Random inspection report
Care homes for older people
Name: Address: Barton Brook Trafford Road Eccles Manchester M30 0GP two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Elizabeth Holt Date: 2 7 0 7 2 0 1 0 Information about the care home
Name of care home: Address: Barton Brook Trafford Road Eccles Manchester M30 0GP 01617878437 01617079855 hooleyn@bupa.com www.bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) BUPA Care Homes (CFHCare) Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 120 Number of places (if applicable): Under 65 Over 65 0 90 0 dementia old age, not falling within any other category physical disability Conditions of registration: 30 0 4 The maximum number of people who can be accommodated is: 120 The registered person may provide the following categories of service only. Care home with Nursing - code N, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: - Old age not falling within any other category - Code OP, (maximum number of places: 90) Dementia - Code DE (maximum number of places: 30) Physical disability - Code PD (maximum number of places: 4) Date of last inspection Care Homes for Older People Page 2 of 14 Brief description of the care home Barton Brook is a care home providing nursing care and accommodation for up to 120 older people. Within the maximum number, accommodation is provided for 30 older people with a dementia type illness. The home is owned by BUPA Care Homes. The home is set in its own grounds in the centre of a residential area in Eccles, Manchester. The accommodation is provided in four single storey units, each unit housing up to 30 residents. Each unit has access to level garden areas. A number of the bedrooms have personal patios accessed by French windows. A central building contains the administration area, laundry and central kitchen. The home is close to local amenities with the Trafford Centre shopping complex within a two-minute drive. The home is readily accessed by local public transport and the motorway network is within close proximity. Barton Brooks fees ranges from GBP364.41-GBP623.50. This covers personal care only to nursing care. There are additional charges for hairdressing, chiropody and newspapers. Information about the home can be gained through contacting BUPA, the registered provider. Care Homes for Older People Page 3 of 14 What we found:
This was an unannounced random inspection carried out on the 27th July 2010. As part of this inspection an expert by experience assisted the inspector for part of the visit to gather the views of people who live at the home. This person talked to a number of people about their quality of life at Barton Brook. She completed a report after the inspection and some of her comments and observations are included in this report. The manager was not told beforehand that we were coming to visit. During the visit we looked at a number of records including a sample of care plans and medication records. A partial tour of the premises was made which included two of the houses including the communal areas. Prior to this visit several concerns were expressed about the care being received by some people using the service, and these have been referred to Salford local authority for investigation under their safeguarding adults procedures. One concern was upheld in July 2010 where there was a marked deterioration in a persons wound. This highlighted shortfalls in wound care documentation and record keeping and shortfalls in the staff having sufficient information on admission about the person to be able to meet their needs fully. Information gathered at the admission stage should be as comprehensive as possible to give a full picture of the persons care needs. During this visit another persons care plan showed shortfalls in how the information gathered from the pre admission assessment had been used and added to. The registered manager left the service in May 2010. At the time of this visit the interim manager was due to commence full time at the service until the newly appointed manager takes up their post. We arrived at the home at 09:20 and visited Irwell House at 10am. Thirty people were receiving care in Irwell House, one Registered Nurse was in the middle of the medicines round and the nurse in charge was delivering care. We were told by one of the registered nurses that it was sometimes difficult to meet peoples nursing care needs because they were short staffed. It was of serious concern that when we arrived on the unit that two staff were present in the lounge area and a persons dignity was compromised. Two people living at the home told the expert by experience they were shielding this person yesterday to protect their dignity from visitors. It was of concern that the staff were not addressing the needs of this person and maintaining their dignity. Information in this persons care plan had shortfalls in relation to how this person should be appropriately supported. Shortfalls were seen in some medication practices. The medicine round did not finish until late morning, the nurse was observed to have removed the plastic coating from two tablets when spoken to she said, This was because the person needed these crushing. This person was at risk of receiving medication inappropriately, by emptying the powder out of the capsule the medicines may be ineffective or potentially harmful. This practice was raised with the manager and we were told appropriate advice would be sought from the person who prescribed them. Care Homes for Older People Page 4 of 14 For another person, the medication administration chart showed they were prescribed atropine eye drops. Although the medication chart had been signed as checked by the registered nurse, this was not appropriately written. This potentially put the person at risk of not receiving the prescribed medication in an appropriate way. A requirement was made in relation to the the arrangements for medication. As part of the visit we looked at the care plans for three people and noted a number of shortfalls in the record keeping for people living at the home. Some of the information gathered at the assessment stage for one person was not adequate and did not clearly identify the persons needs. The care assessments and care plans need to be more person centered and specific to the peoples individual needs. Some risk assessments and care plans for peoples personal hygiene needs, nutritional needs, wound care, moving and handling and social care needs were either not fully completed, updated or reviewed. For one person the record showed they had lost weight and the person themselves expressed some concern to us of their weight loss. During the visit the nurse in charge referred this person to the dietician. We discussed the need for staff to be more pro active in providing additional nutritionally balanced snacks for individuals who are at risk or who have lost weight. The records must show the appropriate interventions and support from health care professionals. We had concerns that the daily statements in the care plans were not clearly recording the detail required and the care that people were receiving. The care plans must be reviewed to show the detail of peoples care needs by staff with the appropriate knowledge, expertise and skills. The records must be written in line with the Nursing and Midwifery councils guidance for record and record keeping. From observations made we had concerns about the number and deployment of staff on duty. A number of people were still in their bedroom late morning. One person appeared unsafe and said they were uncomfortable. One person said, I am always left for ages when I call for the toilet and am always told that someone will be there in a while. I dont always get the bath or shower when I would like it, the staff are always so busy and cant come to chat. Another person said to us,I had hoped to get up earlier but no one came to me. I cannot reach my call bell. do you have a bedpan? Another person was supported to eat their breakfast, at 11.10 am. They were seen to eat barely any lunch as they were clearly not hungry. This person slept throughout most of the dining experience at the table. During the visit staff were not always heard talking to people in a respectful way and staff were overheard calling people love rather than their name. One staff member was encouraged to talk to a relative on the hands free phone in the office for confidentiality, rather than on the corridor. Another person told the expert by experience the staff made her stay in the lounge in an evening when they would prefer to go to their bedroom. Staff spoken said people were asked about the time they wanted to get up and when they wanted to go to bed. From observations made during the visit peoples preferred rising and retiring times were not clearly recorded or met. During this visit we spoke to a person who was still in bed late morning. The persons catheter bag was lying on the floor. As this has the potential to put the person at risk of cross infection this was brought to the attention of the manager and a stand was found for this. Care Homes for Older People Page 5 of 14 We spoke to some people whose mouths looked dry and whose teeth looked in need of cleaning. One person added, I cant really clean them on my own and the staff are busy. One staff member said, We would soak their teeth at night. We asked about the support that would be provided to clean a persons mouth and the care plans looked at did not include detailed care plans for oral health care. We observed that a number of people were not supported to move from their wheelchairs for considerable lengthy periods of time. One person said, It is uncomfortable sitting here and I do get bored. The expert by experience observed one person who was resting or sleeping against the handle of the wheelchair and looked uncomfortable. In relation the mealtime experience the expert by experience made the following observations as she joined a table of people for lunch. There were no menus on display on the dining tables, these were on the wall which was not accessible to a number of people and one person said, I never know what the meal is going to be, its a surprise which can be good or bad. Another person asked for chicken but received sausage. When the expert by experience raised this, the care worker stated, Oh she didnt eat the sweet and sour the last time it was on the menu. The tablecloths on the tables were in need of a wash as they were unclean. One person was not comfortable at being asked to sit at the dining table 10-15 minutes before the meal was brought to the table. This was important to them and they stated it made him feel frustrated. The dining experience did not include condiments on each table. Lunch was still being eaten at 13:45, which was fine for those who received breakfast late but some people had eaten breakfast before we arrived. Staff should be supported to complete the mealtimes in a timely manner. Staff and people at the home were not aware of what was for lunch. When people were asked at the dining table about their preferred choice they were asked, Sausage or chicken rather than the full meal. We looked at some of the duty rotas, the findings on the day showed that the staffing arrangements for Irwell Unit need to be reviewed to ensure peoples needs could be met. One registered nurse was scheduled to be the only registered nurse for two days which would clearly leave this unit short of appropriate staff. The health care records showed when people had received attention from health care and other professionals, for example GPs, chiropodists, opticians. There were shortfalls in the outcome as to whether the prescribed treatment had been effective for people. We did not find all areas of the home to be clean. The chairs and tables were sticky to touch and the small lounge was unclean. We found the waste bin in the staff toilet to be overflowing with paper towels and the housekeeper was asked to change and clean this in the afternoon. We found people were not purposefully engaged and their social or recreational needs were not clearly met. People appeared to lack social stimulation and many dozed off to sleep. The managers did acknowledge on the day of the visit that Irwell House needed attention to the deployment, skill mix and organisation of the staff to ensure peoples needs are appropriately met.
Care Homes for Older People Page 6 of 14 What the care home does well: What they could do better:
At the end of the visit we spoke to the management team about our areas of concern that had been noted during our visit and this report is an overview of what we found. The management team was committed to improving the standard of care delivered and could describe some of the changes they planned to make to address shortfalls identified. An inhouse audit has been carried out by the service and an action plan is being drawn up currently. The care plans must contain sufficient detail to show clearly how peoples needs and preferences will be met. This must include peoples oral health care, peoples preferences in relation to rising and retiring times, evidence that health care needs have been met in full. We raised concerns about the management of Irwell Unit in particular and how the staff are deployed across the shifts to meet the needs of the people living there. Shortfalls
Care Homes for Older People Page 7 of 14 may lead to peoples needs not being appropriately met. Discussion with staff team members and from observations made during the visit identified that some peoples needs were not being met. People were left waiting for attention from the staff, for example more than one person was waiting for support to get out of bed at 11.30am and another person asked more than once for assistance for his position to be changed. Other areas of concern included the lengthy time to give out medication, the shortfalls in the staffing arrangements, shortfalls in the record keeping and the documentation and the staffing arrangements were not sufficient to meet the dependency needs of the people living in Irwell House. Systems must be put in place to monitor the unit, to consult with staff and people accommodated about staffing matters to assure themselves that each house is sufficiently staffed and that staff are deployed appropriately to meet the dependency needs of the people accommodated. 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 2. Care Homes for Older People Page 8 of 14 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 14 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, 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 3 14 The needs of prospective people for whom accommodation is provided must be appropriately assessed This is so an accurate decision can be made as to whether the persons needs can be met by the service. 04/10/2010 2 7 13 Risk assessments must be 30/09/2010 completed for all identified risks for individuals.This must include up to date moving and handling, nutrition and appropriate diet and fluids assessments. This is to ensure that all known risks are identified, recorded and actionis taken to minimise the risks. 3 7 12 The care plans must contain 04/10/2010 sufficient detail to show that peoples needs are being met appropriately and in line with their preferences. To ensure that people are Care Homes for Older People Page 10 of 14 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 receiving the care and support that meets their current and changing health care needs. 4 8 12 The registered person must ensure that proper provision is made for peoples health care needs. This is to make sure people receive the necessary treatment and supervision of this care. 5 9 13 All medicines must be 27/09/2010 administered as prescribed in a timely manner. Records about medicines must be clearly and accurately checked and recorded. To make sure peoples health is not at risk and so medicines are given as prescribed. 6 10 12 The registered person must 13/08/2010 make sure the care home is conducted in a manner which respects the privacy and dignity of people accommodated. This is to make sure peoples need for privacy and dignity is repected. 7 27 18 The registered provider must 08/09/2010 ensure they have enough suitably qualified and competent staff working in the home at all times to meet the needs of the people accommodated. must be
Page 11 of 14 23/08/2010 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 regularly reviewed and monitored to meet peoples assessed needs. To make sure there are enough suitably qualified and competent staff at all times to meet the health and social care needs of people living at the home. 8 33 24 Systems must be in place to monitor and check the care practices in the home. To make sure shortfalls are identified and improvements are made particualrly to record keeping, care plans, medication and staffing. 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 29/10/2010 1 2 7 10 The daily statements in the care plans should record clearly the detail required and the care that people were receiving. The care home must be conducted in a manner that respects the privacy and dignity of the people accommodated. This should include calling people by their preferred name. People should be provided with appropriate recreational and social activites to keep them occupied and stimulated. Mealtimes should be reviewed to make sure people receive meals in comfort, with a choice of food. Arrangements should be flexible to meet the needs of people living at the home. People should at all times have access to the call bell or
Page 12 of 14 3 4 12 15 5 16 Care Homes for Older 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 other suitable equipment so they can request assistance and support from the staff as needed. Care Homes for Older People Page 13 of 14 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial 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. Care Homes for Older People Page 14 of 14 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
