CARE HOMES FOR OLDER PEOPLE
Brabyns House 98 Station Road Marple Stockport Cheshire SK6 6PA Lead Inspector
Sylvia Brown Unannounced Inspection 13th & 24th October 2006 10:30 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 Brabyns House DS0000008542.V314793.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. Brabyns House DS0000008542.V314793.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Brabyns House Address 98 Station Road Marple Stockport Cheshire SK6 6PA 0161-427 4886 0161 427 4886 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) Mr John Arthur Odell Mrs. Kathryn Joan Odell Mrs Lynette Anne Stainton Care Home 39 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (39) of places Brabyns House DS0000008542.V314793.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 39 OP and up to 5 DE (E) Date of last inspection 16th January 2006 Brief Description of the Service: Brabyns House is a large, detached property situated adjacent to Marple locks and canal. Local shops, parks, public houses and restaurants are all close by, enabling service users to independently, and with support from family and staff, visit places of interest. The home is owned by Mr Odell, who takes an active interest in the home and visits each week to undertake an assessment of the building and to consult with the manager. The home is well maintained in both the communal and private parts of the building used by service users. Service users have the use of four lounges during the daytime and evening. There are two dining rooms, one of which overlooks the rear gardens and is enjoyed by service users at all times of the day and evening when, after meals, it is used by service users who play cards and dominoes. Twenty-one of the 31 single bedrooms have en-suite facilities. The home offers four double bedrooms to those service users who prefer to share. The fees for accommodation range from £385 to £530, depending on the accommodation available. Service provision is the same and not dependant on fee structure. The home also implements a top-up fee which ranges from £15 to £204 per week. Individual fee structures should be discussed and agreed before a decision about accommodation is finally made. Brabyns House DS0000008542.V314793.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection site visit to Brabyns House was unannounced and completed over two days. The site visit was conducted as part of the overall inspection process of the home and concentrated on all the key standards and the home’s progress towards meeting the requirements made at the previous inspection. On the first day of the inspection the registered manager was not present at the home. As a consequence, the deputy manager who was on duty made herself available and provided the inspector with all the required records. Time was spent with service users during a meal time and they were also provided with comment cards, as were relatives and staff. Where applicable and relevant, comments received have been included in the report. Comments received after writing this report will be included in the report of the next key inspection. On the second day of the inspection, time was spent with the registered and deputy managers discussing aspects of the home and providing feedback of the outcome of the inspection. Time was also spent in a staff meeting where staff discussed issues arising from medication administration practices. What the service does well:
The home continues to provide a high standard of accommodation for all service users. Public and private parts of the home are of equal standard and all areas have good quality fixtures and fittings. The home is consistently maintained to an extremely high standard of cleanliness. One relative commented, “I thought the home was beautifully clean and no peculiar smells.” Whilst another stated, “We were impressed even on the second visit by the cleanliness of the home and supportive staff who constantly work to keep the home clean. There are no awful smells.” Service users are able to live as they wish and are well supported to maintain their health. Activities appear to be appropriate to meet the needs of those who wish to join in. One service user stated “There are several activities that have been arranged and we are being informed early of the arrangements.” Another said “I am aware of the activities which are arranged by the home and in which I can participate if I wish. To date I have not had time to do so and appreciate the fact that I am not under any pressure to take part.” Such comments indicate that service users are able to make their own decisions and choices and are able to live as they desire. Brabyns House DS0000008542.V314793.R01.S.doc Version 5.2 Page 6 Meals and mealtimes are enjoyable times, with service users commenting favourably about the meals. A service user appreciated that they could choose the portion sizes and that there was always fresh fruit available in a bowl for people to take when they wished. Service users and relatives were, in the main, happy with all the services and support provided at the home. Many positive comments were made about the management and staff team. A service user stated “I visited and was made to feel very welcome by the deputy manager and staff team and I am grateful to say that family and friends are made to feel welcome”. Another: “I continue to be very grateful for the quality of the care that I receive here and for the reliability and kindness of the manager, her deputy and staff team.” What has improved since the last inspection? What they could do better:
Brabyns House has yet to complete a full quality assurance audit which ensures that all stake holders, including service users, relatives, staff and professionals, are able to make an evaluation of the services and conduct of the home. Furthermore, Regulation 26 visits have yet to commence, which ensure that the registered provider monitors records and services within the home each month. Medication administration records were not maintained to the required standard. There were signature omissions and a lack of monitoring procedures. Such practices could place service users at an increased risk if an actual error occurred without timely detection. Brabyns House DS0000008542.V314793.R01.S.doc Version 5.2 Page 7 The home’s pre-assessment procedure needs to be developed to ensure it is sufficiently detailed to enable an accurate evaluation to be made by the home as to whether it can or cannot meet the assessed needs of the service user. Best practice should also ensure that prospective service users are formally notified in writing by the home regarding whether they can or cannot meet their assessed needs prior to them making a decision about moving in. 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. Brabyns House DS0000008542.V314793.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 Brabyns House DS0000008542.V314793.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 4. Standard 6 is not applicable to this home. Quality in this outcome area is good. Service users have their needs assessed prior to moving into the home. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The home completes a pre-assessment for all prospective service users. Of the two looked at, both were found to have minimal information or information absent. There is no concern however regarding the home knowing or meeting the needs of service users but pre-assessments must be thoroughly completed in order that the home can accurately evaluate if it can meet the needs of the service user. The home should also develop the practice of formally recording and informing service users and/or their relatives about the outcome of the assessment and if they can or cannot meet those assessed needs. Brabyns House DS0000008542.V314793.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. Service users have their health care needs met and were treated with dignity and respect. Improvements are needed in maintaining medication administration records. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Two service users’ care files were looked at. Since the last inspection, the home has introduced new care planning systems which have yet to be developed. Basic information was evident, however details regarding service users’ full needs and individual preferences have yet to be included. Service users and relatives commented favourably on all the care received. Chiropody, dental and optical services are provided routinely and when required. Doctors and district nurse services support the home and ensure that the medical needs of service users are kept under review. Brabyns House DS0000008542.V314793.R01.S.doc Version 5.2 Page 11 Medication administration records indicated that medications had been reviewed and changes signed for by the prescriber. Evaluation of the medication administration records identified signature omissions on a number of occasions. It was also evident that monitoring systems were not in place to identify errors in a timely manner. Without exception, all service users spoken to stated they were well treated and that staff were respectful. Staff were observed being polite with service users throughout the inspection. They knocked on doors and awaited a response prior to entering service users’ bedrooms. Personal care support was given discreetly, as was assistance at meal times. Brabyns House DS0000008542.V314793.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. Service users are able to live as they wish, making their own decisions and choices. They receive a varied diet which offers choice. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Service users spoken with stated they were satisfied with their lifestyles. They are able to develop their own daily routines, rising and retiring when they wish. They decide for themselves where they spend the day and are able to join in activities when they want to. Comments received from service users indicated that they felt there were enough activities provided, however staff’s comments indicated that additional activities or daily occupation would be appreciated by some service users. The home displays activities and future events and, at the time of the inspection, Christmas arrangements were underway. Brabyns House DS0000008542.V314793.R01.S.doc Version 5.2 Page 13 One service user stated that “recently a number of school children have visited from a private school and sang lovely and brought presents.” And “a gentleman comes and plays tapes and sings and outings are arranged by a minister.” The home’s visitors record detailed service users’ visitors entering and leaving the home. Visits can take place in private and drinks and light snacks are available during visiting times. Relatives stated that were made to feel welcome by staff and were able to visit when they wished. A number of service users continue to visit the community and remain in contact with friends outside of the home. Service users continue to have a well balanced diet which offers choice and variety. There have been some staffing changes in the kitchen which, for a time, reduced the consistency in standards, however further changes have been made which has again enabled a consistently good standard of service to be provided. One meal time was observed during the inspection. Service users were offered choice and additional servings of food. Vegetarian meals are available, as are special diets. Brabyns House DS0000008542.V314793.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. Service users know of the home’s complaints procedure and feel able to talk with someone when they are dissatisfied or have concerns. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The has written complaints procedures in place and records looked at confirmed complaints received were recorded. Three of the four relatives’ comment cards indicated that they were aware of the home’s complaint procedures. One relative stated they had used the home’s complaint procedure in the past. Staff continue with their training, which includes adult protection. Policies and procedures are in place, as is a whistle blowing policy. Service users’ comments confirmed that they had someone to talk to if they were unhappy or had concerns. Brabyns House DS0000008542.V314793.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25 & 26 Quality in this outcome area is excellent. Service users live in an environment which is well decorated and homely. Their safety is compromised by the wedging open of bedroom doors. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The home remains furnished to a good standard with a high standard of hygiene. Service users gave high praise about the cleanliness of the home, with one stating “The home is beautifully clean by dedicated cleaners who constantly work hard to keep all rooms and the corridors and stairs in excellent condition.” There were minor repairs needed in some areas of the home but, overall, standards are maintained. Brabyns House DS0000008542.V314793.R01.S.doc Version 5.2 Page 16 Lounges and dining rooms were appropriately furnished, with new curtains being fitted in one dining room. A number of residents prefer to remain in their rooms rather than sitting in communal areas of the home. Rooms are decorated and furnished to a good standard, offering service users comfort. For those remaining in their rooms, their bedroom doors were observed to be wedged open. This issue was noted at the last inspection and was again raised with the registered manager. The registered manager stated that increased fire safety precautions are in place, however arrangements are being made to provide either independent door retainers or the fitting of magnetic closures that are linked to fire safety systems. Laundry facilities were clean, with good hygiene standards. Clothes are separated into appropriate washing cycles, with bedding and kitchen items being kept separate from woollens and service users’ general clothing. Bathing and toileting facilities were maintained appropriately, though the rooms are not as personally decorated as other parts of the home, they offer safety to service users. Staffing notices were on display which further minimised the homely affect. Servicing records were in place for hoists and the lift. Equipment is provided for those who need additional support. The grounds of the home are maintained to a good standard with service users continuing to sit out on the front porch in fine weather. Brabyns House DS0000008542.V314793.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. Service users are supported by sufficient numbers of staff who are trained and competent. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The home’s rota indicated the staffing levels were sufficient to meet the needs of service users, though staff stated they would like more staff on duty, particularly in the morning. The home has a management structure of registered and deputy managers and senior carers who all take the lead for each duty and support care assistants and direct ancillary staff. All but two of the staff care team have completed NVQ training at level 2 with some achieving level 3. Observations throughout the inspection were that staff were attentive and supportive to service users. When asked how they felt treated and if staff were available to them, service users commented, “Most of the staff listen and taken notice”. One said that, in their opinion, “there are enough staff and I have always found the management and staff at the home helpful and caring.” Brabyns House DS0000008542.V314793.R01.S.doc Version 5.2 Page 18 Recruitment and selection procedures are followed, however the home does not currently record the interview process or provide letters of appointment to successful candidates. Such practices ensure that procedures are formalised and that they are fair. Mandatory training continues and is repeated to ensure staff have up to date training. Brabyns House DS0000008542.V314793.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. Brabyns House is a well run and managed home, however effective quality assurance procedures are not in place. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The registered manager has had difficulties completing her NVQ training at level 4 due to changes with tutors, however the issue has now been resolved and a timescale for completion of the training, including the Registered Manager’s Award, has been agreed for spring 2007. Brabyns House DS0000008542.V314793.R01.S.doc Version 5.2 Page 20 The home has not completed full quality assurance audits as outlined in Regulation 24 and Standard 33. Currently, the home does not consult with service users as a group nor does it formally seek the views of relatives, staff and professional visitors to the home. Notwithstanding that, service users’ comments received at inspection and through comment cards identify that they are generally satisfied with all aspects of the home and with the way it is managed. Health and safety records were looked at. Fire safety records were up to date and detailed that equipment was serviced and monitored appropriately. There are also systems in place for ensuring all staff have practical fire drill training within a six month timeframe. As stated previously, some service users’ doors are wedged open which places service users at increased risk. Accidents are recorded and information retained within the individual files. Analysis is completed which has enabled a doctor to accurately prescribe and alter medication for one service user. Brabyns House DS0000008542.V314793.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 2 X x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 4 4 X 4 4 4 4 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 X X 2 Brabyns House DS0000008542.V314793.R01.S.doc Version 5.2 Page 22 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 Timescale for action 25/10/06 2 OP19 13 & 23 The registered person must ensure medication administration duties are completed as required and comply with the Royal Pharmaceutical Society’s Guidance The registered person must 15/02/07 make suitable arrangement to protect those service users who wish their bedrooms doors to be retained open which will protect their safety in the event of a fire emergency. Brabyns House DS0000008542.V314793.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP3 OP4 OP15 Good Practice Recommendations The registered person should ensure that all preassessment documents record the outcome of all the assessed needs of service users in detail. The registered person should ensure that service users are formally told if the home can or cannot meet their assessed needs. The registered person should provide service users with the opportunity of meeting as a group to talk about their satisfaction with all service provision and other aspects of the home. The registered person should undertake a full assessment of the home’s showering facilities to determine if they are suitable to meet the needs of the residents. The registered person should ensure that the home’s interview process for staff is documented and that staff receive appropriate letters of appointment. The registered person should ensure that statutory Regulation 26 visits are undertaken. The registered person should ensure that a quality assurance audit is undertaken which seeks the views of all stake holders, including service users, staff, relatives and visiting professionals, and a public report produced, a copy of which is provided to the CSCI. 4 5 6 7 OP21 OP29 OP33 OP33 Brabyns House DS0000008542.V314793.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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