Inspection on 23/04/08 for Bluebrooke Residential Care Home

This inspection was carried out on 23rd April 2008.

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

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

Bluebrooke Residential Care Home 20/04/09

Bluebrooke Residential Care Home 04/12/08

Bluebrooke Residential Care Home 23/05/07

Bluebrooke Residential Care Home 05/06/06

Bluebrooke Residential Care Home 29/10/05

Bluebrooke Residential Care Home 28/07/05

Bluebrooke Residential Care Home 02/03/05

Bluebrooke Residential Care Home 14/09/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Bluebrooke Residential Care Home 242 Stourbridge Road Catshill Bromsgrove Worcs B61 9LE Lead Inspector Philippa Jarvis Key Unannounced Inspection 23rd April 2008 07.40a 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 Bluebrooke Residential Care Home DS0000057561.V362845.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. Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bluebrooke Residential Care Home Address 242 Stourbridge Road Catshill Bromsgrove Worcs B61 9LE 01527 877152 01527 557409 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) Oldfield Residential Care Limited No registered manager in post Care Home 46 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (46), Old age, not falling within any other of places category (46), Physical disability over 65 years of age (46) Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The four bedrooms on the top floor of the home are not used for service users with mobility needs. Staffing levels are increased to match the Residential Forum`s recommended levels which are that seven staff are on duty throughout the waking day. The registered person may provide personal care (excluding nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories:old age not falling within any other category, OP, 46; physical disability - over 65 years of age, PD(E), 46; dementia - over 65 years of age, DE(E), 46; dementia, DE, 3. The maximum number of service users to be accommodated is 46. 4. Date of last inspection 23rd May 2007 Brief Description of the Service: Bluebrooke Residential Care Home is registered to provide personal care for up to forty-six older people who are frail, or who may have a physical disability. The home may also accommodate people over the age of 55 years who have a dementia illness. The total number of people who can live in the home is forty six. The large, detached property, standing in its own grounds, is situated in a pleasant residential area, approximately two miles from Bromsgrove town centre. There is also a small enclosed garden that is accessible to residents. The home was purchased by Oldfield Residential Care Limited in April 2004. The Responsible Individual is Mr Simon Badland, and the Company has several homes in the group. There is no registered care manager in post. There is a manager designate, Ms Cindy Hawkins. We have not received an application from Ms Hawkins for registration as the manager of the home. The Service User Guide was being revised. This should contain information about current fee levels when it becomes available. Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a full inspection of Bluebrooke to look at how it is performing in respect of the core National Minimum Standards (the report says which these are in each section). We call this type of inspection a Key Inspection. We visited the home on one day. This was unannounced and the lead inspector stayed for the whole day. During the day a specialist pharmacy inspector visited to look at the way the home manages their medication. A further inspector came for two hours to observe the residents as part of a Short Observational Framework inspection (SOFI). This is to gain an insight into the quality of life for people living in the home when they have limited ability to express their own views. Before the inspection the home completed an Annual Quality Assurance Assessment (AQAA). This told us how they thought they were performing. We took this information into account in planning our inspection. We sent survey forms to some people who live in the home and to some relatives. We had two replies from each. We also sent surveys to some staff but we had no replies. During the inspection we spoke with the manager designate, some service users, some relatives, some staff and a visiting health care professional to get their views on the home. We checked documentation, including the care records of a sample group of people who live at Bluebrooke, and some staff files. Copies of some other policies and procedures were made available. There was no Service User Guide or Statement of Purpose available for us to get information about the weekly fees charged to people living in the home. What the service does well: There is a pleasant and relaxed atmosphere in the home. Visitors we spoke with said that they are made welcome at all times. They said they were encouraged to be involved with their relatives living in Bluebrooke. In the surveys we received the following positive comments: “I feel that the present level of care could not be improved on.” “Ensures that my wife is kept clean and totally cared for in every respect.” “The staff try hard and work hard.” Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 6 The residents also said that they received good care and were happy with the service they provided for them. They said they thought that the quality of care provided in the home is improving. Prospective residents and their families are encouraged to come and look round the home at any time, or to stay for a short while to help them make up their mind about whether this is the right home for them to live in. People were well presented in a way to reflect their choice and preferences. A new hairdresser is about to provide a service to the home to improve the appearance of peoples hair. The home is clean, fresh and comfortable. The building is generally well maintained, with good quality furnishings, which enables residents to live in a pleasant environment that ensures as far as possible their safety and security. There is space for those who are more active to walk around. There is also a small enclosed garden which they can use. There is ample food available and residents are given a choice at meal times. Residents said they enjoyed the food. There were sufficient care staff on duty when we visited to meet the care needs of the residents. The staff are caring, enthusiastic and committed to providing a good quality of care. A number have completed specialist training in dementia care. What has improved since the last inspection? What they could do better: The Statement of Purpose and Service User Guide is under review so there is no written information available to give to prospective service users or current residents. The care planning process needs further development to include the resident and their family in the development of the plan. These also need to provide clearer instruction to staff about how to meet people’s needs. Risk assessment Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 7 also needs to improve so that the home has carefully evaluated how to provide peoples care safely. There were a number of aspects of medication practice that were not satisfactory. This means there is a possibility of unsafe practice and our concern is reflected in a number of requirements and recommendations made at the end of this report. There is no activities coordinator in post and residents do not have much activity or stimulation to keep them occupied during the day. The person who is designated as the manager has not applied for registration in this capacity. The responsibility for the day to day running of the home therefore lies with the service provider, Oldfield Residential care Ltd. A representative from this company needs to write a report to the company on a monthly basis about how the home is performing. To ensure that the home is run in the best interests of the people who live there, the quality monitoring system should be further developed and implemented. There are a number of requirements and recommendations made at the end of this report and we are therefore asking the service provider to send us an Improvement Plan to tell us how they intend to deal with the matters identified. 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. Bluebrooke Residential Care Home DS0000057561.V362845.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 Bluebrooke Residential Care Home DS0000057561.V362845.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): 1, 2, 3 and 5. Standard 6 is not applicable in this home. Quality in this outcome area is adequate. There will soon be written information available to help people decide if Bluebrooke is the right place for them or their relative to live. Information is obtained during the assessment of prospective residents so that the home has the information they need to decide if they can provide the right care for people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager designate said that prospective service users or their representatives are welcome to call at any time to look round the home; indeed people turned up on the day of the inspection to do this and they were given time to look round the home. An assessment is carried out of each persons needs so that the home can decide whether they can look after them properly. We read the file of a person Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 10 recently admitted to the home and an assessment had taken place. The information in this was basic and would benefit from development. The home also had a copy of the information from the social services department to further contribute to their own assessment. The manager designate said that people are encouraged to come and look round before admission, possibly to stay for lunch and if they are still not certain the home will try to offer them the opportunity to stay for a weekend to gain more insight into what it might be like to live there. The manager designate explained that the Service User Guide and the Statement of Purpose are being revised and have not yet been reprinted. Therefore the home does not have information available currently to provide to prospective service users or for existing residents. When available there are plans to place a copy in each persons bedroom. One person told us that they had not realised there would be so many people with a dementia illness living in the home. This information about the care needs of people living in the home should be detailed in the Service User Guide. The manager designate said that they have not been giving people a contract of terms and conditions of residence following admission, but that there are plans to do so in the near future. Bluebrooke Residential Care Home DS0000057561.V362845.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 and 10. Quality in this outcome area is adequate. Staff are caring and respectful towards people living in the home. Visitors feel their relatives receive good attention from staff. The written care plans need to be developed so that staff always have reliable and up to date information to guide them in giving each person the care that they need. Arrangements for the safe administration of medication need to be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Generally we saw staff having a good approach to the residents in the home and to be patient and flexible in the way that they assisted them. We spoke with visitors to the home and they confirmed that the staff always treated the residents with patience and respect. One relative told us that the home: “Takes a personal interest in individual residents.” We did however observe one incident where the resident needed a more proactive assistance when the toilet closest to her was occupied. Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 12 The people we saw generally looked well presented except for their hair showing that staff had assisted them to look their best. The manager said that they had recently lost the services of their regular hairdresser but that a new one was due to start later that week. The visitors we spoke with at the home said that their relative always looked clean and that they always had their own clothes on and that care was taken with their laundering. However we have received comments from two relatives that have raised issues with the laundry, one said “The laundry is a shambles. Even though clothing is labelled, clothes go astray and even missing.” Systems in this area should therefore be reviewed to ensure that that the right care is taken with residents clothing and that their own clothes are returned to people living in the home. We also spoke to a visiting health care professional who said that in her view residents were well presented and that there were always staff available to assist her during her visit. We saw one lady who was looked after in bed and she looked clean and cosy. We spoke to a number of residents and they all said that they were happy living in Bluebrooke. They said that the staff were kind and looked after them well. We read the care plans for three people. We looked at the needs of these people in particular throughout the inspection process. The care plans did not show any involvement of the residents or their families in writing them. The plans we saw included basic information about how to meet people’s needs. This was often only assessment and did not move on to provide guidance to staff about how to actually meet each persons needs e.g. one person was described as having difficult behaviour but there was no guidance about how to manage this, and for another a description, “Continence pads – needs prompting.” There was no guidance about this individual’s particular need in this area. The manager designate said that she was aware that they were not person centred and that she had prepared a new care plan format and intended to implement this in the near future. The plans have not been reviewed regularly and updated so that staff may not know the current situation with regard to each residents care needs, e.g. we saw one person with food and fluid charts in her bedroom but there was nothing about this in the care plan, nor about how her food was prepared although the staff were able to inform us that it was liquidised. We found that the practice was right but that it was not supported by written evidence. The limited information in the care plans means that staff have to rely a lot on verbal information that may lead to care needs being overlooked. We went to a staff handover between shifts where there was a detailed exchange of information. It was evident that the staff knew the residents well. Information was given about one person who was Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 13 described as having a pressure sore with a small broken area and verbal instruction given that cream should be applied. This would not be good practice, as a referral should be made to a health care professional. On further checking the manager said that the resident did not have any evidence of a pressure sore. We were told by one relative that the home, “Takes notes of aches and pains and call the doctor when necessary.” Information is written each time a health care professional visits the home so that staff know what has been said about their approach to meeting their needs but this has not been translated into the care plans. We saw a range of aids and equipment being used by the residents. There is also a record kept that indicates that the residents have regular access to chiropody and dental and optical care. We were able to talk to a social worker who said that they had reviewed a person recently admitted to the home. They were very satisfied with the care she had received and the way that she had been helped to settle into the home. We could not find evidence that there had been full reviews of residents when they had been in the home for a longer period of time. The risk assessment process also needs to develop so that the home can be sure that it keeps residents safe at all times. One person had bed rails in place but there was no risk assessment or consent to their use. The manager completed a risk assessment later that day. There was very little recorded information relating to the individual persons medication details. For example, one care plan documented ‘Diabetic Insulin controlled’, however there was no available information that the District Nurse visited to administer the insulin. We also saw one example of someone prescribed a medicine to calm and control their behaviour, which was prescribed as ‘Take one three to four times a day’. The medicine record documented that it was being administered three times a day. The care plan seen did not document the medication or provide information on when it should be administered. We spoke to the manager who agreed that there should be information relating to medication in a care plan, however the resident was a new admission and all the records were not completed. Overall the care plans seen did not contain specific written information relating to medication and the specific healthcare needs of the residents. We saw a medication policy, however it was not specific to the service and was not dated. There was no evidence to show that trained staff had read and understood the policy. The manager informed us that a new policy was being written, which would be introduced as soon as the management team agreed it. This means that the current written document was not a working document. Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 14 The manager designate informed us that only staff who had undertaken medication training were able to administer medication to the residents. We were informed by the manager that staff would be required to attend an annual refresher course on safe handling of medication and that competency checks on medication administration would also be undertaken by the manager and the deputy manager. We saw medication stored in a locked storeroom upstairs and in a dedicated clinical room downstairs. The upstairs storeroom was cluttered and untidy. Some medication was seen on a shelf amongst documents and papers, which highlighted poor medication storage and handling. The medication trolley, which was located in the downstairs clinic room, was full and cramped with medication, however a second medicine trolley had recently been obtained in order to separate the medication in order to ensure that residents’ medication could be easily located. We were informed by a senior carer that the medicine trolley remained in the clinic room for the majority of the time and that medication was administered from the clinic room. This means that residents’ medication may not always be transported around the home in a safe or secure way and this may increase the risk of a medication error. The manager agreed that improved transportation of medication was a priority for the service, which was the reason a second medicine trolley was now available. We saw medication stored in a refrigerator in the clinic room. There were daily temperature records available, which stated that the temperature was consistently 9°C, which is just above the safe storage limit (2-8°C). This means that people who use the service are at risk of being given medication that has been stored incorrectly and they are therefore at an increased risk of harm. We checked medication, which requires special storage and recording arrangements. Unfortunately the records did not match the amount of medication for one of the resident’s. We saw a box containing 15 tablets and the balance recorded stated that there were 15 tablets available within the service, however we found another box in a sealed envelope, which contained 17 tablets. This means that there were a total of 32 tablets stored and not 15 as documented. This was of particular concern as a quantity of tablets had previously gone missing from the service. This means that the medication records for medication requiring special storage were not accurate and therefore did not meet the necessary legal requirements. The majority of the medicine records seen were documented with staff signatures to record that medication had been administered to a resident or a code was recorded to explain why medication had not been administered. It was disappointing that some medicine charts were not complete and there were some errors in the records. For example, we saw two medicine records for the administration of a medication that should be administered once a Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 15 week on the same day, however staff had signed for administration on the incorrect day. On one occasion staff had signed for three consecutive days instead of one day only. This means that some of the medicine records were not accurate and staff were not checking what they were signing for which means that people who use the service were not safeguarded and were at an increased risk of harm. We checked some medication to ensure it had been administered correctly. Checks made on medication available in a monthly blister pack labelled with the day of the week were accurate. However not all medication could be accurately checked in this way because some medication was supplied in the original container. We saw boxes of medication that were not dated when they were opened. There was no evidence to show that the service checked medication. This means that accurate checks on medication could not always be made to ensure that medication records for administration were correct. Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 16 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 and 15. Quality in this outcome area is adequate. The choice of food at meal times is developing so that people receive a suitable diet. Lack of activity and stimulation means that people do not have an active well thought through social life. People living in Bluebrooke are generally valued and consideration is given to their treatment as individuals but there are times when staff take actions without telling the residents what they are going to do. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we arrived residents were just beginning to get up and most came down stairs for breakfast when they were ready. There appeared to be a flexible approach to daily routines in the home. One person said that the staff were sometimes too busy to take them for their afternoon bed rest. On the day we visited we saw one person being taken to bed promptly following their request after lunch. Generally there seemed to be sufficient staff available to provide residents with the support that they requested or needed. The inspector carrying out the SOFI practice noted that staff did not spend time in the lounge with the Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 17 residents either observing or interacting with them, other than to carry out required tasks. This meant that those who were able to request assistance or engage in eye contact received more attention and support than those who were less able or more passive. We observed times when staff did not engage with residents before carrying out tasks such as uncrossing someone’s legs without telling them what they were going to do. There was also a situation where visitors were shown round the lounge but the people sitting there were not told what they were doing in their home, nor were they introduced. There was very little information about peoples life history or their interests or hobbies in the care plans. The home has been unable to recruit an activities organiser. This means that there is not a regular programme of activities provided for the people living in the home by someone dedicated to this task. Staff try to provide some diversion in the afternoons, such as playing with a ball on the day we were there, but this is limited. There was also an absence of items available around the lounges for stimulation, such as magazines or suitable radio or television programmes. Some residents were able to be, but were not included in daily activities such as wiping the tables after lunch. We received comments about the lack of activity: “I would like something to do. I would like Monday to be different from Tuesday etc.” One of the concerns raised with us said that there was nothing for the residents to do. People who visited the home said that they were always made welcome. They were able to come at any time. One person told us how the home took care of her as well. She had been able to stay there for the last two Christmases so that she could be with her husband and not lonely at home. The manager is planning to set up residents and relatives meetings on a regular basis but has not yet done this. As part of this she intends to look at the provision of activities. The menus show that the meals are based on traditional home cooking. The main meal of the day was written on a board in the dining room. There was a choice of food for each of the meals of the day with plenty of food available. We saw staff respond to requests for something different after meals had been placed in front of residents. Lunch is brought out from the kitchen, pre-plated. This seems an inflexible and labour intensive way of serving food. Also people are not able to see what the choices are. A trolley is brought round for tea and mid morning and afternoon so people can see what is available and make their choice based on this. They have started to put cut up fruit on the trolley to encourage residents to eat more fruit. Care was taken with soft diets for those that needed them. When people need a soft or liquidised diet, this is served so each food is separate: this means that the colour, taste and texture is preserved and is good practice. Information about how to present meals to the residents was not detailed in their care plans. Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 18 The manager designate said that she intends to have a tasting day when people are given the opportunity to try several different foods. The home will then adapt its menus to include foods that the residents like. This will help them to introduce a greater variety of foods to the residents. People eat in several different areas, some in their rooms, some at tables in front of their armchair and others at the dining tables. Staff were observed to assist them in a considerate way. We saw one lady who was sitting awkwardly in a lounge for a meal and we were concerned about her ability to swallow comfortably. Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 19 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 and 18. Quality in this outcome area is good. The home has complaints, whistleblowing and adult protection policies in place. Staff understand the importance of reporting abuse but this needs to be supported by all staff having training about safeguarding and recognising abuse or neglect. People told us they can approach the manager and the staff if there is something they are not happy about. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some staff have received training about safeguarding (adult protection) that took place in the home in 2007, but there are newly recruited staff who have not done this yet. The manager designate said that further training in this area was in the schedule for this year. It is important that all staff receive training in this aspect of practice soon after starting to work in the home so that they have a full understanding of how to protect people from abuse or neglect. The manager has shown that she is aware of what to do if she has concerns that she thinks should be reported under abuse procedures. She has informed us of two matters that were looked into through safeguarding procedures. We spoke to one member of staff who said that they would not hesitate to report to the manager if they thought someone was being abused or neglected. Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 20 The residents we spoke with expressed their confidence in the care that they receive and said that the staff treated them well. They and their relatives said that they did not have any concerns. The record of complaints kept in the home shows that complaints are looked into. The record included copies of letters to the people who had complained. These contained an apology and an explanation of the occurrence. In the absence of a current Service User Guide people who live in the home and their representatives will not have a copy of the complaints procedure to inform them about how to raise any concerns they might have. We have also received two concerns directly to the commission from members of the public. We took this information into account when we planned the inspection and we made sure we looked into these concerns as part our visit. Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 21 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 and 26. Quality in this outcome area is good. Residents live in a pleasant, well-maintained environment that is clean and comfortable. Their safety and security is generally taken into account but this needs to be constantly monitored. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Bluebrooke Residential Care Home is a large, detached property, situated in an elevated position, approximately 2 miles from Bromsgrove. The building, which is generally well maintained, has been upgraded and extended, over several years to provide accommodation for up to 46 residents. There are 24 bedrooms in the original house, situated on three floors, 8 of which are shared rooms. The new wing has 13 bedrooms, 1 of these being shared accommodation, and all having en suite facilities. Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 22 The home smelled clean and fresh throughout the day. There were two domestic staff at work during the inspection. They were committed to ensuring a clean environment for the residents. We looked at a sample of bedrooms, bathrooms and toilets and the communal lounges. There are a number of small lounges where residents can choose to sit as they prefer. One of these tends to be used for the more physically frail. The areas that we saw were all well maintained and the standard of décor and furnishing was good. There is an ongoing maintenance programme. Where appropriate there were aids for the residents to use to assist with mobility, such as grab rails in the toilets and hoists in the baths. People’s bedrooms had personal items so that they felt individual to them. A carpet and bed was replaced in one bedroom while we were visiting to prepare it for a new person coming to live in the home. The manager said that they have recently replaced the call bell units throughout the home. Those we tested rang at the call board. There is a small enclosed garden at the rear of the home where those who like to walk around can access independently. This area would benefit from some development to provide comfortable seating areas and areas where those residents who like to garden can do so. The laundry was suitably equipped and there were systems in place for controlling infection in the home. Staff said that they had completed training in infection control and that they were aware of the systems that should be in place to protect the residents. Unfortunately there was dirty laundry on the floor when we looked round the laundry. This is not good practice as it can lead to problems with infection control. The records to indicate that water temperatures at washbasins had been tested were incomplete for several months. The manager designate could not find any evidence to show that the temperature of bath water was checked before people were given a bath. She said that this was done because she was aware of staff coming into the office to get a thermometer on a regular basis. Bluebrooke Residential Care Home DS0000057561.V362845.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 and 30. Quality in this outcome area is adequate. There is evidence of improvement in practice in this outcome area. Staff in the home are hardworking and committed to provide people living in Bluebrooke with a caring and respectful service. Recruitment is now carried out in a way that ensures that residents are protected from unsuitable staff being employed. There is an active programme of staff training to ensure that staff have the knowledge they need to meet the needs of residents properly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were sufficient staff on duty when we arrived to meet the needs of the people living in the home. The rota showed that staffing arrangements were satisfactory when the home is fully staffed. We observed that staff in all roles were busy throughout the day. Care staff appeared to mainly task oriented and did not seem to have much time to spend with the residents recreationally. The manager designate reported that there has been a large turnover of staff in the home over recent months. She is now satisfied with the staff group in place and feels that they need to move into a period of stability to build up team relationships and patterns of working. We spoke to some staff. They were enthusiastic, well motivated and were positive about the systems of work Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 24 that are now in place in the home. Residents and people visiting all said that they found the staff caring and helpful. During periods when they were short staffed some staff have worked two consecutive shifts to help cover staffing needs or agency staff were brought in – they were usually able to get the same people on a regular basis. The manager designate acknowledged that there were a number of areas where she has identified that improvements in practice are needed within the home and that she would like to have already made changes. She indicated that she had put a lot of energy into setting up a committed and conscientious staff team and that she had given this priority over some other areas of practice. We looked at three staff files including one for a person newly recruited to the home. These files were not well organised which made it difficult to confirm some information. The recruitment and selection procedures for the newly recruited person were satisfactory. Those for people recruited previously were not sufficiently robust to make sure that residents were protected from the employment of unsuitable people. The manager designate was aware that previous employment practice did not meet the required standard. When staff start to work in the home they go through a period of induction. There was insufficient evidence to confirm that this was to the induction standards set by Skills for Care, the sector training agency. Training is not up to date in all areas and the manager has set up a programme to remedy the short falls. The training plan in place for this year that makes sure that staff will have the opportunity to take mandatory training. There has already been a significant amount of training over recent months and on the day we visited staff came into the home to register for further NVQ training. A number of staff have completed Level 2 and were registering for Level 3, whilst further staff registered to start their Level 2. There was also Food Hygiene training provided in house in the afternoon with ten staff attending. In addition to mandatory training most staff in the home have completed a dementia care course to help them understand how to meet the needs of people with dementia illnesses. There are other specialist areas where staff need some training for example in issues related to diabetes. Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 25 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, 36 and 38. Quality in this outcome area is adequate. The manager designate is working hard to develop a level of service that provides good outcomes for people who live in Bluebrooke. There are aspects of how the service is provided that need further attention to achieve this aim. Health and safety is managed in a way that means the residents are kept safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is no registered manager in post. The manager designate, Ms Cindy Crawford, has not yet submitted an application for registration in this capacity and must do so promptly. She said that the responsible individual for the company, Mr Simon Badland, supports her in her role, and that he visits the home regularly. She was not aware of him, or another representative of the Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 26 company having completed a monthly report under the requirements of Regulation 26. In circumstances where there is no one carrying legal responsibility for the day to day running of the home it is particularly important that the company is informed of the conduct of the home. Staff told us that they have confidence in the man designate. They said that she always had time for them if they approached her with a question or a problem. They also said that the running of the home was more structured and that they had confidence in the way it was managed. The manager designate has a significant number of ideas, practices and record keeping procedures that she was able to tell us about and that she wishes to implement in the home. A number of these are detailed in the text of this report. In view of the amount of shortfalls we question whether there is sufficient management time for the smooth running of he home. The manager designate confirmed that staff at the home do not have any involvement in the residents finances. Arrangements are in place for the family or a representative to take responsibility, where a service user lacks capacity or does not wish to be involved. A small petty cash float is held for incidental purchases, and appropriate records are maintained. There is no active quality monitoring taking place in the home. The manager said that she was aware that this needed to be done and that she had documentation to enable this to take place but had not had the time available to set it up. The monthly reports by the responsible individual would contribute to this process. A formal procedure for the supervision and appraisal of staff has not been developed. This is an area that the manager has identified needs more work. Again the manager reported that staff meetings have not been held regularly because of lack of time to set them up. The home is operating on interim policies and procedures whilst new ones are developed. We did not read the documents that the home is using. It is important that this area is addressed promptly so that there are clear written guidelines about expectations for practice and conduct in the home. We looked at a sample of records (such as lifts, call bells and gas installations) for the servicing and maintenance of equipment in the home. These confirmed the information in the AQAA that these are carried out regularly. The recording in the fire log indicates that the required checks and tests are carried out with appropriate frequency. The home has received guidance about updating their fire risk assessment. Staff received training in fire safety in October 2007. Those employed since that time have completed induction Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 27 training with the manager or her deputy. However neither of these people have completed the training they need to equip them to carry out this training. The accident record was well maintained using suitable forms. The manager has prepared a form for monitoring of fall and accidents in the home but has not yet brought it into use. Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 28 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 1 1 2 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 X 3 Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 29 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 OP9 Regulation 13 Requirement You should ensure Medicine records for the administration of medication must correctly document what has been administered or record a reason why it was not administered in order to ensure that the people who use the service are safeguarded. Controlled Drug (medication requiring special storage and recording arrangements) records must accurately document the amount of medication stored within the service to ensure that legal requirements are met. Care plans should document up to date medication records. This is in order to ensure that medication records for people who use the service are accurate. You should develop a range of social activities so that residents have the choice of whether to be involved in an active social life and stimulation in the home. The manager designate must submit an application for DS0000057561.V362845.R01.S.doc Timescale for action 31/05/08 2 OP9 13 31/05/08 3 OP9 13 31/05/08 4 OP12 12 31/08/08 5 OP31 8 31/08/08 Bluebrooke Residential Care Home Version 5.2 Page 30 6 OP31 26 registration in this capacity. This is so that we can assess whether hey are qualified, competent and experienced to run the home on a day-to-day basis. A representative of Oldfield 30/06/08 Residential Care Ltd, the service provider, should visit the home at least once a month and prepare a report following this visit. This is to report to the company on how the home is functioning and to identify whether they need to take any action to improve the quality of the service. 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. Refer to Standard OP1 OP2 Good Practice Recommendations You should have a copy of the Statement of Purpose and the Service Users Guide fully prepared and available to provide to any prospective service user at all times. You should ensure that each person living at the home is given a Contract or a copy of the Statement of the Terms and Conditions of Residence. This recommendation is repeated from the inspection carried out on 23rd May 2007. You should ensure that there is a more consistent approach to planning the care of each resident. More detailed information should be provided to ensure that their personal and healthcare needs are fully met. This recommendation is repeated from the inspection carried out on 23rd May 2007. You should make sure that each resident and their family is involved in the planning of the care to be provided. You should make sure that each persons plan of care is reviewed regularly so that the guidance about the care to DS0000057561.V362845.R01.S.doc Version 5.2 Page 31 3. OP7 4. 5. OP7 OP7 Bluebrooke Residential Care Home 6. 6. OP8 OP9 8. OP9 9. OP9 10. 11. 12 OP9 OP9 OP30 13 OP8 14 OP33 be provided is up to date. You should make sure that you carry out comprehensive risk assessments when bed rails are in place so that the risk of accident is reduced when they are used. A system should be introduced to ensure that accurate medicine audits can be done and check that people who use the service have been administered medication according to the directions of a General Practitioner. The medicine policy should be reviewed and updated in order to ensure it is specific to the service and that the health and welfare of service users taking medication are safeguarded A system should be introduced which demonstrates that medication is stored at a safe temperature in order to ensure that people who use the service are protected from harm. A system should be introduced to ensure that medication is stored in a safe and tidy manner. A safe system for transporting medication to residents should be introduced to ensure safe medication handling. You should make sure that the induction for care staff in the home complies with the standards set down by Skills for Care so that staff cover all the basic areas needed to work in the home. You should make sure that care staff have the training they need to identify people who have developed or are at risk of developing pressure sores so that the right action can be taken to treat these. The quality assurance system should be implemented fully to ensure that the home is run in the best interests of the people who live there. This recommendation is repeated from the inspection carried out on 23rd May 2007. The supervision of care staff should be undertaken by the manager, and cover care practice, the philosophy of care in the home and career development needs This recommendation is repeated from the inspection carried out on 23rd May 2007. Systems should be put into place to take the temperature of water where it comes out of the tap on a regular basis and to record this so that residents are not at risk from temperatures that are too hot. 15. OP36 16. OP38 Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Bluebrooke Residential Care Home DS0000057561.V362845.R01.S.doc Version 5.2 Page 33 - 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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