Inspection on 10/01/06 for Braeside Care Home

This inspection was carried out on 10th January 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

Braeside Care Home 05/02/09

Braeside Care Home 07/02/07

Braeside Care Home 04/05/06

Braeside Care Home 25/04/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Braeside Care Home 8 Royal Street Smallbridge Rochdale Lancashire OL16 2PU Lead Inspector Diane Gaunt Unannounced Inspection 10th January 2006 08.00 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 Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 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. Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Braeside Care Home Address 8 Royal Street Smallbridge Rochdale Lancashire OL16 2PU 01706 526080 01706 860923 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) East & West Healthcare Limited Care Home 36 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (22), of places Terminally ill over 65 years of age (2) Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home is registered for a maximum of 36 service-users to include: Up to 14 service-users in the category of DE(E) (Dementia over 65 years of age); Up to 22 service-users in the category of OP (Older People) Up to 2 service-users in the category of TI(E) (Terminally Ill over 65 years of age) The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 25th April 2005 2. Date of last inspection Brief Description of the Service: Braeside is a privately owned care home providing personal and social care, nursing care and care for those with dementia. The home was formerly a domestic property, which has over the years, been extended to accommodate 36 residents. It is located on the main Halifax Road, approximately 1 mile from Rochdale and a regular bus service between Littleborough and Rochdale stops close to the home. Accommodation is provided on three floors in both single and double bedrooms. There is level access to the front door and a small garden/patio area is provided to the front of the home. There is no designated parking area but cars may be parked on the minor road. Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this inspection over a period of 10 hours. One inspector spent 6½ hours at the home and the other was there 10 hours. The home had not been told beforehand that the inspectors would visit. The inspectors looked around the building and looked at paperwork about the running of the home and the care given. They spoke with six of the nineteen residents, one visitor, one senior carer, two care assistants, two nurses, the cook, the manager, the administrator and the responsible individual. Carers were watched as they went about their work. Comment cards asking residents, visitors and GPs what they thought about the care at Braeside had been given out a few weeks before the inspection. Three residents and five visitors filled the cards in and returned them to CSCI. Their opinions are also included in the report. None of the comment cards were returned from GPs. The inspector spoke on the telephone to a District Nurse and a social worker. A team of inspectors had visited the home regularly during the five months before this inspection to check whether the 41 requirements made at the inspection of 25 April 2005 had been met, and to follow up further requirements made during each visit. Three legal notices were served in October 2005 as a result of a number of requirements not being met by the agreed date. Inspectors were particularly concerned as the requirements were about important things such as making sure there were enough trained staff on duty and that a manager who knew how to do the job properly was employed; how to move residents safely; how to recognise and report unexplained injuries; to report to the Commission for Social Care Inspection (CSCI) any serious incidents at the home concerning residents; and keeping CSCI informed of monitoring visits by the owner’s representative i.e the responsible individual. Requirements of two of these notices had been met with the given time and the third was not due to be met until 31 January 2006. There was evidence that the home was working towards meeting it. Most of the other requirements had been met, although eight had not. These are listed at the end of the report along with requirements made as a result of this inspection. What the service does well: The home provided a good choice of healthy food which residents enjoyed and some described as ‘excellent’. They made sure that they provided what each resident liked even if it was not on the menu. Residents were also complimentary about the staff most of who they said were ‘great’. Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 6 The home was good at welcoming visitors, offering them drinks during their visit. Where relatives wished to help with care, staff made sure they were able to. What has improved since the last inspection? What they could do better: Plans of care that say how residents should be cared for need further improvement and must show that staff have talked to residents and their relatives when writing the plans. Staff must make sure they follow the plans when checking residents weights and writing down how much residents have eaten and drunk. Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 7 More activities must be provided on the dementia unit and they must be activities that residents enjoy. Staff must keep a record of medicines and tablets that are delivered to the home and those returned. The home must make sure they write down every complaint people make about the home and what they have done to sort it out. The home must carry on providing all the necessary training for staff so they know how best to do their jobs and keep residents safe from harm. The manager must make sure that staff do not start work at the home until they have had satisfactory checks to make sure they are safe to work with older people. The ceiling tiles in the laundry must be made safe; the storeroom floor must be repaired; water must always be provided at a safe temperature; lighting in bedrooms must be improved; toilets should be decorated; uncovered radiators must be covered; bedrooms, furnishings and fittings must be kept clean. Gas and electric checks must be done and action must be taken about the uneven lounge floor and heavy doors to make sure residents can move around the home safely. More staff need to have training in some important areas to help them to do their jobs properly. Management must meet with care staff 6 times a year to talk about how they do their job, what training they need and how they could improve. A system must be introduced for the owner and manager to find out how residents, relatives and staff think they can improve the way the home is run. These suggestions must be used to improve the running of the home. 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. Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 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 Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 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 Information was provided for prospective residents and those living at the home, but it was not all up to date and accurate. EVIDENCE: The new manager had reviewed and updated the Statement of Purpose and Service User Guide but it remained in need of some minor amendments. Both documents were available on the notice board in the entrance area but updated copies had not been given to residents. Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 Staff had a good understanding of residents care needs but not all of the care plans demonstrated how aspects of health, personal and social care needs would be met. Health care needs were met in the main although staff needed to be more vigilant in monitoring weight and food/fluid intake. The medication system in place ensured that residents received their medicines safely and correctly, but recording procedures were not always followed. Residents were treated with respect and their rights upheld. EVIDENCE: Individual plans of care were held for each resident. Three were inspected in the residential/nursing unit and nine in the dementia care unit. Improvement was seen in the completion and review of care plans. A new format had been introduced in the residential/nursing unit making files easier to read and identifying action to be taken to meet needs. These plans encompassed health, personal and social care needs and recorded involvement of GP, District Nurse and other health professionals. Two files were in need of minor updates with regard to outcomes of action recently taken. The manager was in the process of introducing the new format to the dementia care unit also. Examination of all nine care plans on the Dementia Unit indicated that this process had been completed for two residents. A discussion Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 11 with the manager highlighted the need to complete the implementation of the new documentation for the remaining seven residents, as a matter of urgency. The recently reviewed records of two residents were looked at in detail and these clearly described the healthcare needs of the residents. Evidence was seen of the monthly reviews carried out to ensure that the care plans continue to meet individual needs. Not all care plans provided written evidence of residents or their representatives being involved in the drawing up and review of individual care plans. Residents and relative spoken with on the residential/nursing unit had all recently seen and been asked to sign their care plans which had been discussed and reviewed with them. Their care packages were due to be reviewed by care managers from the Social Service Department also. The care of all the residents living on the dementia care unit had been reviewed by the Social Services Department in the month previous to the inspection and the manager was taking action to address identified areas of need. On the nursing/residential unit, risk assessments had recently been reviewed and included moving and handling, nutrition, pressure sores/skin care, risk of falls and use of bedsides. Those on the dementia care unit addressed each of the above areas also and were in the process of internal review. Residents were weighed at least on a monthly basis and the weight recorded on a chart kept in their care plan. District Nurses were appropriately involved in the care at the home but their advice regarding weighing in respect of one resident had not been followed. On occasion they experienced problems in communicating with some of the nursing staff. Pressure care aids were provided and none of the residents had pressure sores. Pressure relief charts were in place for a number of residents on both units of the home and had been filled in regularly, recording appropriate action by staff. Residents said the home called their GP when they needed them and the services of opticians, dentists, chiropodist and audiologist were accessed as and when necessary. Residents were assessed for continence aids as required, evidence was seen of review in this area when necessary Staff interviewed showed an understanding of residents’ needs and action needed to address them, although this was not always clearly recorded on plans in the dementia care unit. Inspection of food/fluid charts on both units showed that they were not consistently completed by staff. There was no evidence of monitoring of the recordings and consequent intervention by the trained nurses. With one exception, relatives returning comment cards considered they were appropriately consulted and kept informed with regard to the residents’ care and well-being. Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 12 Armchair exercises were led by the visiting activities co-ordinator on some of her visits but staff did not continue these between visits. Medicines were administered directly from medicines room on both units. Good practice was observed in the management of the medication rounds. Examination of the medicine trolleys indicated a safe system of storage but a record of medicines received into the home and returned was not being maintained. A random check of controlled drugs was completed and records were found to be accurate. Inspectors observed the caring approach of all the staff towards the residents and was able to confirm that the practices in the home ensured that residents were treated with respect and their right to privacy was upheld. A regular visitor to the home said she had also observed this. It was further endorsed by residents returning comment cards and those interviewed who considered their privacy and dignity was respected at the home. Staff interviewed were able to describe good practice in this area. Privacy curtains were provided in designated double rooms although none were in use at the time of the inspection. Safety locks were fitted to bedroom doors although only one resident had chosen to hold a key. Risk assessments or signed agreements were held on file with respect to those who did not wish to have a key. Lockable space was also provided in rooms. Those interviewed and returning comment cards were satisfied with the overall care provided. Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 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, and 15 Provision of social activities and integration into community life did not fully satisfy each residents’ social, cultural and recreational interests and needed to be improved to enable residents to enjoy a more fulfilling lifestyle. Visiting arrangements at the home were informal and family and friends of residents were encouraged to maintain contact promoting personal relationships. The dietary needs of the residents were well catered for with a balanced and varied selection of food that met the residents’ preferences, tastes and choices. EVIDENCE: The resident’s involvement in social activities varied greatly according to their wishes, abilities and nursing needs. Limited progress had been made in the implementation of meaningful activities for the resident group and provision did not consistently meet residents’ needs. An activities co-ordinator provided half a days’ activities in each unit at the home and two care staff had been designated to plan and deliver activities on other weekdays. Inspection of activity records on the nursing/residential unit indicated that care staff input had not been consistently achieved although improvement was noted. The inspector took the opportunity to discuss the programme of activities with the member of staff who had responsibility for providing activities in the dementia unit during the afternoon. She was able to demonstrate that progress had been made in recording individual preferences but this aspect of the residents’ care needed to be substantially improved. In Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 14 particular more information about previous interests and hobbies should be recorded, although an example was given of one staff member on the dementia unit using such information to introduce an activity to a resident related to his past employment. The home would benefit from this approach being developed. Care plans inspected on the residential/nursing unit recorded social histories which included residents interests. Observation showed that staff on this unit did spend time chatting with residents as they went about their work in the lounge, creating a comfortable and relaxed environment for residents to sit in. One of the residents spoken to on the dementia unit preferred to stay in her bedroom and enjoyed knitting, listening to music and watching the television. She said the staff were helpful and very kind and enabled her to use her own condiments at the table, which she greatly appreciated. More independent residents enjoyed sitting in the lounge chatting, doing crosswords, watching TV and DVDs, those who were less able were seen to sit dozing in chairs and little stimulation was offered to them. Visitors interviewed and completing comment cards considered they were made welcome at the home and could see their relative in private. One visitor welcomed the opportunity to help with her relatives’ personal care and felt supported by staff in doing so. There had been no recent outings from the home. One resident regularly went out independently and others went out with relatives but with these exceptions, residents remained within the home. Some residents spoken with said they would enjoy going out into the community. It was noted that recent review with regard to one resident living in the residential/nursing unit recommended staff take the resident out to the pub on occasion. This had not been actioned. Religious services were not held at the home, although representatives of three faiths visited residents at the home regularly. Residents spoken with were happy with this provision. The choices residents made each day varied, dependent upon their mental frailty but residents generally chose what time to get up, go to bed, what clothes to wear, what to eat, where to spend their day, whether or not to participate in activities and whether or not they wished to have a key to their rooms. The majority of residents’ monies were managed by relatives. Residents and relatives were involved in care planning and they or relatives had been asked to sign their agreement on review. Resident/relative meetings were not regularly held to enable their contribution to decision making within the home, although those who were able to voice an opinion were asked for their views on the food provided. Advocacy advice was not routinely given. Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 15 The manager may wish to include this information in the Statement of Purpose/Service User Guide. Menus were planned over a 4 week period and were seen to offer balanced, nutritious meals. There were a little repetitive and the cook was aware of this shortfall. He planned to review the menus with the manager over the coming weeks. The inspector sampled the lunchtime meal – a choice of bacon hot pot or chicken drumsticks were offered along with fresh vegetables. Both meals were tasty and well cooked. Residents in the nursing/residential unit described the food as ‘excellent’ but two added that they would prefer to serve themselves with gravy. The cook agreed to do this and to also provide a jug of parsley sauce for one resident who required extra with the fish pie. Only one resident on the dementia unit was able to say how much she enjoyed her meal, she also said that the food served was always nice, hot and tasty. Inspection of daily choice sheets in the residential/nursing unit showed that alternative meals were provided if residents did not want the menu’d choice. Choices were offered on the dementia unit as the meal was served, and observation showed that sufficient of each meal was cooked to enable a free choice. On the day of inspection some residents had chosen to have both options. A record of residents’ choices on the dementia unit was not kept however. Although none were required at the time of the inspection, the inspector was advised suitable provision was made to meet individual dietary needs i.e. diabetic and soft diets. Observation showed that each food item of one resident’s lunch was liquidised separately but it was combined together for two other residents. The cook said this was done on medical advice. The manager agreed to verify this information. Hot and cold drinks were seen to be offered to residents on a regular basis throughout the time of the inspection. Breakfast was observed being served on the dementia unit and lunch on the residential/nursing unit. Staff were seen to give appropriate assistance in a pleasant and encouraging manner. Some residents ate their meal in the dining room whilst others were served the meal in their own room or in the lounge area, dependent upon choice. Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 16 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 and 18 Residents were confident that complaints would be listened to, taken seriously and acted upon. Appropriate systems were in place to protect residents from abuse, although a number of staff were in need of training to ensure their full understanding of the procedures. EVIDENCE: The home had a complaints procedure which was displayed on the notice board in the entrance area and included in the Service User Guide. Residents, relatives and staff interviewed were not all familiar with the procedure but each said complaints would be referred to the nurse in charge or the manager. Residents also said that if they raised matters they were immediately addressed, negating the need for a complaint to be made. A complaints book was in place and recorded two complaints since the last inspection. It was noted that no record was kept of one complaint investigated by the CSCI and the previous acting manager’s involvement in it. This complaint related to forced medication administration, which was found to be unresolved; care planning, which was upheld; and a resident’s refusal to eat which was unsubstantiated. The policy and procedure used by the home for the Protection of Vulnerable Adults (POVA) was the Rochdale Inter-agency procedure. The procedure had been followed by the present manager following an allegation of abuse. A whistle-blowing procedure was also in place and staff interviewed showed their understanding of it. Not all staff had received POVA training, although arrangements were in place for all to attend prior to the end of January 2006. Residents interviewed and those returning comment cards said they felt safe living at Braeside. Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 17 At the time of this inspection a POVA investigation undertaken by Rochdale Social Services Department had been ongoing at the home since August 2005, and another since November 2005. The home had co-operated in the investigation process and action had been taken to ensure the safety of residents. Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 18 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, 25 and 26 Whilst significant improvement had been made, the environment remained in need of further action with regard to safety, maintenance and cleaning. Hygiene practices were of a satisfactory standard. EVIDENCE: Since the last inspection recommendations made by the Social Services Department Occupational Therapist had been implemented in the home, although structural issues had not been addressed e.g. uneven flooring, heavy fire doors. Residents commented on the uneven flooring between the conservatory and lounge/dining room on the ground floor, one resident had recently fallen in this area. Other environmental improvements included provision of new carpeting in the entrance area and corridor, 1st floor corridor, 2nd floor corridor, 2nd floor lounge and dining room. Refurbishment of bedrooms had begun and a maintenance and renewal plan of projected works had been submitted to CSCI. Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 19 Inspection of the building showed that the majority of toilets and bathrooms were in need of decoration and the non-slip flooring was in need of cleaning. The toilet area by the main lounge on the 2nd floor had recently been refitted, as a result the decoration and plasterwork was in need of attention. These areas should be included in the maintenance plan and prioritised for action. Due to the small number of residents living at Braeside, the lounge area on the 1st floor was no longer used by them. The manager may wish to tidy this room and promote its use as a quiet lounge for visitors and meetings. The majority of residents had lived at Braeside for many years and this was evident by the individuality of the rooms and the possessions in them. The inspector noted that one bedroom contained very few possession and pictures had been taken down, but was informed that this was by choice. Residents commented on the rubbish amassing in the garden area outside the conservatory. This was as a result of people standing at the bus stop throwing their rubbish over the fence. Although it had been cleared once, the rubbish had not been removed from the site and there was no regular arrangement to keep the garden tidy. Aids were provided around the home to assist the staff in caring for residents and to encourage independence wherever possible. A passenger lift provided access between all three floors. There was an ongoing problem with the boiler at Braeside and difficulties were regularly experienced with water temperatures around the building although records checked on the day of inspection indicated that water was delivered at a safe temperature in line with health and safety guidelines. The responsible individual had plans to replace the boiler once the weather became warmer. GM Fire Officers had not visited since the last inspection. Environmental Health Officers had inspected the kitchen three weeks prior to this inspection. Two requirements were made, one had been met and one remained outstanding. Whilst communal areas were well lit, many of the bedrooms were dark, particularly those overlooked by mature trees. The provision of dark lampshades exacerbated the situation. Whilst the majority of radiators were covered for residents’ safety, two located in the corridor leading to the staff room and one in the disabled toilet nearby remained uncovered. One of these radiators was very hot to touch. Windows opened to provide natural ventilation. A number had been replaced or repaired since the last inspection although the window beside the lift on the 1st floor needed a handle. Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 20 Communal areas of the home were odour free, although a minority of bedrooms had some localised malodour. Two bedrooms carpets were in need of cleaning or replacement (rooms 7 & 9), as were the net curtains in these rooms. With these exceptions the areas inspected appeared clean. Residents and relatives considered the home was generally kept clean. Observation and discussion with staff and residents confirmed there were satisfactory infection control practices at the home. Colour coded disposable aprons and gloves were used and sufficient stocks were held at the home. An infection control course had been arranged for staff two weeks after the inspection. Laundry facilities were adequate, evidence was available that washing machines and fittings met the standard. Residents said that laundry was attended to within a reasonable timescale, inspection of the laundry supported this view. A number of ceiling tiles in the laundry were seen to be missing or loose. Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 21 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 and 30 Sufficient staff were provided to meet residents’ needs. Training had recently been increased for all staff but some remained in need of further input in order to fully equip them to do their jobs competently. EVIDENCE: Inspection of rotas showed sufficient staff were provided to meet the needs of residents. Feedback from staff, residents and relatives supported the view that generally there were enough staff on duty each shift to meet residents’ needs. Problems were experienced if staff rang in at short notice due to sickness. This happened on the day of the inspection. Observation showed that as a result all basic care was provided but that carers had less time to spend directly with residents. Residents and relative spoke well of staff although they considered they were ‘overworked’. They praised the senior carer who they said was particularly good at providing individualised care and noticing if their needs had changed. These comments were reinforced by one relative who completed a comment card. Considerable improvement was noted with regard to staff training, although some of the action had been taken in response to a statutory requirement notice being served. New staff received an in-house induction and plans were in place for each element of health and safety training to be provided for all staff by 31.01.06 as required. All but one carer had had training in dementia care, although a number of nurses had not completed the training. Five care staff had completed NVQ level 2 training and one had completed level 3. Four had begun NVQ level 2 and a further four were to be enrolled once funding Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 22 arrangements were in place. Staff were on course to achieve 3 days paid training per annum. A matrix of planned training had been provided to CSCI, the manager had devised a format for a future training and development programme. Inspection of three staff files showed that the most recently recruited staff member had taken up employment prior to a Criminal Records Bureau (CRB) or Protection of Vulnerable Adults (POVA) check having been received. Only one written reference was in place. An immediate requirement was made. Recent photographs of staff and documentary evidence of completed training were not held on all files. Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 23 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 and 38 The home was well managed and run in the best interests of residents by a manager who demonstrated a clear sense of direction and leadership, but had no recognised management qualification and was not registered with CSCI. The home had limited quality assurance systems for seeking the views of residents and their relatives which affected their ability to plan the service in the best interests of residents. Residents’ finances were efficiently managed. A number of issues which could put staff and residents’ health and safety at risk were in need of attention. EVIDENCE: The home had been without a registered manager for over 12 months. The previous acting manager had been replaced by the present manager in November 2005, and application for registration with the CSCI was being processed. The manager is a qualified nurse who has who has many years experience in caring for older people in residential settings, and management experience in care homes. She was undertaking the Registered Manager’s Award at the time of the inspection. Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 24 Since her appointment the present manager had demonstrated a clear sense of direction and leadership and had made positive changes at the home with regard to management systems, supervision and oversight of care planning/meeting of needs. Throughout the inspection inspectors were able to evidence the professional, capable and approachable manner in which the manager undertook her role when dealing with residents, staff and visitors. One relative completing a feedback card made positive comment about her impact on the home and residents, relatives and staff interviewed all spoke positively of her input. They said she was easily accessible and welcomed her ‘open door’ policy. Residents said she made sure she spoke to them on her arrival at the home each day to check out how they were feeling. The home had no formal quality assurance system in place. Some systems for seeking feedback on the service had recently been introduced i.e. staff meetings; review of care plans and consultation with some residents and relatives. The responsible individual also conducted regular visits to the home as required by Regulation 26 of the Care Homes Regulations 2001. One resident/relative meeting had been held but there were no plans to hold another. Circulation of questionnaires to residents, relatives, staff and other stakeholders to seek their views was not undertaken. There was no current annual development plan at the home. Staff said they did not receive regular formal supervision although the manager had reintroduced the system and the senior carer was due to attend a supervisors course. ‘On the job’ supervision was offered as and when it was required. The responsible individual acted as appointee for three residents, upon their request. Relatives and solicitors acted on behalf of others, although the home remained responsible for monies left at the home by relatives for residents’ use. Records and monies held in respect of five residents were inspected and in the main were seen to be in order. There was evidence of regular audit. A minority of residents did not have bank accounts and their savings were held at the home. The responsible individual was in the process of consulting with residents and their relatives regarding arrangements for individual bank accounts to be opened. It was agreed that advocacy services would be considered in respect of one resident. The yearly Gas Safety check and the five yearly Electrical Equipment check were both overdue. All other safety equipment was regularly serviced in accordance with the manufacturers instructions, and the appropriate documentation to support this was available for examination. Observation, and inspection of care plans highlighted an issue with regard to frail residents who wished to remain independent struggling to get through heavy bedroom doors. These doors were sometimes wedged open to enable Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 25 safe passage. This constituted a fire risk however. Arrangements should be made to enable residents to move around the home safely and freely without fire precautions being compromised. Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 26 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 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X 1 2 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 1 Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 27 Yes Are there any outstanding requirements from the last inspection? 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 OP1 Regulation 4&5 Requirement The Statement of Purpose and Service User Guide must be amended to accurately reflect provision at the home and meet the requirements of Regulations 4 & 5. On completion a copy must be forwarded to the CSCI and copies of the Service User Guide issued to each resident or their representative. All residents must have a care plan that sets out in detail the action which needs to be taken by care staff to ensure that all aspects of the health personal and social care needs of the individual are met. All care plans must be drawn up with the involvement of the resident and their representative Timescale for action 28/02/06 2 OP7 15 28/02/06 3 OP7 15 28/02/06 4 5 6 OP8 OP9 OP12 12 13 16 Staff must be more vigilant in 31/01/06 monitoring weight and food/fluid intake. A record of medicines received 31/01/06 into the home and returned must be kept. Specific social and leisure 28/02/06 activities for residents with DS0000063307.V269772.R01.S.doc Version 5.0 Page 28 Braeside Care Home dementia must be implemented. The activities must be in line with current guidelines. (Previous timescale of 31/08/05 and 31/10/05 not met). 7 OP16 17(2) All complaints about the operation of the home must be recorded, along with action taken by the registered person in respect of any complaint. Two satisfactory written references, POVA and CRB checks must be in place prior to staff beginning work at the home. Ceiling tiles in the laundry must be replaced and made safe. Action must be taken to ensure safe passage of residents and visitors between the conservatory and lounge/dining room. The storeroom floor must be repaired to provide a surface which can easily be cleaned. Action must be taken to ensure water is consistently provided at 43 °C throughout the building. Lighting in residents’ bedrooms must be improved to meet recognised standards. The toilet area off the main lounge on the top floor must be plastered and decorated. All radiators must be covered for residents’ safety. The home must be kept clean throughout, in particular with regard to carpets and curtains in rooms 7 & 9, the non-slip flooring in toilets and bathrooms. Staff must receive training appropriate to the assessed needs of the residents. This must include dementia. (Previous timescale of 31/07/05 DS0000063307.V269772.R01.S.doc 31/01/06 8 OP18OP29 19 18/01/06 9 10 OP19 OP19 23 23 31/01/06 31/03/06 11 12 13 14 15 16 OP19 OP19OP38 OP25 OP19 OP25OP38 OP26 23 23 23 23 23 23 28/02/06 30/04/06 31/03/06 28/02/06 31/01/06 28/02/06 17 OP30 18 28/02/06 Braeside Care Home Version 5.0 Page 29 not met.) 18 OP30 18 All staff must complete induction training which meets TOPSS specifications. (Previous timescales of 31/07/05 and 31/10/05 not met) 31/03/06 19 OP30 17 & 19 Recent photographs of staff and 28/02/06 documentary evidence of completed training must be held on staff files. All staff must have training in moving and handling, protection of vulnerable adults, infection control, health and safety and fire safety. (Previous timescale of 31/07/05 not met). The provider must ensure there is an effective quality assurance and quality monitoring system based on seeking the views of service users. (Previous timescale of 31/01/05 not met) A structured supervision system must be re-established for all staff. (Previous timescales of 31/07/05 and 31/10/05 not met.) Care staff must have food hygiene training. (Previous timescales of 31/07/05 and 31/10/05 not met.) Sufficient staff must receive first aid training to ensure one per shift is on duty. (Previous timescales of 31/07/05 and 31/10/05 not met.) The home must ensure that the fixed electrical installations are inspected and tested The home must ensure that the gas installations are inspected DS0000063307.V269772.R01.S.doc 20 OP30 12 31/01/06 21 OP33 24 31/03/06 22 OP36 18 28/02/06 23 OP38 13/23 31/01/06 24 OP38 13 28/02/06 25 26 OP38 OP38 13 13 10/03/06 28/02/06 Page 30 Braeside Care Home Version 5.0 27 OP38 13 and tested. Arrangements should be made to 31/03/06 enable residents to move around the home safely and freely without fire precautions being compromised. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 8 9 Refer to Standard OP8 OP9 OP12 OP12 OP13 OP19 OP14 OP15 OP30 Good Practice Recommendations Staff should ensure residents are regularly encouraged to exercise in the home. Hand transcribed medication should be witnessed by two staff members to avoid errors. Daily recordings should be made with regard to participation in activities on the dementia care unit. Activities in the residential/nursing unit should be further developed. Arrangements should be made for residents to go out to enjoy local community provision and amenities. The garden area below the bus stop should be regularly cleared and the rubbish taken off site. Residents/relatives meetings should be held. A record of residents’ food choices should be kept on the dementia unit. The manager should complete a training and development programme which identifies all staff’s training needs on completion of planned training. Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 Page 31 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 Braeside Care Home DS0000063307.V269772.R01.S.doc Version 5.0 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. 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