Inspection on 11/05/05 for Begbrook House

This inspection was carried out on 11th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Begbrook House 18/05/07

Begbrook House 11/05/06

Begbrook House 25/10/05

Begbrook House 02/03/05

Begbrook House 10/09/04

Begbrook House 15/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Begbrook Sterncourt Road Frenchay South Glos BS16 1LD Lead Inspector Melanie Edwards Announced 12 May 2005 09:45 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 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. Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Begbrook House Address Sterncourt RoadFrenchaySouth GlosBS16 1LD Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0117 9568800 0117 9569900 Grandcross Ltd Mrs Erma Benedicto Fernandez Residential care home with Nursing 32 Category(ies) of OP Old age 32 registration, with number of places Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate 32 Patients aged 50 years and over requiring nursing careStaffing Notice dated 3 December 2001 appliesManager must be a RN on parts 1 or 12 of the NMC register Date of last inspection 2-Mar-2005 Unannounced Brief Description of the Service: Begbrook a purpose built home, operated by Grandcross Ltd, which is affiliated to Four Seasons Health Care.The home is registered to provide nursing care for 32 people over the age of 50.It has ample car parking space at the rear and a small garden in front separating it from the main road. There is access to local shops, amenities and bus routes. Accommodation is provided on one floor. There is level access through out the home. Toilets and bathroom facilities are adequate for the number of service users and have adaptations to meet their assessed needs. All rooms are equipped with call alarm systems. Visitors may visit at any time. Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Melanie Edwards and Christopher Lewis carried out the Inspection. The inspectors were able to meet twelve residents and a number of relatives to find out their views of the Home and of the service provided. The inspectors also spoke to a group of care staff, and the deputy manager, about their roles and responsibilities, their training needs, and how they assist and support residents. Staff were also observed assisting residents with their needs. A range of records relating to the day-to-day running and management of the Home were inspected. A selection of resident’s care records and care plans were also reviewed. The majority of the environment was seen; the only areas not viewed were a small number of resident’s bedrooms Despite a number of requirements and recommendations that have been made arising from the inspection, these do not seem to have had a significant impact on resident’s views of the care and service they receive. What the service does well: What has improved since the last inspection? The Home has now carried out a risk assessment in respect of the safe use of bleach and has decided not to use this product, which should help to maintain the safety of people in the Home. An inventory of each resident’s personal items has now been completed, thereby helping to ensure the safety of residents’ property. Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 6 These had been requirements from the last inspection in March 2005. What they could do better: In order to ensure people are provided with a range of stimulating and purposeful activities it must be a priority that the home significantly increases these. At the present there is an activities coordinator that works for up to one day each week. This is insufficient time to meet the needs of residents as this was raised by some of the residents the Inspectors met. Residents would benefit from being provided with a suitable statement of terms and conditions of their stay. It is a legal requirement to provide each resident with this information that must be addressed as a matter of urgency. Meals and snacks must be available to residents outside of mealtimes and the kitchen should be managed in way that works to meet this need for residents. Residents would benefit if the cook had greater awareness of food safety legislation and in particular the need for hand washing soap to be available at the wash basin in the kitchen and for all visitors to the kitchen to be provided with suitable protective clothing. Residents with specific cultural dietary needs would benefit if these are met and the home must, as a matter of priority, ensure that such residents are offered a range of dishes reflecting their cultural preferences. All residents would benefit if their care plans are formally reviewed and updated to indicate that staff monitor their changing care needs. Staff would benefit if the supervision process was reviewed. The home should ensure that the format for supervision meets the needs of the home and its employees and is used correctly. In order to demonstrate that the home is providing, at all times, a sufficient number of staff to meet the needs of the service the staff duty rota should maintain a record of all duties covered by catering and ancillary staff, Currently the record only shows the shifts worked by registered nurses and care staff. Regular opportunities to allow staff and management to share and discuss matters related to the home and for staff to air their views would be achieved by having more frequent staff meetings. Residents would benefit from staff that have consolidated their knowledge and understanding of the care needs of older people through achievement of NVQ (National Vocational Qualification) training. Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 7 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. Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 9 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 standard(s) 1,2,3 Residents are not provided with a statement of terms and conditions for their stay at the Home however, residents care needs are met. EVIDENCE: Copies were requested of resident’s statement of terms and conditions. This document is to inform residents of the fees, and the services the Home provides. To date there is no such document available for residents and their representatives. This is a failure by the registered providers and means residents do not have the information they require to enable them to make an informed choice about the Home. A business relationship manager who works for the Commission for Social Care Inspection, and liaises with Four Seasons Care Limited informed the inspectors after the inspection that there had been considerable legal debate between the company and Trading Standards about the content of their statement of terms of conditions, and this had ‘slowed’ its implementation. Three residents assessment records were reviewed to inspect how care needs are assessed. The records were reasonably informative, and showed the Home had assessed the range of physical, mental and social needs the person had. The assessments showed how to meet each residents needs. Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 10 The inspectors spent time talking with residents and some relatives while walking around the Home. There were many comments of satisfaction expressed by residents about the care they receive. Examples of comments made included, ‘I think it’s very nice and the girls are very kind’, It’s a lovely home the staff are very helpful, and, ‘the staff are very good they’re all polite’. These sample comments demonstrated to the inspectors that residents feel satisfied by the care they receive, as they were reflective of comments made by all the residents the inspectors met. Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 11 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 standard(s) 7,8,9 There are plans of care for residents that meet their needs, and the majority of residents needs are being formally reviewed. There is a safe system in place for the handling of resident’s medication. EVIDENCE: Three resident’s care plans were reviewed to see how residents are supported to meet their health care needs. Care plans addressed the physical and psychological health care needs of the person. There was information stating how to assist the residents with their needs. Two care plans had been reviewed and updated on a regular basis by registered nurses, demonstrating these residents care needs were being monitored and kept under review. One resident’s care plan and assessment information had not been formally reviewed or updated for over ten months. This is a failure to demonstrate that the person’s changing needs are being monitored and kept under review by registered nurses. Medication procedures and practises in the Home were also reviewed, and demonstrated the Home operates a safe system of administration, disposal and storage of resident’s medication. Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 12 The inspectors spent time observing staff assisting residents with care needs. Staff were polite, ‘warm’ in manner and friendly when helping residents .The inspectors observed good humoured interaction between staff and residents, helping to demonstrate ‘warm’ relationships have been formed. Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 13 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 standard(s) 12,15 The majority of resident’s, social and recreational interests are not being met and at least one resident’s cultural dietary needs are not being met. A well balanced diet is provided, but there is a lack of flexibility around when residents can chose to eat EVIDENCE: An activities organiser is employed for between one day each week and one day a fortnight. For thirty-two residents this is an insufficient amount of time devoted to providing residents with social activities. The inspectors spent time discussing with residents what activities are provided. Several residents said they did enjoy the activities that are put on such as bingo, quizzes, and a recent party. It is also pleasing that a forthcoming trip to Weston super mare is being planned. However a significant number of residents said they felt there was not enough to do in the Home, and they wanted more activities. Purposeful and meaningful therapeutic activities are vital for resident’s mental and social well-being, and this failure must be addressed as a matter of priority. The kitchen was inspected to monitor food safety standards. The environment was clean and tidy however the soap dispenser at the sink in the kitchen was not working. It is particularly concerning that when this was pointed out to the cook they did not understand the importance of having soap at the sink in the kitchen. Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 14 The resident’s menu choices seen were nutritionally well balanced. Residents were asked their views of the quality and variety of meals provided at the Home and many residents said they thought the food was satisfactory and good. The inspectors were informed by a number of people, including residents that they are often told by the cook they cannot have a snack or alternative meals from the kitchen if they do not like the main meal choices or wish to eat outside of designated meal times. This must be addressed without delay, and the kitchen must be run in a way that is ‘person centred’ and meets the needs of residents. Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 15 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 standard(s) 16,17,18 The Home addresses complaints made about the service, but it fails to support residents to uphold their legal rights, however there are systems in place to protect residents from abuse. EVIDENCE: A copy of the complaints procedure is included in the resident’s guide, and a copy of this is given to residents on admission. There is a copy of the complaints procedure on display, which means visitors, can obtain this information if wishing to complain. A complaints and suggestions book is left in the entrance hall for residents and visitors to be able to express their views about the Home. This demonstrates open management and a willingness to seek the views of residents and representatives. The Home fails to organise the preferred way, for residents who wish, to be able to vote at elections. Currently only residents who have families are given voting cards to ensure that the resident can vote if they so wish. This needs to be addressed to ensure residents’ legal right to vote is maintained. There are procedures and a range of guidance information including a copy of the ‘No secrets’ government issued document for the protection of vulnerable adults from abuse, which should help protect vulnerable adults who live at the Home. A number of staff have attended training to help them better understand issues around the protection of vulnerable adults from abuse. Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 16 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 standard(s) 19,20,21,22,23,24,25,26 The Home is safe, satisfactorily maintained, and suitable for the needs of residents both internally and externally. EVIDENCE: Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 17 The Home is set in woodland gardens, with squirrels and badgers roaming the grounds. This makes the gardens a popular area for residents and visitors in warmer weather. One resident did say they would like more opportunity to be able to sit outside on the patio area, the Home should ensure residents who wish to are afforded the maximum opportunity to sit outside. Several residents told the inspectors how mush they enjoyed looking out onto the gardens from their bedrooms. The building is a purpose built property, on one floor, with a range of suitable adaptations in place throughout the Home, to assist residents who may have limited mobility. The Company regional offices are located on the second floor The inspectors walked around the inside of the Home, and viewed all of the communal living areas and the majority of bedrooms. The environment was clean, tidy and satisfactorily maintained. Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,30 There are the required number of registered nurses and care staff to meet residents care needs however the Home fails to demonstrate if the required number of catering and ancillary staff are employed at all times. Registered nurses are provided with the training required to do their jobs, however there is a failure to provide sufficient training for care staff. EVIDENCE: The inspectors spent time sitting in the communal areas to observe staff carrying out their duties, assisting residents. Staff assisted residents in a good humoured and ‘warm’ manner Staff on duty communicated among each other, and evidently work well as a team. To review how many staff are on duty for each shift, the duty record for the previous four-weeks was inspected, for nursing and care staff, currently there is no record on the rota of hours worked by catering and ancillary staff. This must be addressed to demonstrate there is a sufficient number of catering and ancillary staff on duty at any given time. There is a minimum of one registered nurse recorded as being on duty at all times and five care assistants in the morning, with four care assistants and one registered nurse in the afternoon. At night there is one registered nurse and two care assistants on duty. The manager works a set number of supernumerary management hours each week as well as regular shifts to keep up to date with day-to-day matters in the Home. Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 19 The number of staff on duty meets the required minimum staffing levels agreed to meet resident’s needs, under previous Care Home Legislation. These staffing levels continue to be a condition of registration for the Home at all times. Registered nurses have attended some recent clinical training and updating however, there has yet to be a programme of NVQ in care training in the Home. This needs to be addressed as a matter of priority to ensure care staff can develop their skills, remain competent in their work and meet the needs of residents. Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,36,37,38 The Home’s policies and procedures protect resident’s best interests. The health and safety of residents and staff is maintained, however the majority of staff are not being supervised in the manner that best suits the needs of residents and the Home. There is also a failure to provide staff with sufficient opportunities to express their views. EVIDENCE: Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 21 The environment looked satisfactorily maintained throughout, and there are health and safety policies and procedures in place for staff to follow to ensure the safety of themselves and residents is maintained. The fire logbook was checked and showed weekly tests of fire alarms being carried out. The fire fighting equipment was also being checked regularly, thereby helping to maintain the safety of those inside the building. There was a record that showed staff had attended fire safety update training in the last twelve months, to ensure they were aware of fire safety procedures in the Home. From discussion with care staff it is apparent the deputy manager regularly works alongside staff to monitor and supervise them in their work and care practise, this is to be commended. However, supervision records that were inspected did not reflect this good practice and had not been completed with the direct involvement of the member of staff helping to set their own action plans, which is the company’s own supervision format. The records also showed staff were not provided with regular structured supervision sessions. The record of staff meetings was also inspected to see how frequently the staff team meet to express their views to management and among themselves. There had only been one staff meeting over the previous ten months. Staff should be provided with regular opportunities to express their views, to ensure staff work with management as a cohesive team, and thereby helping to maintain and improve the quality of care. Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 1 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 1 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 2 3 x 2 x x x 2 3 2 Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 23 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 2 Regulation 5.1(b) Requirement Each resident must be provided with a statement of terms and conditions for their stay at the Home. The resident’s care plan and assessment information that was identified at the inspection must be regularly reviewed and updated. There must be a programme of regular, varied, social and therapeutic activities provided for residents. The resident identified at the inspection must be offered a diet that reflects their specific cultural needs. A suitably qualified individual must regularly supervise the cook.The kitchen must be run to meet the needs of residents. There must be a duty record of the hours worked by all ancillary and catering staff. There must be evidence to demonstrate staff are being provided with regular supervision of their work and practise. Timescale for action 12.07.05 2. 7 14.2,15(2 ), (b) 12.06.05 3. 12 16(2),(m) ,(n) 12(4)(b), 12.07.05 4. 15 12.06.05 5. 15 16.(2),(i), 18.(2) 18(1)(a), Schedule 4.7 18. (2) 13.05.05 6. 7. 27 36 13.05.05 12.06.05 8. 9. Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 24 10. 11. 12. 13. 14. 15. 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. 2. 3. 4. 5. 6. 7. Refer to Standard 28 32 Good Practice Recommendations There should be a programme of NVQ in care training in place for all care staff. There should be regular, staff meetings held in the Home. Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Begbrook v199123 d56 s20227 begbrook house v199123 11-120505 stage 4.doc Version 1.40 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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