Inspection on 07/01/10 for Briardene Unit - South View Care Home

This is the latest available inspection report for this service, carried out on 7th January 2010.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Briardene Unit - South View Care... 31/07/07

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Extracts from inspection reports are licensed from CQC, this page was updated on 11/04/2010.

Key inspection report Care homes for older people Name: Address: Briardene Unit - South View Care Home West Avenue Billingham Stockton-on-Tees TS23 1DA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jacqueline Herring     Date: 2 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People 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 Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Briardene Unit - South View Care Home West Avenue Billingham Stockton-on-Tees TS23 1DA 01642530971 01642521811 southview@barchester.net www.barchester.com Barchester Healthcare Homes Ltd care home 16 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 16 The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia Code DE, maximum number of places: 16 Date of last inspection Brief description of the care home Briardene Unit - Southview is now registered to provide nursing care to 16 people with dementia. It is a specialist dementia care unit, which cares for people with challenging needs associated with their dementia. The unit has undergone substantial refurbishment. It is situated on the outskirts of Billingham and public transport and local shops are accessible. A number of the beds are contracted specifically with North Tees Primary Care Trust. The fees range from one thousand and fifty pounds per week to one thousant two hundred pounds per week. 16 Over 65 0 Care Homes for Older People Page 4 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. This Key Inspection was an unannounced inspection and was to check that the home meets the standards that the Commission for Social Care Inspection say are the most important for the people who use the services, and that it does what the Care Standards regulations say it must. This inspection was conducted by one inspector, across two inspection days. This Key Inspection was carried out within six months of the service being reregistered for a different category of care. During the inspection, a number of records were looked at, including records of people who use the service, along with staff recruitment and training records. The medication Care Homes for Older People Page 5 of 25 systems was also looked at and discussed. Discussions also took place with a number of staff, visitors, the clinical lead and manager. An Annual Quality Assurance Assessment (AQAA), the services self-assessment of how well they think they are meeting standards had also been completed prior to the last Key Inspection. Information was also used from it for this inspection. A number of surveys were also completed and returned to us from relatives of people living at Briardene. We have reviewed our practice when making requirement to improve national consistency. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 7 of 25 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. People are provided with the information they need in respect of the Briardene unit. People have their needs assessed prior to being admitted to the home and are assured that there needs can be met. Evidence: The Statement of Purpose and Service Users Guide were both looked at, both of which contained the information to inform people about the service. The AQAA detailed that, residents are fully assessed ensuring their needs can be met, families are supplied with information and are invited to view the home. There are good systems in place for assessing peoples needs, which are completed prior to anyone being admitted to the unit, these assessments are carried out by qualified staff who have the required knowledge and experience to do so. Briardene unit currently has a contract for a number of beds with the local Primary Care Homes for Older People Page 10 of 25 Evidence: Care Trust to provide specialist dementia care to people with challenging dementia care needs. Relatives who were spoken to confirmed that they had been able to visit the service and were provided with sufficient information on which to make a decision. Care Homes for Older People Page 11 of 25 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed and careplans are in place to show how they are to be cared for or supported, further development of the care records will enhance these yet further. The way in which medication is managed is good. Evidence: The AQAA details that, Each resident has a comprehensive care plan identifying their personal and social care needs. The care files of two people who live at Briardene were looked at in detail. It is clear that a lot of work and time has been spent on developing peoples care records. Whilst the assessment and risk assessment documentation are comprehensive in format, there is the need to be mindful of more personal, individual needs. A range of care plans have been developed, however the needs statement and interventions particularly in one were not specific or detailed enough. People also had care plans in place for areas that had not been identified as a care need for example, breathing. Care Homes for Older People Page 12 of 25 Evidence: The monthly evaluations of the planned care had not taken place in the two files looked at. Whilst there were dates specified for monthly reviews, these could not be evidenced within the progress and evaluation notes. Discussion took place with the manager and Clinical Lead about the care records. They had already identified that there was work to do with the assessment of need and care plans and training has already been arranged to enable these to be developed further. This is planned to take place in the very near future. Staff spoke with knowledge about the care needs of people living at Briardene. Of what the service does well, one member of staff said, We look at the individual, we ensure that people are treated as individuals, it is not one size fits all. There was also information about GP, district nurses and other health professionals involvement contained within the care records. Relatives who were spoken to were very please with the care provided at Briardene. One relative said, I am fully involved in his/her care and I can be as involved as I want to be, including washing and showering. The Medication Administration Records (MAR) of the two people whose care files were also looked at. In the main these records were in order. There is however the need to ensure that when medication is handwritten on the records that this is sign for and then countersigned by a second person, ensuring accuracy of medication and direction. This had been actioned by day two of the inspection. The use of PRN medication was also discussed and it was agreed that it would be good practice to have PRN protocols in place for the use of these. It was also recommended that the additional record sheet on the reverse of the MAR sheet should also be used. This had been actioned by day two of the inspection. There is a dedicated medication room,which is fully and appropriately equipped. All medication is administered by qualified nurses and there is also ongoing competency assessment that they complete. Good systems are in place for the ordering of medication. Care Homes for Older People Page 13 of 25 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities to be involved in social and recreational activities, which will be further enhanced with the appointment of a staff member dedicated to this role. The home provides a varied and balanced diet for people who use the service. Evidence: Up until recently, an Occupational Therapist had been employed to develop and implement a range of social, recreational and occupational activities for people living at Briardene. This post has recently been advertised and an appointment has been made. Social assessments take place and were available on the care files looked at. The home has very good facilities for activities purposes. There is a dedicated activities room, which is equipped with a range of materials, there is a portable snoozelin facility, this is a multi sensory therapeutic system used for people and is used for some people for the purposes of relaxation. There is also a music room and also an occupation therapy kitchen, which is accessible to people, which has been fully risk assessed. Care Homes for Older People Page 14 of 25 Evidence: There were no actual printed menus available during the inspection, this is due to a change in the catering manager. A record of the meals being provided this week was available and showed that there was choices available. These meals were of a traditional nature. Printed menus were available by day two of the inspection. There was some discussion about the presentation of pureed diets. The manager confirmed that this was being looked at and would be improved upon. Staff spoken to said that life for people living at Briardene was flexible and very much centred around individual lifestyle choices and preferences. One member of staff said, Life is very much about the individual and their needs and wants. Another member of staff said, It is their home, we are here to support, they have their own lifestyle and life histories. Relatives spoken to also said, I am so happy, it has also become my home, I come in anytime day and night, everyone is so welcoming. During the inspection, people were seen getting up late, having a late breakfast and generally being able to influence their day. Care Homes for Older People Page 15 of 25 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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 are protected by Evidence: The AQAA detailed that there had been no complaints since the service was registered for the current category of care. It also states that, We operate a no blame culture staff are encouraged to raise any concerns and a reflective practice approach is taken. Complaints are encouraged and taken seriously as they can lead to an improvement in service. One relative spoken to said, You just have to mention things and it is done immediately, if I had a complaint would go straight to June (the manager), it would be sorted. The complaints procedure is on display within the entrance area of Briardene. It needed some slight amendment to signpost people to the funding authorities rather than CQC should they have concerns. Staff spoken to confirmed that they had received training on the topics of whistleblowing and protection of vulnerable adults. Individual training records looked at also contained evidence that staff had received this training. Care Homes for Older People Page 16 of 25 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, 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. 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. Briardene unit provides people with an extremely well decorated, furnished, homely and spacious environment in which to live. The physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. Evidence: Briardene is a beautiful 16 bedded care home. It was a previous nursing home for older people and has undergone a full structural change and refurbishment to provide different accommodation and category of care. There are very nicely appointed bedrooms for people, which are all ensuite with shower facilities. Each bedroom exceeds National Minimum Standards sizes and contains all of the facilities required. Each en suite has a walk-in shower, hand basin and WC; again size far exceeds the expected basic. There are several communal rooms and spaces that will be used for a variety of activities, including music therapy, sensory therapy, independence skills maintenance and art therapy. Attention to colour based on evidence based research has been used, and signage will developed according to individual needs, recognition and preference. Barchesters Memory Lane themed corridors and shared areas are being developed. Care Homes for Older People Page 17 of 25 Evidence: Outside there are number of enclosed garden areas and there are plans to develop these. Smoking facilites were discussed during the inspection. Currently people have to use an unprotected shelter in the garden if they want to smoke. This is deemed to be detrimental to their health, safety and well being particularly during periods of bad weather and snow. Immediate action was taken to address this and by the second inspection day, a more protected shelter was in place. Care Homes for Older People Page 18 of 25 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. Peoples needs are met by the staff, who have the skills and knowledge required. People are protected by the way the home recruits staff. Evidence: At point of registration, a new staff team has been recruited and a two week induction and training plan had taken place. This included subjects required by regulations as well a range of other subjects relevant to the homes registration, such as safeguarding adults, challenging behaviour, person centred care, Mental Capacity Act, Mental Health Act and dementia management. Staff recruitment records were looked at and they contained the required information to show good recruitment practices are in place. This included completed application forms, with no gaps and Criminal Bureau checks that has been completed prior to the person commencing employment. There was evidence within the individual training records that all staff had completed induction training. One member of staff said, Definitely gave me the information I needed to do my job but also helped in building the team. Training has also been provided to staff to enable them to deal with some of the challenging behaviours that people living at Briardene may present. Staff thought that the training they had received so far was good and gave them the information they needed to meet peoples needs. Twelve of the twenty permanent Care Homes for Older People Page 19 of 25 Evidence: care staff are qualified to VNQ Level 2 or above in Care. A computerised system is used, which flags when staff need to be updated with their individual training and also for when qualified nurses need to update their registration with the Nursing and Midwifery Council. Surveys completed by relatives had the following comments, The staff are very caring and very good with the residents. The staff have such an excellent understanding of his/her needs. They also make me very much at home. Staff working at Briardene said there was defiantly sufficient staff on duty. Care staff spoke highly of the qualified nursing team and generally thought the whole staff team worked really well together. During the inspection of the service, the duty rota was looked at. Currently there is a Registered Mental Health Nurse on duty twentfy-four hours a day and they are supported by four care staff during the day and three on night duty. Care Homes for Older People Page 20 of 25 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Briardene are assured that their home is well run. The health, safety and welfare of people who live at the home and staff are promoted and protected. Evidence: The manager is registered with CQC and has the qualifications and experience to undertake this role and has a proven track record as a registered manager of care home management. She is enthusiastic about her role and about continuing to develop and improve all aspects of care for people living at the home. The management approach of the home creates an open, positive and inclusive atmosphere, as revealed in numerous positive comments from relatives and staff. This approach is consistent with the registered providers philosophy of care, which is person-centred. Staff spoken to said the manager was supportive and approachable. They believed she listened to them and would always take action to make improvements for the benefits Care Homes for Older People Page 21 of 25 Evidence: of people living at the home. One member of staff said, I love it here, staff are lovely and approachable, if I have any problems I can go and talk about them, I am listened to and supported. Of what the service does well, relatives made the following comments, Making it feel like home from home, warm and cosy and safe and good food. The home not only looks after my husband/wife but look after me and my family, also a kind work and a smile go a long way. Briardene have made my life for much easier as in what they do for my husband/wife. I thank them all from the bottom of my heart. My family are also very happy with the care, its just like being at home. Very welcoming. They do a great job. The service does not manage any of the personal allowances for people who live there. If they need money to make any purchases, then with the agreement of their relatives, an invoice will be sent. The quality assurance system is being further introduced, as is appropriate for a new service. Regulation 26 visits are taking place every month and the manager also carries out a monthly audit of systems in place within the home, such as care records or medication. Meetings with relatives of people living at Briardene take place. The main maintenance and servicing certificates were not looked at as this is a recently registered home and at the time of registration all the appropriate certification was in place and in order. A sample of in house maintenance and servicing records were looked at, this included the weekly fire alarms test and testing and recording of water temperatures. The weekly fire test are now being carried out appropriately and records in place supported this, however there has been times when the weekly test has not been carried out. The records detailing the testing of water temperatures. Where there is body submersion, it is recommended by the Health and Safety Executive that there is the need to test and monitor these facilities on a weekly basis. The policies and procedures were not looked at during this inspection due to the service being newly registered and was an area looked at during the registration process. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 7 Care plans should be reviewed to ensure they are specific to the care needs identified and clearly give the staff the information they need to meet peoples care needs. The evaluation of care should be a valued based judgement about the effectiveness or not of the care provided. The care needs assessments should be developed further to include more specific information about individual needs. 2 3 7 7 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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