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Inspection on 25/10/05 for Begbrook House

Also see our care home review for Begbrook House for more information

This inspection was carried out on 25th October 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents are supported to meet their needs by staff who are kind and caring and residents feel very satisfied by the way they are supported with their needs. The environment is suitable for the needs of residents, and the gardens are a source of much pleasure to residents and visitors.

What has improved since the last inspection?

The overall standard of care remains the same since the last inspection.

What the care home could do better:

Residents and their representatives would be better informed about the services provided at the Home if the service users guide which explains about the Home, was updated to reflect some changes in staff that have taken place, as well as the change in the time allocated for structured social activities. The mealtime experience, as well as individual residents dignity would be further improved if the staff who assist residents with their meals sit down rather stand up while they do this.The safety of the resident who resides in the room identified at the inspection, would be better maintained if the call bell in their room were to be repaired or replaced as a matter of priority, thereby ensuring the person who is in the room can summon help from staff when required. The safety of residents would be better protected if the following food safety practices were maintained. Firstly up to date checks of the kitchen fridge`s and freezer should be maintained, to ensure they are operating within food safety guidance levels. Secondly all foods that food safety guidance advises are `high risk` foods should be temperature probed before serving to ensure the food has reached above the minimum required temperature. Thirdly uncooked eggs should be stored in the fridge, and food that has been stored in the fridge and covered should have the date it was placed in the fridge recorded. Residents would benefit from staff who have consolidated their knowledge and understanding of the care needs of older people through achievement of NVQ (National Vocational Qualification) training, this was a requirement from the last inspection. Staff and residents would also benefit if there was a system in place that demonstrate that all staff are being provided with a suitable form of supervision of their work and practice. This was also a requirement from the last inspection, and it has not yet been met by the Home. The Commission for Social Care Inspection will monitor closely the progress by the Home to meet these requirements that have not been met from the last inspection.

CARE HOMES FOR OLDER PEOPLE Begbrook House Sterncourt Road Frenchay South Glos BS16 1LD Lead Inspector Melanie Edwards Unannounced Inspection 25th October 2005 09:45 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.V261070.R01.S.doc Version 5.0 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.V261070.R01.S.doc Version 5.0 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 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.V261070.R01.S.doc Version 5.0 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 2005 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 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 are welcome at any time. Begbrook House DS0000020227.V261070.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Twelve residents and a number of relatives were consulted to find out their views of the Home and the service provided. Two care assistants, two `adaptation’ nurses (who are working towards registering as qualified nurses in this country) who work as care assistants, the deputy manager, and the manager were also consulted about their roles and responsibilities, their training needs, and how they assist and support residents. The staff on duty were observed while they were assisting residents with their needs. A selection of records that relate to the day-to-day running and management of the Home were inspected. A sample of resident’s care records were also reviewed. The majority of the environment was seen; and the only areas that were not viewed were a small number of resident’s bedrooms. Despite a number of requirements that have been made arising from the inspection, these do not seem to have 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? What they could do better: Residents and their representatives would be better informed about the services provided at the Home if the service users guide which explains about the Home, was updated to reflect some changes in staff that have taken place, as well as the change in the time allocated for structured social activities. The mealtime experience, as well as individual residents dignity would be further improved if the staff who assist residents with their meals sit down rather stand up while they do this. Begbrook House DS0000020227.V261070.R01.S.doc Version 5.0 Page 6 The safety of the resident who resides in the room identified at the inspection, would be better maintained if the call bell in their room were to be repaired or replaced as a matter of priority, thereby ensuring the person who is in the room can summon help from staff when required. The safety of residents would be better protected if the following food safety practices were maintained. Firstly up to date checks of the kitchen fridge’s and freezer should be maintained, to ensure they are operating within food safety guidance levels. Secondly all foods that food safety guidance advises are `high risk’ foods should be temperature probed before serving to ensure the food has reached above the minimum required temperature. Thirdly uncooked eggs should be stored in the fridge, and food that has been stored in the fridge and covered should have the date it was placed in the fridge recorded. Residents would benefit from staff who have consolidated their knowledge and understanding of the care needs of older people through achievement of NVQ (National Vocational Qualification) training, this was a requirement from the last inspection. Staff and residents would also benefit if there was a system in place that demonstrate that all staff are being provided with a suitable form of supervision of their work and practice. This was also a requirement from the last inspection, and it has not yet been met by the Home. The Commission for Social Care Inspection will monitor closely the progress by the Home to meet these requirements that have not been met from the last inspection. 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 House DS0000020227.V261070.R01.S.doc Version 5.0 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 Begbrook House DS0000020227.V261070.R01.S.doc Version 5.0 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): 1,3 Residents and their representatives are provided with some of the information they need to know about day-to-day life at the Home, and staff are meeting residents needs. EVIDENCE: A copy of the service users’ guide to the Home was inspected to see what information is provided to prospective residents and their relatives. The document contained a range of helpful information about life in the Home, the staffing and levels, and the service that is provided. However there were members of staff referred to in the guide who no longer work at the Home, as well as out of date information about the range of social activities that are provided. This could mean residents and their representatives will not have access to the most up to date information they may need about the service. To find out how residents needs are being assessed, three residents assessment records were inspected. The records contained reasonably informative, assessments and showed the Home had assessed the range of physical, mental and social needs the person had. Assessments had been Begbrook House DS0000020227.V261070.R01.S.doc Version 5.0 Page 9 reviewed and updated on a regular basis helping to demonstrate residents’ needs are being monitored by the Home. To find out how residents felt their needs are being met, the inspector spent time talking with residents and some relatives while walking around the Home. There were a number of comments of satisfaction expressed by residents as well as by relatives of residents, about the care they receive. Examples of comments made included, ‘the staff are kind to everybody’, `the Home is generally pretty good’ and ‘the staff are kind and welcoming’. These sample comments demonstrated that residents feel satisfied by the care they receive, as they were reflective of comments made by all the residents and relatives, who were consulted. Begbrook House DS0000020227.V261070.R01.S.doc Version 5.0 Page 10 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): 7,8,9 Residents’ plans of care demonstrate needs are being met, and the systems in place for the handling of resident’s medication is safe. EVIDENCE: To find out in detail about the care that is provided three residents’ care plans were inspected. The care plans contained information about how to support residents with their physical and mental health care needs. There was information stating how to assist the residents with their needs. Care plans had been reviewed and updated on a regular basis by registered nurses; demonstrating residents care needs are monitored and kept under review. The inspectors spent time observing staff assisting residents with care needs. Staff were polite, and helpful when assisting residents to meet their care needs. Staff also demonstrated in discussion an awareness of some of the range of care needs of older people. The medication procedures and practises operating in the Home were also inspected, and demonstrated the Home operates a safe system of administration, disposal and storage of resident’s medication. Begbrook House DS0000020227.V261070.R01.S.doc Version 5.0 Page 11 Begbrook House DS0000020227.V261070.R01.S.doc Version 5.0 Page 12 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): 15 Residents are provided with a healthy, diet however staff are not assisting all residents in a way that best ensures their dignity is maintained. EVIDENCE: The inspector took the opportunity to sample lunch. The meal consisted of either fish pie or faggots with mashed potatoes, and vegetables, followed by a choice of dessert. The fish pie was sampled by the inspector and it was nutritionally well balanced, and tasted adequate. The resident’s menu choices seen were nutritionally well balanced. A number of 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. Staff were observed assisting residents with the lunchtime meal, and there were two members of staff who helped residents who needed extra assistance by standing up next to them, throughout the meal. It is better practise when assisting residents who need help to eat their meals to sit down next to them. Standing up while assisting residents made the meal time experience less personal for residents, and less dignified. Begbrook House DS0000020227.V261070.R01.S.doc Version 5.0 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): 16,18 The Home demonstrates that it aims to protect residents from abuse and harm and the complaints procedure is accessible for residents or their representatives. EVIDENCE: A copy of the Home’s complaints procedure is on display in the Home in the entrance hall, which would mean that residents and their representatives have easy access to the information required if they want to make a complaint. 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 helps to demonstrate `open’ management and a willingness to seek the views of residents and representatives. A number of staff have been on a recent training course on the topic of `protection of vulnerable adults from abuse’, to help them better understand issues around the protection of vulnerable adults. The Home has a `protection of vulnerable adults’ procedure 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 people who live at the Home. Begbrook House DS0000020227.V261070.R01.S.doc Version 5.0 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): 19,20,21,22,23,24,25,26 The Home is safe and mostly satisfactorily maintained, and is suitable for meeting residents’ needs. EVIDENCE: 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 was observed spending time in the grounds feeding the fish in the garden pond, during the inspection. Many of the residents who were consulted told the inspector how much they enjoyed looking out onto the gardens from their rooms. 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 inspector walked around the inside of the Home, and viewed all of the communal living areas and the majority of bedrooms. Begbrook House DS0000020227.V261070.R01.S.doc Version 5.0 Page 15 The environment was clean, tidy and mostly satisfactorily maintained. However one resident’s call bell alarm system in their room, (used to contact staff when a person requires assistance) was not working, which must be repaired or replaced as a matter of priority to ensure the resident who occupies the room can call for assistance when they need to. Begbrook House DS0000020227.V261070.R01.S.doc Version 5.0 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): 27,28,30 Staff are competent in their work and are provided with some training to enable them to meet residents needs. However there is a lack of training provided for care staff. EVIDENCE: Registered nurses have attended some recent clinical training and updating on a range of issues, including `death and dying’ training to help them in their work and to understand residents needs. Care staff had also attended some short courses over the last twelve months on subjects that should help them better understand the needs of residents in their care. However there has yet to be a programme put in place of National Vocational Qualification in care award training for care staff 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. The duty record was not inspected on this occasion however the numbers of staff required for each shift remain as a condition of registration. There must be 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 must be 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 House DS0000020227.V261070.R01.S.doc Version 5.0 Page 17 The number of staff on duty during the inspection met 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 and as such must be met at all times. Staff demonstrated a reasonable knowledge of the needs of residents, and they were also courteous, and evidently have built up close relationships with residents. Begbrook House DS0000020227.V261070.R01.S.doc Version 5.0 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): 36,37,38 The health and safety of residents and staff is only partly maintained, and the majority of staff are not being regularly supervised in their work and practise. EVIDENCE: Begbrook House DS0000020227.V261070.R01.S.doc Version 5.0 Page 19 The environment looked to be mostly satisfactorily maintained, (reference has already been made previously in the report to one bedroom call bell alarm system that was found to be not working). 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 are carried out. The fire fighting equipment is also checked regularly, which helps to maintain the safety of those in the building. There was a record that staff had attended fire safety update training in the last twelve months to ensure they are aware of fire safety procedures in the Home. The kitchen was also inspected to check what systems are in place to ensure safe food handling, storage preparation and serving. The kitchen environment was clean and reasonably well maintained. However there had been no records kept since September 2005 to demonstrate that the cooks were temperature probing `high risk’ foods prior to being served to residents. There was also no up to date record that demonstrated staff were monitoring the temperatures of the fridges and freezer, and there were uncooked eggs not being stored in the fridges as food safety guidelines advise they should be. Food that had been `opened’ and was being stored in the fridge and had been covered in plastic film had not been dated with the date it had been put in the fridge. This could mean the cooks will prepare food from the fridge that is past its ‘use by’ date. As was also applicable at the last inspection the deputy manager regularly works alongside staff to monitor and supervise them in their work and care practice, 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 looked at to see how often the staff team meet to express their views to management and among themselves. There had been two staff meetings held since the last inspection which helps to provide staff with regular opportunities to express their views, to ensure staff work with management as a cohesive team, thereby helping to maintain and improve quality of care Begbrook House DS0000020227.V261070.R01.S.doc Version 5.0 Page 20 Begbrook House DS0000020227.V261070.R01.S.doc Version 5.0 Page 21 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 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 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 X X X X X 1 3 2 Begbrook House DS0000020227.V261070.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? YES 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 5(1)(a) Requirement The service users’ guide to the Home must be updated to reflect the current staff working at the Home, as well as the current range of social activities that are provided. Monitor on a regular basis the temperatures of the kitchen fridges and freezer, to ensure they are operating within food safety temperature guideline levels. All `high risk’ foods must be temperature probed before serving, to ensure food has been cooked to the minimum required safe temperature. A requirement from the last inspection: Provide the Commission for Social Care Inspection with an action plan that includes timescale for the implementation of a National Vocational Qualification in care award training programme for care staff. A requirement from the last inspection: There must be a DS0000020227.V261070.R01.S.doc Timescale for action 25/11/05 2 OP38 13.4c, 16.2(g), 25/10/05 3 OP38 13.4c, 16.2(i) 25/10/05 4 OP28 18(1)(a),( c)(i) 15/11/05 5 OP36 18.2 15/11/05 Begbrook House Version 5.0 Page 23 6 OP24 13.4c,23. 2(a),(b) suitable system of staff supervision for all staff. The call bell in the bedroom identified at the inspection must be repaired or replaced. 25/10/05 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 OP38 OP15 OP38 Good Practice Recommendations Food that has been covered and stored in the fridge should also be dated. Staff should sit down when they assist residents at mealtimes. Uncooked eggs should be stored in the fridge. Begbrook House DS0000020227.V261070.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Bristol North LO 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 House DS0000020227.V261070.R01.S.doc Version 5.0 Page 25 - 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. 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