CARE HOMES FOR OLDER PEOPLE
Barton Brook Trafford Road Eccles Manchester M30 0GP Lead Inspector
Elizabeth Holt Unannounced Inspection 18th January 2006 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Barton Brook DS0000006695.V275501.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Barton Brook DS0000006695.V275501.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Barton Brook Address Trafford Road Eccles Manchester M30 0GP Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0161 787 8437 0161 707 9855 www.bupa.com BUPA Care Homes (CFHCare) Limited Care Home 120 Category(ies) of Old age, not falling within any other category registration, with number (113), Physical disability (7) of places Barton Brook DS0000006695.V275501.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. A maximum of 88 service users requiring nursing care may be accommodated. Up to 30 service users requiring personal care only may be accommodated in Monton House. 1 named individual who requires respite nursing care and is below 65 years of age may be accommodated for up to 2 weeks in any of the nursing units during each period of respite. 3 named individuals who are below 65 years of age may be accommodated in specified areas on Brindley House. When these service users leave, the area will revert to being for the use of service users over 65 years of age. 1 named individual who is below 65 years of age may be accommodated in Moss House. When this service user leaves, the area will revert to being for the use of service users over 65 years of age. Staffing levels as specified in the Notice issued in accordance with Section 25(3) of the Registered Homes Act 1984 on 5th June 1999 shall be maintained for those service users receiving nursing care. 19th July 2005 5. 6. Date of last inspection Brief Description of the Service: Barton Brook is a care home providing nursing care, personal care and accommodation for up to 120 residents of pensionable age (65 years and over). The home is set in its own grounds in the centre of a residential estate 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. 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 Brook DS0000006695.V275501.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the home’s second unannounced inspection visit for the year, which took place over 5 hours during a weekday in January by two inspectors from the Commission for Social Care. A number of residents were spoken to, staff on duty and the manager. The inspection only looked at a limited number of standards, so this report should be read together with the earlier report to get a full picture of how the home is meeting the needs of the residents living there. What the service does well: What has improved since the last inspection?
Since the last inspection it was pleasing to see that attention had been given to improving the care plans. This had been backed up by registered nurses having training in the practical and theoretical aspects of record keeping. Improvements had been made in the planning arrangements for social activities and plans to introduce these were being addressed. Some staff had received training in the Protection of Vulnerable Adults and how to put the policy into practice. Staff spoken to were able to describe the action to be taken if there was an allegation of abuse in the home. Some refurbishment and redecoration has taken place since the last inspection. New flooring had been provided in 20 bedrooms and a number of toilets had been replaced. Since the last inspection a new manager is in post at Barton Brook. Some staff commented that the manager’s clinical and managerial experience shone
Barton Brook DS0000006695.V275501.R01.S.doc Version 5.1 Page 6 through whilst others expressed a lack of communication, clear direction and did not always feel their views were listened to. The need for a more open two-way communication style was discussed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Barton Brook DS0000006695.V275501.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Barton Brook DS0000006695.V275501.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Prospective residents receive the necessary information to allow them to make an informed choice about where to live however the Service Users Guide needed updating. EVIDENCE: A Service Users Guide and a Statement of Purpose was available, however the information for prospective residents required reviewing and updating, for example the complaints procedure. Individual records for each resident were available and the records for five recent admissions included detailed assessment information. All residents have a 6-week probationary period, which is followed by a review meeting. Barton Brook DS0000006695.V275501.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 10 Progress has been made in the care planning to ensure that the health care needs of the residents are identified and met. EVIDENCE: Since the last inspection it was pleasing to note that continued efforts had been made to improve the recording within the individual plans of care. A sample of care plans were examined in each unit. The daily nursing statements were sometimes vague and not reflective of the care delivered on a daily basis. Care plans were reviewed on a monthly basis and included risk assessments, for example falls, nutrition and manual handling. Weight and dietary monitoring was carried out however the forms were not always accurately completed. Care plans in relation to catheter care should contain the serial/batch number of the catheter used from the packaging. This information was provided
Barton Brook DS0000006695.V275501.R01.S.doc Version 5.1 Page 10 handwritten by the staff however it is recommended the actual packaging label be used. The registered nurses had received mandatory training in the practical and theoretical aspects of record keeping. Staff spoken to had found this useful. Evidence was seen of referral to specialist services for example; tissue viability nurse, speech and language therapists and dieticians. Staff were observed treating residents with respect and dignity. Residents were spoken to in a respectful and courteous way. A relative who has been visiting the home for approximately two years said the care was excellent and the staff were always kind and helpful. Barton Brook DS0000006695.V275501.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 14 A range of social activities are provided by the home that matched the resident’s social, cultural, religious, recreational interests and needs. EVIDENCE: Following a requirement made at the last inspection, improvements have been planned and a budget has been introduced for social activities. The manager stated that this was an area for development and she had recently met with the hobby therapist to discuss a programme of activities. Discussions with the staff highlighted that they consulted with residents and relatives about their care and routines within the home; there was no evidence of records of residents’ meetings. A requirement was made to introduce these meetings to assist residents to exercise choice and control over their lives. A number of residents spoken to commented that the food was “not good” and they required more variety and choice. Some residents were seen to leave the lunchtime meal and commented this was not tasty. Some residents commented that they did not always receive what they had requested on the menu. Residents on special diets regularly received the same meal and desert repeatedly. There was no evidence of alternatives at mealtimes being provided, however some residents were observed eating toast.
Barton Brook DS0000006695.V275501.R01.S.doc Version 5.1 Page 12 The manager stated that new menus had been drawn up some months ago however these had not yet been introduced throughout the home. A requirement was made. Barton Brook DS0000006695.V275501.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Residents and relatives knew how to make a complaint. A policy was in place for the protection of vulnerable adults and staff were aware of how to put the policy into practice. EVIDENCE: The home had a comprehensive complaints procedure in place and staff, residents/relatives were aware of this procedure. A record of complaints made directly to the home was available. This included the nature of the complaint, action to be taken for its resolution and the outcome of the complaint. The Commission for Social Care Inspection has received two complaints about this service since the last inspection. Requirements were made in relation to the recording of documentation and some aspects of care practices, which have been addressed by the home. The other complaint is still under investigation at the time of this report. Training in Adult Protection had been carried out for key staff following a requirement made at the last inspection. The induction of new staff included a section on Adult Protection and whistle blowing procedures. A number of staff spoken to were familiar with the homes policy and procedures around the Protection of Vulnerable Adults. Barton Brook DS0000006695.V275501.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23 and 26 Residents live in a clean, generally odour free environment and the home provided comfortable surroundings. Some parts of the premises needed repainting to make them more attractive for residents however a programme of refurbishment was in place. Some fire safety checks and electrical appliance checks had not been carried out and could put residents and staff at risk. EVIDENCE: Since the last inspection it was pleasing to see that new flooring had been provided in 20 bedrooms throughout the home and a number of toilets had been replaced. Bedrooms had been installed with soap and alcohol dispensers. A number of new beds, mattresses and slings had been purchased. Some malodour was evident in the entrance of Monton House, which requires addressing as a matter of urgency.
Barton Brook DS0000006695.V275501.R01.S.doc Version 5.1 Page 15 Some of the fire extinguishers did not meet the required fire safety check of an annual check. A requirement was made for a full audit of these and checks to be carried out. Portable electrical appliance testing had not been carried out and a requirement was made. A requirement made at the last inspection for the fitting of privacy locks to residents’ private accommodation suited to their capabilities had not been fully actioned and a further requirement was made. Barton Brook DS0000006695.V275501.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 and 30 The procedures for the recruitment of staff are robust and provided safeguards to protect the people living in the home. Staff were encouraged to undertake training to equip them with the necessary skills to meet the needs of the residents accommodated. EVIDENCE: Examination of a sample of staff files indicated that the home had undertaken the necessary recruitment checks to ensure the protection of residents. Residents spoken to said the staff were very kind and caring. Duty rotas were examined and each house showed some use of agency staff and there was a vacancy for a housekeeper on Monton house. Comments were made that the staffing levels at night on Monton House did cause some concern. The manager said this was under review and vacancies did exist. Some staff commented this was having a negative effect upon staff morale due to the extra demands staffing shortages places upon the permanent staff members. A discussion with the manager showed that attempts were being made to fill current staff vacancies. The manager confirmed that staffing levels were adjusted according to the dependency needs of the residents accommodated. Barton Brook DS0000006695.V275501.R01.S.doc Version 5.1 Page 17 Staff confirmed that they had regular training sessions and had attended study days on care related topics for example, diabetes. It was pleasing to see that records of regular staff supervision for the care staff were available. Barton Brook DS0000006695.V275501.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 and 38 The manager is able to fully discharge her duties and responsibilities. The home had policies and systems in place to protect the financial interests of residents accommodated. EVIDENCE: The new manager has been in post for 6 months and she is fully aware of her responsibilities. The manager’s application to the Commission is currently being processed and awaiting a Criminal Records Bureau check. Policies and procedures were in place to protect the personal allowances of the residents accommodated. Residents, relatives/visitors and staff generally made positive comments about the staff in the home, however some examples showing a lack of
Barton Brook DS0000006695.V275501.R01.S.doc Version 5.1 Page 19 communication were expressed. Some of the staff felt they lacked direction and were unclear about what was expected from them and did not always feel their views were listened to. These issues were discussed with the manager at the time of the inspection and a need for a more open two way communication style is required to ensure the best interests of the residents accommodated. Barton Brook DS0000006695.V275501.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 X X 2 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 3 X X 3 Barton Brook DS0000006695.V275501.R01.S.doc Version 5.1 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 Requirement The registered person must ensure that an up to date Statement of Purpose and Service User Guide is available. Evidence must be provided that residents and relatives have the opportunity to be consulted about care and routines in the home. The registered person must provide in adequate quantities, suitable, wholesome and nutritious food, which is varied. Doors to residents’ private accommodation must be fitted with locks and keys suited to their capabilities unless their risk assessment suggests otherwise. (This has been carried over from the last inspection.) A full audit of all fire extinguishers must be carried out to ensure they are safe to use. The odour in Monton House must be investigated and addressed as a matter of urgency. All electrical appliances must be checked for safety.
DS0000006695.V275501.R01.S.doc Timescale for action 30/04/06 2 OP14 12 30/04/06 3 OP15 16 10/03/06 4 OP24 12 30/06/06 5 OP19 23 17/02/06 6 7 OP19 OP38 23 13 17/02/06 31/03/06 Barton Brook Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations The batch number of the catheters used should be taken from the packaging rather that being handwritten and entered into the care plan. Barton Brook DS0000006695.V275501.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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