Care Home: The Brambles

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What has improved since the last inspection? The home has employed more staff. This means people can chose more activities. Key inspection report Care homes for adults (18-65 years) Name: Address: The Brambles 103 Great Park Street Wellingborough Northants NN8 4EA The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Catherine Perrins Date: 2 4 0 8 2 0 0 9 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 32 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: The Brambles 103 Great Park Street Wellingborough Northants NN8 4EA 01933381550 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Brambles@consensussupport.com www.concensusupport.com Consensus Support Services Limited care home 10 Number of places (if applicable): Under 65 Over 65 10 0 learning disability Additional conditions: The maximum number of residents who can be accommodated is 10 The registered persons 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 are within the following category: Learning Disability - code LD. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 32 A bit about the care home 10 people can live at The Brambles. Each person has their own room. No-one has to share. Care Homes for Adults (18-65 years) Page 5 of 32 The home has a comfortable lounge, a dining room and a sun room. The home is in Wellingborough near to shops and buses. Current fees are £600 to £1200 per week. Care Homes for Adults (18-65 years) Page 6 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 32 How we did our inspection: This is what the inspector did when they were at the care home We did not tell the home we were going to visit. We talked to some of the people who stay at the home. We talked to some of the staff who work at the home. Care Homes for Adults (18-65 years) Page 8 of 32 We looked at people’s care plans. Care plans tell staff how to care and support people in the right way. We looked at other records that told us how the home is run. This included staff records and health and safety records. What the home does well Care Homes for Adults (18-65 years) Page 9 of 32 Two people at the home are developing person centered care plans. These will give detailed information about the person’s needs, their likes and dislikes and what is important to them. Staff have a good understanding of people’s needs and how to support them in the right way. People are involved in running the home by helping with the cooking and laundry. Care Homes for Adults (18-65 years) Page 10 of 32 What has got better from the last inspection The home has employed more staff. This means people can chose more activities. Care Homes for Adults (18-65 years) Page 11 of 32 What the care home could do better Records are not clear about whether people have had some health appointments. Two people had refused to go to their health appointments. It was not clear how much help they had been given to understand this decision. Care Homes for Adults (18-65 years) Page 12 of 32 One new staff member only had one written reference. The home has not carried out any satisfaction surveys recently. Some staff had not signed the medication record when they had given medication. Care Homes for Adults (18-65 years) Page 13 of 32 If you want to speak to the inspector please contact Catherine Perrins Care Quality Commission. Citygate, Gallowgate, Newcastle upon Tyne. NE1 4PA Tel: 03000 616161 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 set out 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. Care Homes for Adults (18-65 years) Page 14 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 15 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given good information and their needs are assessed before they move to the Brambles to make sure that the home is right for them. Evidence: The home has a statement of purpose and service user guide which give people good information about the home and the services it offers. The service user guide contains pictures to make the information easier to understand for people with learning disabilities who may not be able to read. Records show that peoples needs are assessed before they move to the Brambles to make sure that the home is right for them. The manager explained that people are able to visit the home before they move in to help them decide if it is the right move for them. The contracts for two of the people we case tracked had not been signed by the person. The manager explained that everyone had been issued a new contract with up to date information about the terms and conditions of their stay at the home and that some Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: people had yet to sign these. Care Homes for Adults (18-65 years) Page 17 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People generally have their needs met and their choices respected and the development of person centred care plans will enhance this further. Evidence: Each person who lives at the home has an individual plan of care. This contains their care plans and other information that staff need to support and care for people in the right way. Care plans seen covered areas such as communication, eating and drinking, personal care, mobility, culture and religion, health and continence. They contained some detail about peoples preferences such as their preferred name and some of their likes and dislikes. One of the people we case tracked is hoping to move from the Brambles into supported living where he will live more independently. His care plan detailed how the home is supporting him to develop new skills and to achieve this move. Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: Where needed, care plans seen gave detailed information about how to support people to reduce their anxiety. This included what made the person anxious, how they show anxiety and what staff can do to help and support them. It is important that staff have this information so that the support people receive is consistent. Where people have difficulty communicating verbally the home supports people to use other methods of communication such as Makaton sign language and picture boards so that they can make their wishes known. The manager explained that two people who live at the home are in the process of developing person centred care plans which will detail their needs, preferences and aspirations in a way which is more individual and personal. People are generally supported to be safe without restricting their lifestyles by written assessments of the risks they face from the environment and the various activities that they do. These cover areas such as safety at home, falls and going out for walks. The risk assessment for one person who goes out in the local area by herself did not show how her personal safety or road safety had been assessed or the measures in place in these areas to ensure that she was protected from any unnecessary risks. Staff told us that people are involved in the running of the home and will assist with household tasks such as cooking and laundry. Care Homes for Adults (18-65 years) Page 19 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recent recruitment of new staff has enabled enough staff to be available to offer people a choice of activities. Evidence: Peoples individual plans of care contain some information about their interests and hobbies. Some of the people who live at the Brambles attend local day centres, others attend college courses. The manager explained that the home had been short of staff in the past which had made it difficult for people to do the activities that they wanted to sometimes. The recent recruitment of a number of new staff has helped resolve this. A new programme of evening activities is also being developed to give people more choice about how they spend their time. The home has a vehicle to make it easier for people to access different places. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: Staff explained that the people who live at the Brambles have house meetings where they get together with staff support to discuss the running of the home and to plan the menus. Menus seen were varied and contained a variety of fruit and vegetables. There were two choices of main course available to people each day and staff explained that people could chose to make something different if they preferred. People told us that the food is good. Care Homes for Adults (18-65 years) Page 21 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Records do not consistently demonstrate how peoples health and personal care needs are being met. Evidence: Individual plans of care contained evidence that people attend health appointments with a range of health professionals such as dentists, General Practitioners, podiatrists and opticians. In some cases however, it was not clear whether follow up appointments had been arranged as advised. For example there was no record to say whether one person had collected his new glasses or whether another person had been for a follow up dental appointment. Records stated that two of the people we case tracked had refused specific health appointments. There was nothing recorded to show how they had been supported to make sure that they understood the decision that they were making and any implications to their future health. The administration of medication is generally well managed and staff are trained and assessed to ensure that they are competent to administer medication in the right way. There were, however, some signatures missing from the medication administration record for one person who has a cream on prescription. A spot check of the total number of Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: tablets for one person showed that they had four more tablets then could be accounted for on the medication administration record. The manager stated that the balance from a previous sheet had not been carried forward onto the current sheet which accounted for this discrepancy. Care Homes for Adults (18-65 years) Page 23 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has policies and procedures in place to make sure that people can raise any concerns that they may have and to protect them from harm. Evidence: The home has a complaints procedure which outlines what people should do if they wish to raise a concern about the home and the response that they can expect. This is also available in a format with pictures to make the information easier to understand for people with learning disabilities. The manager said that the home has not received any complaints since the last inspection. The manager explained that the home has made one referral to the Local Authority under the locally agreed safeguarding adults procedure. Records show that the correct procedures were followed. Staff spoken to had a good knowledge of how to safeguard adults and their responsibilities under the locally agreed procedures. Care Homes for Adults (18-65 years) Page 24 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a homely, comfortable and safe environment. Evidence: The Brambles is a large detached property in a residential area of Wellingborough. The property has a large communal lounge which is comfortably furnished and has been made homely with pictures and soft furnishings. There is also a communal dining room and small sun room. The manager explained that the kitchen was due to be refurbished in the near future. The property has ten bedrooms, four of which are on the ground floor. Two of the downstairs bedrooms and two of the first floor rooms have en suite shower rooms and the other bedrooms have a wash basin in. Bedrooms seen had been made personal with pictures, photographs, ornaments and personal effects. The property also has two communal shower rooms and a bathroom. There is a small garden area at the rear of the property and a laundry room situated in an out house in the garden. The property is generally well maintained and clean throughout. Care Homes for Adults (18-65 years) Page 25 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recent recruitment of staff has meant that there are sufficient numbers of staff employed but the pre recruitment checks are not consistently robust to ensure that all staff are suitable to work with people with learning disabilities. Evidence: The recruitment of staff is generally well managed, however one person who has been recently recruited only had one written reference. The manager explained that a verbal reference had been obtained and the person was being closely supervised until the written reference was obtained. It is important for homes to carry out pre recruitment checks to ensure that staff are suitable to work with people with learning disabilities. Staff told us that they had an induction when they first started working at the home which included working alongside an experienced colleague to make sure that they had all of the information that they need to do their job in the right way. Staff explained that they attend training courses such as food hygiene, safeguarding of adults, fire safety, infection control, first aid and moving and handling. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The views of people living in the home are not consistently sought and used to influence how the home develops. Evidence: The current manager has been in post since December 2008 and is in the process of registering with the Care Quality Commission to become the registered manager for the home. The home has had three acting managers in the two years since the last inspection. The manager spoke highly of the staff team saying that they have worked hard to raise standards within the home. The results of an annual audit of the national minimum standards conducted by the provider showed that the home has improved from a sixty percent score last year to a ninety-two percent score this year. The manager explained that she carries out an audit of the care plans and medication on a monthly basis but does not keep a record of this. Records show that the necessary safety checks such as fire checks, checks on the water system and portable appliance testing have all been carried out recently. The fire risk assessment had however not been Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: reviewed within the last twelve months. There were no hazards observed during the inspection. All of the radiators have covers on to prevent people being burnt and the manager told us that there is a hot water regulator fitted to the bath to ensure that the water is dispensed at a safe temperature. The manager told us that the home has not carried out any satisfaction surveys in the past twelve months but is planning to do so in the near future. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 19 13 28/09/2009 Records must demonstrate that people receive where necessary, treatment, advice and services from relevant health professionals. To ensure that peoples health needs are met. 2 20 13 28/09/2009 Arrangements for the administration and recording of medication must ensure that all medication is given as prescribed and appropriately accounted for. To ensure that people receive their medication as prescribed. 3 34 19 All the required prerecruitment checks must be undertaken on new staff prior to their commencing work in the home. 28/09/2009 Care Homes for Adults (18-65 years) Page 30 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action To ensure that all staff are suitable to work with people with learning disabilities. 4 39 24 The views of the people living in the home and their representatives must be consulted and those consultations used to inform how the service develops. 28/12/2009 To make sure that the home is meeting the needs and preferences of the people who live there. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Individual plans of care should be further developed to give more detail about peoples preferences and aspirations and how the staff can support people to meet these. Risk assessments should be developed further to ensure that they detail how all the potential risks to the person or others from the given activity have been considered and the measures in place to reduce the risks to an acceptable level. Where someone refuses a health appointment records should show how it has been assessed that the person has the capacity and understanding to make this decision, and if they do not have the capacity how it has been deemed as being in their best interests. 2 9 3 19 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or 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). 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