Care Home: The Brambles

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What the care home does well People have a good standard of information about the home to assist them in their decision where to live. People live the life they choose, and have their needs met with support, within a framework of risk and care planning. People are provided with opportunities to live an excellent quality of life. People are safe as they receive a good standard of personal and health care. People are listened to and are generally safe from the risk of abuse. People live in a clean, safe, homely and comfortable place. People are safe as they receive care from well-trained and well-recruited staff. People benefit from good management of the home. What has improved since the last inspection? Both of the requirements have been met; these were regarding medication records and staff training in safe moving and handling. The recommendation has been considered as policies and procedures have been developed. Within the last twelve months the home has improved from a poor rated service to that of a good service due to the actions taken by the home in response to our inspection activity. The Manager is aware that the improvements that have been made are to be sustained for the benefit of the people living at The Brambles. What the care home could do better: The training of staff in safeguarding people against abuse could be improved. We expect the home to manage this rather than we make a requirement on this occasion. Most of the staff have received recent training in the safe handling of medicines but some have yet to complete this training. It is expected that those who have yet to complete this training are not permitted to handle medicines unsupervised and we expect the home to manage this without the need to make a requirement. The supervision sessions of staff should increase in their frequency as part of good practice. CARE HOME ADULTS 18-65 The Brambles 104 Station Road Soham Cambridgeshire CB7 5DZ Lead Inspector Elaine Boismier Unannounced Inspection 3rd June 2008 10:00 The Brambles DS0000015227.V365275.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 The Brambles DS0000015227.V365275.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. The Brambles DS0000015227.V365275.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Brambles Address 104 Station Road Soham Cambridgeshire CB7 5DZ 01353 722971 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 Anthony Eric Barnes Mr Anthony Eric Barnes Care Home 3 Category(ies) of Learning disability (2), Learning disability over registration, with number 65 years of age (1) of places The Brambles DS0000015227.V365275.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One service user over 65 years of age with learning disabilities (LD(E)) for the duration of their residency 19th November 2007 Date of last inspection Brief Description of the Service: The Brambles is a small home for three people with moderate to profound learning disabilities, and some physical disabilities. The home is a converted bungalow, and each service user has their own room, sharing communal accommodation, which includes a lounge/diner, kitchen, bathroom and two WCs. Current fees are £1,122 per week with additional costs for chiropody, confectionary, some toiletries and clothing. A copy of the inspection report is available at the home or via the CSCI website. The Brambles DS0000015227.V365275.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 2 star. This means the people who use this service experience good quality outcomes. We, The Commission for Social Care Inspection, carried out this unannounced key inspection, by two Inspectors, between 10:00 and 12:30 pm and it took 2.5 hours to complete. We looked around the home, spoke with people, staff and the Manager and we looked at documentation. Whilst we were at the home we also watched the activities of both staff and the residents. Before the inspection we received surveys from staff and a relative of a resident and we also received the Annual Quality Assurance Assessment (AQAA) that was completed by the Manager. We also looked at the history of the home since our last inspection, in November 2007 and up to this inspection of June 2008. For the purpose of this inspection report people who live at the home are referred to as “people”, “person” or “resident/s”. What the service does well: People have a good standard of information about the home to assist them in their decision where to live. People live the life they choose, and have their needs met with support, within a framework of risk and care planning. People are provided with opportunities to live an excellent quality of life. People are safe as they receive a good standard of personal and health care. People are listened to and are generally safe from the risk of abuse. People live in a clean, safe, homely and comfortable place. People are safe as they receive care from well-trained and well-recruited staff. People benefit from good management of the home. The Brambles DS0000015227.V365275.R01.S.doc Version 5.2 Page 6 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. The Brambles DS0000015227.V365275.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 The Brambles DS0000015227.V365275.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 Quality in this outcome area is good. People have a good standard of information about the home to assist them in their decision where to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA informed us that there have been no new admissions to the home. The AQAA also informed us that an area the home could improve upon is to carry out a review of the home’s Statement of Purpose and Service User’s Guide and to have these documents in a format that the residents, and any prospective resident, may be able to understand. We examined the current Service User’s Guide and this was in a format that was easy to read and had information provided in pictures. Staff told us that they had seen the last inspection report and were aware of its contents. We noted that there had been no new admissions to the home; this standard was assessed as met at previous inspections of the home. The Brambles DS0000015227.V365275.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is excellent. People’s individual needs and choices are supported and valued and these are protected by an excellent standard of record keeping. This judgement has been made using available evidence including a visit to this service. EVIDENCE: According to the AQAA “Written Individual Care plans indicate individual likes/dislikes, wants and needs and methods of support and approach. Daily diaries and weekly summary sheets monitor day to day activities, opportunities and issues.” One of the staff surveys said, “Care plans are updated regularly and any changes are put in change over book…” We examined two people’s care files and we found these to be person centred and very detailed in how individual care was to be provided. This detail included, for example, the amount of toothpaste to be put on a person’s toothbrush and what type of clothes the person liked to wear. There was information that had been obtained from the internet with regards to cerebral The Brambles DS0000015227.V365275.R01.S.doc Version 5.2 Page 10 palsy and this information was available in one of the people’s care files. Information about the person also included their life history, their family relationships and what the person liked and did not like. Daily review sheets were detailed and any change in a person’s needs had written action to be taken by care staff to meet these changed needs, such as skin care. Monthly reviews of people’s care were clear and there was evidence that the reviews considered what action could be taken to improve people’s quality of life. Staff were provided with clear guidance in how to interpret non-verbal signs when people were making choices about when to get up, get out of bed and when they wanted to return back to the home from visits out. We noted that staff were supporting people in making decisions and these included going out to the local shops. Risk assessments were identified in that none of the people are able to take part in the wide range of activities they take part in, without the support of the staff of the home. The Brambles DS0000015227.V365275.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is excellent. People are provided with opportunities to live an excellent quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA told us that none of the residents attend day services. There have been no new placements since our last inspection and therefore this standard, standard 12 is not applicable. The AQAA also told us that the home supports people in maintaining links with their family and that daily routines, such as when to go to bed and when to get up, are flexible, according to the wishes of the residents. Examination of people’s care records and observation of staff working indicated that people are supported in maintaining links with their families, with each other and within the local community. The AQAA described a range of leisure opportunities for the residents that included going to “local shops, cafes, garden centres, library, chapel etc.” The The Brambles DS0000015227.V365275.R01.S.doc Version 5.2 Page 12 AQAA told us that due to an increase in the number of staff this helped with “…regular times out and more focussed activities” for the people. Examination of people’s care records, receipts of money spent and discussion with the care staff indicated that people continue to benefit from a range of leisure opportunities such as going to garden centres, shops and eating out. Since our last inspection, in November 2007, one of the people has started attending swimming sessions, and does so with the support of staff. On Christmas Day all of the residents spent the day at the Manager’s own home. One of the surveys from care staff said the home does well because it ”Suport (sic) the indival (sic) in what they like to do on a daily basis and work around what the service uses (sic) likes and dislikes are.” Staff were seen to interact with the people in a respectful and appropriate manner. The time of when people eat, what they have and how much, is recorded in individual daily diaries. These records demonstrated that people have a variety of menus and they take their meals at a time when they choose to. Main cooked meals continue to be prepared by the neighbouring care home. On the day of our inspection people were having sausage, mashed potatoes and carrots. Examination of care records and people’s receipts of money spent indicated people have opportunities to have a meal and drink when they are out of the home. The Brambles DS0000015227.V365275.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is good. People are safe as they receive a good standard of personal and health care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA told us that the home has been advised by a local health team to provide care in a way to reduce the risk of pressure sores. The AQAA also told us that there are plans to help “…implement Healthcare individual action plans”. Observation of staff working indicated that they provide people with personal care and this was done in private. Care records were clear in detail of how people’s individual personal care was to be provided including washing, bathing and having a shave or their beard trimmed. Examination of people’s care records indicated that choice is respected when people are to be assisted out of and into bed. Care records provided evidence that residents have access to GPs, district nurses and dentists. According to the Manager access to community The Brambles DS0000015227.V365275.R01.S.doc Version 5.2 Page 14 occupational therapists and physiotherapists has been difficult due to a lack of community specialist support. A specialist pharmacist inspector examined the procedures for the safe use of medicines. There are clear and details written procedures for care staff to follow. There are clear records of when medicines are received into the home, when they are given to residents and when they are disposed of. This provides a good audit trail to account for all medicines and shows that people have received the medicines prescribed for them. There were clear guidelines in care plans and with medication records as to how individual residents wished to take their medicines and what they were used for. The requirement made on the last inspection that complete and accurate records must be kept of all medication administered or not, together with a reason why the medicine was not given, in order to demonstrate that people who use the service receive the medicines prescribed for them, has therefore been met. Most of the staff have received recent training in the safe handling of medicines but some have yet to complete this training. It is expected that those who have yet to complete this training are not permitted to handle medicines unsupervised as this could put residents at risk. The Brambles DS0000015227.V365275.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. People are safe and are listened to and are generally safe from the risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the three surveys from staff said that the person would know what to do if any person raised a concern, about the home, to them. According to the AQAA, and confirmed by the Manager, there has been no complaint made against the home and there has been no allegation of abuse made against any resident. We have received no complaint against the home and we have received no such allegation of abuse. The AQAA identified the need for the care staff to attend a more formal training in safeguarding procedures and we found this also to be the case. Discussion with staff, including the Manager, indicated that there is some understanding of the procedures to follow in the event of an allegation or suspicion of abuse although this could be better. We expect the home to manage this rather than we make a requirement on this occasion The policy and procedure provides clear guidance in what is abuse and what action is to be taken in such an event. The home also has guidance in following local reporting procedures, to include telephone numbers for the police and the local authority. Staff knew where this information could be found. A person’s record of their personal monies was seen and this was satisfactory. The Brambles DS0000015227.V365275.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. People live in a clean, safe, homely and comfortable place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no changes to the home environment since our last inspection. It is easily accessible for people who need the assistance of a wheelchair and the home is generally well maintained and comfortably furnished. The AQAA told us that the home has written and developed policies and procedures on infection control and that staff have attended training in prevention and management of infection. We examined staff training files and the home’s policy manual and we confirmed the information provided in the AQAA was factual. The home was clean and smelled fresh. The Brambles DS0000015227.V365275.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. People are safe as they receive care from well-trained and well-recruited staff although the frequency of supervision of staff could be improved upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA told us there is 71.4 of care staff with an NVQ level 2 in care. Examination of the staff roster, examination of people’s care records and observation of staff working indicated that people’s needs and choices are met in a flexible and unhurried manner. The AQAA told us that staff have attended training in communication and care of people with the conditions of epilepsy and diabetes. Examination of staff training records, and discussion with staff, confirmed that this was the case and arrangements are in place for those staff, who have not received this training, to be able to do so. Two staff files were examined and evidence told us that all the required information is obtained before the member of staff started working at the home. The Brambles DS0000015227.V365275.R01.S.doc Version 5.2 Page 18 All of the three surveys from care staff said that they had received an induction training that covered “very well” everything the person needed to know to do their job. All of these staff surveys said that the person had received ongoing training, they felt supported by the home and that there was always a sufficient number of staff to meet the individual needs of the residents. Staff attend 1:1 supervision sessions although records of these, and discussion with staff, indicated that there has been a lapse in these. For example for one member of staff records indicated that they had attended their last supervision session in January 2008 and for another member of staff, records indicated that they had attended their last supervision session in February 2008. The Manager told us that he is reviewing the current system of supervision for these sessions to take place at least 6 times each year. The Brambles DS0000015227.V365275.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 & 42 Quality in this outcome area is good. People benefit from an improved management of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager was on duty when we inspected the home. Evidence from our inspection and discussion with him indicated that the management of the home has greatly improved within the last 12 months and this is reflected in the improved quality rating of the home. Examination of the staff roster and discussion with the Manager indicated that there is a continued trend in reducing the amount of consecutive hours that he was working. He also told us that he has protected time to enable him to focus on the management aspects of the home. The Brambles DS0000015227.V365275.R01.S.doc Version 5.2 Page 20 We found evidence that he has taken action in response to a recommendation to develop policies that were not previously available and the quality of these policies was of a high standard. The AQAA was completed in detail and identified areas that the home does well in, what has improved in the last 12 months and areas were identified that the home could improve upon and how this was to be acted on. The AQAA informed us that all staff have attended training in fire safety, safe food handling moving and handling and first aid and examination of staff training files and discussion with staff confirmed that this was the case. Records of fire tests, emergency light tests, hot water check and portable appliance tests were found to be satisfactory. A requirement was made for staff to attend safe moving and handling and as a result of the above evidence this requirement has been met. The Brambles DS0000015227.V365275.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 x 4 x LIFESTYLES Standard No Score 11 x 12 N/A 13 4 14 4 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 4 x 3 x The Brambles DS0000015227.V365275.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Brambles DS0000015227.V365275.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eastern Region Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI The Brambles DS0000015227.V365275.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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