Inspection on 27/06/06 for Brackens The

This inspection was carried out on 27th June 2006.

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

Brackens The 03/03/09

Brackens The 16/07/07

Brackens The 18/10/05

Brackens The 05/10/04

Brackens The 21/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

Tudor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Brackens The The Brackens 5 Elm Road Beckenham Kent BR3 4JB Lead Inspector Wendy Owen Unannounced Inspection 10:00 27th June 2006 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 Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 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. Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Brackens The Address The Brackens 5 Elm Road Beckenham Kent BR3 4JB 020 8658 6343 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 Serge Jhurry Mrs Prunjodee Jhurry Mr Serge Jhurry Care Home 9 Category(ies) of Dementia - over 65 years of age (1), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Old age, not falling within any other category (7) Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th October 2005 Brief Description of the Service: This is a registered care home for 7 people in the category of old age, one mental disorder and one dementia/learning disability. The current Registered Provider is also the Registered Manager. The home was first registered 29th August 1997 to the current owner. The Brackens provides care and accommodation in a family like setting. The home is an adapted building located in a residential area of Beckenham, close to local shops and Beckenham Town centre. The accommodation is located on three floors accessed by stairs only. This makes it difficult for service users with mobility problems. Staff are available throughout the 24-hour period. Mr Jhurry, the Registered Provider / Registered Manager, is on site five days a week working as part of the care team. In addition, he provides the on call cover when he is not on duty. Health provision is provided through the local Primary Care Trust. The GP is in the same street and the visiting district nursing service is provided through the surgery. The pre-inspection questionnaire details charges from £385-£450 per week. The charges include accommodation, staffing and meals. Information relating to the home is provided in the home’s Statement of Purpose and Service Users’ Guide. Contracts are provided on admission. A copy of the inspection report is available on request from the home. Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over the course of one day with two inspectors undertaking the inspection. The inspection included written feedback from five residents and four relatives; verbal feedback from one relative and discussions with a group of residents; viewing of records; tour of the home. What the service does well: What has improved since the last inspection? The Manager now maintains a daily record of the food provided and has, since the last inspection, ensured adequate insurances are in place. Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 6 What they could do better: Whilst the feedback from residents and relatives was very positive, the inspectors found a number of shortfalls in the service. The main concerns centred on the environment, with a number of health and safety issues that must be attended to. The home is not complying with its category of registration with regard to a recently admitted resident. This is currently beng addressed by the Provider. The Commission has sent a letter to the Provider detailing the breach. The Statement of Purpose needs to be amended to fully reflect the care the home provides and how it is to be provided. The pre-admission procedures, whilst good in some areas, still have significant shortfalls, including the assessment records and lack of information in relation to the individual’s property on admission. This is also evident in gaps in the care planning records. These were not fully reflective of the care needs of the individuals and lack any meaningful assessment of risk. The medication practices must also be improved to ensure that the residents’ health needs are not put at risk. The residents confirmed they enjoyed the food provided and had some choice in what was provided. However, records maintained by the home did not reflect the menus produced to the Commission and showed little variety for the weeks viewed. The recruitment practice is not robust enough with gaps in many of the checks required. This places vulnerable residents at risk. The written feedback showed that the activities and stimulation provided concentrated on mental stimulation. The inspectors noted there were few external or physical activities and no entertainment brought into the home. Residents generally went outside the home to attend appointments and this was, in the main, with their family member, acting as escort. There were a number of issues which required addressing as a matter of health and safety and action must be taken to address the redecoration and refurbishment requirements. The Provider must also review the use of communal areas in relation to the tenants who also live on the premises. Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 7 Infection control practices were inadequate. There was no evidence of gloves or aprons being available. This was also true of hand-washing facilities, such as paper hand towels. There was evidence of some staff receiving some core training, although the benefits of this were not evident. The lack of evidenced comprehensive induction programme, including moving and handling by a competent person, places both the residents and staff at risk. Staff are not sufficiently trained and failed to display sufficient knowledge and understanding of all the specific categories for which the home is registered for, specifically dementia and mental health. The home has a complaints procedure which needs a little amending to ensure people have the correct information. Whilst the number of staff are adequate, the Manager’s care role is integral to the provision of care as a carer and Manager. The Commission has concerns that if the Manager is absent, the staff have insiffcient knowlsge and experise to manage the home and to make decisions in his absence. Staff are not formally supervised. There is still a lack of independent review on the quality of care provided by the home. This must be addressed to ensure there is an objective perspective about the care provided. 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. Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 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 Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 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): 1,2,3,4,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The admissions assessment procedures, whilst adequate, do not reflect the home’s category of registration meaning that residents may be placed inappropriately. EVIDENCE: The Manager/Provider has produced a Statement of Purpose which also acts as a Service Users Guide. This is basic and needs to be further developed to ensure it provides full information on the care and how he intends to provide it. For example, it says the home will accept residents between 65 and 95. Whether the home transfers residents out beyond this age is not addressed. It also states there is adequate staffing but not the actual staff number nor does it detail the training undertaken by staff or the number of staff with NVQ. There are other gaps such as assessment and care planning procedures. The Provider has kept a copy of the Statement of Purpose in all residents’ files. However, the document would benefit from being in a larger print. All those residents who provided completed comment cards, stated that, they had received full information on the home prior to admission. Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 10 The home invites prospective residents for trial visits which may take place over a number of days. One resident commented that: “The manager came to my home for a chat about an hour. I visited the home nine times for tea or lunch before I came to stay.” The viewing of records showed there to be issues regarding compliance the registration category of the home. The home is currently registered for one resident with mental health and one with dementia. The remaining numbers reflect older people. This raises concerns about the assessment process. (See requirement 1) The inspector viewed the records of three residents including the records of the latest person admitted. There was evidence of some information being obtained from the care manager but no full assessment of needs and a lack of a full assessment by the Manager/Provider prior to admission. The assessment had no date or signature but appeared to have been completed on date of admission and contained very basic information. The file contained the CPA care plan developed by the care-coordinator who is responsible for overseeing the care. This reflected the mental health issues and lacked information on holistic needs. The staff were therefore reliant on basic information and word of mouth to meet the needs of the residents. There was no record of medication prescribed on admission. (See requirement 2& 3) Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected 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. This judgement has been made using available evidence including a visit to this service. Although improving, the variable practice regarding the planning and delivery of care means that all services users cannot be sure that their health and personal care needs will be fully met. Medication practices are adequate, although gaps in records may potentially at risk. EVIDENCE: Three records were viewed. One contained no care plan and a basic assessment. The daily log showed there to be some risks including behaviour which had not been recorded. The other two care plans were very basic and confusing to read. Where there was evidence of incontinence or mobility problems there was no record of aids used or health related issues affecting mobility such as rheumatism. There was no identified needs in respect of personal care issues or non -compliance with medication detailed in the care plans despite the daily logs showing evidence of this. There were review dates entered but no changes to the care plans had been made to reflect any changes to the assessed need. For example there is a Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 12 need to fully record health issues such as diabetes and how this is being managed. The care plans had been reviewed but there was little recorded input from either the resident or their family member. No resident expressed an interest in being involved and felt the staff understood their needs. Relatives made the following comments: “I do not know how often reviews take place and I have only attended one.” “I have not been involved on individual care plans for X but X seems happy.” (See requirement 4) Case tracking confirmed good practice with evidence from relatives and residents that their health needs are being met. The GP surgery is in close proximity and daily records show regular visits. The Chiropodist was attending to a number of residents on the day of the inspection and there was evidence of optical and hospital appointments. Family or care staff provide escort and all relatives feedback stated that the home communicated any health issues whether it is by phone or during a visit. However, staff have limited knowledge in some areas, leaving most of the health issues to the manager. This is a cause for concern especially when the Manager is absent from the home leaving residents potentially at risk with staff not being able to recognise health problems or not taking appropriate action. Three medication records were viewed, including that of the last person admitted. This record did not detail what medication; amount; date and person responsible for signing receipt of the individual’s medication into the home. The inspector also noted some medication that was due to be returned to the pharmacy, was loose presenting a risk of being used or taken. There is also a need to ensure full administration guidelines for “as required” medications. The records viewed were generally complete with full recording including allergies, correct use of codes when not administered and photographs in place. Some shelf life medication had been open but had no date of opening and had been prescribed November 2005. This medication had a timescale for use within 28 days of opening. (See requirement 6) The inspectors noted staff interacting with residents calling them by their preferred name. However, please note that the chiropodist carried out tasks in the double room on the ground floor which is occupied by a resident and that the space in the home was so limited that the inspectors were provided with the use of a residents’ rooms to use as a work place. (See requirement 5) Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 13 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 adequate. This judgement has been made using available evidence including a visit to this service. A limited range of activities within the home and community mean the service users do not have a range of opportunities to participate in stimulating and motivating activities. Meals and mealtimes are relaxed and an enjoyable part of the day, although there is a lack of variety at times. EVIDENCE: The inspectors noted that residents choose to spend time in their rooms reading or listening to music etc or in the main lounge watching TV. In the main activities provided are of an intellectual nature such as debates, crosswords or quizzes. One relative said that, “Activities are usually limited to watching TV, doing crosswords and chatting about current affairs.” Previous reports have commented on limited external activities or visits by entertainers or community groups. When asked about activities being offered; four said sometimes they are arranged and one said usually. No other comments were made, although it is evident from the records that external activities are limited and are in the main undertaken by family members. Staff on duty cover domestic and cooking tasks as well as general. Therefore the opportunities for other activities are limited. This must be reviewed Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 14 especially where one resident has had a lifestyle of going out into the community with staff support. (See requirement 7) Residents spoken to were generally happy with the routine being able to go to bed and get up when they like. There is some evidence of meetings taking place involving discussions about complaints; adult protection and meals provided. Most enjoyed the regular visits from the hairdresser. All feedback from relatives confirmed the welcoming approach of the home at any time of the day. Some relatives visit daily, others a number of times a week and some weekly. There is also evidence of friends visiting residents. “The Brackens operates a very flexible approach to visiting and I always feel welcome.” Said one relative. The written feedback from residents showed that; three always liked the meals and two usually. This was also confirmed during the inspection with the residents. However, records viewed showed that the meals provided did not reflect the menus developed. Over the last two weeks the records showed a number of chicken and minced or diced lamb. There was little variety. Residents spoken to felt the meals to be satisfactory and that they chose meals the night before with the manager saying what he is going to prepare and residents saying if they are happy with it. There was evidence of meals for other cultures and the home is currently addressing the issue of the preferred food to be provided for the latest resident. There was little sign of fresh fruit kitchen. The Inspector heard a resident request a cup of tea in their room and observed refreshments made throughout the day, including the afternoon with a little snack. Some residents have their meals in dining room, their room or the lounge where they are seated all day. (See recommendation 2) Residents are entered on electoral register and vote through the postal vote. Residents meetings are held every few months with general discussions regarding a variety of subjects. Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 15 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): 16,17 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users feel safe and listened to. However formal processes need to be further developed so that the home’s procedures are available, understood and consistently applied. EVIDENCE: The home’s complaints procedure was on display in the entrance hall. It was satisfactory, except for the out of date contact details for the CSCI. All residents who provided feedback stated that they knew how to make a complaint and who to speak to if they were not happy. There was also evidence of the Manager discussing complaints during a residents’ meeting. A relative spoken to also said they knew who to complaint to. However, there is so much daily communication any issues are resolved without going through formal procedures. The complaints book showed no complaints logged over the last year nor has the Commission or the local authority complaints department received any complaints. The home’s adult protection policies and procedures are limited and staff knowledge was basic. The Provider needs to develop procedures which can give staff information and guidance local to the home which also reflects the local inter-agency guidelines. Whilst the Provider/Manager has a satisfactory knowledge, there is a need to ensure staff have a fuller understanding of the types of abuse and what other agencies are involved in protecting vulnerable adults. (See requirement 8) Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 16 The regular relative contact and visiting also helps to ensure any abusive practices are highlighted and dealt with. There are issues with some residents presenting with challenging behaviour. The policies and procedures are limited and there is no evidence of challenging behaviour training. (See requirement 9) The home has a procedure in case residents go missing. This should contain information regarding providing a recent photograph and description of the resident and how they contact the relatives or next of kin in such circumstances. (See recommendation 2) Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements in décor and fixtures and fittings would provide service users with a more comfortable environment in which to live. A number of areas require repair or maintenance to ensure residents live in a safe environment. EVIDENCE: The home is generally of an adequate standard of decoration and well carpeted although the furniture in many areas, especially bedrooms, is outdated and mismatched. This has a negative impact on the home and diminishes the overall standard. One resident has no side table and lamp in their bedroom. Communal areas were adequate, serviceable and generally comfortable but the home, generally, is restricted for space. There is not room for all residents if they choose to be in the lounge. The dining room is located in the conservatory and there is not enough room for all residents to partake their meals in there, if they chose. The chiropodist was visiting the home on the day of the inspection and residents were seen in another resident’s room whilst they were Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 18 in bed. There is no hairdressing area available or room for GP examinations, if required. (See requirement 5) The kitchen units are tired and worn and consideration should be given to their replacement but the edging strip to the island work-top needs replacement. There has also been a leak in the kitchen roof which requires urgent attention. (See requirements 10 & recommendation 2). There were a number of areas which require urgent attention due to the potential health and safety risks they cause. The garden pond is uncovered with dangerous ornaments around the edge. This needs to be covered over and ornaments removed to make safe. The ramp to the conservatory is unsafe and must be temporarily made out of commission until it is repaired. The front rainwater pipe located on the left hand side of the porch needs fixing and the concrete riser to the front doorstep has fallen away and needs making good. (See requirements 11-13) At the top of the house there is a flat split into two which accommodates a family and another person. Two staff membes are empoyed via this arrangement to provide the on call service to the home at night, and another member of staff. There is no separate means of access and the garden is shared as are internal corridors. This places children and residents, potentially, at risk and may breach terms of the Providers insurance. (See requirement 14) The home is generally clean with the home having achieved a Clean Food Award from Environmental Health. However, a deep clean of this area is required each year. There is also a need to provide hand washing facilities in many of the areas such as the kitchen, laundry and bathrooms. Discussions with staff and a tour of the home also showed also a lack of personal protective equipment such as gloves and aprons. (See requirement 15) Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. The reliance on the knowledge and experience of the Manager means that, potentially, the quality and consistency of care may deteriorate in his absence. The recruitment procedures are not robust enough to fully protect residents. EVIDENCE: Four relatives provided written feedback with one verbal feedback on the day. They all stated that they felt the staff understood the needs of the clients, the home is adequately staffed and considered staff to be competent. All five of the residents written feedback confirmed staff to be available and understood their needs and they provided the care and support they needed and acted upon what they said. One relative said of the staff; “They definitely have a full appreciation of her particular needs.” However, discussions with staff highlighted gaps in their knowledge and understanding of residents’ needs with some inappropriate words used, possibly reflecting their limited understanding in relation to mental health and dementia. Staff spoken to were not aware of the diagnoses for two residents. It is evident that much of the knowledge and skills comes from the Manager with staff referring back to him on a number of things due to their limited knowledge and understanding (See requirement 16) Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 20 Discussions with staff also showed them to have a basic understanding of issues such as adult protection; fire procedures and dealing with accidents. Whilst the home provides induction to new staff it is difficult to determine the quality of the induction programme as it is a tick box list of headings. This needs to be more detailed to determine how competency is assessed and how emergency procedures are communicated to new staff. The Manager should investigate the use of the Skills Sector induction and foundation training information to ensure staff are fully trained. The inspector is also concerned about the lack of moving and handling training. Currently the Manager provides this during the induction period, although he is not an accredited trainer. (See requirement 17) It is evident that the Manager is working hard to ensure staff are trained with health and safety; infection control and medication training all having taken place over the last twelve months. However, the Manager must ensure that specific training for mental health and dementia training is provided to ensure an understanding of the needs of the residents with these diagnoses. (See requirement 17) The rosters showed that two people are on duty during the day and one on “waking night” and one “sleep in”. Staff also have to undertake kitchen, laundry and domestic tasks. The report has commented on the possible impact of this on various aspects of the care and environment. The Manager/Provider is also a member of the care team and provides a lot of the care hours. The Commission is concerned about the impact on the quality of care when he is on annual leave or for other reason, absent from the home for a period of time, especially where staff have limited understanding and knowledge and defer many basic decisions to him. (See requirement 18) The recruitment practices were raised as a concern during the last inspection and these have not improved. The files viewed had gaps in a number of areas. One had a Criminal Records Check from another organisation dated much earlier, there were no POVA checks carried out and some of the references were not appropriate. (See requirement 20) The home has progressed well despite a number of set backs with staff leaving the home who had been trained to NVQ 2 or above. The home currently meets the requirement to have 50 of staff trained to NVQ 2. Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. Whilst management arrangements are meeting the needs of the service without additional management support there is limited capacity for improvement. EVIDENCE: The Owner/Manager is a Registered Nurse with an up to date PIN. He has many years experience in the hospital setting and as Owner/Manager of The Brackens. However, the documents in realtion to his management exepreince and qualifications are still required. There are limited resources, there is no computer or fax etc and the office space is extremely limited and not a usable space. The policies and procedures are all written by hand, making amendments to these documents is very time consuming. The amount of time spent as part of the care team Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 22 also means lack of time spent on management of the home. Please note the comments in the previous staffing standards regarding the role of the carers. (See requirement 19) Previous inspection reports have highlighted the lack of quality assurance systems. Whilst the Owner/Manager is in close contact with residents and relatives, the service would benefit from an independent objective review on the quality of care. There is no evidence of any reviews or formal consultation with service users taking place. (See requirement 21) Staff receive limited formal supervision with none recorded on the three files viewed of recently recruited staff. The staff spoke of spoke of “supervisions” whilst working but no formal time for this to take place. This is needed, especially for new staff, to discuss areas such as training needs; practices; residents etc. (See requirement 22) Generally, the servicing of equipment and plant is satisfactory. A number of staff have undertaken and are currently undertaking health and safety training. This is good practice and covers fire; COSHH; moving and handling and risk assessments etc. However, please note the comments made in the staffing outcome regarding the knowledge and understanding of the staff in emergency procedures and ensuring core training is provided to staff before commencing on staff rosters. The inspector noted that there were some COSHH items stored in the kitchen units which were not kept locked. The residents’ records showed limited information on risks such as aggression and moving and handling and general risks within the home were also limited. (See requirement 23) Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 23 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 3 2 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 2 2 2 2 2 2 2 2 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 2 X X 2 Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 24 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 OP3 Regulation Requirement Timescale for action 01/07/06 2 OP3 Regulation The Registered Person must 24 ensure that admissions to the home comply with the home’s registration. 14 The Registered Person must ensure that all prospective residents are fully assessed prior to admission and comprehensive information obtained from the placing authority, if appropriate. 17 The Registered Person must ensure that the home maintains a record of the resident’s belongings on admission to the home. The Registered Person must ensure that the care plans developed reflect the identified needs and problems of the individual. Residents and relatives, where appropriate, should be involved in the developing of care plans and their subsequent review. The Registered Person must review their arrangements for visiting professionals to ensure DS0000006913.V291104.R01.S.doc 01/07/06 3 OP37 01/07/06 4 OP7 15 01/09/06 5 OP10 12 & 23 01/09/06 Brackens The Version 5.1 Page 25 6 OP9 13 7 OP12 16 8 OP18 13 9 OP18 13 10 OP19 23 11 12 OP38 OP38 23 23 13 14 OP38 OP22 23 23 that appropriate space and accommodation is provided which does not impinge on residents’ privacy. The Registered Person must ensure that the systems and practice for the safe receipt and administration of medication is improved. The Registered Person must make suitable arrangements for residents to access community activities and ensure appropriate activities are provided within the home. The Registered Person must develop comprehensive procedures for the protection of adults based on current good practice. This must include a Whistle-Blowing policy and staff must be provided with training in these procedures. The Registered Person must develop more comprehensive procedures in relation to the management of challenging behaviour, including aggression. Staff must be trained in how to manage behaviours identified. The Registered Person must ensure the edging strip to the kitchen units are repaired and that the leak in the roof is also repaired and redecorated. The Registered Person must ensure that the garden pond is made safe. The Registered Person must ensure that the ramp from the conservatory is repaired and deemed out of order until this time. The Registered Person must ensure that the concrete riser to the front doorstep is repaired. The Registered Person must ensure that the tenants living in DS0000006913.V291104.R01.S.doc 01/07/06 01/09/06 01/09/06 01/10/06 01/09/06 01/09/06 01/09/06 01/09/06 01/08/06 Page 26 Brackens The Version 5.1 15 OP26 13 & 23 16 OP27 18 17 OP30 18 18 OP27 18 19 OP31 16 20 OP29 18 the top floor flat are not using the homes access and communal areas. The Provider must ensure the home has adequate insurance in place for such circumstances. The Registered Person must ensure that there are appropriate hand washing facilities located around the home and that the kitchen undergoes a deep clean every twelve months. The Registered Person must ensure that staff have the appropriate knowledge and understanding of the residents identified needs. This must include training in relation to mental health and dementia. The Registered Person must ensure that staff are fully inducted into the home and a record maintained of the induction. Core training on emergency procedures and moving and handling must be provided during the induction. The Registered Person must employ a competent and experienced person to manage the home in his absence. The Registered Person must ensure there is a fax machine, in good working order, in the home. The Registered person must ensure that the appropriate checks are made on all new employees prior to the commencement of employment. This is an outstanding requirement with the timescale of 1/11/05 expired. The Registered Person must ensure that staff receive regular formal supervisions. DS0000006913.V291104.R01.S.doc 01/08/06 01/11/06 01/08/06 01/09/06 01/08/06 01/07/06 22 OP36 18 01/09/06 Brackens The Version 5.1 Page 27 23 OP38 13 The Registered Person must ensure that where there are identified risks in relation to the individual or the home, risk assessment detailing the risk and the action to be taken to minimise the risk are developed. 01/09/06 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 OP15 OP19 OP33 Good Practice Recommendations The Registered Person should ensure there is a variety of food on offer. The Registered Person should consider replacing the kitchen units. The Registered Person should investigate the implementation of a quality assurance system which would provide monitoring and auditing within the home. Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brackens The DS0000006913.V291104.R01.S.doc Version 5.1 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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