Care Home: Bryony Lodge

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What the care home does well People living in the home are supported by staff with positive approaches and a good working knowledge of the needs of the people living there. This and the open management style led to us receiving positive comments from people living in the home about the care and support they receive at the home. Personal care and health needs are planned to be supported and involving external professionals. The service provides a clean well decorated and well maintained environment for people to use and demonstrates a commitment to make changes to improve following consultation with the people living in the home. There was a commitment to staff support, training and development to ensure that they were able to fulfil their roles and responsibilities and meet the complex and diverse needs of people living in the home. What has improved since the last inspection? No requirements were made following the last inspection of the home and the home has made some improvements to the environment. However, there are some areas of practice that has raised concern now and these are addressed below.Bryony LodgeDS0000028547.V377645.R02.S.docVersion 5.3 What the care home could do better: We have made some requirements following this inspection to ensure that the personal aims and social and recreational needs of people living in the home are fully assessed and met. We have also identified that some risk assessments must be reviewed and in consultation with others where necessary and there must be improvements to the recruitment procedures when next used. We have also made a requirement about reviewing the medication procedures. Other reviews are needed and have been identified in the relevant sections of the report such as reviewing the non provision of doors to the en-suite facilities, increasing confidentiality, adding pictures to the service users` guide and complaints procedures and producing an improvement plan following the homes quality auditing. Key inspection report CARE HOME ADULTS 18-65 Bryony Lodge 19 St Mary`s Road Hayling Island Hampshire PO11 9BY Lead Inspector Sue Kinch Key Unannounced Inspection 26th August 2009 09:00 Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Bryony Lodge Address 19 St Mary`s Road Hayling Island Hampshire PO11 9BY 023 9246 0358 02392 463446 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) Mr A Rutter Mrs J V Rutter Mr Shaun David Brough Mrs J V Rutter Care Home 9 Category(ies) of Physical disability (0) registration, with number of places Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Physical disability (PD). The maximum number of service users to be accommodated is 9. Date of last inspection 3 September 2007 Brief Description of the Service: Bryony Lodge is a large modernised house, furnished and decorated in a contemporary style, and is set in a quiet residential street on Hayling Island. The home is registered to accommodate nine younger adults with physical disabilities including one service user with a learning disability. The people who live at this service make use of the local shops that are within walking distance, and use public transport or the homes mini bus. The home is able to accommodate service users who use wheelchairs. All service users have ensuite bathrooms and these contain assisted bathing facilities. At the time of the site visit to the home as part of its key inspection the weekly fees ranged from £450 to £1,000, and this did not included the cost of items such as, hairdressing, newspapers, and toiletries and other sundries. Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection consisted of a review of the information sent to the Care Quality Commission since the last key unannounced inspection on 3rd September 2007.This included a review of the Annual Quality Assurance Assessment (AQAA) document completed and sent in by the manager before the inspection visit. The visit took 7.5 hours and started at 13:00. Most people living in the home were met and spoken with at varying lengths. We also spoke with some relatives and two staff members. The manager was on annual leave but attended the home for the whole of our visit and the Registered Provider was also spoken with briefly. Parts of the physical environment were assessed. A sample of records and documents were examined. What the service does well: What has improved since the last inspection? No requirements were made following the last inspection of the home and the home has made some improvements to the environment. However, there are some areas of practice that has raised concern now and these are addressed below. Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 6 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has been fully occupied for the last two years and has not needed to admit anyone but has systems and procedures in place to identify the help people may need before future admissions in order to ensure that the home would be able to meet their needs. EVIDENCE: As no new people have been admitted to the home since the last inspection records of admission were not viewed and admissions not discussed with staff. A discussion was held with the manager about the admissions procedure and what processes he would go through should an admission be needed. This, he said, would include: obtaining an assessment from the care manager first; an assessment visit to the person to assess their needs; provision of opportunities for the person to visit the home before admission and others living in the home would be consulted. He would obtain current care plans and risk assessments and make amendments to them and the person would have an initial three month trial. A service user guide is available in the front hall but does not include any pictures. As some of the people already living in the home rely on mostly non Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 9 verbal skills and this could also apply to new people moving in this was brought to the manager’s attention who agreed to address it. Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9,10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessment and care planning procedures are in use in the home, involving people in planning their care. However, some risks have not been assessed and some not recently reviewed. Care plans identify some preferences for day to day care but do not adequately identify people’s personal aims and how they are to be individually supported to achieve them leaving them at risk of not having full choice about their lifestyles. Confidentiality is not adequately promoted in the home to ensure that personal information is only accessible by those with a right to see it. EVIDENCE: We asked to view care plans for four people using the service and these were available. There was some evidence of personal reviews taking place and reviews of care plans. The care plans have been written to include some of the wishes of the people in the home and how they like their care to be provided. Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 11 The care plans viewed lacked information about goals of people living in the home and the focus was on general care and lacked details about how people wished to spend their time on a day to day basis. The manager said that other people were more active but in the care plans viewed for some people needing support for day to day activities there was not enough evidence of forward planning based on their wishes or of activities having taken place to show that they were offered enough stimulation. We noted that none of the care plans viewed included pictures although for some people spoken with use of pictures during the inspection helped communication and in the two files sampled for people with communication difficulties there was little guidance for staff regarding communication. For example, some of the behaviours and signs of one person were observed, and spoken about with the manager during our visit, but none of them were recorded. This leaves the person at risk of their communication style not being fully assessed and available for all staff to ensure their needs are met. Feedback from people and staff told us that people are consulted about aspects of the service to be provided including care needs and preferences. A conversation was held with one person who was not sure initially about whether they had viewed their care plan or not. In conversation with the manager while looking at the care plan they showed some knowledge of it. The person has some short term memory problems but has not been given a copy of the care plan to help keep them informed. The manager agreed to address this. Staff spoken with showed a good working knowledge of the people that they support in the home and said that there is good communication between staff and with the manager. They also said that care practices are discussed. The home has carried out some risk assessments for people living in the home for some aspects of their day to day lives. Some of them were in need of review and had not been recorded as reviewed since January 2008. We noted from conversations and observations that one person has bed sides and this was not included in the risk assessment although raised at the last inspection. Also generally people do not use the kitchen. One person was standing at the kitchen door and the manager said that they did not go into the kitchen, however, there was no risk assessment regarding this or guiding staff what to do if the person did want to use the kitchen. The manager agreed that they were in need of review. We noted that the care plans for people living in the home are held securely but that other records including day to day recording were not. These were held in an unlocked cupboard in the lounge leaving people at risk of their personal information not protected. This was pointed out to the manager who agreed that he would take action. Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 12 Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12,13,15,16,17 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are provided with some activities that interest them in the home and whilst using the local community, but a reduction in staff has meant that opportunities to pursue individual interests outside the home are less frequent and limited by personal aims not clearly identified and worked on for everyone. EVIDENCE: From conversations with people and observations during our visit we noted that some people are involved in a number of activities. We heard about sailing opportunities, shopping, holidays and attending football matches. We heard of college craft and exercise courses held in the home during term times and of independent use of the community. When talking with people we noted that people had some equipment such as televisions, books and musical equipment for personal hobbies. Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 14 During our visit we noted that several people had gone to day services for the day and that people go from one to four days a week depending on what has been agreed for them individually. Staff said that they are able to go out with people during the day if the manager is available in the home for direct care. In conversations we heard examples of things people like to do, such as sitting in the garden, cooking, and helping in the office. However, care plans and records were not clear in describing how people, in the sample considered with higher support needs, were individually supported in activities and provided with stimulation on a day to day basis as referred to in the section on individual needs and wishes. It was not clear how the home had fully identified, planned and addressed people’s individual social and recreational needs or personal aims and this could impact on their quality of life. Changes have been made in the staff level since the last inspection when there had been a third person working in the home two days a week for social stimulation. This post is no longer used. As two staff are needed in the home in evenings and weekends when the manager is not available there were no regular activity plans requiring staff support out of the home. This limits the choices and decisions of some people living in the home. A requirement has been made about personal aims in relation to the individual needs and choices section. People are welcomed into the home and some visitors confirmed that they are always made to feel welcome and are provided with refreshments. People are supported to maintain family relationships and we heard of this involving weekends away, holidays, parties and day to day activities. People are encouraged to eat healthily and one person talked about the support successfully received to obtain some weight loss. This was discussed with the person and the manager together and it was agreed by them that the approach to this was based on the person’s wishes and decision-making. In various conversations about the food with people and staff it was confirmed that people living in the home are able to influence the menus and these are sometimes the subject of a resident’s meeting. One person said that they did get their favourite food and that alternatives were offered if they did not want what was on the menu. In general comments from people living in the home about the variety and quality of food were positive. People are sometimes involved in shopping and preparation of food and the manager spoke of some people having opportunities to cook at the day service. The kitchen at the home has not been adapted for people with physical disabilities and although some food preparation can take place in the lounge/diner this restricts people’s involvement. One person said that they would like to do more cooking. Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18.19.20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are provided with support to have their health needs met and to obtain support from external professionals although some of the risk assessments have not been recently reviewed meaning that people may not have the support needed. Medication is managed safely in the home but reviews of staff competence and medication procedures have not recently taken place leaving people at risk of errors being made. EVIDENCE: In the sample of care plans viewed we noted that the help and support individual people need with personal hygiene and physical care was detailed indicating individual preferences. A staff member was also able to give details of how to meet that person’s health and personal care needs. We also noted that for one person where particular risks had been identified in relation to Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 16 health and personal care these have been assessed with staff guidance provided. However, evidence in the section on individual needs and choices show that this is not consistent. Aspects of personal care were discussed with some people and with some relatives and we were given information that people were receiving the care that they needed. This for example included discussions about people’s preferences for baths or showers and the adaptations and equipment to meet individual needs. We noted that all people we asked had been provided with the equipment needed. En-suite facilities have been provided for all people though in the rooms visited we noted that there were no doors separating these rooms. The manager said that this had been discussed with people and had been like it for some time. He agreed to keep this under review with people or their representatives. A district nurse arrived during our visit to attend one person and we heard, from people living in the home, of the involvement of other health professionals in their care including doctors dentist and psychiatrists. A member of staff commented that the manager often attends the visits but that staff are kept informed of the outcome and action to be taken. They gave an example of someone recently undergoing a medication review and were aware of the changes. They were also aware of the risks of epilepsy and of the procedures in place should this occur. We noted from a sample of files that there are records indicating that routine health checks are taking place and outcomes are documented so that staff can support people appropriately. We sampled the medication procedures for the home and noted that a monitored dosage system is in operation in the home for most of the medication given out except for those unable to be held in the system. The medication is held securely in two medication cabinets. We sampled the records of administration, receipt of drugs and disposal and found that these were in use and recording was taking place as required. The home has a policy of two staff being involved in medication administration. At the last inspection it was noted that the home had written policies and procedures about the management of medication. These were part of an “off the shelf” package and did not reflect the actual practice in the home. They referred to a different monitored dosage system of medication than was actually used in the home. It was also noted that risk assessments for self medication had not been completed. The home’s registered manager had agreed to address this but at the time of this visit we did not see any evidence that this had been completed. The manager was referred to the Royal Pharmaceutical Society Guidance for medication to enable him to review this. We also noted that there was no reference in the medication guidance about how to deal with medication going to day services. Whilst we did not find Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 17 major errors in the medication practices sampled, we did note that guidance was in place for one person for a medication no longer used –potentially causing confusion. The manager said that staff are provided with medication training at the beginning of their employment and that they are assessed as competent before carrying out medication administration. We asked for evidence of recent re assessment and although training records sampled indicated that staff have had recent training in medication with more training planned their competence had not been re-assessed. The manager agreed to do this. Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A complaints procedure is available in the home and people living there feel supported and that their issues are listened to. Staff are receiving training in the home regarding safeguarding and systems are in place to ensure that concerns are followed up. EVIDENCE: A complaints procedure is available in the home in the front entrance of the building and people were aware of it. It does not include pictures and the manager agreed to give this attention as some of the people using the service use non verbal skills. The complaints log is available although no entries had been made in the last year indicating that matters are resolved at the informal stage. We had consistent information from people using the service and relatives about the manager being approachable and being able to raise issues with the staff if needed. One person felt confident that they would get the help they needed. Another said that they did not have any complaints and any grumbles were listened to and dealt with. We noted that staff are provided with training in adult protection and the two staff on duty had received training in July 2009.They were aware of the types of abuse that could occur and the need to take action. The home has not Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 19 reported any incidences of abuse in the home and staff said that relationships were friendly in the home. At the last inspection it was noted that the policy and procedures for following safeguarding allegations were not in line with the locally agreed procedures and indicated that the home would investigate any allegations or suspicions of abuse rather than refer to external agencies in line with procedures. At the time the manager was advised to include a clear reference to the local authority adults services department as the agency with the lead responsibility for investigating any allegations or suspicions of abuse that may occur in the home. In the AQAA for this inspection the manager informed us that the safeguarding policies had been updated in February 2009. Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24.30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are provided with a safe, comfortable, clean and bright environment to live in with regular improvements taking place. EVIDENCE: At the time of our visit to the home people were talking about the improvements to the garden which now provides a decked area partitioned off from the rest of the garden and drive, offering people an attractive area to spend time in as they wish. Further painting was taking place to improve the external appearance of the home. The internal home was clean and well decorated with furnishings and fittings were in a good state of repair. A number of wheelchair users live at the home and the corridors include protective strips to prevent damage to the walls. People told us that things were fixed as needed and that equipment had been provided based on needs and wishes in personal areas of the home. All but two Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 21 people living in the home have their own rooms and en suite facilities. These areas were clean and equipped including ceiling hoists, and rails where needed. It was noted that none of the en-suite facilities had doors from the bedroom and some people spoken with could not remember discussing it. The manager said that it had been like this for some time but agreed to review it with individuals. The home addresses infection control and had notices to visitors about using a hand wash as they entered the home and provided the hand wash for this purpose. A discussion was held with a member of staff who agreed that infection control had been included in their training since working in the home. The training records was viewed and this was noted to have taken place this year. Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home receive support from staff receiving training and supervision to meet their needs but staffing levels will need to be reviewed when people living in the home have been consulted about their personal aims and stimulation. Employment procedures in the home must be reviewed to ensure that they are robust and offer people working in the home adequate protection. EVIDENCE: The manager said that the home was fully staffed and that the home was not using agency staff because members of staff covered spare shifts that arose. In the AQAA the manager said that there are 9 full time staff and 2 part time staff of who 5 are assessed to National Vocational Qualification level 2 or above. At the time of the inspection two staff were on shift and they, the manager and the rota confirmed that this is the usual level of staff provided in Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 23 the day time. The manager works during the week from 9-5 but the additional worker who worked during the day time two days week had left and, without a change in the number of people living in the home, had not been replaced reducing the staffing available for supporting individual needs in and outside the home. In addition there are two staff in the evenings and weekends. These are required to be in the home meaning that opportunities to go out in these times are limited. We did not receive complaints about staff levels during our visit but as detailed in the section on individual needs and choices and activities, care plans viewed need development to be more person centred regarding hobbies and stimulation and this may have implications for staffing levels to meet people’s needs. The home has recruited staff in the last year and we sampled the records held for this. We found that the pre employment checks that the manager told us in the AQAA had been completed before staff were employed in the home were not fully evidenced. We issued an immediate requirement notice and followed this up with a letter. Although Criminal Record Bureau (CRB) checks were completed before the inspection visit they were employed before full CRB checks were completed and evidence of POVA First checks were not held. We also noted that for one of these staff members only one written reference had been obtained. We asked the home to respond to us by 10th September 2009.This was received within the timescale and the Registered Provider has given details of action taken. Staff spoken with during the inspection confirmed that they are in receipt of regular training and formal and informal support from the manager. One member of staff said that care practices are regularly debated in both forums. Both staff on duty felt able to address matters with the manager and were able to show an understanding of aspects of their roles discussed with them. Comments from the staff and the manager and observation of records and certificates indicated that the staff team are given regular training for understanding their role. This is supported comments by made in the Annual Service Review of 4/8/08 when we received surveys from staff who commented positively on training. The manager uses an external agency for courses usually run for staff at the home and these vary from a few hours to a day. He also attends them and is considering involving people in the home in some of them. Records of training undertaken and planned are recorded. Those viewed indicated that staff are provided with training in moving and handling, infection control, fire, first aid, medication, and safeguarding. The current plans include training in medication, and moving and handling. At the last inspection that it was suggested that it would be beneficial to arrange training for staff in subjects about the specific needs of some of the people living in the home to increase their knowledge and understanding of matters such as; multiple sclerosis; epilepsy; strokes; Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 24 etc. We note that the training plan included epilepsy awareness and further advised the manager to consider other specialist training in the plan. Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager provides open management in the home which means that people living and working there can approach him for support but more work is needed of the monitoring of the effectiveness of systems in the home to ensure that people’s needs are fully met and safeguarded. EVIDENCE: Positive feedback we received from this inspection about the management of the home is consistent with previous information provided such as for the Annual Service Review 4/8/08. We heard comments about the manager knowing what is happening on a day to day basis and being involved in the direct care and support of people living in the home. The manager was described as approachable and providing ‘open management’. Staff say that Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 26 they can discuss things with him and are listened to. The manager said that he does the training that the staff do to keep himself up to date and he had also had training in the Mental Capacity Act. We considered quality assurance and noted that the AQAAS submitted to us for the Annual Service Review and this inspection have not provided us with enough information to give a full self assessment of how the home is developing or how the matters that we are raising have been addressed in the home. We found at this inspection that action taken about some of the matters we have raised such as about revising the medication policy and having risk assessments for bed rails, were not sufficiently evidenced. We have also noted that care plans are not fully person centred and risk assessments need to be reviewed. We also made an immediate requirement about staff recruitment records. We noted that the home does have a system for consulting people about the service and that changes have been made such as menus and alterations to the garden based on the wishes of the people living in the home. However, the comments from people have not yet been reviewed and used with information from an audit of the home to inform a development plan. The manager agreed to address this. The manager, in the AQAA indicates that regular servicing of equipment takes place and policies and procedures were reviewed in June 2009. There is a fire marshal for the home and tested the bells during the inspection visit and people warned that it was just a test. One resident said that they were tested regularly. We noted that the fire doors in close proximity to the office released and closed during this test. Staff training records showed that health and safety matters such as moving and handling, infection control, health and safety and fire are included. The manager said that the in house fire marshal provides the second fire training session and agreed to record it the homes training log. The manager spoke of plans to include some of the people living in the home in aspects of training in the future. Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 5 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 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000028547.V377645.R02.S.doc x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 2 2 2 LIFESTYLES Standard No Score 11 x 12 2 13 2 14 x 15 2 16 2 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bryony Lodge Score 3 3 2 x 2 x 2 x x 3 x Version 5.3 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement The registered manager should ensure that people living in the home are encouraged to have person centred plans to identify their aspirations and provide staff guidance for working towards them. Timescale for action 26/11/09 2 YA9 13 3 YA20 13 4 YA34 19 This is to ensure that people have opportunities to review the quality of their life and levels of stimulation. The registered person must 26/10/09 ensure that people living in the home have all risks relevant to them as individuals, assessed with consultation of relevant others and kept under review. This is to ensure that all support needed is provided and reviewed. The registered person must 26/10/09 review the medication policy in the home to take account of the Royal Pharmaceutical Society Guidelines and provide an accurate procedure for the home including self medication. The Registered Person must 28/08/09 ensure that that pre employment DS0000028547.V377645.R02.S.doc Version 5.3 Page 29 Bryony Lodge checks are fully completed before staff commence employment. 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 OP10 Good Practice Recommendations It is recommended that practices in the home are reviewed to ensure that all personal information held in the home is held securely. Bryony Lodge DS0000028547.V377645.R02.S.doc Version 5.3 Page 30 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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