Care Home: The Brambles

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What the care home does well Silver Street provides a warm and safe home suitable for people`s needs. Staff had a close relationship with people staying at the home and could describe people`s individuals needs in depth. Positive comments we received included : "I like all of them (the staff) they look after me as I want." Equality and diversity was promoted. Each person`s individual differences likes and dislikes were known and respected. Opportunities were available to all the people living at the home that took into account their individual needs. People living at the home had a written care plan so that all their needs were identified. People`s health care needs were known and monitored so that access to health specialists was available to maintain good health. Relatives could visit the home at anytime to maintain contact. Staff said they worked well together. The health and safety, safeguarding and complaints procedures protected people. What has improved since the last inspection? This was the first inspection of a newly registered service. What the care home could do better: The premises require some additional works to ensure people using the service are able to maintain their independence and personal choice as identified within the environmental section of the report. Key inspection report Care homes for adults (18-65 years) Name: Address: Silver Street 28 Silver Street Dodworth Barnsley Yorkshire S75 3NP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ian Hall     Date: 0 2 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 26 Information about the care home Name of care home: Address: Silver Street 28 Silver Street Dodworth Barnsley Yorkshire S75 3NP Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Silver Street Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care home with nursing; Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Learning disability: Code LD. Date of last inspection Brief description of the care home The service provided at the home is in partnership with Barnsley Metropolitan Borough Council (owner of the property) and is managed by St Annes Community Service. The home provides a respite service for up to six adults with a learning disability including those with a physical disability who require personal care. Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 6 Brief description of the care home The home is a modern purpose built single floor building. The accomodation consists of six single ensuite bedrooms. Information gained on the 2nd December 2009 indicates that the current fees vary according to individual care needs packages. The home provides information to guests and their relatives prior to admission into the home. Service user guides are available from the manager. Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means that people who use this service experience good quality outcomes. This was the first inspection of the respite care services provided at Silver Street. The unannounced inspection was conducted by the link inspector Mr I Hall. It took place over 6 hours, starting at 08:45 and finishing at 14.45 on the 2nd December 2009. Comments and feedback from people living at the home have been included in this report. On the day of our visit staff were seen interacting with people who live at the home. A tour of the premises was made and records relating to care and the running of the home were examined. All people that lived at the home and staff on duty were spoken with. Care Homes for Adults (18-65 years) Page 6 of 26 Feedback of the inspection was given to the manager Mr D Blondin. Care Homes for Adults (18-65 years) Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 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 9 of 26 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. The home provides people with detailed information to enable them to choose whether the home is the one for them. Detailed assessments ensure that peoples needs could be met. Evidence: We examined two peoples case records. A comprehensive assessment had been made to ensure that peoples needs could be met. The placing authority also provided detailed information about the peoples needs. New people were always encouraged to visit the home for tea to meet other people and staff before deciding to use the respite services. The manager has the responsibility to visit new people and assess their care needs. Relatives and carers were encouraged to be involved in the gathering of information. Surveys confirm that people receive information from the home prior to their respite stay. A relative said There were plenty of opportunities to visit the home for tea and meet other people who have respite care, They always ring me before any planned care to see if there have been any changes to his care needs. My son always looks Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: forward to his stays at the home. Care Homes for Adults (18-65 years) Page 11 of 26 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. Individuals were involved in decisions about their lives, and play an active role in planning the care and support they receive. Evidence: Two peoples person centered plans (PCPS) were looked at, some of the information was incomplete. However other supplementary plans were still being used while the PCP was being completed. The manager said PCPs were being developed for all people as they returned to use the service. The format was comprehensive and used pictures and symbols to make them user friendly. The individual and their family were involved in putting the information together. Comprehensive risk assessments for each person were seen, they had been regularly reviewed. Staff were proactive in the management of risks to ensure people were able to continue with their lifestyle whilst staying at the home. People said they were aware of information written about them and had been involved in putting together their plan. A relative commented that staff were good at asking for information, especially if Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: there had been any changes in their relatives health. Surveys confirmed that staff continue to meet peoples care needs, while giving them encouragement and support to maintain their independence. When people bring small amounts of money with them during their respite stay they do not have a lockable place to keep them. People bring monies so that they can participate in activities and outings as they choose. Care Homes for Adults (18-65 years) Page 13 of 26 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 provision of respite care at the home means that people return to their families after their stay. Staff were aware of the importance of maintaining routines to ensure continuity of care for peoples return to their home environment. People were able to maintain and develop new friendships during their stay at the home. People were able to bring in personal items to help them feel at home. Evidence: People were supported and encouraged to continue to attend their daycare placements while staying at the home. People attended their daycentres during the day. People leaving for daycentres were supported by staff. We observed good interaction using various ways of communication. The atmosphere was warm and welcoming. People were supported and helped to their daycentres and outings by staff. Meals were well balanced and nutritional and cater for varying dietary and cultural Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: needs of people staying at the home. Staff encourage people to assist in making meals and setting tables. People said they enjoyed the cakes theyd made. A choice of light lunch was available at midday with the main meal usually being served at tea time. Care Homes for Adults (18-65 years) Page 15 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based upon their individual needs. The principles of respect, dignity and privacy were practiced by all staff. Evidence: The manager said all people retain their GP whilst staying at the home, although an emergency arrangement can be made if needed. Records seen and discussion with staff confirmed that peoples health-care needs were met. The manager said people were escorted to medical appointments and comprehensive records were completed to ensure that information was shared with those who care for the person. Medication stocks and records were found to be correct. Staff at the home ask relatives to ensure sufficient medication is provided for the length of stay and that it is labelled and in its original packaging to maintain peoples safety. No one currently self medicates. Peoples independence and life skills would be more easily maintained by having a locked cupboard in their bedroom to keep their own medications. Trained nurses currently administer medication and have been supported and required to provide evidence of safe practice to protect people living at the home. Care Homes for Adults (18-65 years) Page 16 of 26 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. People who use the service were able to express their concerns via a robust complaints procedure. They were protected from abuse and had their rights protected. Evidence: The home had a complaints procedure that was available to people and their visitors. The procedure was also referred to in the information given to new people, identifying the stages to follow; this includes the timescales to respond to complaints. The manager confirmed that any complaints received had been actioned within the timescales specified. Surveys confirmed that people felt confident that the home would act promptly to rectify any concerns they may have. Staff spoken with were clear when any incident may need external input and how to make referrals. Staff had received in-house training about safeguarding adults and were aware of the whistleblowing policy. External local authority training with access to deprivation of liberty and mental capacity legislation training has been planned. The manager agreed to ensure that the South Yorkshire Adult Safeguarding policies and procedures were readily available and incorporated into the company documentation. Care Homes for Adults (18-65 years) Page 17 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe well maintained environment for people. The home provides a clean and hygienic environment for people who use the service. Evidence: We toured the building and found it to be clean and free of odours. There were a number of rooms to enable people to pursue life skills, this included a lounge, laundry and kitchen/dining area. There was level access throughout the single storey building with handrails provided. Most bedrooms were found to be quite well equipped and met spatial requirements. We identified that that the overhead tracking did not extend into particular bathrooms and other areas. This increased the frequency that people had to be moved and handled, and presents a potential hazard to both people using the service and staff. Nurse call points were seen to have been located at inappropriate points in bedrooms; this limits peoples choice of bedroom layout. Providing some people with a ready access to nurse call equipment was impossible to achieve in one room. There was a limited number of electrical sockets in each bedroom; this took no account of the age and individual needs of the young adults living at the home (for use of hairdryers, personal stereos, DVDs, computers etc). People could not easily access them due to their height and location. There was a lack of shelving for personal possessions. Bedrooms had not been provided with televisions. This limited peoples choice of one Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: programme to the main lounge area. Free-view television was available to increase the choice of programmes available. Bedrooms were seen to lack individualization, many of the pictures and clocks provided needed to be relocated to a position where people were able to see them. One bathroom had been effectively decorated/personalized by staff to soften and reduce its clinical appearance. The home lacks storage space, equipment was being stored inappropriately in bathroom, toilet and kitchen spaces. This did not present a homely appearance. The snoozlem provided was small and would not permit more than one person with complex needs to use the facility and thereby limit peoples choice and independence. The garden area was readily accessed. However the footpaths were too narrow to permit two people using aids and equipment to pass each other thus limiting peoples independence and choice. The gardens were pleasant and well maintained; the manager discussed his plans to develop a sensory readily accessible areas for people that are to commence in Spring 2010. Care Homes for Adults (18-65 years) Page 19 of 26 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. Staff were trained, skilled and in sufficient numbers to meet the needs of people living at the home. Evidence: Staff rotas seen indicated that sufficient staff were on duty to meet peoples needs. Staff interviewed confirmed that they were a true reflection of the actual numbers of staff working. Staff said they had been supported and trained to meet the needs of people living at the home. Surveys received indicated that staff were very competent and caring and always kept the family informed of any changes that took place. The manager confirmed that training was a high priority for his staff team. He had developed a training matrix, a chart, that enabled him to review the training staff had completed and planned to develop their skills and knowledge. Trained staff were supported to maintain their professional skills and knowledge in accordance with their code of professional conduct. Staff had been provided with additional traing to enable them to meet peoples complex needs such as peg feeding. All staff had been required to complete the learning disability induction award. Care staff were then enrolled upon national vocational qualifications in care (level 2). Two care staff had achieved this award and have commenced the higher level award (level 3). Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: Moving and handling training was being provided for staff throughout the day of our inspection. Staff said, On site training is beneficial; we are able to practice our skills much more realistically .We are practising with the equipment we use everyday, its very helpful. Regular supervision takes place to monitor staff performance and professional development. Staff files seen demonstrated that required checks had been made to protect and maintain the safety of vulnerable people. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is well managed and takes account of their wishes. Evidence: The manager has worked at the home for a month. He is a trained nurse who has achieved the registered managers award. He continues to update his professional knowledge and skills through ongoing training. He has had a positive impact to improve services and the quality of life for people who use the service. There was a strong ethos of being open and transparent in all areas of running the home. He was focused upon the guests using the service and leads a strong team who have been recruited and are being trained to a high standard. Staff had received management supervision; this is required to develop staff and monitor care practices. The homes owners visit regularly to monitor care and standards provided at Silver Street. Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: The manger has undertaken a quality assurance survey and initiated regular meetings for staff and people using the service. This gives people a voice and a chance to say how the home should be run. People felt their views were listened to and taken into account by the staff. No fire exits were obstructed and substances hazardous to health were securely stored. Statutory servicing and checks of equipment were up to date. Risk assessments had been completed and were being regularly reviewed to maintain a safe environment. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 23 The homes management must review the facilities and equipment provided to meet the needs of service users. They must submit an action-plan with timescales to achieve changes to improve peoples lives and access. The premises will enable people living at the home to exercise choice and maintain their independence. 01/02/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 24 Lockable storage space should be provided within each persons bedroom. This would enable people to exercise choice and maintain their personal independence. Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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