Inspection on 27/01/10 for Le Brun House

This is the latest available inspection report for this service, carried out on 27th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Le Brun House 28/03/08

Le Brun House 15/05/07

Le Brun House 28/06/06

Le Brun House 13/02/06

Le Brun House 10/05/05

Le Brun House 29/10/04

Le Brun House 01/06/04

Le Brun House 07/07/03

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for older people Name: Address: Le Brun House 9 Prideaux Road Eastbourne East Sussex BN21 2NW     The quality rating for this care home is:   one star adequate 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: Gwyneth Bryant     Date: 2 7 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 36 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Le Brun House 9 Prideaux Road Eastbourne East Sussex BN21 2NW 01323734447 01323438528 enquirieis@lebrunhouse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Ilona Austen care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 20 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category: Dementia (DE) Date of last inspection Brief description of the care home Le Brun House is a care home providing care and support to up to twenty people who have dementia. The home changed its registration in 2006 to accommodate people who have dementia prior to this it was a care home for older people. The home is situated approximately one mile from Eastbourne town centre, with a main bus route within easy walking distance. The premises is a detached domestic house that has been extended over the years. Accommodation is provided on three floors with a passenger lift providing access to the first and second floor. Residents accommodation consists of twenty single bedrooms eighteen of which have their own toilet ensuite facilities with six ensuites also having shower facilities and two a bath. The communal facilities include a large combined lounge and dining room, separate lounge leading into a conservatory and a small rear secure garden. The home Statement of Purpose Care Homes for Older People Page 4 of 36 1 1 0 3 2 0 0 9 20 Over 65 0 Brief description of the care home states that it aims to provide quality tailored care to meet the needs of elderly service users with dementia. The fees for residential care are currently £435 to £650 per week, depending on the services and facilities provided. Extras such as: newspapers, hairdressing, chiropody, transport, dry cleaning toiletries are additional costs. Care Homes for Older People Page 5 of 36 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: one star adequate 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 reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Le Brun care home will be referred to as residents. This was an unannounced inspection which began at 08:10 and ended at 15:55. The purpose of the inspection was to check compliance with key standards and other standards. There were eighteen people in residence on the day and one person was in hospital. Two residents were involved in the inspection as were the Registered Manager and one carer. A number of documents and records were viewed; including personnel files, medication charts and care plans. Twelve bedrooms were visited in addition to were two communal bathrooms, two communal toilets, the kitchen and the communal lounge and dining Care Homes for Older People Page 6 of 36 areas. We sent out surveys to both residents and staff of which ten were returned by residents and five from staff and the responses and comments are included in this report. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 36 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 9 of 36 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 10 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements need to be made to the pre-admission process to provide documentary evidence that Le Brun can meet the needs of people admitted to the home. Evidence: Copies of the Statement of Purpose and Service Users Guide were provided and although they had been updated the Statement of Purpose did not include all of the information as required under Schedule 1 of the regulations. Information that needs to be included in the Statement of Purpose is the qualifications and experience of the registered manager, the number of care staff and their qualifications, the organisational structure of the home, the arrangements for consulting with residents, the arrangements for contact between residents and their families, the number and size of rooms and fire precautions. All prospective residents and their supporters are now informed in writing that the home can meet assessed needs. Care Homes for Older People Page 11 of 36 Evidence: Four typed pre-admission records were viewed in conjunction with the information in care plans, however they did not indicate what action was necessary to meet assessed needs nor did they include all the required information such as leisure interests and likes and dislikes. The pre-admission assessment for three people stated that they needed full assistance with bathing, washing and dressing, however information in the care plans showed that these people were able to do these tasks independently, with staff just supervising them. This was discussed with the manager who said others involved in the assessment process provided this information. In addition the manager confirmed that she made handwritten notes but destroyed them as soon as she had typed them up so it was not possible to ascertain who supplied the erroneous information. The home must carry out detailed pre admission assessments which include input from other agencies and indicate how the home will meet assessed needs. Following the site visit the registered manager confirmed that the Statement of Purpose has been updated and now includes all the required information. Care Homes for Older People Page 12 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All aspects of service users health, welfare and care must be identified and planned for, in order to clearly direct staff in the delivery of appropriate care and improvements in the storage and recording of medication need to be made to ensure people living in the home are not at risk. Evidence: Four care plans were viewed in conjunction with other records such as daily notes, pre admission assessments and medication charts. In the main the plans were found to include most aspects of care needs. However, information in the plans were often a single sentence and it is important to ensure full details of how needs are to be met are recorded as a point of reference for staff. The plans frequently had the comment staff to monitor and report changes, however the inspector spent just under two hours sitting in the lounge with up to eight residents and staff did not engage with them during this time except to ask one person if they wanted a bath. Although three different carers came into the lounge to collect used cups none spoke to residents while doing so. Therefore residents are not being closely monitored or engaged with. Care Homes for Older People Page 13 of 36 Evidence: All care plans and medication administration records included a dated photograph of the resident to facilitate identification. Care plans did have comments about each part of the individuals care needs but they lacked the detail to clearly inform the reader that care needs were fully understood and the action needed to meet them. Two care plans indicated that the individual should have regular checks at night however these checks were not recorded in the care plans. This was discussed with the manager who created a suitable record template on the day. All care plans included information on chiropody and eye sight tests but they did not include information on oral health except to state whether or not an individual had dentures. Important information was missing from the plans such as those for residents who are diabetic. Two residents were found to be type 2 diabetics and the plans just stated that they were to follow a diabetic diet and one of the plans also stated NO SUGAR. Detailed information on how the dietary needs and the possible effects of diabetes must be included in the plans and, where possible, information from an appropriate healthcare professional. Three residents plans showed they had lost weight but there was no information to direct staff in the action they need to take to address the weight loss. Discussion with the manager found that one person was overweight when admitted and the intention was for them to lose weight, however there was no information from an appropriate healthcare professional to ensure the weight loss programme was safe. The manager also said that they did not tell the person that they had been placed in a weight reducing diet. In such cases a Best Interest Assessment should be carried out to ensure weight loss is in their best interests. Following the site visit the registered manager confirmed that a dietician has been contacted to provide advice for all residents who have particular dietary needs. Each resident has a personal care chart on which staff should record when people are bathed or given a shower. A discussion with the manager found that all residents should have a bath or shower each week, however the care charts did not show that this actually takes place. In addition these charts had space for comments and there were comments made such as for one person on 14/11/09 it says graze on left shoulder and bump on left eye but there were no follow up notes nor was there information in the care plans to show how the injuries occurred or action taken. Similarly, the care chart for another person notes that on 2/12/09 they had an open sore on their bottom and on 201/10 and 22/1/10 were sore on their genitals. Again there was no follow up notes to show that action had been taken. A discussion with the manager found that this person is subject to tissue breakdown and they have Care Homes for Older People Page 14 of 36 Evidence: been supplied with a special mattress but there was no mention of this in their care plan. It is crucial to ensure that all residents subject to tissue breakdown have a detailed risk assessment to improve tissue viability and to direct staff in appropriate care. This is more important for staff in Le Brun as staff training records indicate that none have been trained in this matter. Care plans were variable in respect of dealing with challenging behaviour with one giving good information on distraction techniques and another which just notes they can be aggressive. Daily notes were equally variable with some giving good information about how the individual spent their day and other with comments such as not in a good mood, argumentative and meds given. It is important that all daily notes outline how the person spent their day and that comments are not judgemental. One daily note stated was found trying to walk downstairs again but there was no information to show why they should not walk down the stairs or whether they should only do so when accompanied by a member of staff. Generally, risk assessments were not fully completed in that they did not identify risks, indicate the level of risk and then provide details as to how the risk is controlled. Furthermore, risks are not linked to care plans to ensure support is provided in the safest way. For example, there are falls risk assessments but they do not state that staff need to ensure the environment is uncluttered, the person is wearing glasses etc. Some risk assessments were a scoring system and even where the score showed a high risk there remained the lack of detail to direct staff in reducing the risk. One person has begun to walk along a windowsill in the conservatory but a risk assessment has not been carried out. The risk assessments viewed mostly directed staff to monitor and report changes. There were no risk assessments in place for use of the stairs even though some residents had good mobility. It is important to ensure residents autonomy and independence is promoted by the effective use of risk assessments to ensure they are enabled to to things independently. This same persons care plan states that they are at high risk of absconding but there was no evidence to show that a Deprivation of Liberty Safeguard authorisation has been applied for nor what action state need to take in the event the person leaves the home. Discussion with the manager found that this person spends time looking out of the door and waving at passersby which suggests they may wish to leave the home. Following the site visit the registered manager confirmed that an Independent Mental Capacity Assessor had visited and assessed this particular resident. Although the care plans had been signed as reviewed and the comment no change Care Homes for Older People Page 15 of 36 Evidence: this was not accurate as a number of changes were identified such as changes in medication and weight loss. All care plans listed the medication the individual was prescribed but this was not consistent with the medications listed on the medication administration records (MAR) and there was no information in the plan to show why medication has changed. One plan did stipulate the the person was restless at night so the GP had prescribed night sedation. Two people were noted to be on as required medication but there was no information in care plans to indicate whether or not the individual could express a need for pain relief. One plan stated that the person could not have night medication due to side effects but the pre admission assessment stated that they have been prescribed this medication, therefore it is not clear why they can no longer take it nor who made the decision. MAR charts were viewed and were found to be mostly accurate, clear and up to date. There was one gap but this had been identified by the manager during the medication audit which demonstrates that internal monitoring systems are effective. The home still does not have a controlled drugs cupboard that meets latest requirements nor did the controlled drugs register meet the latest legislation. There was a locked case which was kept locked in the medication cupboard which the manager believed met the requirements. Until a controlled drugs cupboard and an accompanying controlled drugs register which complies with the latest legislation is provided, the home cannot admit residents who are on controlled drugs. The privacy and dignity of one resident was observed to be seriously compromised during the site visit. The sound of two carers giggling was heard from the ground floor bathroom and as the inspector approached a carer came out and in doing so showed a naked resident sitting on the toilet. The carer then re-entered the bathroom and came out again which exposed the resident for a second time. This is not acceptable and the registered provider must ensure all staff have robust training on respecting residents privacy and dignity. Two people spoken with both praised staff for the care given, but one person said they are not given a choice of food but they did enjoy the food. Comments in surveys included: Care Homes for Older People Page 16 of 36 Evidence: * they look after me well * they cook well * they talk nicely * need more choice in food * staff do well - they try On two occasions residents needed to wipe their nose and instead of providing a tissue staff give one some toilet paper and another a paper hand towel. Neither is appropriate and this practice needs to be reviewed. Care Homes for Older People Page 17 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lifestyle experience by people living in the home does not always match their expectations, choice or preferences. Evidence: The home has a daily programme of activities and on the day someone came to play an electric organ. Residents clearly enjoyed this activity but it was disappointing to see that one carer was writing up the notes rather than encouraging residents to participate. When the inspector brought this to the attention of the manager another carer came in and showed a good level of engagement with residents by dancing with them. From this it appears that some staff need further training in working with residents in person centred manner. The daily programme of activities was varied and included baking, exercises and arts and crafts. Information in care plans and risk assessments were generic and this practice does not recognise residents individual needs and capabilities. It is important that the home is run in the best interests of residents. One carer was taking a resident out in a wheelchair and it was good to note that they engaged positively with the resident by talking them through the trip and who they would see. This is good practice and reassures the resident when leaving the home. Each care plan included a record of Care Homes for Older People Page 18 of 36 Evidence: activities that residents had participated in but it was mostly a scoring system which did not show if the activity was related to a past hobby or if they enjoyed it. Care plans were limited in that they did not always identify past leisure interests and this aspect of daily life was not assessed at all during the pre admission process. One care plan stated that staff should encourage reminiscence by giving the resident their knick knacks as a prompt but there was no evidence to show that this happened. One pre admission assessment states that the individual is an avid church goer and the care plan stated that a pastor would visit. However, there was no information in the care plan to show how often staff would take the person to church nor how often the pastor would visit and there was no information to show that either of these had actually taken place. It is vital that past leisure interests are identified at the time of admission and details of how the home will meet these needs and record when they have been met. During the two hours that the inspector spent in the lounge staff interaction with residents was minimal as they only spoke to one resident to ask them to have a bath, one carer told another resident that she was leaving the newspaper and the person giving out tea only spoke to two residents saying to each here is your tea. This carer did not speak to the other residents and just left their tea on the side tables. This same carer was heard to say to a resident no you can only have one biscuit and she refused to allow them to pour out their own tea saying that she will spill it and burn herself. Discussion with the manager found that residents are not restricted to one biscuit and the resident could pour their own tea with supervision. Further discussion with the manager found that this carer was from an agency, therefore the home needs to ensure agency staff are briefed on how the home operates. The home has an open house visiting policy which enables visitors to visit at all reasonable times. During the tour of the premises it was noted that all ground floor bedrooms were locked and information in care plans showed that it was to prevent residents entering others rooms. However, not all residents are given a key to their rooms therefore their autonomy is compromised as they cannot easily access their private accommodation as they have to ask staff to let them in. Following the site visit the registered manager agreed to reassess this practice and explore ways to facilitate easier access for residents. The cook was not well on the day so a carer came in on their day off to take over the cooking. This is good practice as the carer will be familiar with residents likes and dislikes and whether or not they need special diets. Discussion with her found that the advertised meal of roast chicken followed by lemon meringue pie could not be provided as the registered provider had not brought in the shopping. Instead residents Care Homes for Older People Page 19 of 36 Evidence: had roast lamb followed by semolina. It was good to note that the carer was doing sausages for one person who requested them and a vegetarian option for another person. This demonstrates a good understanding of treating residents as individuals. However, further discussion found that food portions are limited as only one leg of lamb is provided for 15 residents and had it been roast chicken just two chickens are provided for the same number of people. Such small portions may account for some residents losing weight. Later discussion with the manager found that staff also have a meal if they are working a full day. The small portions were discussed with the provider who was more concerned about wastage than ensuring residents are well fed. Comments in surveys returned by staff also raised concerns about food quality and quantity and comments included: * need better quality food and enough food and food choices for the quantity of service users. * make sure service users dietary needs are met constantly and for the laundry areas to be better accessible. * Proprietor needs to bring the correct amount of food for service users. Although there were sufficient stocks of fresh foods in the home, there were little stocks in respect of tinned or packet foods that could be used as a stand by option and two items of out of date food were found in one cupboard. Good food stock rotation systems need to be in place to ensure out of date foods are destroyed. Care Homes for Older People Page 20 of 36 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. The home has a satisfactory complaints procedure with evidence that those living in the home feel that their views are listened to and acted upon. People living in the home are further protected by satisfactory adult protection systems. Evidence: The manager confirmed that there are policies and procedures on both complaints and safeguarding adults. Since the last key inspection the complaints policy has been reviewed and how shows the correct information. The complaints log was viewed and there have been no complaints since 14/8/09 and this had been recorded satisfactorily and included actions taken and outcomes. The staff training matrix showed that all staff except those most recently recruited have been trained in safeguarding adults. One carer spoken with showed a good understanding of action she would need to take in the event of an allegation. It was of concern that two plans indicated that the residents families had stated that they must not have alcohol. Unless there is a Lasting Power of Attorney in place family members do not have the legal right to make such decisions. Care Homes for Older People Page 21 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most parts of the home are maintained providing a homely and comfortable environment for people living in the home; improvements need to be made in respect of the provision of bedroom furniture and refurbishment to ensure all areas of the home are pleasing and safe. Evidence: Twelve bedrooms were visited as were two communal bathrooms and toilets. In addition the lounge, dining room, laundry and conservatory were also visited. Door leading to the stairs have had an additional handle installed, requiring considerable dexterity in order to open the door and this may put staff and residents at risk in the event of fire. Following the site visit the registered manager confirmed that the fire safety risk assessment deemed these type of handles to be safe as long as staff and visitors shown how to use them and that they are regularly checked to ensure they open easily. It is of particular concern that these doors also give access to stairs. There is no evidence in care plans to suggest that residents are incapable of using the stairs. One persons notes stated that was found walking down the stairs this afternoon. again. Such comments suggest that residents are discouraged from using the stairs even though most are mobile. This was discussed with the registered manager following the site visit and she agreed to assess residents mobility and encourage them to use the Care Homes for Older People Page 22 of 36 Evidence: stairs if possible. All of the downstairs bedrooms and two of those on the first floor are kept locked but the occupant is not always given a key and this prevents them having easy access to their private areas. Care plans for those residents merely stated that they could not have a key in case they lose it. This practice needs to be reviewed and detailed risk assessment carried out and where possible a mechanism to reduce the risk of residents losing keys. It was of concern that the laundry person was seen to be carrying an ironing board around the side of the building. The manager explained that during cold weather the laundry area is too cold and therefore a residents bedroom is used at such times. The manager said that both the resident and their family had agreed to this arrangement, however it is not acceptable to use residents own bedrooms as a laundry room. It is the responsibility of the registered persons to ensure staff working areas are heated and comfortable to use. Following the site visit the registered manager confirmed that residents rooms are no longer used for laundry purposes. There were a lack of grab rails in communal areas and toilet riser seats so the home may not fully meet the needs of those residents who are more dependent. An assessment of the premises needs to be carried out by a suitably qualified person to ensure the home can meet residents needs. Of the twelve bedrooms visited two did not have locks and this needs to be reviewed as all residents should be offered a key to their private accommodation unless a risk assessment suggests otherwise. In addition, seven did not have a bedside lamp and four did not have a bedside table. It is important that residents have easy access to light during the night hours to reduce the risk of falls. The registered manager said that one room did not have a bedside table as the resident had hit their head on it but this persons care plan did not include a risk assessment for this. Three bedrooms had badly stained carpets and one had a patch on it which detracts from the general look of the room and presents a trip hazard. Water delivery temperatures were below the recommended 43 and this needs to be addressed to ensure residents can wash in comfort. Following the site visit the registered manager confirmed that she has now ensured all water delivery temperatures are at the recommended 43 degrees. It was good to note that each of the bathrooms visited appeared to have been recently refurbished and were in good decorative order. Care Homes for Older People Page 23 of 36 Evidence: There were no light switches for the stair lights and discussion with the manager found that they can only be switched on from the ground floor and that it can only be accessed via use of a key as its locked away. This practice puts residents at risk of falls due to lack of light, therefore the manager agreed to address the matter on the day so no requirement was made. At the start of the site visit there was no hand washing gel or soap in the staff toilet and no gel in the kitchen. Although the registered provider brought some in later in the day, discussion with staff found that they frequently run out of hand washing gel and other items. One staff survey included the comment should provide cleaning materials and replace inadequate equipment. Recent good practice recommendations suggest that antibacterial hand gel is provided for all staff and visitors to reduce the risk of cross infection, however this gel is not provided in Le Brun. Following the site visit the registered manager confirmed that hand gel is now provided in the staff toilet and visitors encouraged to use it and staff also carry small bottles in their pockets at all times. Care Homes for Older People Page 24 of 36 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. The number of staff deployed is sufficient to meet the needs of service users and staff training needs to be improved to ensure they have the skills to meet assessed needs. Recruitment practices are such that people living in the home are safeguarded. Evidence: The personnel files for the last three staff to be recruited were viewed and were found to contain most of the required information. Two staff had provided a protection of vulnerable adult check, two written references and a criminal records bureau check. One person was waiting for their criminal records bureau check to arrive but the manager said they do not have unsupervised access to residents. One other person had not provided an explanation for gaps in their employment record but the manager was aware of why there were gaps and agreed to ensure this was completed. One other person had not completed their health check and again the manager agreed to deal with this on the day. It was of concern that all new staff had their induction completed in one day. This practice needs to be reviewed as it is not possible for new staff to understand the homes practices in just one day. The manager confirmed that there are three care staff on duty for all shifts including during the night hours. Cooks and cleaners are also employed to ensure care staff Care Homes for Older People Page 25 of 36 Evidence: have time to carry out care duties. In addition she confirmed that all new staff are enrolled on National Vocational Qualification in care as soon as possible and currently all care staff either has or is in the process of gaining this qualification. This shows there is a plan to ensure the home exceeds the required 50 of staff with this qualification. On request the manager provided a copy of the staff training matrix and it was noted that the two cooks employed had both done training in food hygiene and infection control. Of the fourteen care staff none had been trained in pressure sores so may not be able to quickly identify the early onset of tissue breakdown. Two care staff have not done dementia care training and two need this training to be updated. Only four staff have been trained in infection control and continence management. It is crucial that care staff are given the training to ensure they have the skills and knowledge to meet residents needs. Responses in staff surveys indicated that they felt supported by both other staff and the manager and that there was a good staff team. Care Homes for Older People Page 26 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff need to be provided with clear leadership and direction and systems need to be put in place to ensure all aspects of service users health, welfare and safety are protected and promoted. Evidence: The manager is registered with the Commission and has the required qualifications and experience to effectively manage the home. Discussion with her found that she does not have budgetary control in respect of staff training, food and maintenance and therefore must have such expenditure approved by the registered provider before organising these matters. There are a range of quality monitoring systems in place including surveys, and staff meetings each of which enable people to be consulted on how the home is run, however the manager said that it was difficult to convene residents meetings therefore other means of consulting them need to be devised. The Registered Provider needs to ensure she makes unannounced visits every month as part of the monitoring process Care Homes for Older People Page 27 of 36 Evidence: and make the subsequent reports available for inspection. On the day there were no records of the registered provider visits for either December 2009 or January 2010 and the ones for November and October were very basic and limited to single sentences. It is important that these visits are used to monitor what is going on in the home and to obtain detailed feedback from both staff and residents. Comments in returned staff surveys were variable and included: * the proprietor shouldnt bring her moods into the workplace and take it out on staff as it brings staff down. * need more support from the proprietor. * the manager gives us all the supports thats necessary in the workforce. * our manager is always there for us. * less criticism and more praise and thank you. * praise where it is due instead of constant criticism. The manager has carried out safety checks on water delivery temperatures, emergency lighting, fire alarms and also arranges for regular fire drills to be carried out. All fire drills need to be recorded and include response times and who attended and if any shortfalls were found. The manager also said that all electrical appliances had been tested in May 2009 and this was confirmed during the tour of the premises. The manager confirmed that the home does not hold residents monies and any items purchased on their behalf are added to the monthly invoice and receipts provided. Although fire risk assessments had been carried out in 2007, 2008 and 2009 the lack of intumescent strips and smoke seals on bedroom doors had been identified at each assessment but no action had been taken to meet this shortfall. In addition four bedroom doors did not close fully. These shortfalls put residents at risk in the event of fire and therefore need to be addressed. Information in care plans found that residents were falling or been found on the floor and this had been recorded as incidents rather than on appropriate accident forms. It is important to ensure all accidents are reported as such both to facilitate the care Care Homes for Older People Page 28 of 36 Evidence: plan reviews/risk assessments and for quality monitoring purposes. Following the site visit the registered manager confirmed that this practice has been reviewed and accident forms are now completed for all falls whether or not they are observed. Staff training records showed that only one member of staff has been provided with up to date training in fire safety and this needs to be addressed as a matter of urgency. Following the site visit the registered manager confirmed that she is arranging for all staff to have up to date training as required. During the site visit one incident of poor manual handling practice was noted, however it was done by the agency carer, therefore the manager needs to ensure all staff follow good practice to reduce the risk of injury to residents. A carer who is employed in the home was observed to follow good practice by allowing a resident to hold her arm whilst escorting them into the dining room. Care Homes for Older People Page 29 of 36 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 30 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 Further additons need to be 20/02/2010 made to the statement of purpose to ensure it includes all the required information. To ensure prospective service users and their supporters are clear on what is provided in the home. 2 2 14 That the pre admission 20/02/2010 notes be retained for inspection and that the assessment process demonstrates how the home will meet assessed need. To ensure service users needs are met. 3 7 13 That risk assessments inlcude identified hazards and the action staff must take to reduce risk and that they are regularly reveiwed. To ensure risks to service users are identified and reduced. 27/02/2010 Care Homes for Older People Page 31 of 36 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 4 7 15 That all services users have a comprehensive plan of care devised by the home that inlcudes dietary requirements, direction to staff in the delivery of care and are regularly reviewed. To ensure the home can demonstrate how it is meeting care needs. 27/02/2010 5 9 13 That a controlled drugs cupboard and register is purchased that meet the latest legislation. To ensure service users are not at risk. 27/02/2010 6 12 15 That service users leisure preferences are identified and evidence provided to show they are met. To ensure service users have a good quality life. 27/02/2010 7 14 12 That staff respect service 27/02/2010 users privacy and dignity and locks be fitted to bedroom doors and service users be offered keys unless a risk assessment suggests otherwise. To ensure service users are respected. Care Homes for Older People Page 32 of 36 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 8 15 15 That there is sufficient food on the premises to provide the advertised menu and that advice is sought in respect of portion sizes. To ensure service users have a good nutritional intake. 27/02/2010 9 19 12 That all bedrooms have a 27/03/2010 bedside table and lamp and water deliver temperatures are comfortable unless a risk assessment suggests otherwise. To ensure service users autonomy is promoted and that they are safe and comfortable. 10 19 13 That all parts of the home are safe, well maintained and that an assessment of the premises be carried out by a suitably qualified person. To ensure service users live in a pleasant and safe environment 27/03/2010 11 26 13 That handwash gel or soap is available at all times in the kitchen and staff toilets. To reduce the risk of cross infection. 27/02/2010 Care Homes for Older People Page 33 of 36 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 12 30 18 That all staff are provided with appropriate training such as fire safety and that the manager is trained in the Mental Capacity Act and Deprivation of Liberty Safeguards. To ensure they have the skills and knowledge to meet service users needs. 27/03/2010 13 33 26 That the registered provdier makes visits to the home every month and ensure that they are sufficiently detailed to show she has sought feedback from both staff and service users. To ensure she is aware of shortfalls in the service. 27/02/2010 14 38 13 That accidents are recorded in line with the latest legislation. To ensure action is taken to reduce accidents. 27/02/2010 15 38 12 That advice is sought from 27/02/2010 the local fire service in respect of the findings of the fire risk assessment and the use of two handles on doors leading to fire exits. To ensure service users, staff and visitors are safe in the event of fire. Care Homes for Older People Page 34 of 36 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 2 26 38 That antibacterial hand gel is provided for staff and visitors entering and leaving the home. That the registered provider ensures staff working environment is heated to ensure the practice of using service users rooms for laundry purposes ceases. Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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