Inspection on 23/05/07 for Bluebrooke Residential Care Home

This inspection was carried out on 23rd 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bluebrooke Residential Care Home 20/04/09

Bluebrooke Residential Care Home 04/12/08

Bluebrooke Residential Care Home 23/04/08

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

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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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bluebrooke Residential Care Home 242 Stourbridge Road Catshill Bromsgrove Worcs B61 9LE Lead Inspector Rachel McGorman Unannounced Inspection 23 May, 13 June & 19 July 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bluebrooke Residential Care Home DS0000057561.V340857.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.V340857.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 Mrs Carole Ann Hutchinson 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.V340857.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 5th June 2006 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, who may have a physical disability, or who may have mental health problems. The home has a high proportion of service users who have a dementia illness, and may also accommodate three people under the age of sixty five who have dementia. 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 an 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 now has several homes in the group, and is continuing to expand. Mrs Carole Hutcinson is the registered care manager, and has responsibility for the day-to-day running of the home, with regular support from the Provider, and other managers in the Oldfield group. The range of fees varies between £360 and £390 per week. The stated aim of the home is to ensure that all the care provided within the home is personal and unique, that each individual is treated with the utmost respect that ensures their privacy, and that high professional standards are maintained in every way. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of this routine key inspection, was to monitor the care provided at the home, to assess how well the service meets the needs of the people who live there, in relation to the stated aims and objectives, and to follow up previous requirements and recommendations. Preparation for the inspection included viewing previous reports, and documents relating to the home, and considering the various contacts made with the home since the last inspection. Three unannounced visits were also made to the home, and took approximately 4 hours on each occasion. One of these included consideration of several concerns that had been brought to the attention of the Commission. Discussions were held with the registered manager, Mrs Carole Hutchinson about her role, and the management of the home. The inspector also spoke at length with the deputy, who was in charge during one of the visits. The proprietor and managers from other homes in the group, who provide support and assistance to Bluebrooke, were also at the home during one of the visits. Relatives, and visitors to the home at the time of the inspection, were asked for their views of the service and the care that is provided, and surveys were also circulated to ten people. The experiences of professionals when visiting the home were sought, and these included the NVQ Assessor, the District Nurse and the Reviewing Officers. Time was spent with several residents, discussing with them what it is like living at the home, and observing their interactions with staff. The care records of five residents were checked in detail for case tracking purposes. During conversations with staff, comments were made about their experience of working at the home, and several staff files were also seen in relation to recruitment practices, and to confirm the training and supervision provided. The records were checked during the course of the inspection, including those required for the protection of residents, and those relating to the business and to care practices. The Medication Administration Records were also seen. The inspector was able to speak briefly with the staff member responsible for the maintenance of the building, and to check the records relating to the servicing of equipment, and to health and safety matters. A tour of the premises was undertaken, and the ongoing maintenance, various improvements that have been implemented, and the future proposals for the development of the home were discussed with the management. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 6 What the service does well: A warm welcome is given to visitors, and the atmosphere is relaxed and friendly. The residents who were spoken to said they were comfortable and very happy to be living at the home. Information about the service, and what can be provided at Bluebrooke, is available to residents, their families, and other interested parties, in the Statement of Purpose for the home and the Service Users Guide. The policies and procedures relating to the administration of medication and the training provided for staff help to ensure that residents are protected. There is a commitment from the staff team to providing good care, and comments from residents confirmed that this is achieved, and that they are satisfied with the care received. The involvement of friends and relatives at the home is actively encouraged, and everyone with whom the inspector talked were very positive about the home and the service provided. The arrangements regarding the provision of food reflect the preferences of each resident, and everyone was complimentary about the meals. The provision of a nutritious and wholesome diet helps to maintain the health of residents. A satisfactory complaints procedure has been produced and is implemented at the home, in a clear and open manner. A record is also kept of comments that are made about the home, which helps to give a balanced view of the service that is being provided. The building is generally well maintained, and the house is clean and comfortable, with good quality furnishings, which enables residents to live in a pleasant environment that ensures as far as possible their safety and security. The National Vocational Qualification (NVQ) training programme is in place at the home, and additional care related training is also provided for staff, which should enable them to provide a good standard of care for residents. Support continues to be provided to the Registered Manager by the Responsible Person and also managers from the other homes in the group. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Further review of the Statement of Purpose and the Service Users Guide should ensure that the information provided is more detailed, and therefore can more effectively assist prospective residents and their families to make an informed decision about their future care. A copy of the Terms and Conditions of Residence or a Contract should be provided to all residents, to ensure that each person is aware of their rights and responsibilities in regard to their occupancy at the home. The need for a more consistent approach to the assessment process is needed, prior to admission, to ensure that the care needs of each person living at the home can be met appropriately. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 8 A satisfactory admission procedure is in place, although this needs to include more detail about dealing with emergency admissions to the home, to ensure that the procedures are always implemented appropriately. A more consistent approach to the care planning and risk assessment processes should be developed. The care plans are generally completed to a satisfactory standard, and include the relevant assessment of risk, but some need more detailed information to show that the care needs of each resident have been clearly identified, to enable staff to provide appropriate care. Referrals to the placing authority for review of the changing needs of residents should be made at a much earlier time than is the current practice, to ensure that the personal and health care needs of residents continue to be met. Relevant training and closer supervision should be provided for staff who have limited experience, and who lack an understanding of the issues relating to privacy, dignity and respect. The appropriate deployment of the Activities Co-ordinator will provide more leisure opportunities for residents, develop greater involvement in the local community, and enable each person to do the things they enjoy. Further training for some staff is needed to ensure that they fully understand all the issues relating to abuse and the protection of vulnerable people, to enable them to more effectively care for everyone living at the home. The areas of the house that experienced flood damage, the repairs identified in the maintenance survey, and the inadequate water supply to some parts of the building, should be responded to immediately, to ensure that appropriate living standards are maintained for residents. The need for improvement in several other areas was also identified, and work is ongoing to upgrade the premises, and to develop the services and facilities that can be provided at the home. The advice of an occupational therapist would enable the management to provide appropriate equipment and facilities to maximise the independence of people living at the home. Further training for staff in moving and handling techniques and in the use of lifting equipment and hoists, should ensure that staff are competent, and that the safety and welfare of residents is assured. The staffing arrangements at the home should be regularly reviewed, to ensure that an adequate number of staff are on duty at all times to meet the needs of residents, that staff are suitably trained, and that they also have the relevant experience to provide the care that is needed. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 9 Residents will be better protected by the recruitment procedures at the home being implemented more rigorously. Specifically, two written references, a health declaration and a photograph should be obtained for all applicants. The reasons for the high number of staff changes that have taken place should be identified by the management, and appropriate action taken to improve the stability of the team and to provide a more consistent approach to the care of the people who live at the home. 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. Formal supervision is now provided for care staff, although the format does not specifically cover care practice, philosophy of care in the home and career development needs, neither is it being undertaken by the Registered Manager. The management should ensure that Notifications under Regulation 37, which requires reports to be sent to the Commission of the death, injury or serious illness of a service user, or other events in the home, are submitted to an acceptable standard and contain relevant information. 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.V340857.R01.S.doc Version 5.2 Page 10 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.V340857.R01.S.doc Version 5.2 Page 11 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, 5 & 6 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is provided for prospective residents, to assist them in making a decision about living at the home, but more detailed information when made available, will help them to know if they are making the right decision. The pre-admission assessment is now more specific in relation to the provision of care for people with dementia, to ensure that the home is able to meet their identified needs more appropriately. The admission procedure provides a satisfactory introduction to the home for service users, although a more detailed procedure for emergency admissions would be of benefit to all concerned. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 12 EVIDENCE: The Statement of Purpose for the home, and the Service Users Guide for residents have been reviewed to reflect a recent change in the name of the home, and to provide prospective residents with information about the home and the care that can be provided, which should then help them to decide if the home is likely to be suitable. Discussions with the manager identified additional information that needs to be included, to ensure that the home complies fully with the National Minimum Standards. A written contract/statement of terms and conditions of residence, is issued to new residents when admitted the home, although some people who have lived at Bluebrooke for a longer period of time said they had not been given this information. The matter was discussed previously with the management of the home, who agreed, at that time, that the situation would be rectified, therefore immediate attention should now be given to providing all residents or their representative with a copy of their agreement for residence with the home. A pre admission assessment for all prospective residents is undertaken, either at home or in hospital, following an initial referral, and the care plans seen by the inspector provided evidence that these assessments can be very detailed and informative, with all the relevant information recorded. The inspector also found that some records were less well completed, and therefore a clear picture of the needs of the resident was not easily available. Consequently, a satisfactory standard of care for that person would be less likely to be provided. The need for a more consistent approach to the assessment process is therefore identified, to ensure that the care needs of each person living at the home are appropriately met. The need for a detailed assessment of the specific needs of people who experience dementia had been discussed with the manager previously, and it was pleasing to note that this is now being implemented. A satisfactory admission procedure is in place, although this needs to include more detail about dealing with emergency admissions to the home, to ensure that the procedures are always implemented appropriately. A visit to the home is encouraged, and prospective service users are invited to spend time with the resident group and to have a meal. Arrangements may also be made for a short stay, if this is preferable, prior to making a decision about living at the home. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 13 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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans contain relevant, but limited information, therefore more detailed records need to be maintained, to ensure that the personal care needs of residents can be fully met. The health care needs of residents would be met more effectively by making referrals to the placing authority in a more timely way. Risk assessment procedures enable the needs of each person to be identified, and ensures their safety and protection as far as possible, and also encourages their independence. The policy and procedures covering the administration of medication ensure the protection of residents. Many staff demonstrated a good understanding of the needs of residents, and offer care in a way that encourages and promotes their independence, but some do not fully understand the issues relating to dignity and respect. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 14 EVIDENCE: A plan of care is produced for each resident based on the initial assessment undertaken prior to admission, and the information provided is relevant, although more detail is needed. Specifically, all interventions with residents need to be recorded, and the plans define how the care is to be implemented, the outcomes that are intended and the future proposals for the individual. The individual plans of care for five residents were examined in detail, and some evidence was seen of further development and improvements in some parts of the process, but this was not found to be consistent. The health and personal care provided to a resident will be based on their identified needs, which, when recorded in the individual plan of care, informs staff about how the resident should be cared for, therefore a detailed record is essential. Concerns about the lack of detail in some care plans were discussed with the care manager, specifically, one relating to a resident who was sleeping on a mattress on the floor. The information was not sufficiently detailed, and did not adequately record the reasons, although these were legitimate. In addition there was limited evidence of consultation with the family, or professionals who may have been able to assist with the management of this difficult situation. The content of one care plan was more informative, and covered both short term and long term care needs. A ‘monthly dependency assessment’ had been completed, although not every month, and as some of the comments were repetitive, the extent of the review could not be determined. The daily report referred to ‘nursing’ care, which is not appropriate, and this document should therefore be amended. The content of the daily log was variable, and seemed to depend on who wrote it that day - some comments were quite brief, while others were very informative, and some were just repetitive. The medical records gave a detailed account of the involvement of the GP and the District Nurses, and also any visits to hospital, the treatment provided and the ongoing needs of the resident, which were specifically identified. Risk assessments were completed for moving and handling, nutritional needs and tissue viability, and there was also a specific risk assessment for dealing with episodes of agitation sometimes experienced by the resident. The care plan of another resident recently admitted to the home had been completed well, although again the information was quite brief. Relevant aspects relating to the persons care needs were covered, and a body map had been completed noting a leg injury that had been treated appropriately. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 15 The care plan of a resident who had lived at the home for several years, and was recently admitted to hospital was seen. The information relating to the care needs of this person had noticeably increased over recent months, and the care plan provided evidence of a gradual deterioration in the general health of the resident. The terminology used at times in the daily report demonstrated a lack of professionalism and showed a limited understanding by some staff, and had not been identified by senior staff or addressed with the carers. A formal review of residents, whose care is funded by the Local Authority, is undertaken annually by a Reviewing Officer from the Social Services Department, to ensure that the assessed needs of each person can be met at the home. Concerns were identified at a recent review regarding the care of a resident, who should have been referred to Social Services, by staff at the home. Discussion by the reviewing officer with the inspector, and the findings during the review process confirmed that referrals to the placing authority, for a review of the changing needs of a resident, should be made at a much earlier time than is the current practice, to ensure that appropriate health, personal and social care needs of each individual are met effectively. Staff were observed administering medication to residents, and the correct procedures were being followed. The Medication Administration records were checked, and had been completed to a satisfactory standard. The deputy manager holds responsibility for the administration of medication at the home. The inspector was told that a training course for senior staff on the administration of medication is planned, and that training for all care staff is to be arranged with the local pharmacist in the near future. Evidence to indicate that residents are treated with dignity and respect was observed in the interactions of many of the staff with the people they are caring for, but there was also a lack of awareness by some staff that their actions may not be acceptable, and this was also confirmed in discussion with them. E.g. two members of staff were using a commode in the bedroom of a resident, to toilet another resident, instead of using the communal facilities or the residents’ own room, which was upstairs. The deputy manager said she was unaware of this practice, and that it would be stopped forthwith. Commodes are used quite extensively throughout the home, including some bedrooms with en-suite facilities. The care manager agreed to undertake a review of the situation, with the involvement of residents, and to monitor the future use of commodes. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 16 Further examples of a lack of respect were overheard by the inspector in the terminology used by some staff when speaking to residents. Terms of endearment can be considered by some people to be patronising, and indicate a condescending approach to that person, therefore all residents should be addressed by their preferred name, which is noted in some care plans. The comments made to the inspector by residents were each positive and include the following: • • • • • • • • Staff are always kind to me Everyone is very caring in their way I wouldn’t want to change anything This a nice place They look after me very well The staff are lovely I have a lovely room and a comfortable bed I’m very happy here Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 17 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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The absence of a co-ordinated programme of social and cultural activities, which is suited to the individual needs of residents, limits the opportunities available to them, and consequently affects their quality of life. Residents have freedom in regard to their contacts, both within and outside the home, which is beneficial to them, although more involvement with the local community would be desirable. The practices at the home enable residents who are able, to exercise choice and control over their lives. Residents are offered a choice of nutritious, wholesome and well-balanced meals. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 18 EVIDENCE: There has been some development in regard to the recreational needs of residents, specifically during the afternoons, to providing various activities. These may include a sing-along, bingo, card games, dominoes, skittles, hand massage, and reminiscence sessions, and entertainers are also arranged from time to time, the inspector was told. The leisure needs of people with dementia and other cognitive or sensory impairment, had been discussed previously with the management of the home, and in order for appropriate and effective responses to be made, staff need to have an understanding of the specific needs of each person. Dementia Awareness training was recommended, but remains outstanding. The appointment of an Activities Co-ordinator should have improved the leisure opportunities available for residents, although staff shortages have prevented further progress, as the person appointed has been deployed on night duty, until additional care staff can be recruited. The need for a recreational programme, that includes activities in the community, to be developed and implemented, was again identified, to ensure that the social, cultural and recreational interests of residents are met. The involvement of family and friends is encouraged, and visitors said they are always made welcome at the home. Professionals spoken with during the inspection, including the District Nurse and the NVQ Assessor were very complimentary about the care provided to residents. Several other people were visiting the home with whom the inspector had a chat, and they were also impressed with the services provided, and about the kindness of staff. The following views were expressed: • • • • • • • • • • • • • I can go home feeling mother is well looked after Mother has not been here very long but so far everything is fine We are always made to feel very welcome We are delighted with the care given here We cannot speak too highly of the staff – they do a great job The care is excellent, and mom can be very difficult My observations have been positive The care practices of staff are satisfactory There is a good atmosphere here There have been improvements in several areas in recent months Staff are responsive to requests Communication is good The information provided is relevant Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 19 Comments from the surveys sent to relatives were also very positive, although a common concern was, ‘the lack of activities, and the need for much more stimulation for everyone living at the home’. The general opinion was, ‘that the home is a happy place, the staff are very caring and do an excellent job in a demanding environment, the management are very helpful and communication with them is good, the atmosphere is always welcoming and staff are bright and cheerful’. The people who live at the home are encouraged to exercise choice, as far as they are able, about when to get up or go to bed, and how they wish to spend their day. The activities of daily living are flexible and residents are encouraged to express their views, and to retain as much control over their lives as they are able. The catering arrangements at the home are satisfactory, and comments about the meals were all very good. The menus cover a three weekly period and confirmed that a choice is offered, and that alternatives are also available. The lunch today consisted of boiled ham or omelette, with chips or mashed potato and carrots, peas or broccoli, followed by bread and butter pudding and custard or semolina. Special diets can also be catered for, and at the moment these are mainly for residents who are diabetic, the inspector was told. The preferences of each person are recorded, and a record of the food provided to individuals is also maintained at the home. A visit was made to the kitchen, which is large and airy, and very clean and functional. Several new cupboards had been fitted recently, and discussions with the catering staff confirmed that there is no shortage of food or equipment and that everything is in good working order. The inspector was also told that the Environmental Health Officer, ‘had been impressed with the improvements in the kitchen’, when visiting the home earlier in the year. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 20 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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure is implemented at the home, in an open manner, to ensure the protection of service users. The policy and procedures that are in place at the home, in relation to abuse, should provide protection for the people who live there, and who may be vulnerable, but further training for some staff is needed to ensure that they fully understand all the issues relating to abuse and protection. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 21 EVIDENCE: A satisfactory complaints procedure has been produced and is accessible to residents and their families. A record of comments and compliments received by staff at the home is also maintained. The following remarks were recorded: • • • • • • • • • The care you provide is second to none The home should be proud of its dedicated staff Thank you so much for everything The kindness and patience of staff is appreciated We are so grateful for all the support Thank you for all the loving care The staff work together as a team Everyone is always so friendly You do make a difference The remarks from a GP about the high standard of care provided to one of his patients had also been recorded. A complaint had been sent to the Commission recently, from someone who wishes to remain anonymous. The relevant issues were discussed with the care manager during recent visits to the home, as part of the inspection process, and include the following: • • • • • • • • The welfare of residents Some residents are not being cared for properly Several people wander a lot and have falls There is no stimulation for residents There are not enough staff They have no medical training Night staff have to do laundry and cleaning The management of the home Several concerns have also been brought to the attention of the placing authority and to the Commission, about some aspects of the care provided to residents at the home during the past year, and further issues have been identified during the reviewing process. The management have responded to all these concerns very professionally, and have worked to resolve them in an open and cooperative manner. The findings in regard to all these issues have been taken into account and included in the body of the report. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 22 The policy and procedures on the Protection of Vulnerable Adults (PoVA) have been reviewed and amended, as previously requested, to include the procedure to be followed in relation to staff who may be unsuitable to work with vulnerable people. All staff are given training on abuse awareness as part of their induction package, and this is also covered during NVQ training, to increase their understanding of the issues relating to the protection of vulnerable people. In addition several staff have attended courses specifically relating to PoVA, and a further training course is planned in August. Observations made during the inspection and conversations held with several members of staff confirmed that some have a clear understanding of the various aspects of abuse, while others are less aware and therefore further training is needed to enable them to more effectively care for all residents living at the home, and also to ensure that each person is protected from abuse. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 23 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): 19,21,22,24 & 26 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a pleasant environment that is clean and comfortable, and that ensures as far as possible their safety and security, although this needs to be constantly monitored. The décor and furnishings are in good condition, and the building is well maintained. The programme of improvement and upgrading of the home is helping to enhance the quality of life for the residents who live there, although not all the work has yet been completed. Consultation with a qualified person, and further work to the gardens at the home will help to improve the facilities available for residents throughout the home. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 24 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. The home complies with the National Minimum Standards in many respects. The following upgrading and improvement work has been undertaken during the last 12 months: • • • • • • • • • • The entrance hall, passageways and stairs on the ground floor have been painted and new carpets fitted The laundry has been redecorated Additional storage has been provided Advice sought from the fire safety officer regarding fire exits that are accessed through shared bedrooms has been implemented on the second floor The dining room has been fitted with new flooring, and new dining tables and chairs have been provided Several bedrooms have been redecorated and new curtains and carpets fitted New furniture has been provided in some bedrooms Improvements have been made to some toilets A new wet room has been installed New fencing has replaced the old hedging in the garden Further improvements are planned with the ongoing redecoration of bedrooms, completion of work in the garden to create a secure area, and reconsideration of the ratio of single to double bedrooms. The work that remains outstanding from previous inspection visits was discussed with the management of the home, who confirmed that it remains part of the maintenance programme and includes: • • • • Approved door locks to be fitted to all bedroom doors Lockable furniture to be provided for in all bedrooms Refitting and upgrading of the bathrooms Guarding of radiators and pipe-work Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 25 The condition of a bathroom on the first floor of the home was of concern to a relative, who referred the matter to the Social Services Department and to the Commission. He had found water on the floor from a leak through the ceiling, and also reported that there was no hot water to the wash hand basin, neither was there any toilet paper available. The inspector checked this room during a visit to the home and discussed the findings with the manager, who explained that the recent torrential rains had caused a problem with the roof of the building, and that this bathroom, and the one on the floor above, should not have been in service at the time. There have been ongoing problems with the hot water supply in this part of the home, which is also affecting several bedrooms, and contractors have been investigating the cause recently. She confirmed that the roof has been repaired, the water supply will be rectified in the near future, and that the two bathrooms will not be used until they have been upgraded. The Reviewing Officer advised the Commission of the outcome of a recent review of the care needs of a resident, when concerns had been identified with manual handling practices at the home in relation to the increasing frailty of the resident. Advice was provided on different types of hoist, and that the Community Occupational Therapist should have been contacted previously for advice and assessment The inspector also advised that an assessment of the premises and facilities by a suitably qualified person, e.g. an occupational therapist, would assist in the provision of appropriate equipment for individuals living at the home. In addition further training in moving and handling techniques and the use of lifting equipment and hoists, should ensure that staff are competent, and that the safety and welfare of residents is assured. The Care Manager confirmed that regular maintenance and servicing of equipment is undertaken, and that everything is in good working order. Contracts are in place, and the records seen during the inspection are well maintained with all the appropriate certificates available. Staff confirmed they are familiar with the procedures regarding the control of infection, and also that they have been given training in health and safety matters. An inspection of the premises was undertaken, and most areas of the building were found to be nicely decorated and well furnished, and the bedrooms seen were comfortable and had been personalised to a good standard. The home was clean, and there was no malodour, although some toilets were stained and the surface of some baths was worn. In addition the following concerns were noted: Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 26 • • • • • • • • • Bedroom doors were not all fitted with approved locks Some locks were not functional The closures were broken on some doors Several doors were not closing on to the rebates The water supply was limited in several wash hand basins The water temperature was variable to some wash basins The plug was missing from several wash basins The hinges were broken on some doors Some were squeaking loudly and could cause annoyance These matters were discussed with the manager, who said that the person responsible for the maintenance of the premises had recently been asked to do a detailed survey of the home to identify where improvements were needed, and that these were to be implemented in the near future. She confirmed that urgent attention will be given to all these areas to ensure that the safety of residents is promoted, and that a well-maintained environment is provided for them. A further concern discussed with the manager was in regard to the maintenance hours for the home having been reduced recently. Clear evidence was found during the inspection, of the need for ongoing attention and upgrading to both the internal and external areas of the home, which are very extensive. In addition the house, with its various extensions, the grounds and also the maintenance of equipment, require constant and intensive input in order to ensure that a satisfactory standard is achieved at all times. The Care Manager agreed that this matter would be brought to the attention of the provider for immediate reconsideration. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 27 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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The dependency of each person living at the home needs to be reflected in the number and skills of the staff who are employed to meet their assessed needs. The training programme for staff needs to ensure that each member of staff is competent, has a clear understanding of their role, and therefore is able to deliver care appropriately. Procedures for the recruitment and selection of staff need to be sufficiently robust in their application to fully ensure the protection of residents. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 28 EVIDENCE: The staff rotas were seen and the care manager considered that care staffing levels are adequate for the needs of residents. However, the Activities Coordinator is not being deployed in the role to which she was appointed, there is not always a senior member of staff on night duty, and on further discussion it became evident that the senior status of staff is not necessarily related to their training and experience. Additional concerns were also identified during discussion with the care manager, who said that the number of domestic staff and also the hours of the person responsible for the maintenance of the building have been reduced recently. The need for these matters to be urgently reviewed and resolved, to ensure that the people who live and work at the home are not affected adversely by these decisions, and that the level of cleanliness and hygiene, and the building and equipment are maintained to a satisfactory standard, was agreed by the manager. The home also has had some difficulty in retaining staff, although there are no vacancies on the day shifts at the moment, but the management are advertising for night staff. There has been an increase in the number of staff changes at the home, and during the last twelve months a total of twenty-nine staff have left. Approximately half of these worked at Bluebrooke for less than a year, and 12 staff left within 6 months of commencing their employment. The management were advised to explore the underlying cause for this high incidence of change. Several staff were interviewed, and confirmed that they are given training and supervision, and also that they enjoyed working at the home. They were all enthusiastic and well motivated, and there was an obvious commitment to their work, although some were very young and with limited experience. The need for the awareness of some staff to be raised, about the issues relating to privacy and dignity, and also matters regarding abuse and protection was evident, and this was discussed at length with the management of the home. One member of staff, whom the inspector had met on a previous visit to the home, having joined the staff team only recently at that time, has been given various opportunities to develop her practice, and also her career, during the last twelve months. She was delighted to have completed the NVQ Level 2 in Care course, and was now going on to do Level 3. She said she was glad to be working at Bluebrooke, and confirmed that she felt supported in her work by the management. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 29 Seven members of staff are doing the National Vocational Qualification Level 2 in Care, and eight carers have completed the course. Two senior staff are doing NVQ Level 3 in Care, and the Registered Manager is undertaking Level 4, together with the Registered Managers Award. Three domestic staff have achieved the NVQ Level 1 in Cleaning and Support Services. The inspector was able to speak with the NVQ Assessor who was visiting the home during the inspection, and she confirmed that the NVQ training programme at Bluebrooke is ongoing. Her comments were positive about the observed practices, and about the enthusiasm of the staff, and also that the atmosphere at the home was always pleasant and welcoming. A record is maintained of the training undertaken at the home, and includes both statutory and care related courses, but the need for an individual training and development assessment and profile, to identify the training needs of each person was discussed with the care manager. The records indicate that ‘core’ training has been provided for staff in health and safety, basic first aid, fire safety, basic food hygiene, and moving and handling. In addition, some staff have attended care related training sessions on the administration of medication, dementia care, infection control, and abuse awareness. Further training is planned for the coming months, the inspector was told, and includes Person Centred Care, Dementia Awareness, PoVA, Health & Safety, and Risk Assessment. A satisfactory recruitment and selection policy and procedure is in place at the home, although it is not always followed. The files of several members of staff were seen, but they did not all contain the relevant documentation, although a more detailed approach to recent appointments was evident. Some references provided limited information about the applicant, whilst others did not have two written references, and did not always include one from the previous employer. Evidence of identity had not always been confirmed, and a photograph of the person was not available. A health check had not always been completed, neither was the interview always recorded. Criminal Records Bureau checks had been undertaken, for all staff employed at the home. The Registered Manager was advised that the recruitment procedures at the home should be implemented more rigorously, to ensure the safety and protection of residents, and the need for a stable staff team to be employed at the home, was also discussed. In addition, the management of the home should ensure that all care staff understand the issues relating to the care of older people, have an awareness of the needs of residents with dementia, and also be able to communicate well, both verbally and in writing, to ensure that the needs of each person living at the home can be met appropriately. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 30 Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 31 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 & 38 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements at the home are satisfactory, and residents and staff benefit from the leadership they receive. The quality assurance system, when fully implemented, should ensure that the home is run in the best interests of the service users. The records maintained at the home, comply with legislative requirements, and therefore help to safeguard the rights of service users, although the standard of some records could be improved. The health, safety and welfare of service users and staff is promoted in respect of all safe working practices Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 32 EVIDENCE: Bluebrooke Residential Care Home, previously known as Catshill, was purchased in 2004 by Oldfield Residential Care Limited, a company with several other homes in the area. Mr Simon Badland is the Responsible Individual. Mrs Carole Hutchinson, the Registered Care Manager, has responsibility for the day-to-day running of the home. She has been employed by the Company for the last eighteen months, and prior to that had worked in the care industry for over 20 years, initially as a care assistant in a nursing home, and more recently in a management role in the Primary Care Trust. She has extensive experience in working with older people, and those who have dementia and other mental health problems, and has also supported people with Parkinsons Disease. She is currently undertaking the Registered Managers Award, which should be completed within the next six months. A quality assurance system is being introduced at the home, but has not yet been implemented. The Mulberry System has been purchased, the inspector was told, and surveys and questionnaires for residents and their relatives are being prepared and will be circulated in the near future. The management of the home confirmed that staff do not have any involvement with the financial affairs of service users. 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. The records regarding health and safety were not all checked in detail during the inspection, although those seen had been completed to a satisfactory standard. A health and safety policy and procedure is in place, and all staff are trained in safe working practices. Contracts are in place for the regular servicing and maintenance of equipment. The Fire Log indicated that regular practice evacuations, and weekly checks of the fire alarm system are undertaken. The Fire Risk Assessment for the home has been completed. The Accident records are well maintained, and notifications are made under Regulation 37, which requires reports to be sent to the Commission of the death, injury or serious illness of a service user, or other events in the home. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 33 The Care Manager was advised that not all these forms had been completed to a satisfactory standard, and therefore the procedure should be reviewed. The following issues were identified: • • • • • • • • • All notifications need to be checked for accuracy The form is not always completed correctly Relevant information is not always provided The full name of the service user is not always included The time if the incident is not always noted The outcome is not always recorded on the form Information about the cause of death is not always given The writing is often not legible An incorrect form has been used on occasions Formal supervision sessions have been implemented for care staff, and this was confirmed by the inspector in conversation with staff, but the format does not reflect the process recommended in the National Minimum Standards, and cover care practice, philosophy of care in the home and career development needs. In addition supervision should be undertaken by the manager to ensure that the process is effective and that the supervision is appropriate. The manager agreed that she will review the way in which staff are formally supervised. Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 34 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 2 2 X 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 2 1 X 2 X X STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 35 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 OP18 Regulation 13(6) Requirement Training must be provided for staff to give them a clear understanding of all aspects of abuse and to ensure the protection of residents Recruitment procedures must be implemented rigorously to ensure that residents are protected. Training must be provided for staff in moving and handling techniques and the use of lifting equipment and hoists, to ensure their competence, and the safety and welfare of residents. Timescale for action 31/12/07 2 OP29 19 30/09/07 3 OP38 18(1)(c) 31/12/07 Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 36 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP1 OP2 OP3 OP5 OP7 Good Practice Recommendations Further review of the Statement of Purpose and the Service Users Guide to provide more detailed information should be undertaken to ensure full compliance The management 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 A more consistent approach should be implemented in the assessment of all prospective residents, to ensure that the home is able to provide appropriate care The admission procedure should include more detail about dealing with an emergency admission to the home, to ensure that the process is always properly implemented A more consistent approach to planning the care of each resident should be introduced to include more detailed information to ensure that their personal and healthcare needs are fully met Referrals to the placing authority for the changing needs of a resident to be reviewed should be made much earlier, to ensure that they continue to receive appropriate care The management of the home should ensure at all times that residents are treated with respect, that their dignity is preserved, and their right to privacy observed To protect the dignity of the individual, the use of commodes in en suite bedrooms should be reviewed in consultation with the resident, to confirm that there is an ongoing need The Activities Co-ordinator should be deployed in the role for which she was appointed and organise a programme of recreational activities for residents Opportunities for more involvement with the local community should be made available to service users The upgrading and development of the premises should continue, and appropriate attention be given to any malfunction within the home to ensure the comfort and safety of residents is maintained The advice of an occupational therapist should be sought, to ensure the provision of appropriate equipment and DS0000057561.V340857.R01.S.doc Version 5.2 Page 37 6 7 8 OP8 OP10 OP10 9 10 11 OP12 OP13 OP19 12 OP22 Bluebrooke Residential Care Home 13 14 15 16 17 18 OP27 OP30 OP30 OP33 OP36 OP38 facilities to maximise the independence of residents The staffing arrangements at the home should be regularly reviewed, to ensure that an adequate number of staff are on duty at all times to meet the needs of residents The training programme for staff needs to ensure that each member of staff is competent, that they understand their role, and are able to deliver appropriate care. An individual training and development assessment and profile should be provided for each member of staff to identify training need of each person 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 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 Notifications regarding an event that adversely affects the well being or safety of a resident, should provide accurate and detailed information and include the outcome Bluebrooke Residential Care Home DS0000057561.V340857.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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. 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