Care Home: The Briars

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What the care home does well There is a good approach to referrals and admissions, helping to ensure that the service should be able to meet the needs of people who move in. The Briars is clean, comfortable and homely. A good care planning framework is in place, helping to ensure that people`s needs and wishes are identified and responded to. Risk assessment is also well handled, promoting the safety of the people living in the home. The people living at the Briars are encouraged to make choices, helping them to feel more in control of their lives. Efforts are made develop individual activity programmes for people which reflect their needs and interests, although in some cases it has been difficult to overcome barriers to this. Contact with family is also supported, helping people to maintain and develop important relationships. A varied and balanced diet is offered to people. Fresh ingredients are used and people are offered choice about what they eat and drink. People`s personal care needs are met in an individualised and sensitive manner. People`s healthcare needs are also being identified and met, helping them to stay well. Arrangements are in place for recognising and responding to concerns and complaints, helping people to feel listened to. Appropriate steps are taken to safeguard people living in the home from harm and abuse.The home is well run, helping to ensure that good standards of care are maintained. Staff are skilled, caring and knowledgeable. Systems are in place which help the team to monitor and improve the service they provide. What has improved since the last inspection? A recent admission which presented great challenges has helped the team to reflect on their strengths. The experience has also resulted in a more thorough approach to admissions to ensure that the service will be able to meet the needs of people who move in. Further progress has been made with person centred planning. An internal financial audit has helped the home to improve practice in the management of people`s money. Some specialised training as relevant to people`s needs has been provided for team members, or booked for the near future. CARE HOME ADULTS 18-65 The Briars Naas Lane Lydney Gloucestershire GL15 5AS Lead Inspector Mr Richard Leech Key Unannounced Inspection 27th March & 1st April 2008 10.15 The Briars DS0000067090.V360312.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 Briars DS0000067090.V360312.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 Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Briars Address Naas Lane Lydney Gloucestershire GL15 5AS 01594 844728 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) www.brandontrust.org The Brandon Trust Mrs Elizabeth Buckley Care Home 5 Category(ies) of Learning disability (5), Physical disability (2) registration, with number of places The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability- Code LD 2. Physical disability - Code PD The maximum number of service users who can be accommodated is 5. Date of last inspection 09/11/06 Brief Description of the Service: The Briars is a large, detached house providing care and accommodation for up to five adults with learning disabilities, some of whom may also have physical disabilities. It is close to the centre of Lydney. The home provides transport to enable residents to access local services and amenities. There is 24-hour staffing cover. People are accommodated in single rooms on the ground and first floors. One of the bedrooms has an en-suite. There are also two shared bathrooms and two separate toilets. The Brandon Trust runs the home, having taken over from the previous service provider in April 2006. People who are considering moving to the Briars and others involved in their care are offered information about the home including copies of the Statement of Purpose and Service Users Guide. Up to date information about fee levels was not obtained during this visit. The Briars DS0000067090.V360312.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 two star. This means that the people who use this service experience good quality outcomes. The home was visited twice, on a Thursday and a Tuesday in Spring 2008. We did not tell the home that there would be a visit. Before the visits took place the manager completed an Annual Quality Assurance Assessment (AQAA) providing information about the service. Surveys were also sent out to people with an interest in the home and several of these were returned. During the visits various records were looked at including examples of care plans, healthcare notes, risk assessments, daily records, medication charts, training information and staffing files. Discussion took place with the manager and members of staff. General observation of life in the home took place, including some mealtimes. All of the people living in the home were met. What the service does well: There is a good approach to referrals and admissions, helping to ensure that the service should be able to meet the needs of people who move in. The Briars is clean, comfortable and homely. A good care planning framework is in place, helping to ensure that people’s needs and wishes are identified and responded to. Risk assessment is also well handled, promoting the safety of the people living in the home. The people living at the Briars are encouraged to make choices, helping them to feel more in control of their lives. Efforts are made develop individual activity programmes for people which reflect their needs and interests, although in some cases it has been difficult to overcome barriers to this. Contact with family is also supported, helping people to maintain and develop important relationships. A varied and balanced diet is offered to people. Fresh ingredients are used and people are offered choice about what they eat and drink. People’s personal care needs are met in an individualised and sensitive manner. People’s healthcare needs are also being identified and met, helping them to stay well. Arrangements are in place for recognising and responding to concerns and complaints, helping people to feel listened to. Appropriate steps are taken to safeguard people living in the home from harm and abuse. The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 6 The home is well run, helping to ensure that good standards of care are maintained. Staff are skilled, caring and knowledgeable. Systems are in place which help the team to monitor and improve the service they provide. 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 Briars DS0000067090.V360312.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 Briars DS0000067090.V360312.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good approach to referrals and admissions, helping to ensure that the service should be able to meet the needs of people who move in. A review of the process following one recent admission has resulted in a sharper focus on referral and assessment considerations. EVIDENCE: The AQAA outlined the admissions process, including the assessment procedure. The manager said a local referral procedure had been drawn up for the home, based on the Brandon Trust’s admission procedure, in order to make the process clearer and smoother. However, a copy of this procedure could not be located during the visits. Two people had moved into the home since the last inspection. The admission of the person who had most recently moved into the home was looked at. Documentation included an assessment completed by the manager and another staff member, background information from the person’s home at the time and an assessment from the care manager. Records and discussion with staff provided evidence that the person had visited the Briars on several occasions before moving in. Detailed notes had been kept of these visits. The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 9 Reference was also made in the notes to providing family members with information including copies of the Statement of Purpose and Service Users Guide. Staff spoken with generally felt that the person was settling in well after some initial difficulties, and that the admission was appropriate, although some concern was expressed about dynamics in the home. The manager said that a full review of the placement was being planned for May 2008. There was some discussion with the manager and staff about an earlier admission which had taken place in late 2006. The manager described the referral and assessment process. Additional staffing had been put in place related to the person’s complex needs. Staff confirmed that relevant training had been provided to help them to support the person. The manager and staff said that they had raised various concerns about the admission at the time, including the impact on budgets and on the other people living in the home. It was not possible to form a view on the overall appropriateness of the above admission, partly because the documentary information had been passed to another home when the person had move there some months later. It was clear that the team felt very proud of the care that they had provided in respect of areas such as healthcare but also around improving the person’s overall quality of life. It was also clear that the experience had been a huge learning curve for the team and that this would have an ongoing influence over the referral and assessment process. The manager described a referral which had not been accepted and showed an email related to this. A regulation 26 report from the Trust in September 2007 had also made reference to a referral which had been turned down. This demonstrated that careful consideration is given as to whether an admission would be appropriate, in some cases resulting in referrals being turned down. The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A good care planning framework is in place, helping to ensure that people’s needs and wishes are identified and responded to. Risk assessment is also well handled, promoting the safety of the people living in the home. The people living at the Briars are encouraged to make choices, helping them to feel more in control of their lives. EVIDENCE: The AQAA outlined the home’s approach to care planning, describing it as person-centred (putting the individual’s needs and wishes at the heart of the care planning process). Some team members had undertaken training about person-centred planning. Examples of person centred work were seen. The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 11 For example, one person had a pathway diagram showing the different things that were important to them as well as goals and ideas. There were timescales for various objectives such as around expanding activity provision and social opportunities. Care planning files for two people were looked at. In one case the person had moved in about 8 weeks previously. The home had acquired care plans and risk assessments from the person’s former home and were continuing to use these pending creation of documentation specific to the Briars. These covered areas such as personal care, continence, eating & drinking, safety when bathing and infection control. Whilst it was accepted that assessment was still taking place and the team was getting to know the person, it was agreed that updated care plans and risk assessments as relevant to the person’s new home needed to be developed as soon as possible. Some work had already begun on reviewing and updating documentation. Where reviews indicate significant changes then documents should be retyped so that they are as clear as possible. The second person’s care plans were very clear and comprehensive. There was evidence of plans being reviewed and updated. Areas covered included communication and choice, behaviour and anxiety management, personal care and preferred routines, health and family contact. There was a care plan about eating and drinking. A letter was seen following a recent specialist assessment in this area. It was agreed that this needed to be incorporated as soon as possible, particularly as some staff appeared not to be fully aware of the content and recommendations. There was documentary evidence on file that the manager had requested a review of the person’s needs by the placing authority, particularly in relation to activities. To date this had not been forthcoming (see section on ‘lifestyle’). Risk assessments for the second person were seen to be clear and up to date. They covered areas where significant risks had been identified such as around bathing, anxiety, healthcare and travelling in the vehicle. Daily records and observation provided evidence of care plans and risk assessments being followed, such as around the management of behaviour which could impact on the others living in the home. Discussion with staff demonstrated that they had good knowledge of the person’s needs and conditions and of the support that they required. Daily records described people’s choices being recognised and responded to, such as deciding what time to go to bed and what to have for breakfast. People were observed being offered choices, such as options for lunch. The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 12 Staff were also seen recognising and responding when people were expressing a wish non-verbally, such as to go out. Where significant restrictions were in place these were seen to be documented along with the rationale and to be subject to review. The AQAA referred to advocacy services being accessed for the people living in the home. The manager and staff confirmed this and described advocates’ involvement. There was reference in documentation to newly identified risks being identified and prompt action being taken, for example, in relation to the safety of people in the garden. Staff were heard communicating significant risk issues that had arisen over the course of the shift during handover. The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Efforts are made develop individual activity programmes for people which reflect their needs and interests, and to overcome barriers to provision, promoting their quality of life. Contact with family is also supported, helping people to maintain and develop important relationships. The rights and responsibilities of people using the service are respected, helping to make them feel valued and included in the running of the home. A varied and balanced diet is offered to people, promoting their wellbeing. The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 14 EVIDENCE: Daily notes for the person who had most recently moved in were looked at over a two-week period. Activities were noted on most days. These included activities in the house such as playing musical instruments, playing games, watching TV programmes reflecting their interests and listening to music. Activities in the community included going for drives and walks, visiting local places of interest, accompanying staff on errands, having lunch out and attending an evening social club. Some of the activities accorded with care planning documentation describing the person’s likes and dislikes. They were said to like trains. They had not yet visited a local railway station though staff reported that this would be offered. Some notes could have provided more detail about the activity and how successful it was. For example, some entries just referred to the person having a long drive. The team was still getting to know the person and their needs/interests. As such it was accepted that the person’s activity programme was still being developed. In the meantime daily records, observation and discussion with staff provided evidence that they were taking part in a range of appropriate activities in the home and community. The manager reported that assessments were taking place in conjunction with the Community Learning Disability Team for the person to access swimming and trampolining. A second person’s activities were tracked from records over a two-week period. Activities in the community included going out for meals and picnics, attending a social club, going to the cinema and pub, visiting places of interest, going for walks and drives, and helping staff with errands in town. Other activities included playing games in the home, helping with household tasks, watching TV, interacting with staff, singing and playing on a computer. Some staff expressed concern about the length of time it was taking to develop a structured programme for the person, following the closure of a day centre that they used to attend. The manager said that work was continuing on identifying suitable options. Documentary evidence was seen this about this, such as a write-up of different ideas completed in February 2008. There was also written evidence of repeated requests for a review by the placing authority, though to date this had not been forthcoming. On the second visit the manager said that the team had the go-ahead to start of trial for the person at a centre in Gloucester. A review from the placing authority was also now expected in the near future, possibly facilitating access to another local day centre. The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 15 During the visits people were offered the chance to go out, such as to the cinema or for walks and drives. Staff were also very conscious of one person’s need for quiet time in the home. The manager described some recent research by staff which had resulted in a local hydrotherapy pool being identified and accessed. The manager and staff confirmed that one person regularly attends church, helping them to feel part of the local community. The AQAA also referred to this and to a general aim to promote greater community involvement and access. People living in the home were reported to be accessing barbers in the local community. The manager and staff commented on the fact that just one vehicle was available. In the past there had been two vehicles, allowing more individual activities to take place. Concern was also expressed about whether some of the people living in the home could safely access the current vehicle, and this was echoed by a relative completing a survey form. Assessment of this was taking place in conjunction with the Community Learning Disability Team. This issue had been raised during the previous inspection. There was documentary evidence in daily records and files of contact with family being supported, and of relatives being involved during the admission process. Positive feedback was obtained from family members completing survey forms. One person said, “The Briars operates as a family home where the residents’ needs are met individually. I am very pleased that [my relative] receives such excellent care”. Another person commented on the good communication they had with the home, adding that the staff worked well together as a team. Observation, daily records and discussion with staff provided evidence that the routines in the home were flexible and were centred on each person’s needs and wishes. People were seen helping around the home, such as clearing the table. There was also reference in daily notes to people helping with household tasks and errands in the home and in the local community. People were seen choosing where to spend time in the home and having freedom of movement. Some mealtimes were observed. Food was freshly prepared and attractively presented. The atmosphere was relaxed and people appeared to be enjoying their food. People were offered fresh fruit. Menus were seen and these indicated that people were offered a varied and healthy diet. Staff said that if people made it clear that they wanted an alternative then this would be provided. During the visits people were seen making choices about what they ate and drank as far as possible. Daily notes also referred to people’s choices around eating and drinking. Entries described people going out for meals and having takeaways in the home. A family member completing a survey form commented positively about the quality of the food served in the home. The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 16 Daily diaries generally noted what people had to eat on a particular day. However, in some cases there was just reference to whether the person ate well. Staff said that for the evening meal it could be inferred that the person had what was on the menu. However, this would not be the case for lunch or breakfast. Daily notes about eating and drinking should include a description of what the person actually consumed. The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 17 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. This judgement has been made using available evidence including a visit to this service. People’s personal care needs are met in an individualised and sensitive manner, promoting their wellbeing and dignity. People’s healthcare needs are also being identified and met, helping them to stay well. Medication is generally well handled in the home, although there is scope to improve some aspects of practice and thereby further promote people’s safety and wellbeing. EVIDENCE: Care plans described how people’s personal needs were to be met. These included reference to respecting people’s choices and routines, as well to privacy and dignity. Discussion with staff indicated that they had good knowledge of people’s needs and wishes around personal care and of the principles around privacy and dignity. The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 18 One daily diary entry was seen which referred to an intimate aspect of personal care. The staff member described what they had done and why (checking the integrity of the person’s skin) and also made clear reference to promoting the person’s privacy and dignity. People were seen to be dressed smartly and individually. As noted, the manager said that people were accessing barbers in the local community. This was said to be a significant development for one person in particular. One person had a mark on their jaw. This was reported to relate to shaving. There was a discussion with the manager about whether the use of body maps may facilitate the recording of any marks, bruising and scratches and provide a clearer record of when they were identified and of whether the cause was established. A protocol and linked risk assessment was seen in relation to the use of an audio monitor used to check if a person may be having a seizure whilst in their bedroom. There was good recording of seizures in examples seen. During the visits staff were seen to be very sensitive to the needs of one person who had recently experienced a seizure, for example, ensuring that the environment was quiet and calm and picking up on indications that the person may have a headache. Daily entries also demonstrated awareness of the signs that a person may be about to experience a seizure and of this being communicated to the team. Healthcare records for two people were looked at. One person had recently moved into the home. Background information about their health had been obtained from their former home. There was documentary evidence that the team had been proactive in ensuring that the person became registered with local services and that the Community Learning Disability Team became involved at an early opportunity. Clear write-ups were seen from healthcare appointments to date. New equipment was being obtained in relation to the person’s postural and mobility needs. The person’s weight had been recorded as a baseline for future monitoring. The second person’s healthcare records provided evidence that they were being supported to access routine and specialist healthcare services in accordance with their needs. Their weight was being regularly monitored. A ‘health action plan’ for the person who had recently moved in had been obtained from the previous setting. The manager said that this would be reviewed and updated. The second person whose healthcare notes were checked had some health action planning documentation (the team was using the Gloucestershire devised formats). However, some of the documents were incomplete or had not been recently reviewed (such as a hospital assessment from January 2006). The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 19 Medication records for the same two people were sampled. These appeared to be in order. An error had been noted for another person living in the home on March 16th 2008. There was documentary evidence that appropriate action had been taken when this was discovered later that day. The manager said that she had investigated the incident. The home has a system of staff signing a separate document as well as the medication administration record to say that they have administered medication, serving as a double check. This had been signed, indicating that on some occasions people were not actually doublechecking. The manager had reminded staff to ensure that when people signed for this check they were confident that they had verified correct administration. The double check referred to above was not always being signed for. Sometimes there was just a tick, and on other occasions nothing was recorded. Examples were seen of protocols for ‘as required’ medication. Staff spoken with were able to demonstrate a good knowledge of these. Where such medication had been administered this was appropriately recorded. Medication files included a list of the medications that each person was taking along with information about possible side effects. There was a list of authorised signatories for administration (although this needed updating to reflect some staffing changes). Documentary evidence was seen that staff had been trained to administer a particular rescue medication. Evidence was also seen on staffing files that appropriate general training about the safe handling of medicines was being provided for staff, and they confirmed this during discussions. One staff member had been delegated with lead responsibility for overseeing the handling of medication in the home. The manager said that one of their priorities was to reintroduce a system of regular audits of medication. A summary of people’s homely remedies approved by their GP was seen. However, this had not been reviewed for several years. This should be done, particularly in view of a person having recently moved into the home. Some preparations had not been labelled with the date of opening, including one which needed to be disposed of four weeks after opening. This should always be done. The Trust has medication procedures which have recently been updated. Some local procedures linked to the Trust’s policies were also seen. These outlined specific points about how medication was handled in the Briars. The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 20 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. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for recognising and responding to concerns and complaints, helping people to feel listened to. Appropriate steps are taken to safeguard people living in the home from harm and abuse. EVIDENCE: A regulation 26 report noted that a complaint had been received about the home in February 2008. This was talked through with the manager. The complaint had been withdrawn but there were ongoing discussions with the complainant about the issues that they were raising. Evidence gathered for other sections of this report demonstrated that the home was taking steps to try to resolve the areas of concern which had been identified. The Trust has a complaints procedure. This is available in text and symbol format. In survey forms family members indicated that they knew how to make a complaint if they wished to and that any concerns were promptly addressed. There were notes in people’s files about communication, including how they indicated distress and dissatisfaction. Discussion with staff along with observation provided evidence that they were attuned to these signals, including non-verbal cues. The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 21 The AQAA referred to staff being trained in adult protection. Certificates were seen on staffing files confirming this, although some certificates appeared to be missing (see training section). Staff spoken with confirmed that they had received this training and were able to demonstrate a good knowledge of safeguarding. Staff expressed confidence in the systems in place to prevent harm and abuse and said that they would feel confident reporting any concerns. The manager said that training about challenging behaviour (including reference to safe systems of physical intervention) was being provided for the team in June 2008. The Trust uses a method which is approved by the British Institute of learning disabilities (BILD). Records were seen describing incidents of challenging behaviour. These provided evidence of appropriate responses. Staff spoken with described how they managed situations such as signs of tension and conflict between people. This was based on diversion and distraction to reduce people’s anxieties and restore calm. Two people’s current financial records were sampled. These appeared to be in order, with numbered signed receipts and cash balances tallying with records. Daily checks of receipts and spending were being signed for. A representative of the Trust had recently done a financial audit. The action plan drawn up as a result of this was seen and follow-up visit was expected. This provided evidence of the Trust monitoring its own financial procedures and taking steps to safeguard people’s financial interests where necessary. A write-up was seen of a session of reflective practice between the manager and two staff undertaking their NVQ qualifications (see staffing section). This included consideration of how the service safeguarded the people living at the Briars and of staff members’ roles and responsibilities in this area. The manager said that adult protection and whistle blowing would be part of a forthcoming team meeting. The Trust has policies and procedures covering safeguarding and whistle blowing. The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 22 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. This judgement has been made using available evidence including a visit to this service. The Briars is clean and homely, promoting people’s comfort and wellbeing, although there is scope to improve some aspects of the physical environment. EVIDENCE: All bedrooms and shared areas of the home were checked. Bedrooms were personalised and had fresh décor. The manager said that two of the bedrooms had recently been repainted. On the second visit there was a slight odour of urine in the lounge. The manager explained the possible causes of this and said that replacement furniture which could more easily be cleaned/wiped would be beneficial. The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 23 The laundry was reasonably clean and tidy. A new washing machine had recently been provided. An unlocked cupboard in the room contained a chemical marked as harmful. The manager was confident that the people living in the home would not access this, although it was agreed that it should be risk assessed, or simply locked away in the cupboard where other hazardous chemicals were stored. Some areas of the home had stained or worn paintwork and would benefit from being redecorated, for example, the first floor toilets and bathroom. The manager understood that the home was on the Housing Association’s list for general redecoration within the next couple of years. The first floor bathroom had a tile missing above the bath and the surrounding tiles were bulging away from the wall. This had been reported. The manager was contacted a few days after the visit and confirmed that the wall had been completely re-tiled. The first floor corridor contained a number of objects apparently in storage. The manager said that the old shed was no longer useable but that a new shed would be provided in due course to create additional general storage for the home. The kitchen was reported to have been refurbished in 2005, although some parts of it were beginning to look tatty. A new freezer had recently been provided. Staff reported that the windows in the lounge were not sufficiently secured to their frames. The manager said that they had been made safe and that further work was expected within the near future to fully rectify the problem. Staff described the infection control procedures in the home. The home appeared to be clean throughout. The manager reported that considerable information had been gathered about specific aspects of infection control as relevant to the service. Staff spoken with were able to demonstrate a good knowledge of this. The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 24 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, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are skilled, caring and knowledgeable, promoting the quality of care. However, shortfalls in training records could increase the risk of some staff not having the training that they need. The manager’s knowledge of requirements around recruitment and selection, underpinned by the Trust’s policies and procedures, should help to provide a sound framework for ensuring the fitness of staff. EVIDENCE: Staff spoken with demonstrated a thorough knowledge of the needs and conditions of the people that they supported. Observation in the home provided evidence of staff responding to people’s needs and wishes in a sensitive, caring and professional manner. Staff were seen to recognise and respond to the different ways that people communicated. Information about NVQs (National Vocational Qualifications) was provided by the manager though the AQAA and during discussions. At the time of the visits The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 25 about one third of the team (excluding the manager) had attained a relevant NVQ. Several team members were in the process of doing NVQs meaning that the qualification rate should shortly rise to about two thirds. The manager confirmed that staff are provided with copies of the GSCC (General Social Care Council) code of practice. As noted earlier, surveys provided positive feedback about the staff team and the quality of care. Some staff felt that higher staffing ratios at certain times of the day/week would be beneficial to the people living at the home, particularly in terms of facilitating a greater range of activities and one to one time. The Trust has policies and procedures covering different aspects of recruitment and selection. The manager talked through the recruitment and selection process, demonstrating an understanding of what needed to be in place before a person could start work. The manager said that there had been no new staff since the previous inspection. Staffing files were therefore not checked. The manager was recruiting to a vacant senior post. She described that checks that needed to be in place before the person could start work. The standard was assessed as met on the basis of the above. As with all services actual practice will be checked during future visits. Staff spoken with expressed satisfaction about the training they were provided with. Training records for three staff were checked. These consisted of certificates in staffing files, combined with some information from a recent training audit. Whilst there was some evidence of staff being provided with appropriate basic and specialist training, the records were incomplete. For example, it was not possible to ascertain whether two people had received training about food hygiene in their time at the home (although they were booked onto courses in the near future). In some cases there was no record of any moving and handling training having been provided recently or at all. Other training that the manager and staff reported doing was not always backed up by a record and/or certificate. For example, this included training about the Mental Capacity Act 2005 and adult protection. As noted, the manager and staff reported that relevant training was provided in advance of one person moving into the home in 2006. This is good practice. The manager said that some input about autism had been provided from a healthcare professional during a team meeting in January 2008. This was confirmed by staff and recorded on minutes of the meeting. The manager said that a staff member was booked onto a course about autism and music, with a focus on communication. The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 26 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 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run, helping to ensure that good standards of care are maintained. Health and safety is generally well managed, although some areas could be improved in order to further promote people’s wellbeing. Systems are in place which help the team to monitor and improve the service they provide. EVIDENCE: The manager has attained the NVQ level 4 in health and social care as well as the Registered Manager’s Award. Staff spoken with felt that the home was well run. Comments included that the manager was supportive and hands-on. The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 27 The manager described how she kept up to date with best practice and current legislation, including by accessing relevant training. The manager is also undertaking some visits to other services and writing reports about them (as part of the service provider’s duty under Regulation 26), helping in turn to promote reflection about practice at the Briars. The manager said that there were managers’ meetings about every three months, and that there were also monthly peer group meetings which she found very useful. The manager expressed concerns about the home being over-budget due to some issues earlier in the year. However, it was understood that this would be absorbed by the Trust, given the exceptional circumstances leading to this. Regulation 26 reports about the Briars by a representative of the Trust are being forward to us. As part of quality assurance the trust also has a series of standards against which services audit themselves. The action plan for 2008/09 for the Briars resulting from this audit was seen. Objectives included further developing person centred planning and issues around budget management. The manager said that consideration was being given to joining a national autism accreditation scheme, though this idea was at early stage. Health and safety records were sampled, including for fire, gas and electrical safety. These were generally satisfactory although the following was noted: • • • • There had been no test of emergency lighting recorded in February 2008. There was a gap of about 8 weeks between tests. Testing of hot water temperatures had ceased. The six monthly servicing of the adapted bath was slightly overdue. Some of the recent temperature records for the fridge were below freezing. 20°C was also recorded on one occasion. Staff spoken with felt that health and safety was generally well managed. As noted, some people expressed concern at the accessibility of the vehicle. The Trust has health and safety policies covering general principles as well as specific areas of operation such as moving and handling. The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 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 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA35 Regulation 17 (2). Sch 4 (6) (g) Requirement Ensure that a full, accurate and up to date record of all training undertaken by staff is kept in the care home. Timescale for action 30/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations Fully review and update care plans and risk assessments as relevant to the Briars for the person who has most recently moved in Where reviews indicate significant changes then documents should be retyped so that they are as clear as possible. Outcomes and recommendations from specialist assessments should be incorporated into care plans as soon as possible. Notes about activities should always provide some detail about the activity and how successful it was. See example in text. Continue with efforts to develop a suitable activity programme for one person in particular, as discussed during the inspection. The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 30 2 YA12 3 YA13 Consider providing a second appropriate vehicle in order to promote more individualised activity provision. Take any necessary actions to ensure that the existing vehicle is safely accessible for all of the people living in the home. Daily diary entries about eating and drinking should include a description of what the person actually consumed. Consider using ‘body maps’ for recording of any marks, bruises and scratches to provide a clear record of their location and when discovered, and of the cause (if identified). Ensure that each person has a comprehensive and up to date health action plan and associated documentation. Ensure that the twice-daily system of double-checking that medication has been correctly administered is consistently implemented and signed for. Move forward with plans to reintroduce periodic medication audits as an additional way of checking that medication of being properly handled in the home. Review the individualised homely remedies list in consultation with appropriate healthcare professionals. Document the date when preparations are opened to help ensure that they are discarded when no longer safe to use. Consider replacing the seating in the lounge with furniture which can more easily be cleaned/wiped. Redecorate areas with stained/worn paintwork. Regarding the potentially accessible, harmful chemical in the laundry conduct a risk assessment on this or lock it away in the cupboard where other hazardous chemicals are stored. Ensure that emergency lighting is tested at last monthly. Restart periodic testing of hot water temperatures to ensure that the risk of scalding to people living in the home is minimised. Chase up routine servicing of the bath if this is not forthcoming in the near future. Check that the thermometer used in the fridge is accurate and that the temperature the unit runs at is satisfactory. 4 5 YA17 YA18 6 7 YA19 YA20 8 YA24 9 YA24 10 YA42 The Briars DS0000067090.V360312.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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