Care Home: Northbrook Care Home

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What the care home does well There is a small fairly stable staff team that know the people living there well. People using the service appear happy and relaxed in the company of staff and one person said, "the staff are nice to me". The bedrooms are all of a good size and have ensuite showers and toilets. One relative said, "I would be happy for my daughter to stay at Northbrook if it were nearer to us." A social worker said, "my client has come on in leaps and bounds. They have done a lot for her."Another social worker said, "although my clients complex needs are only partially met they are good with her and she is not at risk. They do try hard and her cultural needs are met". What has improved since the last inspection? The manager has applied to be registered with the Commission and is waiting to have her interview. The health and physical condition of one person has improved a lot due to the care and support that the staff team have given her. All of the staff have completed NVQ level 2, two have NVQ level 3 and the remainder are due to start NVQ level 3 in September. Therefore staff continue to develop their skills and knowledge. What the care home could do better: A relative said, "my daughter needs to go out more". A person living in the home said, "I get bored, I want to go swimming and to go out". The staff team need to continue to develop and support activities to ensure that people have a full and interesting lifestyle and that they also develop their skills and independence. Staffing levels need to allow for this. Enough staff must be on duty to meet peoples` needs and to allow the manager time to carry out her duties. Staff need to have more specific training to enable them to appropriately and safely meet the complex needs of some of the people using the service. Staff terms and conditions continue to be poor and this will effect staff satisfaction and retention which in turn will have an impact on the people using the service as at present they receive a service from people that they know and who know them well. CARE HOME ADULTS 18-65 Northbrook Care Home 63 Northbrook Road Ilford Essex IG1 3BP Lead Inspector Jackie Date Unannounced Inspection 15th May 2008 10:00 Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Northbrook Care Home Address 63 Northbrook Road Ilford Essex IG1 3BP 020 8911 9110 020 8911 4900 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) Northbrook Homes Limited Manager post vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender : Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 4 2nd August 2007 Date of last inspection Brief Description of the Service: Northbrook Care Home opened in March 2006. It is a home for 4 adults with learning disabilities. The 2-storey house is in Ilford close to bus routes, the station, shops and leisure facilities. The home is not accessible to wheelchair users and the service will not be accepting people who are wheelchair dependent. There are four single bedrooms, each with ensuite toilet, shower, and wash hand basin. In addition there is also a communal bathroom. There is a small lounge upstairs and a dining room downstairs. At the time of the visit three women were living at the home. They do not attend formal day services but are supported by the staff team to do activities. The scale of charges is £1177 to £1400 per week. The manager provided this information at the time of this inspection. Information about the service provided is contained in the service users guide. Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 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. This inspection was unannounced and started at 10:00am. It took place over seven hours. This was a key inspection and all of the key inspection standards were tested. Staff were asked about the care that people using the service receive, and were also observed carrying out their duties. Where possible, people using the service were asked to give their views on the service and their experience of living in the home. All of the shared areas and one of the bedrooms were seen. Staff, care and other records were checked. Relatives, social workers and healthcare professionals were contacted and asked for their opinions of the service. At the time of writing this report feedback had been received from 1 relative, 1 healthcare professional and the social worker/care manager of 2 people. Feedback forms were also received from 3 staff and staff supported one of the three people using the service to complete a feedback form. Services are now required to complete an AQAA (Annual Quality Assurance Assessment) and the completed form was received in April 2008. Information provided in this document also formed part of the overall inspection The inspector would like to thank the people living at Northbrook Road and staff for their input during the inspection. What the service does well: There is a small fairly stable staff team that know the people living there well. People using the service appear happy and relaxed in the company of staff and one person said, “the staff are nice to me”. The bedrooms are all of a good size and have ensuite showers and toilets. One relative said, “I would be happy for my daughter to stay at Northbrook if it were nearer to us.” A social worker said, “my client has come on in leaps and bounds. They have done a lot for her.” Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 6 Another social worker said, “although my clients complex needs are only partially met they are good with her and she is not at risk. They do try hard and her cultural needs are met”. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 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 Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Appropriate information is gathered on people before they move into the home and this gives staff a picture of the individual’s needs and how to meet these. People thinking of moving into Northbrook and their relatives can spend time in the home to find out what it would be like to live there and to enable them to make a choice about living in the home, within their capacity to do so. The Service User Guide is being simplified to help them with this. Each person has information about the service that they are entitled to. EVIDENCE: As at the time of the last inspection the manager is still in the process of making the Service Users Guide more user friendly. She has simplified it and now plans to include photographs. The manager has translated the guide into Urdu and put this on tape for one person. This is good practice. There have not been any new admissions to the home since the last inspection. The newest resident moved into the home in December 2006. At the time of a previous inspection the paperwork with regard to this individual Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 9 was examined. It contained an assessment by the placing authority, a referral form and also an assessment that the manager of the home had carried out. A care plan was also in place. This contained an assessment profile. Therefore sufficient information was gathered on that person to enable their needs to be identified and for a decision to be made about the home’s capacity to meet their assessed needs. There was also evidence that the person visited the home on occasions and had met the other people living there. Therefore, when possible, people are given the opportunity to visit the service and to meet staff and other people living there before they decide if they want to live there. Each person has been issued with contracts/terms and conditions. These were in individual files. Therefore people have information about the service that they are entitled to. Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Overall the care plans and risk assessments contain sufficient information to enable staff to safely meet people’s needs. People are consulted about what happens in the home as far as they are able. Peoples’ personal information is safely stored to maintain confidentiality. EVIDENCE: Each person has a plan which gives details of how they need/like to be supported. Areas covered included health, personal care, communication, behaviour, sexuality and cultural and religious needs. All of these were up to date and are reviewed monthly by keyworkers. All three people have had full reviews this year attended by their care managers and relatives. All three care plans were examined during the visit and the information contained in them was relevant. For example the care plan of one person Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 11 indicates that she is Muslim but does not attend the mosque. Care plans also contain information on dealing with inappropriate or difficult behaviours. However one person does have complex needs and although the care plan gives strategies for managing some of her behaviours and meeting her basic needs her overall needs are not fully met. This person’s care manager said that the staff work well with her, meet her cultural needs very well and try very hard but that she does need a lot of skilled support. For this reason and the fact that her family wish her to move nearer to them an alternative specialist placement is being sought. Feedback from another care manager was that staff have ‘done a lot’ for the person and that she has ‘come on in leaps and bounds’. Daily recordings are made about what each person has done and support that they have been given. These recordings are broken down into various areas including night care, personal hygiene, communication, socialisation and meals. Therefore there is information about each individual, which can be used as part of the review process and to identify ongoing and changing needs. These records also show ways in which people make choices. For example, one person usually goes to bed late, about midnight, and then gets up about 9am. Another goes to bed about 10pm but is up early. There are risk assessments in place. These identify risks for people using the service and staff and indicate ways in which the risks can be reduced to enable peoples’ needs to be met as safely as possible. Risk assessments have been reviewed and are up to date. They are also relevant to each person. Residents’ meetings are held each month and a record is kept of these. One person can and does express her views about what she wants to do and what she likes. Another person does not speak but appears to understand English & Urdu and can express herself, to a limited degree, using sounds, facial expressions and body movements. Minutes of the meetings contain information on discussions about behaviour and peoples responsibilities to each other and confirm that discussions are held about issues at the home. For example, Christmas, menus and activities. During the course of the visit it was noted that staff asked people direct questions so that they can easily indicate a yes or no response. For one person this is by smiling. People using the service are involved in the running of the home as far as they are able. They are encouraged to make decisions about what happens as far as they are able. Peoples’ records and other information are stored in a lockable cabinet in the office and staff are aware of issues of confidentiality. Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Although the staff team are caring and supportive people living at the home do not have an interesting or stimulating lifestyle. People are supported to keep in contact with their relatives and most relatives visit regularly. People are supported and encouraged to have a diet that is healthy and meets their need. This includes their cultural preferences. EVIDENCE: At the time of the last inspection one person had become more independent and no longer needed staff support all the time. She was travelling independently to visit her mother at the weekend. She was going to the local shops to buy things like bread and milk. Unfortunately she had a fall when out Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 13 and badly broke her leg. Her recovery has been quite long and she needed 2 operations. As a result of this she has not been able to do very much and has also lost a lot of her confidence. Changes to staffing levels and the complex needs of another person have meant that she has not had a lot of support to go out and she said that she is bored and daily notes refer to her spending a lot of time in her room watching television. This needs to be addressed. However feedback from her care manager was that “she has come on in leaps and bounds, and emotionally she is much better”. The other two people living in the home need a lot more support from staff and one person needs two staff to take her out in the community and this level of support has not been regularly available. However her placing authority have recently agreed an extra 10 hours per week of additional support to help to address the problem. The staff team have been trying to develop more activities for people living there and a massage therapist has visited and it is hoped that this service will be available soon. One person has been introduced to an independent service and does two sessions per week. One is facial expressions and the other is music. However there was no information in the daily records as to whether she enjoyed this or whether she had attended. The manager said that sometimes she does not want to go. The third person has attended a sensory room but due to her complex needs has to go when other people are not using it. This has been arranged but the facility is now closed and will re open in September. Feedback from one relative was that her daughter needed to go out more. Staff said that they are trying to introduce activities and to take people out. However there is little evidence that this has been successful or that people have an interesting or stimulating lifestyle. Additionally staffing levels have not been adequate to allow for this. On the day of the visit all three people were at home, one spent most of the time in her room. These issues must be addressed. Two of the people living in the home have regular contact with their families who visit the home. Families are invited to celebrations at the home and celebrations are held for birthdays, Eid and Sabaarat and for Christmas. One of the people using the service said that she goes home to visit her mother regularly and was looking forward to staying at her mothers for a few days. Therefore people are supported to keep in contact with their family and relatives are welcomed at the home. Staff were observed to knock on bedroom doors and wait for reply before opening it. Peoples’ privacy is respected. The most independent person has a key to the front door and is able to use this. One person can and does say what she wants to eat. This person has diabetes and staff support her to eat appropriately. Meals for other people are based on their likes and dislikes. One person is provided with Halal meat to meet her cultural needs and another has Caribbean takeaways occasionally. There were concerns previously about the low weight of one person when she moved in. Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 14 However she continues to gain weight and is much healthier and as a result of a good diet needs less medication. Her care plan says that she likes fruit and fruit juices and needs a diet high in iron content. For another person she can be offered a choice and can sign yes or no. We joined one person at lunchtime. She was supported to eat by a member of staff and was offered extra drinks. This person was really happy sitting with the staff and was smiling at them. Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. People using the service receive personal care that meets their individual needs and preferences and the staff team support them to get the healthcare that they need. The health of people living at the home has improved due to the good care that they receive. People are given their regular prescribed medication safely but medication records need to be more robust to minimise the risk of errors and to provide a more accurate record of medication administration. EVIDENCE: People using the service require differing amounts of support with their personal care. Two people require a lot of support and are dependent on staff for their personal care needs. The help that they need is in their individual plans. The other person is fairly independent but was given additional support for some months after she sustained a serious injury to her leg. People living in Northbrook Road have been supported by a stable staff team who have got to know them well and know how they like to be supported. For example one Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 16 person has a routine of teeth cleaning whilst in the shower. People are encouraged to choose what they wear and one person wears the traditional clothing of her culture. Another person is helped to dye her hair and she said that she likes this. All of the people using the service go to the local doctor and specialist help is received from the community learning disabilities team. One person has received input from the psychologist and it is hoped that she will soon be receiving speech and language therapy. Staff support people to all of their medical appointments. Evidence was available that people have had checks from the optician, dentist and when appropriate chiropodist. When one person moved into the home she was very weak, quite thin and unable to walk. She has put on weight, is enjoying her food and can even go upstairs now. From observations this person is very happy and relaxed. She was obviously comfortable with staff and smiled when they talked to her and looked around for them when they left the room. The staff team are to be commended for the care and support that this person has been given as she is much stronger and happier than when she moved in. As stated previously another person had an accident and badly broke her leg. The staff team supported her through the treatment, which included two operations. None of the people living in the home are able to self medicate and medication is administered by staff. Medication is administered from the Boots monitored dosage system and staff have received training from Boots. In addition the manager has also assessed the competency of staff to administer medication. It is recommended that the manager carries out periodical checks to ensure that staff are administering medication in line with good practice guidelines and that they are still competent to do this task. Medication is securely stored in an appropriate lockable cabinet in the office. The medication file contained photographs of each individual and a record of any allergies or health issues. There was also a list of staff that are able to administer medication and their signatures. This is good practice. Medication administration records are completed but recently the record for one person had not been signed although the medication had been given from the dosage system. This had been an issue at the time of the last inspection but records show that this had been addressed and that records had been signed regularly up until very recently. Other records had been signed when medication was administered. The manager will raise the issue with staff to find out what had happened and to address the problem Due to a healthy diet and being more active one person no longer regularly requires laxatives. The manager said that the doctor said that they could be given when required. However the MAR(Medication Administration Record) has not been amended to reflect this. Staff were aware of the change and this medication was not being given regularly. However the MAR(Medication Administration Record) must accurately reflect the medication that a person is Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 17 receiving. If this is now PRN(when required) new guidelines must be put in so that staff are clear as to when and how to administer this medication. Producing guidelines for another persons PRN medication was a requirement of the previous 2 inspections and has not been fully addressed. Unmet requirements can have an impact on people’s welfare and the Commission will consider enforcement action to secure compliance when necessary. However this is a small home with a stable staff team and staff are aware of this persons needs in terms of medication and although we are satisfied that it is being appropriately administered the necessary paperwork must be in place at the time of the next visit. This will help to ensure that people receive their prescribed medication as safely as possible. Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. There is a complaints procedure that would be followed in the event of any complaints being made. Although staff have received safeguarding adults training this did not give them sufficient understanding of some types of abuse. Other training did not give them sufficient understanding or knowledge of how to deal with difficult behaviour in an appropriate way. Whilst they have learnt from the situation that arose as a result of this they have not yet had the necessary training to enable them to deal appropriately with difficult behaviour in a way that safeguards people using the service. EVIDENCE: The home does have a complaints procedure, which is displayed. One person living at the home would be able to say if she was not happy about anything. She said that she could tell her mother or speak to her social worker. She has a mobile phone and is able to contact both people when she wants to. The other two people would be reliant on other people to raise concerns on their behalf. One care manager said that she did not feel that her client was at risk at the home. One person said that she liked the staff. The two other people living there were observed to respond positively, by smiling, to staff and seemed happy and relaxed in their company. There was one recorded complaint made by the mother of one person and this was addressed under the safeguarding procedure. Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 19 The local authority’s adult protection procedure is available in the home and staff have read this. The manager was aware of the action to be taken in the event of a suspicion or allegation of abuse and the staff team have received protection of vulnerable adults training. The safeguarding issue that arose was related to the manager and the staff team not having clear strategies to deal with the behaviour that one person was exhibiting and therefore they managed the situation in a way that could have been considered emotionally abusive. However this was not intentional and the safeguarding meeting concluded that this was a training issue. Therefore there are requirements in relation to this in the section on staffing. Staff, relatives and care managers spoken to say that they did not have any concerns about the care of residents. At the time of the visit the service was only dealing with the finances of one person. The manager knows the PIN number for the persons account and withdraws money each week. The person usually accompanies her. For a second person money is requested periodically from the Court of Protection and the third persons finances are managed by her family. The first persons finances were checked and cash amounts held agreed with records. Receipts were on file. A running record is kept of the amount of cash held and any withdrawals are recorded in this. This is then checked against the bank statements that are received. The person carrying out the monthly monitoring visits checks finances. For the second person receipts are kept but there is not a running record of expenditure and this needs to be in place along with evidence that this is also appropriately checked. This will offer better safeguards for this person’s finances. At the time of this inspection we were focussing on safeguarding issues and the manager, two staff and one person using the service were asked specific questions about this. Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 & 30. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. People live in a clean home that is suitable for their needs and that is gradually becoming more homely. EVIDENCE: The home is a 2-storey house in Ilford close to bus routes, the station, shops and leisure facilities. The home is not accessible to wheelchair users. However, there are two ground floor bedrooms. There are four single bedrooms, each with ensuite toilet, shower, and wash hand basin. In addition there is also a communal bathroom. There is a small lounge upstairs and a dining room downstairs. Most of the home has been redecorated and looks much brighter. New curtains have been purchased and also some new furniture. The communal areas are quite small and since the redecoration the staff are gradually making these more homely and this is an ongoing process. The kitchen was also refurbished. Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 21 The people living at the home do not require any aids or adaptations although two of them require wheelchairs to go out in the community. An additional handrail has been fitted on the stairs to assist people to use them safely. There is a garden at the rear of the building and most of this is a grass lawn. There are items of garden furniture available for people to use. Each person has a single bedroom and these are appropriately decorated and have some personal items. One person said that she had chosen the colour for her room and said that she was happy with her room. At the time of the last inspection there were not any facilities for staff to change or to store personal belongings. There has been a vacant room since the home opened and this is now used by staff for sleeping in and also for storage of personal belongings. Therefore at this stage the requirement in relation to this has been met. However the proprietor is reminded that should a fourth person move in it will then be necessary to provide suitable facilities for staff for the purpose of changing and for storage. At the time to visit the home appeared to be clean and hygienic and received a satisfactory environmental health report in January 2008. Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Although staff have completed a lot of training and have developed a lot of skills the needs of one person are very complex and staff will need specialised training to meet her needs if she continues to live in the home. Staffing levels have not always been sufficient to meet the needs of people using this service. Staff have the opportunity individually and collectively to discuss their own development or any problems and developments within the service and feel supported by the manager. People using the service are supported and protected by the organisations recruitment practice. EVIDENCE: Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 23 There is a small female staff team in post and the intention is that the home will only provide a service for females. From discussions with staff it was evident that they know the people living there very well and are able to understand the non-verbal communication of two of them. However feedback from staff was again of low pay and poor conditions, for example no additional pay for working on bank holidays or recognition of their qualifications. Staff also said that they have had to pay for some of their training. As at the time of the last inspection this continues to affect staff morale and could have an adverse affect on staff retention and the recruitment of experienced and qualified staff. This in turn could affect the quality of service provided. The registered person is reminded that it is his responsibility to ensure that persons employed at the home receive training appropriate to the work that they are to perform and that they are given suitable assistance for the purpose of obtaining further qualifications appropriate to such work. A good staff team are key to the development and running of a service and this staff team have undertaken a lot of training, including recognised qualifications, and deserve to be recognised and valued for their contributions to the service. The staff team have undertaken a lot of training to assist them to carry out their duties. This has included induction training, working with people with challenging behaviour, managing difficult situations, medication administration, first aid, infection control and food hygiene and POVA (Protection of Vulnerable Adults). All staff have completed NVQ level 2 and two also have NVQ level 3. The remainder of the staff team are due to start NVQ level 3 in September. The staff team have had the training that they need to provide an appropriate and safe service for people living there. However as the result of a complaint and safeguarding issue the staff team need further POVA (Protection of Vulnerable Adults) and ‘restraint’ training to ensure that they have a good working understanding of this and of good practice in this area. The manager said that she had applied to a local college for this training and is awaiting confirmation that this has been accepted. One of the people using the service has complex and quite specialist needs and staff have tried very hard to meet her needs. Her care manager said that the person needs a lot of skilled support and that the staff team “are very good with her”. For some time there have been suggestions that an alternative placement is sought for the person but so far this has not been successful. If this person is to remain at the home for any length of time the staff team will need specific training to enable them to appropriately and fully meet her needs. The staffing ratio is still two staff on each shift but between 9 & 5, Monday to Friday, the manager is now the second person. This is in effect a decrease in staffing levels, as the manager was previously an extra person. Two of the people living at the home need a lot of physical support from staff and one person needs two staff with her when she goes out. Although a third person is quite independent she had an accident at the end of last year, which resulted Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 24 in a serious injury to her leg. She needed extra support because of this and at present has not regained her confidence so needs staff support to go out. Current staffing levels were not sufficient to support this. One person using the service commented that another person “takes all the staff time so I cannot go out”. Two staff are also on duty at night. Staff said that both staff are awake until people are settled, which can be around midnight, and then they sleep in the empty bedroom. There are not suitable facilities for two staff to sleep in and the manager said that one sleeps on a mattress on the floor in the empty room. They then get up about 5am when one person gets up. The rota showed and staff confirmed that they then often work the next day. This is not acceptable and staff need to have adequate breaks from their duties to allow them to have sufficient rest to carry on their duties the next day. Staffing levels are not adequate to meet peoples’ current needs. This was discussed with the manager and after the inspection she confirmed that the proprietor had agreed to return to the staffing levels at the time of the last inspection. These were two staff on duty during the day with the manager extra and 1 waking and 1 sleeping staff at night. The requirements in relation to this have still been made to stress that staffing levels have not been sufficient and to ensure future ongoing compliance. A selection of staff files were examined at the time of previous inspections and found to contain the necessary information and checks. On this occasion the file of the newest member of staff was checked. This contained a copy of the application form, the interview test, references, confirmation of identity, POVA (Protection of Vulnerable Adults) first check, CRB (Criminal Records Bureau) check and other required details. The person started work after the CRB (Criminal Records Bureau) check had been received. Therefore an appropriate recruitment process is now in place, as required by the previous inspection. This helps to safeguard people using the service. Staff are receiving regular supervision and staff meetings are being held each month. This gives staff the opportunity both collectively and individually to discuss work practice, any concerns and the development of the service. However the minutes of the last three meetings are virtually the same on each occasion. The manager was not able to provide an explanation for this. Also there was a complaint that led to a safeguarding issue. Although the staff team were aware of the issues the minutes do not reflect that these issues were discussed. Whilst there may be a standing agenda for each meeting it is important that minutes accurately reflect the discussions and decisions reached. This will assist staff to be clear about what is expected of them. At the time of the last visit the manager stated that she is in the process of introducing staff appraisals. At the time of this visit the manager said that she has given staff the appraisal forms to complete but the process is only just starting. The introduction of the appraisals has been slow and may be related to the changes in the rota and the decrease in management time available for the manager. Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Whilst there are areas of good practice and people using the service have benefited from this, and previous developments, there has not been significant developments in the service since the last inspection. The registered provider monitors the service appropriately to check the quality of the service provided to people living there. People are living in a safe environment. EVIDENCE: The manager started at the home in September 2006. She has a lot of experience of working with people with learning disabilities and of managing Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 26 residential services. She has successfully completed the RMA (Registered Managers Award) and NVQ 4 in care. The manager therefore has the necessary experience and qualifications to manage the service. The manager has submitted her application to be registered by the Commission and is waiting to have her interview for this. There is an evident commitment from the manager and staff team and they obviously work well together. Staff said that they receive the supervision and support that they need from the manager to carry out their duties and that they are able to talk to her and discuss any issues and concerns. At the time of the last inspection in August 2007 the service had improved greatly but the development has not continued in all areas. For example, the development of meaningful activities for people. Part of the reason for this is related to the complex needs of one person and the effect that this has on the service. In addition another person had an accident and could not be as independent as usual. This increased the amount of time that the manager needed to be ‘hands on’ and more recently staffing levels changed, due to the manager being required to make financial savings. The manager did not then have specific management time available to concentrate on the development of the service. Some examples of this have been mentioned in the report. For example, the staff appraisals and the Service Users guide have not been completed. As stated in the previous section on staffing the proprietor has agreed to return to the staffing levels at the time of the last inspection. Which will mean that the manager is an additional person and will have dedicated management time. A requirement in relation was made in standard 33 to secure future ongoing compliance. Monthly monitoring visits are carried out by an experienced person on behalf of the proprietor. The reports received are detailed and cover the necessary areas. They also indicate any action that is needed. This person also provides the manager with professional supervision to enable her to discuss any issues, problems and the development of the service. The manager has developed quality assurance questionnaires to obtain feedback on the service provided and these were due to be sent out after the last inspection in August 2007. However this has still not happened. Therefore it is now a requirement that a quality assurance and quality monitoring review, based on seeking the views of people using the service and their representatives, be carried out to find out their views on the service provided and to identify any developments and improvements needs. The staff team carries all of the necessary health and safety checks out regularly. For example fire call points are tested weekly, as are hot water temperatures. Fridge and freezer temperatures are tested daily. Regular fire drills take place and these are recorded. The working practices in the home are safe and there have not been any preventable accidents. Records show that there are very few accidents and staff confirmed this. Appropriate servicing is carried out on the fire system and fire equipment. Electrical items Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 27 and the electrical intake are checked by appropriately qualified people as required. The landlord’s gas safety certificate that was available in the home had expired. The manager said that she believed that the current certificate was with the proprietor. Overall a safe environment is provided for the people living there but a copy of an up to date gas safety certificate must be sent to the Commission to confirm that gas services are safe. Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 2 2 X X 3 X Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 29 YES 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 YA13 Regulation 16 Requirement People using the service must be supported to choose and to attend a range of fulfilling activities both in the home and in the community. This will help them to have a more interesting and fulfilling lifestyle. This requirement also relates to standards 12 & 14. Protocols/guidelines must be in place for any PRN (as required) medication. Staff will then be clear as to when, how and why to administer this medication. (Previous target of 15/03/07 & 31/08/07 not met). Medication records must accurately reflect the medication that is prescribed and administered to each person. This will ensure that they receive their correct prescribed medication. In addition to receipts a record of money received and spent must be kept for each person. A running total must be kept and this must be checked and reconciled regularly so that people’s monies are safeguarded DS0000066343.V364189.R01.S.doc Timescale for action 31/10/08 2 YA20 13 30/06/08 3 YA20 13 30/06/08 4 YA23 13 30/06/08 Northbrook Care Home Version 5.2 Page 30 as much as possible. 5 YA33 18 There must be sufficient staff on duty at all times to safely and appropriately meet the needs of people using the service and to ensure that the manager has allocated time to carry out her management duties. This requirement also relates to standard 38. Staff must have specific training to meet the complex needs of one of the people living there. This will mean that she gets a service that meets her needs and that her behaviour and needs do not adversely affect other people. All staff must have POVA (Protection of Vulnerable Adults) and ‘restraint’ training to ensure that they have a good working understanding of this and of good practice in this area. This requirement also relates to standard 23. A quality assurance and quality monitoring review, based on seeking the views of people using the service and their representatives, must be carried out to find out their views on the service provided and to identify any developments and improvements needed. A copy of an up to date gas safety certificate must be sent to the Commission to confirm that gas services are safe. 30/06/08 6 YA35 18 30/11/08 7 YA35 18 31/08/08 8 YA39 24 30/09/08 9 YA42 13 30/06/08 Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 31 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 YA20 Good Practice Recommendations It is recommended that the manager carries out periodical checks to ensure that staff are administering medication in line with good practice guidelines and that they are still competent to do this task. It is recommended that minutes for staff meetings and other important discussions more accurately reflect what was discussed so that staff have clear information about what is expected of them and what action has been agreed. 2 YA36 Northbrook Care Home DS0000066343.V364189.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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