Inspection on 03/03/09 for Brackens The

This inspection was carried out on 3rd March 2009.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Brackens The 16/07/07

Brackens The 27/06/06

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 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Brackens The The Brackens 5 Elm Road Beckenham Kent BR3 4JB Lead Inspector David Lacey Unannounced Inspection 3rd March 2009 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 Brackens The DS0000006913.V374238.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. Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 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.V374238.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 7) Dementia - Code DE (maximum number of places: 1) Mental Disorder, excluding learning disability or dementia - Code MD (maximum number of places: 1) The maximum number of service users who can be accommodated is: 9 16th July 2007 2. Date of last inspection Brief Description of the Service: The registered provider of services at The Brackens is also the registered manager. The home was first registered in 1997 to the current provider. The Brackens provides care and accommodation in a converted older style building, which is located in a residential area of Beckenham close to local shops and the town centre. The accommodation is arranged on three floors accessed by stairs only. This can make moving around the home difficult for people with restricted mobility. All bathing and toilet facilities are shared, as bedrooms do not have en-suite facilities. The provider/manager is on site five days a week working as part of the care team, and also provides on call cover when he is not on duty. Health care 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 fees for this care home are £400 per week (this information given to CSCI in March 2009). The provider/manager confirmed there had not been changes in the ownership, management or service registration details for The Brackens in the 12 months before our inspection in March 2009. Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star, which means that people using the service receive an adequate service. The unannounced site visit for this key inspection was completed over one day. Six residents living in the home were spoken with and the care of three of them was looked at in detail. Discussions were held with the home’s manager and two members of staff were interviewed. Initially, the person in charge and later the provider/manager facilitated the visit. The site visit included a tour of the premises and sampling of documentation such as care plans and records of care provided, staff recruitment files, and policies and procedures. As part of the inspection, we carried out a survey by questionnaire of residents and staff members. The responses received by the time of writing this report have contributed to the evidence underpinning our judgements. The inspection included a review of information received about this service. Since our last key inspection, we carried out an annual service review of the home and have used findings from that review in planning this key inspection. At our request, the care home provided us with its annual quality assurance assessment (AQAA), which also informed the inspection. This self-assessment document focuses on how outcomes are being met for residents and also gives us some numerical information. The service had supplied us with its AQAA in August 2008. The provider/manager was invited to update this document before our inspection visit but declined to do so as he stated there had not been any changes. What the service does well: Encouraging people thinking about moving into the home to visit to see if it is the right place for them. Making sure residents’ health care needs are met. Treating residents with respect and upholding their privacy. Responding promptly to residents’ requests for assistance. Supporting contact with families and friends, where this is a resident’s choice. Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 6 Enabling staff members to complete NVQ awards, which are relevant to their work with people living in the home. What has improved since the last inspection? What they could do better: Improve aspects of the home’s environment. For example, the condition of the communal baths needs attention. The temperature of hot water from the bath taps must always be kept within safe limits. Our previous requirement to locate appropriate hand washing facilities in the laundry must be met. We have repeated this requirement twice and have now taken further action to ensure compliance. Make sure the tenants in the top floor flat are not using the home’s access and communal areas, and that the home has adequate insurance in place that covers this arrangement. Make sure testing of portable appliance safety and testing for Legionella is up to date. Offer residents the choice to have a lockable facility in their bedrooms. Consult each resident about a programme of activities that would meet their individual needs and preferences. This needs to include making suitable arrangements so that residents may be offered support to access community activities. Make sure that any staff members who may be in charge of the home understand how to follow local safeguarding procedures. Always sign handwritten changes to medication charts, preferably by two staff members to minimise the possibility of error occurring. Always comply with CRB and POVA check requirements before new staff members begin work in the home. Make sure the staff rota records accurately the staffing levels in the home. Consider keeping the menus under review to make sure they offer residents a nutritious and healthy diet. Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 7 Summarise the findings from quality assurance surveys into reports that can be made available to residents and other interested parties. 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. Brackens The DS0000006913.V374238.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 Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are assessed to ensure the home can meet their needs. People thinking about moving into the home are encouraged to visit to see if it is the right place for them. EVIDENCE: Needs assessments were seen in residents’ files. Residents spoken with whose placement had been arranged through a local authority had received care management assessments and the relevant local authority had reviewed most placements. The manager carries out pre-admission assessments to make sure the home can meet a potential resident’s needs. It was evident he had visited people either in their own home or in hospital to carry out an assessment of their needs before deciding whether the home would be suitable for them. Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 10 People thinking about moving in are encouraged to come and visit the home to have a look around, and meet residents and staff. They may bring family members and may stay for a meal if they wish. A resident said he had chosen the home with the help of his family. He said the manager had visited him in hospital to see what care he would need and told him about the home. All the residents responding to our survey confirmed they had received enough information about the home before they moved in so they could decide if it was the right place for them. One commented, “I have visited this place before, I like the home and the staffs and other resident who are very nice and polite”. In discussion with the owner/manager during feedback from the visit, he confirmed he understood clearly about the home’s registration categories and that they must be adhered to when deciding to admit any new residents. The Brackens does not offer intermediate care thus standard 6 has not been assessed. Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health care needs are met and residents are satisfied with the care they receive. Care records are satisfactory. Residents are treated with respect and their privacy upheld. Medicine administration is generally satisfactory, though a specific issue needs to be addressed. Residents and their families are supported well at the time of death. EVIDENCE: Care practices seen during the inspection visit were satisfactory and residents were positive about the care they receive. Seventy-five per cent of residents who responded to our survey stated they always receive the care and support they need, with 25 stating this is usually the case. A resident commented, “I’m quite happy with things as they are here and everything is done very nicely, that’s how I feel”. All respondents stated they always receive the medical support they need. A staff member responding to our survey Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 12 commented that what the home does well is to “care for the needs of the individual and try to make them happy and secure in their surroundings”. The care of three residents was looked at in detail through case tracking. Each had a care plan in place, which gave guidance to staff about meeting residents’ needs. Supporting risk assessments had been completed on care documentation seen. The plans seen had been reviewed regularly and there was some evidence that either residents or their representatives had been consulted about their care. Staff members responding to our survey stated they are always given up to date information about the needs of the people living in the home. One respondent commented, “Each service user has an upto-date care plan and any changes are recorded”. One resident’s mobility needs had changed in recent months following a change in medical condition. In discussions, the owner/manager confirmed his awareness of the circumstances in which a resident would need to be considered for an alternative placement because of mobility needs. This is particularly important, as the home does not have a lift to assist people to access the upper floors. A resident who uses a walking frame said she manages climbing or descending the stairs by holding on to the stair rails. She said a care worker always walks with her on the stairs in case she needs assistance. Residents spoken with during the inspection visit were well groomed and dressed appropriately for the time of year. Three residents spoken with separately said they have a daily wash in the sink in their bedrooms, and a bath each week. Two use the bath with manual hoist and said a care worker is always available to help them as needed, whereas the other resident uses either of the baths in the home. Please see further comments about the bathing facilities in the Environment section of this report. The home makes sure that residents have access to specialist health care services as they need. The home is in the same street as the surgery of the home’s GP. The GP visits the residents at the home regularly. A resident said the GP monitors his blood pressure regularly and keeps his medication under review. Other health care services that residents had received included optical and dental services. Appointments and their outcomes are recorded. Observations and discussions during the inspection visit showed that residents are treated with respect and that their rights to privacy are upheld. For example, staff interacting with residents called them by their preferred name and knocked on residents’ doors before entering their rooms. The home’ policy and procedures for medicine administration were readily available to staff. Staff confirmed they have to complete relevant training before they can give medication to residents. The medicine administration records (MAR) sampled for inspection were complete with no unexplained Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 13 gaps. It is good practice that two staff members sign handwritten changes on MARs, to minimise the possibility of errors occurring. On two of the three MARs seen, there were handwritten changes to add “when necessary” to prescriptions but no signatures at all to show who had written the amendments (see requirements). Medication was being stored safely. The home has a controlled drug (CD) cabinet but no CDs were being stored at the time of the inspection. No residents were self-medicating, and one said he prefers the home to look after his medicines. Residents said they get the right medication at the correct times. One commented that, “they give me my medications on time morning and evening – everyday”. The home’s policy for death and dying outlines how to care for people and their relatives in a respectful way during illness and at their death, including who to contact and when to send people to hospital. Residents are usually asked how they wish to be treated during illness and at the end of their life, including how to meet any particular religious or cultural needs. Two of the three care files seen had the person’s wishes at the time of their death recorded. Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported to retain some choice and control over their lives. A limited range of activities within and outside the home limits residents’ opportunities to take part in stimulating and motivating activities. Contact with families and friends is supported and visits are encouraged. Mealtimes are relaxed and an enjoyable part of the day. Residents are generally satisfied with the food offered but it sometimes lacks variety, and the home could do more to make sure it always provides a balanced and nutritious diet. EVIDENCE: Residents’ views about the activities at the home were mixed. Fifty per cent of residents responding to our survey stated there are usually activities arranged by the home that they could take part in, with 25 stating this is always the case and 25 that this is only sometimes the case. Comments included, “I like group discussion with staff and other residents – I do participate in indoor games sometimes” and “Apart from watching TV in the residents’ lounge, there are few other activities”. Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 15 The home’s AQAA stated, “There is a wide range of social activities list available”. When questioned during the inspection visit, the provider/manager confirmed there is no structured programme of daily activities but said that residents decide what they are going to do each day. There was no evidence that each resident is consulted about a programme of activities that would meet their individual needs and preferences (see requirements). It was apparent from records that external activities are limited and mainly organised by family members. A resident said she does not go out from the home anymore except to the garden in good weather. She said her family visits every weekend and that “I’m not bothered about going out anymore, I’m alright staying here”. Another resident said he gets out and about independently, for example, visiting family or friends and going to the local shops. Staff members cover domestic and cooking tasks when they are on duty as well as providing care to residents. This means the opportunities for staff to support other activities are limited. This needs to be reviewed, especially where a resident has been used to going out into the community but would now need staff support to do so (see requirements). Residents spoken with said there is normally a relaxed atmosphere in the home and they were happy with the routine of being able to go to bed and get up when they like. The home has a flexible approach to visiting and residents are welcome to have visitors at any reasonable time of the day. Some relatives visit daily, others a number of times a week and some weekly. There was also evidence of friends visiting residents. Residents responding to our survey were mostly positive about the meals at the home, with 75 stating they always like them and 25 that they usually do. Comments included, “very nice food” and “plenty food”. A resident told the inspector the food is good and commented, “they know our likes and dislikes”. Another resident said the food is usually satisfactory and that, although there is only one choice on the menu, staff will provide sandwiches on request as an alternative. Residents spoken with said breakfast is always cereals. Toast can be made in the kitchen but they did not get cooked breakfasts. Supper is usually sandwiches or “something on toast”. A resident said he could have a snack later in the evening if he chooses. There is always plenty to drink. Another resident stated a preference for more culturally appropriate food and greater provision of fresh foods. From observation and discussions, there is a reliance on non-fresh food with limited fresh fruit or vegetables. For example, the single choice for lunch served on the day of inspection was sausage, egg, chips and baked beans. There was no fruit openly available for people to help themselves. There was little evidence that menus were being kept under review to make sure there is a variety and choice of meals that offer a nutritious and healthy diet (see recommendations). Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 16 The home’s care workers do the cooking and have completed food hygiene training. In July 2008, the local environmental health department gave the home a 4 star rating (“very good”). Their report was seen during the inspection and it was understood from the provider/manager that the six action points in the report had been addressed. Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has policies and procedures for complaints and for safeguarding adults. Residents know how to raise any concerns and can have confidence they will be listened to and their concerns taken seriously. Training in adult protection has been made available though more needs to be done to make sure staff members fully understand how to follow safeguarding procedures. EVIDENCE: The commission has not received any complaints or concerns about this home since our last inspection, and we are not aware of any safeguarding alerts in relation to people living at The Brackens. The complaints log in the home did not show any complaints recorded and the provider/manager confirmed his statement in the AQAA that none had been received. The home’s complaints procedure was on display in the entrance hall. The content was satisfactory, except for out of date contact details for the commission. It was understood the procedure had not been made available in any alternative formats. All residents who responded to our survey stated that they knew how to make a complaint and knew who to speak to if they were not happy. One Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 18 commented, “I always speak to members of staff and they always listen to me and understand me”. Another stated, “If I have to make a complaint, I would ask for a hearing with the staff and the management or any other professionals”. There is a high level of daily communication, which means that any concerns are normally resolved without going through formal procedures. There is regular contact with relatives who visit the home. Staff members responding to our survey confirmed they knew what to do if a resident or one of their representatives raised a concern. The provider/manager stated he gives staff training in protecting residents from abuse, including at induction, and that this issue is also addressed through staff members’ NVQ programmes. Staff interviewed during the inspection confirmed they had completed training in adult protection. They showed basic understanding of their internal reporting responsibilities in relation to safeguarding the people in their care but would be reliant on the manager for following local procedures including liaison with external agencies. Given that staff members are sometimes in charge of shifts in the absence of the manager, this needs to be addressed (see requirements). The home has a policy and procedure for protecting residents from abuse, and also had a copy of the local (Bromley) procedures available. The home has a whistle blowing policy that staff confirmed they knew about. Please also see comments and requirement under standard 29 about CRB checks, as this is relevant to protecting residents and keeping them safe. Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 19 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, 22, 24, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is kept clean and tidy, with no unpleasant odour in communal areas. Residents are generally satisfied with their accommodation but further improvements in furnishings and facilities would provide them with a more comfortable environment in which to live. Some matters require repair or replacement to ensure residents comfort and safety. An unmet requirement about hand washing facilities has implications for infection control and we have taken further action to make sure this requirement is met. EVIDENCE: The home was clean and tidy on the day of the inspection, with no unpleasant odour noted in communal areas. Seventy-five per cent of residents responding to our survey stated the home is always fresh and clean, with 25 stating this Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 20 is usually the case. At the inspection, odour was present in one of the bedrooms though not evident outside the room. The provider/manager said the floor covering in this bedroom is due to be changed shortly in order to address the odour problem. The home is of an adequate standard of decoration and, since our last inspection, painting and decorating had been completed in some rooms, corridors, kitchen, toilets and bathroom. It was noted residents do not have lockable facilities in their rooms. A resident said he had a tin to lock away valuable items (see recommendations). Communal areas were adequate, serviceable and generally comfortable but the home is restricted for space. For example, there would not be enough room for all residents if they chose to sit in the lounge at the same time. Repairs had been carried out to the conservatory roof. It was understood the provider had applied for a grant to renew the main roof to the building but the grant had not been obtained so this work had not been undertaken. The provider assured the inspector the roof was effective but he had applied for the grant as the roof is old and renewal would be ideal. Our previous requirement to provide appropriate hand washing facilities in the laundry had not been met. This was raised with the provider/manager, as it is a repeated requirement with previous timescales of 01/03/07 and 20/12/07. The failure to comply has implications for infection control if staff members are not able to wash their hands immediately, especially after dealing with soiled laundry. At present, staff have to climb the stairs from the basement where the laundry is situated and use a sink in one of the ground floor toilets to wash their hands. Following the inspection visit, the CSCI held a management review and has sent a warning letter to the provider/manager to make sure the home complies (see requirements). Attention was needed to the bath on the upper floor. The bath panel was loose and needed replacement or repair. Some tiling around the bath was cracked, and there was bad staining around the base of the bath tap and in the bath beneath the tap (see requirements). Attention was also needed to the bath on the ground floor, as the bath enamel was worn away in several places with one area having rusted (see requirements). It is important these defects are rectified, as they make the baths unpleasant for residents wishing to have a relaxing bath, they are unhygienic, and some of them could lead to problems such as skin tears. The hot water from the tap in the bath on the upper floor measured 51 degrees centigrade, using the home’s thermometer. It is a mixer tap with shower attachment and the person in charge, in whose presence the measurement was taken, stated a member of staff mixes the water so it is not too hot for people. However, at least one resident uses this bath sometimes without help from staff. The measured temperature was above the acceptable Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 21 safe limit and the matter was brought to the manager’s attention so he could ensure it is addressed (see comments and requirement under standard 38). The home’s provision of bath and toilet facilities remained unchanged from the previous inspection. As noted in the Health and Personal Care section above, residents said they have a daily wash in the sink in their bedrooms and a bath each week. One resident commented it would be good to have the choice of a bath or a shower. There is a shower attachment to the bath taps, which is used only for hair washing while in the bath. A resident said the shared toilet facilities are acceptable but not ideal. It is necessary to share because the home does not have any en-suite facilities and sometimes there is no toilet available when this resident wishes to use one. These points were raised with the manager during feedback from the inspection for his consideration. There is a flat at the top of the house, which at the time of this inspection was accommodating two people. These tenants were not in the flat during the inspection visit but it was understood they provide the sleep-in service to the home at night, and it was said they have nursing qualifications (please see further comments and requirement under standard 29 about the sleep-in cover). There is no separate means of access to the flat, other than through the care home. The home had a certificate of liability insurance on display, valid till October 2009, but it was not clear whether this tenancy arrangement was within the terms of the insurance. A requirement has been made to ensure residents are not placed at risk by the terms of the home’s insurance being breached (see requirements). Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Suitably qualified and competent staff are employed to meet residents’ needs, though rotas do not record accurately the staffing levels in the home. Staff respond promptly to residents’ requests for assistance. Staff members are supported to undertake training that is relevant to their work and benefits residents. There are appropriate recruitment procedures, which must always be carried out to ensure they support and protect residents. EVIDENCE: It was evident from discussions and from examination of records that our previous requirement about staff training had been met. For example, staff on duty had training and experience in meeting the needs of people with dementia. Staff members responding to our survey stated their induction had covered what they needed to know to do the job when they started. They also stated they were being given training that is relevant to their role, helps them understand and meet people’s individual needs, and keeps them up to date with new ways of working. Half the staff respondents felt they always had the right support, experience and knowledge to meet residents’ different needs and half felt this was usually the case. Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 23 The home supports its staff to complete NVQ awards. The provider/manager confirmed his AQAA statement that 11 of 13 staff have NVQ 2 or above. Staff members interviewed during the inspection had either completed or were in the process of completing NVQ in care at level 3. A staff member said the provider/manager was “very supportive of my NVQ study and very helpful with it”. Staff said there are normally at least two people on duty for each day shift, and this was confirmed by further discussions and examination of staff rotas. Half the staff members responding to our survey stated there are always enough staff on duty to meet residents’ needs and half stated this is usually the case. Residents responding to our survey stated that staff are always available when needed. A resident told the inspector whenever she has to use the call alarm for assistance staff members always respond promptly. Residents responding to the survey confirmed that staff listen and act on what they say. The night staffing arrangement for this home is to have one waking staff member on duty and either one or two people sleeping in. The provider/manager stated the two people living in the upstairs flat provided sleep-in cover (and please see comments above in the Environment section). Their names were on the staff rotas seen but it was not shown what shifts they were working thus no sleep-in cover was shown on the rotas examined. This omission was discussed with the provider/manager at the inspection, as it needs to be addressed (see requirements). The home’s AQAA stated that “all staff CRB checked”, however it was evident at the inspection visit that improvement is needed in this respect. Staff members responding to our survey stated their employer had carried out checks such as CRB and references before they had started work. However, examination of a random sample of three staff files showed that all three staff members had started work on CRB disclosures obtained from previous employers rather than obtaining a new one through the home or a POVA First followed by a CRB check. This was raised with the provider/manager at the inspection visit so he could begin to take the action necessary to support and protect residents. He stated the home had experienced difficulty in finding a new ‘umbrella body’ for CRB applications but he had now made arrangements with one and would ensure enhanced CRB checks for these staff are obtained (see requirements). Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 24 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, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s provider/manager is experienced and has the appropriate skills to run the home. The home communicates well with residents and their representatives. An unmet requirement evident at this inspection did not reflect well on the running of the home. There is a need to summarise information about how people’s views are being taken into account into reports that can be made available to residents, their representatives and other interested parties. The health and safety of residents, staff and visitors is promoted though there are specific matters that need improvement. EVIDENCE: Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 25 The provider/manager is a qualified nurse who has maintained his registration. He has owned and managed this home for many years, and has an open management style. Since our last inspection, the home has appointed a deputy manager to assist the provider in managing the home and take responsibility in his absence. This is to be welcomed, as the staff team has appeared to rely heavily on the provider/manager. The deputy was on leave at the time of our inspection. Half of the staff members responding to our survey stated the ways they pass information about residents between staff, including the manager, always works well, and half of the respondents stated this is usually the case. All staff members responding to our survey stated the manager meets with them regularly to give support and to discuss how they are working. The home’s AQAA states the intention to “introduce new technology”. At the inspection visit, the provider/manager clarified this refers to his present efforts to gain basic competence in the use of computer software such as using email and the internet. The inspector indicated support for this initiative as it has the potential to benefit residents, for example, by the provider and his staff team being more able to keep updated about matters such as regulatory guidance from the commission. We look forward to hearing about progress with this intended improvement. Residents have regular meetings, which are recorded in a ‘meetings book’. The last one had taken place in January 2009, at which a new resident had been formally introduced to the other people living in the home. All had agreed to make her feel welcome and help her as they were able because she was feeling somewhat unsettled after moving into her new surroundings. From these meeting records, it was evident residents could voice their opinions, that their differences are respected, and that requests for change will be noted and acted on if possible. The residents spoken with and those responding to our survey were mostly satisfied with how the home is run. However, an unmet requirement that had already been repeated at our last inspection did not reflect well on the effectiveness of the home’s quality assurance arrangements (details of this requirement are given above under standard 26). A summary of the home’s satisfaction survey findings is needed, so the results can be published and made available to residents, their representatives and other interested parties (see recommendations). At our last inspection, we found that the home’s procedures protected residents’ financial interests. These procedures had not been changed. The home does not manage any resident’s finances, as residents either do this themselves or their families assist them with their financial affairs. At the time of this inspection, three residents were paying extra for hairdressing services. The home will keep a small amount of money on request to cover a resident’s day-to-day expenses such as this, which is topped up as needed by relatives or other representatives. Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 26 Some information about maintenance of the home had been given in the AQAA. During the visit, the inspector sampled the home’s documentation relating to health and safety, finding most items to be up to date and within the appropriate timeframes. However, there were some matters needing attention and these were raised with the provider/manager so he could begin taking action. Evidence was needed of up to date testing of portable appliances to ensure safety of residents and staff, and testing for Legionella so that risks to residents from this infection are minimised (see requirements). The bath hoist had last been serviced in March 2008. The home had a record dated September 2006 from a competent person that this item only needs annual servicing, as it is a manual hoist. As noted in the Environment section above, the hot water from the tap in the bath on the upper floor measured 51 degrees centigrade, using the home’s thermometer. It is a mixer tap with shower attachment and the person in charge stated a member of staff mixes the water so it is not too hot for people. However, at least one resident uses this bath sometimes without help from staff. The hot water temperature in the ground floor bathroom was 45 degrees, using the home’s thermometer. The measured temperatures were above the acceptable safe limit for total body immersion and the manager agreed to make sure the matter is addressed promptly (see requirements). Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 27 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 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 2 X 2 X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 28 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 OP26 Regulation 13 & 23 Requirement Timescale for action 31/08/09 2 OP9 13 3 OP12 16 4 OP18 13 The registered person must ensure that there is appropriate hand washing facilities located in the laundry. This is a repeated requirement with previous timescales of 01/03/07 and 20/12/07. We have taken further action to secure compliance. The registered person must 30/04/09 ensure handwritten changes to medication records are always signed, preferably by two staff members to minimise the possibility of error. The registered person must 30/04/09 ensure each resident is consulted about a programme of activities that would meet their individual needs and preferences. This needs to include making suitable arrangements so that residents may be offered support to access community activities. The registered person must 30/04/09 ensure that any staff members who may be in charge of the home understand how to follow DS0000006913.V374238.R01.S.doc Version 5.2 Brackens The Page 29 5 OP19 23 6 OP19 23 7 OP22 23 8 OP27 17 9 OP29 19 (Sch2) 10 OP38 13 11 OP38 13 12 OP38 13 local (Bromley) safeguarding procedures. The registered person must ensure improvements are made to the bath on the upper floor. Specifically, the bath panel and the cracked tiling around the bath must be repaired or replaced, and the staining around the base of the bath tap and in the bath beneath the tap must be removed. The registered person must ensure improvements are made to the bath on the ground floor. Specifically, the worn areas of bath enamel must be repaired or replaced. The registered person must ensure the tenants living in the top floor flat are not using the home’s access and communal areas, and must ensure the home has adequate insurance in place that covers this arrangement. The registered person must ensure that the staff rota records accurately the staffing levels in the home. The registered person must ensure CRB and POVA check requirements are always followed before new staff members begin work in the home. The registered person must ensure the temperature of hot water from the outlets where people are at risk from scalding during whole body immersion do not exceed 44 degrees centigrade. The registered person must ensure it is evident that testing to ensure portable appliances are safe is up to date. The registered person must DS0000006913.V374238.R01.S.doc 30/04/09 30/04/09 30/04/09 30/04/09 31/03/09 31/03/09 30/04/09 30/04/09 Page 30 Brackens The Version 5.2 ensure it is evident that testing for Legionella is up to date, so that risks to residents from this infection are minimised. 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 OP24 OP33 Good Practice Recommendations The registered person should keep the menus under review to make sure they offer residents a nutritious and healthy diet. The registered person should ensure residents are offered the choice to have a lockable facility in their bedrooms. The registered person should ensure the findings from quality assurance surveys are summarised into reports that can be made available to residents, their representatives and other interested parties. Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brackens The DS0000006913.V374238.R01.S.doc Version 5.2 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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