Inspection on 18/05/07 for Begbrook House

This inspection was carried out on 18th May 2007.

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

Other inspections for this house

Begbrook House 11/05/06

Begbrook House 25/10/05

Begbrook House 11/05/05

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 House Sterncourt Road Frenchay South Glos BS16 1LD Lead Inspector Wendy Kirby Key Unannounced Inspection 09:30 16 , 17th, 18th May 2007 th 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 Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 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. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Begbrook House Address Sterncourt Road Frenchay South Glos BS16 1LD 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) 0117 9568800 0117 9569900 begbrook.house@fshc.co.uk Grandcross Limited(wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Erma Benedicto Fernandez Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate 32 Patients aged 50 years and over requiring nursing care Staffing Notice dated 3 December 2001 applies Manager must be a RN on parts 1 or 12 of the NMC register Date of last inspection 11th May 2006 Brief Description of the Service: Begbrook is 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 throughout 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. The cost per week to reside at the home is £570.00. Fees are reviewed annually and if care needs increase. This weekly fee does not include provision for items such as hairdressing, chiropody, dental, ophthalmic, or audiology services. Prospective residents can be provided with information about the home by accessing the Service Users Guide, which will detail the services and facilities available at the home. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced site visit as part of a key inspection carried out over three days. The inspector sent surveys “Have your say” to people who live in the home, visitors and health/social care professionals prior to the inspection and thirtyfive were completed and returned. Information received from the surveys is detailed throughout the report. The inspector spent time throughout the visit talking to people who live in the home, relatives, the manager and staff; a number of records and files were looked at, including care records, staff training records, and the complaints log and medication records. The inspector spent time over the three days looking at the environment. Feedback was given on the outcome of the inspection. What the service does well: What has improved since the last inspection? Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 6 The preferences of all people living are taken into consideration when planning social and therapeutic activities. A diary of all activities and events are given to individuals so that they can plan their week and choose which they wish to take part in/attend. What they could do better: People should only be admitted to the home once a full comprehensive assessment is undertaken by people who are trained to do so. All care plans should be developed from a comprehensive assessment with the people, who live in the home and/or their representative so that the care and support given is expected, agreed and signed. The care plans must set out in detail individualised care instructions for staff so that they know all aspects of health, personal and social care needs of the people will be met. The home must consistently review the plans at least once a month so that they are up to date and reflect current needs of people living in the home. The home must evidence that it has respected peoples’ wishes with regards to their preferred gender of carer when receiving care so that residents feel comfortable and their dignity is not compromised. People who use the service must be assisted to exercise choice and control over their lives by planning their preferred daily routines, including what time they like to get up and go to bed and their likes and dislikes of food. This must be clearly recorded so that their expectations are met consistently. People who live in the home must be assisted with their meals and drinks in a dignified manner. One staff member who should be sitting at the same level should assist people singularly. The grounds must be kept tidy, safe, and attractive so that people who use the service have a pleasant outdoor space that they can use and enjoy. Carpets in the communal rooms and bedrooms must be assessed for their quality and cleanliness. Poor carpets identified must be either cleaned to eliminate any stains and odours or otherwise be replaced so that people in the home live in pleasant odour free surroundings. Commodes that are rusty and have lost their protective plastic covering on the legs and arms must be condemned and replaced where necessary, so that Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 7 people who use them are safe from potential injury and possible cross infection. Deep cleaning of bedrooms must be provided at regular intervals. Any spills or accidents must be cleaned up on the spot so that cleanliness is maintained and people are not sitting in ingrained dirty lounge chairs and wheelchairs and have sticky furniture surfaces. Additional staff training must be accessed which, is relevant to the needs of the people they are caring for so that they will understand their illness, disability or impairment and why such care is required. Trailing electrical cables must be secured so that people will be protected from possible trips or falls. 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. The summary of this inspection report can be made available in other formats on request. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Pre-admission assessments are poor and lack crucial detail, which may result in people who live in the home receiving a poor quality of care and will be at risk through lack of trained, knowledgeable staff. EVIDENCE: The evidence suggests that a needs assessment is carried out before a client moves into the home. Where possible the manager also obtains comprehensive assessments and care plans from other professionals involved for example, social workers and hospital staff. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 10 The inspector looked at four pre-admission assessments conducted for people now living in the home. The actual format of the assessment was very detailed including activities of daily living, a full health screen and personal history background, emotional and psychological well being and personal safety. The assessments completed were very poor in content with very little detail or no detail at all in each section. Most assessments were completed similarly to that of ticking boxes and when a need had been identified there was no other information to evidence that the person had been consulted on how that need would/could be met. The inspector was informed that the documentation used for assessment was relatively new to the home. Unfortunately the deputy who had received training on how to use the documentation has since ceased employment. Although the manager has not received the training to complete the new assessments satisfactorily this is not a justified reason for not completing a comprehensive assessment. The information gathered pre-admission should provide a sound benchmark of a persons ability and state of health prior to admission, allow for care plans to be developed prior to admission and clearly indicate whether the home has the skills, knowledge and resources to care for that person. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The variable practice regarding planning and delivery of care means that people cannot be sure that their health and personal care needs will be fully met. Because they are not consulted about their health and personal care needs people cannot be sure their views and expectations will be considered. Safe systems of practice in receiving, storing, administering, and disposing of drugs protect people living in the home. People living in the home cannot be confident that staff have a good awareness of their needs and that they will be treated with dignity and respect. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 12 EVIDENCE: During this inspection the inspector examined four care files including, care plans, personal history profiles, preferred daily routines, key worker accounts, daily record and risk assessments. Once again the formats that the home uses are very good and when used correctly would provide holistic documentation on identified needs, care instructions for delivering care, personal preferences and preferred daily routines and safe procedures of care. When needs are identified a care plan detailing how the needs can be met through “Care Instructions” are developed. Care instructions on some plans were sparse in detail and required more information on how staff can meet those needs identified. The plans were not person centred and written in a sense that the person living in the home and/or relative had been involved in this process. Signatures from neither party had not been sought to evidence that an agreement had been made about any care provisions put in place. People who use the service confirmed that they were not aware that they had care plans and are not actively encouraged to be involved in its review or development. The inspector found that in some cases needs had been identified in the care records, including Dementia, Multiple Sclerosis, and Difficulty with Communication but care plans for these had not been developed. Where needs have been identified a care plan must be developed, giving clear detailed instruction about how staff are to manage the care required. This will make sure that peoples health and welfare is properly maintained and ensure consistency and continuity when delivering the care. The home has procedures for providing Key Workers to support individuals living in the home. The Key Workers have a very limited role in the contribution towards the care plans. When the inspector asked some of the staff why people had been admitted to the home and what their needs were, they were unable to demonstrate knowledge of any of their ailments. Most answers given stated they were in the home because they were frail; no mention was made of diagnosis such as Multiple Sclerosis, a Stroke or Dementia. One staff member stated that residents and relatives would prefer it if the carers did not know this information. One survey stated, “I feel staff do not understand my condition, which is Multiple Sclerosis” and a relative said, “I do sometimes feel that staff are not fully aware of the care that my relative needs”. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 13 Only two out of eleven relatives agreed that the home always meets the needs of their relative, comments included, “Sometimes I have to do things myself e.g. cleaning glasses, cleaning sticky eyes and tidying and dusting their room” and “My relatives face sometimes hasn’t been washed”. Health Care needs were well evidenced in the care files and included, nutritional assessments, oral assessments and pressure area risk assessments. Not all of the information had been completed or regularly reviewed. Records of the General Practitioner visits/contact with residents and the outcomes are also available. Specialist referrals and visits from other professionals were evidenced in care files including Community Chiropodists, Opticians and Dentists. Surveys stated that they always felt that they received the medical support they needed. Five health/social care professional surveys were returned and in general comments were positive. Some felt that communication between staff was not always effective and that on occasions appropriate decisions were not always made when the home can no longer manage the care needs of the resident. Other comments included, “The staff are always helpful and cooperative when I visit”, “The care always appears to be of a good standard” and “ I have a good relationship with the homes manager”. Policies and procedures for receiving, storing, administering and disposing of medications were examined; systems in place are effective and well managed. The home operates a monitored dosage system for the administration of medication, which is supplied at regular intervals by the local pharmacist. The GP’s conduct a medication review every six months. The administration charts were legible and continuity of administration was shown with a signature from the person dispensing. During the three-day inspection there were occasions when it was clear that peoples’ dignity was valued and supported, at other times this was compromised. Staff were seen being warm, humorous, respectful and courteous, some close, trusting relationships had obviously been formed and individual carers were named by the people living in the home to the inspector. Comments included, “Staff are so caring and kind” and “The staff are very good especially my named nurse and key worker”. However information was not available to ensure that residents were called by their preferred term of address or they preferences about receiving care from either male or female carers. One person stated in their survey that they didn’t like being changed by men and a relative said, “More consideration should be given to ensure that my relative is attended to by female carers”. Other examples where dignity and respect was compromised is evidenced later in the report. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 14 Staff were seen knocking on doors before entering. All rooms have a telephone point from which residents can make and receive calls. Private telephone lines can be installed. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home benefit from a varied activities programme, which is both enjoyable, stimulating and meets individual preferences and expectations. Encouragement and support from staff enables people living in the home to maintain good contact with family and friends. Lack of written evidence suggests that people’s choices, preferred daily routines and preferences may not be respected by staff at all times. People living in the home receive a varied and wholesome diet that they are able to influence; however some people who require assistance with eating their meals have their dignity compromised. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 16 EVIDENCE: Following repeated requirements for the home to develop a programme of regular, varied, social and therapeutic activities, that meets individual needs an activities coordinator has since been deployed. The inspector spent some time with the coordinator throughout the three-day visit and was impressed by his enthusiasm and eagerness to implement new initiatives. Already some systems put in place since his arrival has made a vast difference in the well being and morale of people in the home. Activities arranged during the inspection were very popular and well attended. People spoken with were all very pleased with activities provided, organised events and visiting entertainers to the home. A diary of all activities and events are given to individuals so that they can plan their week and choose which they wish to take part in/attend. The coordinator is in the process of meeting people individually to develop profiles detailing hobbies and interests and what their limitations may be due to any disabilities/impairment. People talked about the plans for “Sprucing up” the greenhouse so that they can start planting vegetables and flowers and they were obviously pleased to be involved. One person said how much they were enjoying short trips that were being organised and recently went to play Bingo at a local venue in the High Street. The home operates an open door policy for visitors. People are able to see visitors in the privacy of their rooms and there are several semi-private seating areas around the home and in the gardens. All relatives/visitors agreed that staff welcome them when visiting. Comments included, “Staff are always friendly and welcoming to visitors”, “They create an easy going relaxed atmosphere for residents and visitors” and “I am always made to feel welcome”. Although in practice it was evident that personal preferences are considered there was no documentation in the care files to enforce how people prefer to spend their day and live the life they choose to live. Staff were seen offering choices at mealtimes and asking individuals if they would like to take part in activities. Records for personal preferences with regards to likes and dislikes of food had not been completed and records did not indicate what time people like to get up or go to bed. The menu rota displays traditional meals and choice is available at each sitting. The menus are reviewed to reflect seasonal trends and availability of produce. Extras are ordered on request for birthdays and special occasions. Fresh fruit Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 17 and vegetables are delivered daily and bowls of fruit are on offer throughout the day. Surveys confirmed that people were generally satisfied with the meals provided and comments included, “The chef is excellent if there is anything I fancy I can ask him” and “The food is good and I look forward to particular dishes on the menu”. People living in the home are able to influence the choices on the menus, which is often discussed at their meetings. The inspector spent some time with the chef who was mindful of individual preferences and any special dietary requirements. The chef spends time with individuals on a daily basis to see if they have enjoyed their meal and if they are happy with the menus and he attends their meetings. The kitchen was clean and spacious and stores exhibited a good range of foods. Documentation was provided to show the inspector that required temperature checks were being carried out on fridges and freezers and that food was also being probed after being cooked before serving. The size and layout of the dining rooms enable people to enjoy the social advantages of dining together. The dining rooms were light, spacious and the tables are attractively laid with tablecloths and napkins. During one lunchtime the inspector saw that some staff were assisting with drinks and meals standing over people and not sitting down. Another staff member was feeding two people at the same time with a spoon in each hand. This is very poor practice and undignified, this has been discussed at previous inspections. One staff member was however particularly sensitive when assisting with feeding allowing plenty of time between mouthfuls, offering drinks in between and talking to the person in a kind manner. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service feel that they are listened to and the service responds appropriately, however regular monitoring of practice is required to ensure consistency in maintained. Peoples’ safety may be compromised if staff training in the Protection of Vulnerable adults is not effective. EVIDENCE: A copy of the complaints procedure is on display in a well-frequented part of the home, which means people will know how to obtain the required information if they want to make a complaint. The complaints policy and procedure is clearly written and contains all the required information. The complaints procedure is given to all people living at the home on admission. People living in the home understand how to make a complaint and said that they knew who to talk to if they were not happy. Comments included, “I get on famously with all the staff and I’m able to make my feelings known” and “I prefer to talk to my daughter first”. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 19 The majority of relatives said that they knew how to make a complaint; three said that they didn’t and one said they couldn’t remember. It was agreed that sometimes people could forget the information they are given on admission to the home and that it’s useful to remind people about the complaints policy and procedure at the relatives meetings. Relatives were asked if complaints/concerns were responded to appropriately by the home and most usually felt that they did. Comments received were, “They always listen and they always want to help” and “I have spoken to them about my concerns and they try to put them right”. Relatives explained to the inspector that although the manager responded well to concerns, the outcomes are not monitored afterwards which means things often go back to how they were before. Comments included, “Things are always resolved but unfortunately things slip back” and “Problems are sorted out but then two weeks later bad habits come back.” These frustrations were fed back to the manager who agreed that systems such as random spot checks and regular auditing would assist in ensuring that standards are maintained and that reviewing outcomes following concerns/complaints would provide consistency of good practice. There are policies and procedures as well as a range of guidance information on the topic of protection of vulnerable adults from abuse. The availability of this information should increase staff awareness and understanding of their role in protecting vulnerable adults who live at the home. The manager stated that training of staff in the area of protection is provided by the home. The inspector asked staff about different types of abuse that people could be subjected to and what would staff do if they witnessed someone being cruel to another person. In general staff were able to demonstrate a fair understanding but the inspector had to prompt some answers and there seemed to be some gaps in their knowledge. It was difficult to determine if this was because of a lack of understanding or because the staff were nervous speaking to the inspector. This was discussed with the manager who stated that she was surprised by this and agreed that staff may benefit from an update in the Protection of Vulnerable Adults Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People do not live in a safe, clean and well-maintained environment and their health, safety and well being is therefore compromised. Bathing and toilet facilities are adequate to meet the needs of the people who use them. EVIDENCE: The home is purpose-built to care for elderly people. The gardens are designed to meet their needs. People were complimentary about the layout and facilities in the home and the garden areas. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 21 The inspector walked around the inside of the home and viewed, most of the bedrooms, and the communal living areas including the dining room, several lounges and bathrooms. The corridors were light and wide providing good access for wheelchairs and electric scooters. Doors to the bedrooms, lounges and toilets were also wide to aid independent access into these areas. Whilst talking and walking around the home with the maintenance man it was noted that various radiator covers had been knocked off their runners and this was dealt with immediately. There are several lounges in the home, which are tastefully decorated and quite homely with lounge chairs, furniture, ornaments and pictures. One carpet in a lounge needed replacing due to its quality and numerous stains. Bathrooms and toilets were well equipped, clean and spacious. Bedrooms have en suite facilities and are of a good size. Rooms had been personalised with their own furniture, photographs, pictures and ornaments. People living in the home told the inspector, “The size of the rooms are good and I have everything I need”. Not all rooms were of a satisfactory standard and details are as follows: Some rooms required redecoration and the maintenance man confirmed that rooms identified had been targeted for this year. Some rooms had trailing electric cables, which were not fixed and were a potential hazard for trips and falls. Various rooms had curtains that were not hung properly and did not have enough curtain hooks on them. A number of carpets were badly stained and in some instances required replacing. Some people living in the home require feeds through a tube into the stomach (PEG feeds). Splashes made from disconnected feeds were found up the walls and the bedside cabinets where the feeding apparatus was kept were sticky and dirty where feeds had been spilt. Commodes were dirty and rusty where the plastic covering on the arms and legs had come away. Wheelchairs were dirty and encrusted with food and drink spills. Beds were dusty, and lounge chairs in bedrooms were badly stained with foodstuff such as crumbs, crusts, biscuits and sticky sweets were found under the cushions. At least four of the bedrooms had an offensive odour. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 22 The inspector had conversations with people who live in the home, relatives and visitors before and during the inspection, comments were also received in the surveys. Comments included, “Sometimes I bring in some washing up liquid and a nail brush and scrub my relatives wheelchair because it gets so dirty”, “I think the home could improve by keeping the place clean”, “They need a better cleaning service, they are over worked and do their best but sometimes the rooms are dirty, sticky drink marks are on the table and food is left down the sides of chairs”, “PEG feed spills are not cleaned up” and “The home is clean in parts but my daughter in unhappy about the condition of my room, my wheelchair is coated in food and my carpet is messy”. The inspector spoke with the head housekeeper and the manager. There has been a shortage of ancillary staff but seventy hours of ancillary hours is allocated per week by the home. When the posts have been filled this should be enough hours to keep the cleanliness of the home up to a good standard, in the interim alternative provision must be sought to deep clean many areas in the home to bring it up to the required standard. The manager agreed that it was not the responsibility of relatives to dust and clean rooms or scrub wheelchairs. The housekeeper confirmed that the lack of staff had made it impossible to follow a deep cleaning rota of the bedrooms because staff resources at present could only manage some surface cleaning and cleaning of the communal areas and bathrooms and toilets. There is no time available to spot clean carpets when a spill has been reported. The grounds outside are very pretty and each bedroom has a door leading out to the garden and small individual patio areas. Many had bird tables and baths and families had brought in flower planters. The gardens provide immense pleasure to the people in the home who made various comments about the types of birds they see, taming squirrels and even spotting the odd dear. Unfortunately these areas and communal areas in the garden have not been well kept and various parts required a good sweep, pruning and weeding. The maintenance man said that most of the time there was only enough time to cut the grass due to other responsibilities. Besides the daily maintenance and health and safety checks he has to regularly pick up prescriptions deliver specimens to the doctors and has been providing transport to the manager when she conducts assessments in the community for prospective clients. A relative was seen during the inspection tidying up the patio area outside of her relatives’ bedroom, comments in the surveys said, “They could do with some extra help/input on the maintenance and gardening aspect” and “Some of the paving slabs could do with some attention and need relaying”. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is capacity to improve the outcomes for people using the service when plans address the staffing levels and further relevant training needs of the staff. EVIDENCE: The inspector examined the dependency levels of people living in the home; this information had been supplied by the manager in the pre-inspection questionnaire. The number of people with a diagnosis of dementia was five, people requiring help with dressing and undressing was thirty, people who require supervision with eating and drinking was sixteen, thirty-one required help with washing and bathing and twenty-eight required the use of a wheelchair. This information and observation during the inspection indicates and confirms that there is a high level of dependency in the home. The manager stated that staffing levels are indicative of the needs and levels of care required by people living in the home twenty-four hours a day and confirmed that levels of staff would rise should dependency levels increase. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 24 People who live in the home were asked in the surveys about staff availability. Out of nineteen responses only one said, “Yes staff are always available and act promptly when needed”. Thirteen felt that staff were usually available and comments included, “Sometimes I have to wait especially when staff are on breaks and numbers are down” and “I don’t ring my bell for help many times but sometimes I have to wait up to 20-30 minutes, suppose this was an emergency”. Relatives and visitors to the home were asked in their surveys how they felt the home could improve their services. Comments received were, “At times there seems to be to few carers to carry out basic procedures like assisting residents to the toilet, rather than simply changing pads at a set time”, “Often through lack of time things are rushed and older people cannot be rushed” and “I still have to do things for my relative” and “We need more staff, people who care, people who have time to talk to staff who think of residents as people”. During the inspection the atmosphere did seem calm and relaxed, staff didn’t seem to be rushing although the earlier incident mentioned about a member of staff feeding two people at the same time indicates that staffing levels at lunchtime may be stretched. People were up, washed and dressed a fair time before lunch was served and one relative said, “They are usually up on time and dressed very well”. Although the comments received are from a small minority of the people who use the service it is a cause for concern and it is therefore recommended that the manager monitor the staffing levels and spend some time with the people in the home to determine if they feel that their care is compromised by the staffing levels and if so how will it be resolved. A recruitment policy and procedure is in place and the files inspected showed all the appropriate documents and checks were in evidence. CRB disclosures are being retained until the inspector has examined them. The home continues to support staff with NVQ training and the enrolling programme continues. A training matrix has been developed and the inspector was able to see that training for manual handling, health and safety, Fire Safety and COSSH has been completed and future course dates had been organised for staff. Although some additional training has been accessed such as Infection Control and Palliative Care, many staff confirmed that they had not received training relevant to the care needs of the people in the home. Their knowledge and understanding about needs associated with Dementia, Multiple Sclerosis and Cerebral Vascular Accidents (A Stroke) is weak and suggests that staff are not skilled to meet the specialist physical and emotional needs of individuals. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 25 As mentioned previously in the report concerns have been raised about whether staff have the right skills and experience to look after people properly, only two out of eleven relatives surveys confirmed that they felt staff did. The manager is aware that there are some gaps in the training programme and plans to deal with this. The inspector met with several members of staff throughout the three-day visit. Staff were respectful of the inspection process and understood its purpose, they were polite and helpful and appeared happy and dedicated to the people living in the home. People who use the service also made positive comments including, “Staff are usually cheerful and bright”, “The staff are caring and friendly”, “I have been here for four years and I am very happy” and “On the whole most of the staff are very caring and I would recommend them and the home to anyone”. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are some areas of management that have major weaknesses, which compromise running the home in the best interests of the people who use the service. The homes record keeping policies for financial procedures safeguard people so that they can be sure their finances will be managed correctly. The health and safety of people who use the service will be further protected when trailing electrical cables are secured out of harms way. EVIDENCE: Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 27 Although there are some good systems in place to help ensure that the home is run in the best interests of the people who use the service, questions must be asked as to why some of the services provided give great cause for concern particularly around care planning, staffing levels and training, the environment and the health, safety and wellbeing. There are areas in the service, which are failing, and it is apparent that this is due to varying contributors, which have been detailed throughout the report. It would seem that the manager has failed to monitor some standards of practice in the home, which has resulted in a number of requirements being made as a result of this inspection. The inspector does believe however that with the support and additional training from senior management and with the pending recruitment of a deputy manager, the registered manager has the ability to meet the requirements and develop systems to ensure that satisfactory levels of standards are reached and maintained. Attention must also be given to the fact that the manager has not been supernumerary and in addition to this has been without administrative support due to leave of absence. However the registered manager must accept some accountability in that when circumstances like these develop ultimately they will reflect on the ability to manage adequately and provisional help should have been sought from a senior management level. The Regional Manager has informed the inspector that she intends to work closely with the registered manager and make regular visits to the home. She will now be conducting thorough monthly visits to the home (Regulation 26 visits) and will be sending copies of these to CSCI. These visits must be unannounced and include interviews with staff and residents and an audit of the premises to ascertain the quality of care provided. This should enable the management team to be able to make a judgement of the standard of care provided in the home and address any evident issues that have been identified. Meetings are held and are well attended by people living in the home and relatives. Minutes are taken and circulated to individuals and their families on the notice boards throughout the home. Staff will ask people prior to the meeting if they have any issues they would like to discuss and any information they would like to share with the group. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 28 A new system of quality assurance has been introduced in the home and people who use the service have completed questionnaires about the standards of services provided. The results were being collated at head office at the time of the inspection so evidence of their findings will be provided to CSCI through their future Annual Quality Assurance Assessment (AQAA)-self assessment. Completion and availability to CSCI of this document is a legal requirement, which focuses on the outcomes for the people who use the service. The policy and procedure for holding personal money was examined and three individual accounts were looked at. It was evident that good accounting methods are adopted which account for all transactions documented and receipts for sundries were available to see. The inspector saw that all relevant checks were maintained correctly and at the required intervals including all fire alarms, equipment and emergency lighting. The homes records showed that all necessary service contracts were up to date including, gas and electrical services, manual handling equipment and lift servicing. As mentioned previously in the report trailing electrical cables in bedrooms must be secured to prevent potential trips or falls. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 29 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 X X 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 3 2 X X X 1 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 X X 2 Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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 OP3 OP31 Regulation 14 (1) (a) Requirement The registered person shall not provide accommodation to a service user unless, so far as it shall have been practicable to do so- needs of the service user have been assessed by a suitably qualified or suitably trained person. People must be admitted to the home only when a full comprehensive assessment is undertaken by people who are trained to do so. 2 OP7 OP8 15 (1) (2) (a) (b) (c) (d) Unless it is impracticable to carry 20/08/07 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met. The registered person shall— (a) make the service user’s plan available to Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 31 Timescale for action 26/06/07 OP33 the service user; (b) keep the service user’s plan under review; (c) where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service user’s plan; and (d) notify the service user of any such revision. All care plans should be developed from a comprehensive assessment with the people, who live in the home and/or their representative so that the care and support given is expected, agreed and signed. The care plans must set out in detail individualised action for staff so that they know all aspects of health, personal and social care needs of the people will be met. The home must consistently review the plans at least once a month so that they are up to date and reflect current needs of people living in the home. 3. OP10 OP32 12 (2) The registered person shall so far as practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare. The home must evidence that it has respected peoples’ wishes with regards to their preferred gender of carer when receiving Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 32 26/06/07 care so that residents feel comfortable and their dignity is not compromised. 4. OP12 OP14 OP33 12 (3) The registered person shall, for 26/06/07 the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feelings. People who use the service must be assisted to exercise choice and control over their lives by planning their preferred daily routines, including what time they like to get up and go to bed and their likes and dislikes of food. This must be clearly recorded so that their expectations are met consistently. 5. OP15 12 (4) (a) The registered person shall make 04/06/07 suitable arrangements to ensure that the care home is conductedin a manner, which respects the privacy and dignity of service users. People who live in the home must be assisted with their meals and drinks in a dignified manner. People should be assisted singularly by one staff member who must be sat at the same level. 6. OP19 OP33 23 (2) (b) The registered person shall 26/06/07 having regard to the number and needs of the service users ensure thatThe premises to be used as the care home are of sound construction and kept in a good DS0000020227.V337934.R01.S.doc Version 5.2 Page 33 Begbrook House state of repair externally and internally. The grounds must be kept tidy, safe, and attractive so that people who use the service have a pleasant outdoor space that they can use and enjoy. The registered person shall having regard to the size of the care home and the number of needs of service usersProvide in rooms occupied by service users adequate furniture, bedding and other furnishings, including curtains and floor coverings and equipment suitable to the needs of service users and screens where necessary. 7. OP20 OP33 16 (2) (c) 30/07/07 8. OP22 OP33 23 (2) (c) Carpets in the communal rooms and bedrooms must be assessed for their quality and cleanliness. Poor carpets identified must be either cleaned to eliminate any stains and odours or otherwise be replaced so that people in the home live in pleasant odour free surroundings. The registered person shall 04/06/07 having regard to the number and needs of the service users ensure thatEquipment provided at the care home for use by service users or people who work at the care home is maintained in good working order. Commodes that are rusty and have lost their protective plastic covering on the legs and arms must be condemned and replaced where necessary, so that people who use them are safe from potential injury and cross infection. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 34 9. OP26 OP33 23 (2) (d) The registered person shall 26/06/07 having regard to the number and needs of the service users ensure thatAll parts of the care home are kept clean and reasonably decorated. Deep cleaning of bedrooms must be provided at regular intervals. Any spills or accidents must be cleaned up on the spot so that cleanliness is maintained and people are not sitting in engrained dirty lounge chairs and wheelchairs and have sticky furniture surfaces. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service usersEnsure that the persons employed by the registered person to work at the care home receivetraining appropriate to the work they are to perform including structured induction training. Additional training must be accessed which, is relevant to the needs of the people they are caring for so that they will understand their illness, disability or impairment and why such care is required. The registered person shall ensure thatUnnecessary risks to the health or safety of service users are identified and so far as possible eliminated. Trailing electrical cables must be secured so that people will be protected from possible trips or falls. 10. OP30 OP32 18 (1) (c) (i) 26/06/07 11. OP38 13(4) (c) 04/06/07 Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 35 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. Refer to Standard OP16 OP18 OP27 Good Practice Recommendations The people who use the service would benefit from consistent good practice if the manager monitored outcomes when complaints/concerns have been resolved. People who use the service would be safer if staff had further training in the Protection of Vulnerable adults. The manager would gain a clearer picture about whether there are sufficient numbers of staff on duty by seeking the views of people who use the service and by monitoring daily routines in the home. Begbrook House DS0000020227.V337934.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 House DS0000020227.V337934.R01.S.doc Version 5.2 Page 37 - 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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