportunity to speak to a wide range of health care professionals, who were based at Brookhaven and who were involved in the care of the people living there. They provided us with positive comments about the care and support received by the people living at Brookhaven. Staff spoken to were easily able to discuss the assessed needs of people in their care and they were fully aware of how individual needs could be best met. In general, medications were managed well. Policies and procedures were in place to ensure medications were stored properly and handled appropriately. However, hand written entries on the Medication Administration Records had not always been signed, witnessed and countersigned in order to reduce the possibility of any transcription errors. The manager told us how the home intended to progress over the next twelve months, she commented, We will continue to move toward an increasing self medication policy. We will do this within a framework of risk management, structured support, vigilance and encouragement for the client. When asked if the managers and care staff treated them well, eight people who returned comment cards felt that, in general, they did and all ten staff members who responded to our questionnaire felt that, in general, they had enough support, experience and knowledge to meet the different needs of the people who lived at the home. When asked what the home does well comments from those living at Brookhaven included, It does very well for me, The home takes care of me and The staff are very kind and caring. In response to the same question staff commented, Person centered care and Brookhaven meets clients personal needs and interests and makes it a good place to work. Care Homes for Adults (18-65 years) Page 20 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those living at Brookhaven are protected from abusive situations and systems are in place to ensure that complaints are well managed. Evidence: A comprehensive complaints procedure was in place at the home, which was widely available to any interested parties, including being prominently displayed in the reception area of the home and included in the Service Users Guide. A system was in place for recording any complaints received, although none had been recorded since the last key inspection. A suggestion box was also available, so that people could forward any comments, anonymously if they preferred to do so. Policies and procedures were in place in relation to the protection of vulnerable adults, so that staff were fully aware of their responsibilities should they feel that someone in their care was being harmed. The training matrix showed us that staff had received specific training about safeguarding people living at Brookhaven, which was periodically updated, so that staff were kept up to date with current guidance and best practice. Staff spoken to told us that they would know what to do should they feel that someone in their care was being abused. When asked what the service does well an extract from what the manager wrote was, We promote open and honest dialogue with our clients and their relatives. We hold weekly client meetings where people are encouraged to express their opinions about Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: their residency, care and social activities. We are aware that it is not always easy to express opinions in a large group so residents are regularly given the opportunity to comment on an individual basis to either their named nurse or some other member of staff of their own choosing. Complaints and suggestions are welcomed and a detailed policy is in place. Of the ten comment cards received from people living at the home, nine said that they would know how to make a complaint if they needed to do so and one person told us that they would not know how to complain. Responses varied when people were asked if the care staff and managers listened to them and acted on what they said. However, seven of the ten people said that they would know who to speak to if they were not happy. All ten staff members we surveyed told us that they would know what to do if someone had concerns about the home. The Care Quality Commission had not received any complaints about this service since the last key inspection. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Brookhaven is comfortable, hygienic and well maintained providing a pleasant place for people to live. Evidence: During our visit to Brookhaven we toured the premises, visiting a random selection of bedrooms and all communal areas of the home. We were very impressed to see the massive improvements made to the environment in order to modernise the home for the people living there. Excellent progress had been made, providing a much more comfortable and less institutionalised environment for this client group. A smart reception area had been created as well as an activity room, various meeting rooms and offices. The whole ground floor had been upgraded as well as other areas of the home and although some parts, particularly the bedrooms on the first floor and the games room were still in need of modernising, plans were in place for this work to be done. A designated skills area had been created for the people living at the home, which included a fully equipped kitchen and diner, laundry, activity room and a quiet room where clients could have private time with their key workers, other professionals or visitors. Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: One person whose care we tracked was eager to show us her bedroom and it was quite evident that she was very proud of her personal space, which contained many of her own belongings. It was pleasing to learn that although this individual was not yet a permanent resident at Brookhaven she was able to occupy the same bedroom each time she stayed at the home. She told us that she could leave all her personal belongings locked in the room during her absence and proudly showed us the door key, saying, This is the first key I have ever owned. When asked what improvements had been made in the last twelve months the manager of the home wrote on the self assessment, The environment has greatly improved and given the clients more choice, pride and a sense of ownership. There are more homely touches within the building, which have included client involvement in decor decisions. Repairs are completed in a timely fashion. Purchase of games equipment for clients use. Plans for further improvement within the next twelve months included, The refurbishment and redecoration will continue, to be carried out in stages because of the need to minimise disruption for the residents. Landscaping of the garden area. Second phase of refurbishment will include the updating of all bedrooms with some having full en-suite bathrooms. Infection control policies and procedures were in place at the home and the training matrix showed that staff received training to educate them in the control of infection. The environment was clean, tidy and odour free, providing pleasant surroundings for the people living at Brookhaven. Nine of the comment cards received from people living at Brookhaven indicated that the home was, in general, fresh and clean. One staff member commented, The home should continue with the refurbishment programme. Care Homes for Adults (18-65 years) Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Brookhaven are protected by the recruitment practices adopted by the home and their needs are consistently met by the skill mix and competence of the staff team. Evidence: A training co-ordinator was employed at the home who was responsible for organising all staff training, to ensure that the staff team was qualified and trained to meet the assessed needs of those living at Brookhaven. We established that 57 of care staff had obtained a recognised qualification in care, which exceeded the National Minimum Standards expected. We examined the staff records of three people recently employed at the home in order to assess recruitment practices adopted by Brookhaven. We found that all relevant checks had been conducted before people started working at the home, to ensure that they were deemed fit to work with the vulnerable adults living at Brookhaven. A training matrix was in place at the home, which showed that staff were provided with a wide range of training, so that they were kept up to date with new ways of working. New employees were guided through the external common induction standards, which was provided over two days, progressing to four levels of detailed Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: core competency frameworks within the home, to ensure that new starters could do the job expected of them. PETALS (Preparing to teach in the lifelong learning sector) training had been provided for identified staff members, so that they were deemed competent to deliver training packages for Brookhavens work force. A wide range of mandatory courses were provided for staff as well as specific training in relation to the individual needs of those living at the home. This was confirmed by certificates seen and staff spoken to said that there was plenty of training provided to enable them to support the people in their care. The manager of the home told us what the service does well and gave some good examples of evidence to demonstrate this. All ten staff members who sent us comment cards told us that there were enough staff to meet the needs of all the people who used the service, although one person felt that there could be more qualified staff on duty. However, all said that they were being given training which was relevant to their role and which enabled them to do their job properly. Nine of these people felt that their induction, in general, covered everything they needed to know to do the job and all of them told us that their employer carried out all relevant checks before they started working at the home. One staff member wrote on the comment card, We all work well as a team. Care Homes for Adults (18-65 years) Page 26 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and safety of those living at the home is well protected and systems are in place so that the quality of service provided can be closely monitored. Evidence: The manager of Brookhaven had been in post for one year and had evidently worked extremely hard in order to take the home forward. Significant progress and improvements had been made in all areas of the service provided, in order to improve the quality of life for those living at Brookhaven. It was pleasing to establish that all eight requirements issued at the last key inspection had been appropriately addressed, which was commendable. People spoken to told us that they felt supported by the management of the home and that they were very approachable. A wide range of systems had been implemented by the manager of the home, so that the quality of service provided could be closely monitored, so that any strengths were recognised and any areas for improvement could be addressed within a timely fashion. Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: A variety of surveys had been conducted so that the views of people could be gathered to establish what life was like at Brookhaven. It is suggested that the views of stakeholders in the community now be sought in order to obtain their views about how goals are being met for those living at the home. A variety of meetings were arranged regularly, with minutes kept, so that any important information could be passed on to the relevant people and so that any issues could be discussed. A wide range of audits were in place, so that systems adopted by the home could be monitored and any areas of good practice identified with any shortfalls being quickly rectified. Written policies and procedures had been periodically reviewed and updated, so that staff were provided with up to date guidance and all relevant information to allow them to do their jobs well. The home had received an accredited award from a recognised professional body, showing that Brookhaven was being periodically audited by an external organisation. Accident records seen were completed appropriately and were maintained securely within the home, so that peoples identity and personal details were protected, in line with data protection guidance. The Responsible Individual had previously compiled monthly reports, following his unannounced inspections of the home in order to monitor the quality of service provided for those living at Brookhaven. However, due to the vast amount of additional work created by the structural improvements and the implementation of a wide range of new systems, policies, procedures and practices these reports have not been completed for several months. However, people spoken to confirmed that the provider visited Brookhaven regularly to make sure that the home was being managed in the best interests of the people living there. Records showed that staff had received a variety of training on Health and Safety matters, so that they were aware of their responsibilities of keeping people living at the home safe and protected from harm. A random selection of certificates were examined, which showed that systems and equipment within the home had been serviced, in accordance with manufacturers guidelines, to ensure they were safe for use and in good working order. A variety of internal checks had been conducted regularly, such as hot water Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: temperatures, the fire alarm system and emergency lights to ensure that people living at the home were kept safe. A wide range of environmental risk assessments had been conducted to ensure that the home was safe for people to live in. The majority of staff who sent us comment cards said that their manager gives them enough support and meets with them to discuss how they are working. They all told us that the ways they share information about people in their care with other carers and managers worked well. The homes self assessment told us what the service did well, an extract from which is, The Manager has sound knowledge of strategic and financial planning. She has clear vision of the organisations values and corporate policies. She prioritises, Equality & Diversity, Human Rights and person centered thinking and is aware of the importance of equal opportunities. Care Homes for Adults (18-65 years) Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 39 26 A representative of the organisation must prepare a written report every month following an unannounced visit to the home. This is so that the provider can form an opinion of the standard of service provided at the care home. 31/07/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 It is recommended that any potential risks are recorded using a risk management tool, as well as being included in the plans of care so that the level of risk is identified and guidance is provided for staff about how the element of risk may be eliminated or minimised, so that people are protected from harm. The care plans should reflect more about how the social care needs of people are being met and should show how people living at the home are supported to maintain their abilities. Any hand written entries on the Medication Administration Page 31 of 33 2 13 3 20 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Records should always be signed, witnessed and countersigned in order to reduce the possibility of any transcription errors. 4 24 It is recommended that modernisation and upgrading continues throughout the home, so that the whole environment is of the same high standard. It is recommended that the views of stakeholders in the community be sought in order to obtain their views about how goals are being met for those living at the home. 5 39 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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