Care Home: The Brook

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What the care home does well . One person told us that moving into the home had been a very good thing for them. People told us the staff treated them well and the staff were "nice".People told us they liked living at the home and said that there is a good choice of things to do inside and outside the home. Comments included, “I like going out every day and the staff are always with me". We saw good care plans which people are involved inputting together, so they know the care they are going to receive. People have a good choice of activities to choose from. Staff help to plan activities and holidays. The manager encourages staff to go on courses to make sure people living at the home receive the best possible service. What has improved since the last inspection? The home is developing a room which will provide people living there with sensory equipment. Staff said this will help some of the residents to relax. What the care home could do better: . Staff should make sure records they make are written about the persons activities as they have happened so the records is clear and shows what that activity has been.The home could improve the environment by making the lounge and dining room more homely. More personal items such as photos or ornaments would make the rooms more inviting. People living at the homewould benefit from having a complaints policy in suitable formats so the records are clear and show what people have done. Key inspection report Care homes for adults (18-65 years) Name: Address: The Brook 303 Leyland Lane Leyland Preston Lancashire PR25 3BP three star excellent service The quality rating for this care home is: 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: Jacqueline Riley Date: 2 9 0 3 2 0 1 0 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Information about the care home Name of care home: Address: The Brook 303 Leyland Lane Leyland Preston Lancashire PR25 3BP 01772432080 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dawaking Care Ltd Name of registered manager (if applicable) Ms Patricia Anne Powell Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 6 0 care home 6 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection A bit about the care home. The Brook is owned by Dawaking Care Limited. It is managed by Patricia Powell. The care home provides care and support to adults with a learning disability. Six people with a learning disability can live at the home. Each person has their own room. The fees at the time of the inspection were £801.00 to £1329.00 per week. Each person pays for their own leisure activities, chiropody, hairdressing and personal items including clothing and toiletries. 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: three star excellent 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 How we did our inspection: This is what the inspector did when they were at the care home The inspector was helped during the inspection by a person who has experience of living in a care home and being supported. We spoke to people who live at the home and staff during the inspection. We had surveys returned to us from people living in the home and staff. They told what it is like to live and work in the care home. We looked at the care records of two people living in the care home. We looked at other records which told us how the home is run. This included staff records and health and safety records. What the care home does well . One person told us that moving into the home had been a very good thing for them. People told us the staff treated them well and the staff were nice. People told us they liked living at the home and said that there is a good choice of things to do inside and outside the home. Comments included, “I like going out every day and the staff are always with me. We saw good care plans which people are involved in putting together, so they know the care they are going to receive. People have a good choice of activities to choose from. Staff help to plan activities and holidays. The manager encourages staff to go on courses to make sure people living at the home receive the best possible service. What has got better from the last inspection The home is developing a room which will provide people living there with sensory equipment. Staff said this will help some of the residents to relax. What the care home could do better. Staff should make sure records they make are written about the persons activities as they have happened so the records is clear and shows what that activity has been. The home could improve the environment by making the lounge and dining room more homely. More personal items such as photos or ornaments would make the rooms more inviting. People living at the home would benefit from having a complaints policy in suitable formats so the records are clear and show what people have done. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Jacqueline Riley 3rd Floor Unit 1 Tustin Court Port Way Preston Lancashire PR2 2YQ 01772730100 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. 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 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 admission and assessment procedures are clear to ensure people and their representatives were confident their needs could be met by the home. Evidence: We looked at the care records for two people in the home. Both had detailed assessments carried out by staff at the home before admission. Both had information from social services staff and from staff at their previous placement. Each person had a support plan produced from the assessment information. One person had moved from another home and we saw how this was done so that it was a positive experience for the person. There was detailed information about visits to the home, how the person made choices about their room, and how this was managed. The information shows the move was managed well and done with the full participation of the resident involved. We saw the home has written information for people who may come to live at the home so they know what to expect. This literature is made available in various formats if necessary. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are supported to make decisions, which help them in order to meet individual needs and preferences whilst taking risk factors into account. By using standard phrases in daily reports means that there is no accurate record of individual activities. Evidence: The two care records we looked at each had an individual support plan for the person. The support plans were very detailed and included information relating to how peoples individual needs were being met. The support plans were signed by the person where possible, and also by staff to indicate that they had read and understood the plan. The support plans were reviewed monthly, sometimes more often if there was a significant change in the persons condition or circumstances. One person we spoke with was aware of their support plan and confirmed they had been involved in the planning and review of the support they received. However most people living at the home have profound levels of learning disabilities and therefore had limited understanding of the records which are maintained for them. There were risk assessments in place for each person. The risk assessments had been reviewed monthly. The support plans included details of any limitations placed on the person with the reasons for this. There was evidence from the daily records that people were supported to take responsible risks. Staff spoken with were aware of individual needs and preferences. They were able to describe limitations placed on people in the home and explain the rationale. They were clear that individual choices should be respected wherever possible and that independence should be promoted. When we looked at records showing daily activities for two people living at the home, they were found to be repetitive in that standard sentences were being used on a daily basis, and did not reflect what activities people were actually undertaking. We spoke Evidence: to the manager about this and they said they would make sure staff are instructed to record daily activities for the resident and not use standard sentences. The information we received in the annual quality assurance assessment (AQAA), told us people are supported to express themselves within a safe environment, and that this is managed in a way which does not impede their right to respect and their dignity. Staff told us they are trained to understand behaviour patterns, so they can act before a crisis develops. Comments included, “some people have challenging behaviour but we get to know what the triggers can be and can act before it becomes a problem. The expert by experience found staff to be very supportive in the way they helped people living there. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were flexible routines, a range of activities and a varied menu so the lifestyle in the home meets people’s individual needs and preferences. Evidence: The care records showed that people were involved in a range of activities, such as swimming, shopping, and activities in the home. The person helping us carry out the inspection spoke to a number of people living there and was told there are lots of things for people to do including getting DVDs and takeaways on Saturdays which people said they liked very much. We were told some people had been on holidays in this country and abroad. Staff spoke to said they use person centred planning to find out what people like to do and to plan events around their choices. All activities are risk assessed so that they are managed in a way which does not have a negative impact on the person. The records we looked at showed they are regularly reviewed and changes made accordingly. Staff spoken to said risk is taken very seriously and this is reflected in the records seen. People we spoke with said they could get up and go to bed when they wanted to and could usually do what they wanted to during the day, evening and weekend. The home endeavour to assist people to remain in contact with family and friends and this is recorded on their care planning records. Records we looked at also showed instances where contact with family and friends need to be monitored and managed by other professionals. Staff spoken to were aware of such instances and could explain how they were managed for positive outcomes for the people involved. Evidence: The person helping us to carry out the inspection had lunch with people living there. They said the food was nice and they had the opportunity to talk to people. People we spoke to and surveys we received from people living there said the food was nice and there is always a choice. Staff told us they decide on the menus with people living there so they have what they want, but it is always balanced so their nutritional needs are being met. One person said they like to go with staff to get the shopping whenever they could. The care records included an assessment of the person’s nutritional needs. In addition the records show the weight of people living there is regularly checked and monitored as part of their physical wellbeing checks. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were detailed support plans so that the health ands personal care people received were based on their individual needs. Evidence: We looked at the care records of two people living at the home. We found they were complete and up to date with a range of information telling us about how peoples personal and health needs were being met. People living at the home have a range of complex needs which staff spoken to were aware of and could clearly identify how those needs could be met. Comments we received included, we have really good access to other professionals who we work closely with, peoples needs can vary but as this is a small home we are able identify individual needs and spend time with people and help them to get a better quality of life. Specialist equipment and aids and adaptations were in place for people who needed the support. Specialist advice is sought where necessary to ensure the right equipment is in place for the individuals needs. We saw excellent examples of person centred planning where people had specific health care needs. We saw staff had received specific training in these areas so they can respond to the needs of people and manage their health needs more effectively. We saw people have a detailed medication profile listing current medications and the medication assessment shows the level of support needed. Medication administration records (MARS) were seen to be accurate and complete. Regular audits ensure medication is being handled safely by the staff team, who have received training in the safe handling and management of medication. Evidence: 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. There were systems in place to make sure concerns and complaints are handled well by the home. People are protected by good staff training and awareness. Evidence: We saw the home has a complaints and concerns procedure which is made available to people from the Statement of Purpose. We were told this could be improved by using formats that are easier to read by people living there. In addition we were told by some people they are not sure how to make complaints. There is a need to make sure people living at the home have the necessary understanding of how to make a complaint so they are protected and not disadvantaged. There were policies and procedures in place to manage issues of safeguarding people should a concern arise. In addition staff told us they have received training in protecting people and they felt confident they know the procedures should abuse be suspected. Staff training records showed most staff have received training in safeguarding people and this training is currently being updated for all staff in the near future. The personal money of people in the home is kept securely. There were records of transactions made, which is audited regularly. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean and a generally comfortable environment which meets peoples needs and preferences. A lack of personal items in communal areas meant that they lacked a homely feel. Evidence: We looked around the home and found it is designed to meet the needs of people living there. People’s rooms are personalised, with items of their own in place. A resident told us they like their room very much, and were encouraged by staff to personalise it. Another person was encouraged to display their collection of planes, which they were keen to show us. The lounge area and dining room were seen to be sparse with limited evidence of making the communal areas more homely, with pictures or ornaments. A second lounge has been made into a resident’s room. We found this room has an external door which was previously the main entrance door. A notice is in place in the window instructing people to another entry, which was difficult to find as it is not signposted. We found having the door there has the potential to be disruptive to the person using this room and suggest the door be removed if this is to be a permanent resident’s room. The home is creating a sensory room for people in the loft space. Access to this is by a steep flight of stairs therefore could only be used by people with good mobility. There is a rear enclosed garden area, which has seating and bar-b-cue facilities. People told us they like using this area in the summer. Some people like to plant flowers and vegetables, which staff told us they help them with. We saw there is a designated laundry area and polices and procedures in place for infection control to protect and safeguard people. Evidence: 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. People were protected by the homes recruitment and selection process and staff have the skills knowledge and experience to meet people’s needs. Evidence: There has been little change to the staff team since the previous inspection. The two records we looked at showed there is a good recruitment procedure in place to make sure staff are recruited using systems which make sure they are suitable to work with people who may be vulnerable. Staff we spoke to told us they felt they were supported by the management team. Comments included, Ive worked here a long time and we work well as a team, the residents have been here a long time and you get to know their individual needs. We saw the home is staffed in accordance to the needs of people living there. We saw staff are available to assist people with activities in the home and beyond the home. We were told, there are always people around so residents can do the activities of their choice. Staff have good access to a range of training and records we looked at showed they were up to date. Some people required updated mandatory training so they were up to date with current practices. This was being arranged for people as acknowledged by staff on duty. We saw staff induction was based around health and safety as well as the homes policies and procedures. Staff induction is assessed around the Learning Disability Award Framework which meets the Skills For Care Induction Standards. Staff supervision and appraisal is taken seriously and the staff records we looked at Evidence: showed supervision occurs with appraisals in place for each member of staff. Staff surveys told us they feel supported. 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. Management systems and practices promote Independence and choice with people’s views and opinions being listened to. By not having a suitably qualified person to manager the home on a temporary basis has the potential to put people at risk. Evidence: We found the registered manager was temporarily overseeing another service. The acting manager did not have the minimum required experience at a senior level to manage the service. We spoke to the registered manager about this and it was agreed the registered manager will work in the home with immediate effect. By not having appropriate management cover has the potential to put people at risk. Information we received from the AQAA, surveys and by talking to people told us they feel supported by the management team, and they said members of the management team were always available to talk to. Comments included, “It’s an open door policy and there is always someone to talk to. Records we looked at showed there are regular staff and resident meetings, which are recorded. We saw resident meetings include information being given about activities being planned. Residents requests are noted and acted upon, including new lounge furniture being agreed at the most recent meeting. People told us there are weekly house meetings where they talk about menus, shopping and any other issues they might want to discuss. Staff told us they find meetings to be useful and where they can share ideas, whilst being kept up to date with things going on in the home. Surveys we received by people living and working in the home told us they are satisfied Evidence: with all aspects of living and working there. The homes own quality assurance systems mean they take what people say seriously and use this information as part of planning and developing the service. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 37 38 31/05/2010 In the absence of a registered manager for more than a period of 28 days, the provider must inform the Care Quality Commission of the expected length of absence, the reason and arrangements including employing a person in the post who has at least the minimum Qualifications and experience to undertake that role. The home will at all times be run by responsible, experienced and qualified people. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Daily records show standard sentences being used on two 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 care plans. The records should be personal for the individual and reflect the activities for that person so that it is an accurate record. 2 24 The main lounge and dining area were seen to be sparse. Personalisation of these areas would make the rooms more homely and a comfortable environment for people living there. It is recommended the external entrance door leading into a resident’s room be removed, as it caused confusion to people wanting to access the home and has the potential to be disruptive for the person living in the room. 3 24 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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