Inspection on 25/04/05 for Braeside Care Home

This inspection was carried out on 25th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 10/01/06

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 8 Royal Street Smallbridge Rochdale OL16 2PU Lead Inspector Ruth Hughes Unannounced 25 April 2005 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 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 F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Braeside Address 8 Royal Street Smallbridge Rochdale OL16 2PU 01706 526080 Telephone number Fax number Email 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 Ltd CRH Care Home with Nursing 36 Category(ies) of DE(E) - Dementia over 65 registration, with number OP - Old age of places TI(E) - Terminally Ill Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 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 CSCI. Date of last inspection 30th November 2004 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 formally 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 is provided to the front of the home.There is no designated parking area but cars may be parked on the minor road. Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two days with three inspectors, one of whom was a pharmacy inspector. Information included in this report also comes from visits by other professionals following concerns raised by a District Nurse into two residents care. The professional visits involved District Nurses assessing resident health and social care needs. A Community Psychiatric Nurse assessing residents mental health needs and an Occupational Therapist assessing the equipment used within the home and the environment. The CSCI Inspectors looked at parts of the environment, checked care plans, staff records of employment and training and also the systems involved in medication. Three residents, two visitors, four members of staff, the manager and the proprietor were spoken to during the inspection. What the service does well: What has improved since the last inspection? The home has complied with some of the environmental requirements from the last inspection. The second floor dinning room had been decorated and appeared much cleaner. Bedroom door locks had been made safe and accessible to staff in an emergency. Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 Page 6 What they could do better: Records stating how residents should be cared for need to be improved. This is so that staff can understand how to help residents, or what they need to do to protect a resident from harm. Staff must be more careful at observing how much diet and fluids residents are taking especially poorly residents. It is important that these records are clearly and accurately recorded. Several issues caused the inspector concern with regards to basic nursing care. Some residents had a dry or dirty mouth which must be cleaned more often. Staff need to know when to wear disposable gloves to stop the spread of infection. The management of medicines must be improved; the records must be clear, the storage must be tidied and the ordering organised so that medicines do not run out. Residents had nothing to do during the day and said they get ‘fed up’ at times. The home must find out what residents interests are and provide something for them to do that interests them. The home needs to let residents know what is on the menu for the day so they can choose what they like to eat. The home owner must record what parts of the home have been or need repair or decorating. There are not always enough staff on duty to make sure the residents were getting the care they needed. Not all staff had received training in how to do their jobs properly, nor had they all had 3 days training over the past year. More training was needed in how to move residents safely, good hygiene and what to do if there was a fire. The home takes residents with dementia but none of the care staff had any training in dementia care. Staff must be given training in dementia. The manager must be able to talk and listen to residents and also lead staff in providing better care. Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 Page 7 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 F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 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 standard(s) 3,4 and 5 The assessment process prior to people moving into the home was quite basic and lacked detail. Without this process of risk assessment there is no assurance that care needs will be met. The lack of recent staff training in basic care practices has resulted in staff with a lack of skills and experiences, resulting in poor delivery of care. EVIDENCE: Records and discussions showed that, before admission, the manager visits prospective residents in their own home or in hospital to assess whether the home could meet their needs. The assessment form covered the basic areas of health and social assessment. However there was no mental health assessment tool and the document used lacked space for the manager to give a clear explanation of the persons needs. For those residents admitted in an emergency the basic assessment details were obtained soon after admission from the Rapid Response team. Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 Page 10 The home is registered for dementia care, however the manager confirmed that he was not aware of any care staff having had dementia care training. The main mental health input had been from a qualified nurse who is now on sick leave. The manager is a mental health nurse but has not had regular input into care for the dementia residents. Staff training has not been provided since the last manager resigned almost 12 months ago. There is a core of regular staff that have been with the home for several years. However there have also been several staff changes and regular agency staff used. This does not provide continuity of care or ensure that staff have the skills and experience necessary to care for residents. District Nurses also reviled their concerns with the level of knowledge some staff have of residents and lack of basic care skills. Comments received from residents and relatives have also been included in the report. Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 and 9 The inadequate development, review and evaluation of care plans does not ensure that the health care needs of residents are identified and met. This has potentially placed residents at risk. Lack of staff training and development has also contributed to placing residents at risk, by the delivery of care not being appropriate. Medication was poorly managed putting residents at risk of not receiving their medicines as prescribed. EVIDENCE: Limited progress had been made in the development and evaluation of care plans. Care plans had not been reviewed from December 2004 to March 2005. Individual records are kept for each of the residents and inspection of the records showed that following admission on not all risk assessments were completed. One resident admitted for respite care never fully received a complete assessment of needs during her short stay at the home. Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 Page 12 One of the plans last reviewed in March was not consistent with current practice. The entries made into other care plans gave little indication of the actual care being given. The dietician periodically reviews one resident who has a PEG feed regime, the last report in the file from the dietician was from October 2003. This report stipulated a feed regime to follow. This regime differs from what the resident actually receives. Discussions with staff suggested that some needs were being addressed, although there was a lack of clear care planning. This approach to care is dependent on staff memory and good verbal communication. Residents are at risk of not having their health care needs met if these informal systems break down. Oral health care for those residents not taking an oral diet was poor. Residents had equipment in their bedrooms for staff to ensure good oral health care. However, it had not been used recently and the resident’s mouth did require cleaning. From inspection of charts recording a residents fluid intake it was evident that these are not accurately completed and therefore do not reflect the correct amount of intake. Following concerns raised by the District Nurse, the Tissue Viability Nurse and Social Services Departments. All residents needs have been re-assessed by the District Nurses, the Community Psychiatric Nurse, the Social Worker and the Occupational Therapist. Feedback from these professional assessments has revealed concerns about the delivery of adequate nursing, residential and dementia care. The District Nursing staff observed poor standards of hygiene and infection control with regards to the changing of peg feeds and catheters. It was also noted that residents receiving nutrition via a peg feed did not have an elevated bed, as required, to aid the safe administration of the feed. Wound care documentation is in place, however it is incomplete in its recordings and lacks detail. All staff who are involved in record keeping require further training to update their practice. The District Nurses stated they found the care plans were not up to date or consistent with care given and there were contradictions within the reports. The mental health nurse assessment concluded that the majority of the care plans he reviewed were all written over a year ago and in his opinion did not accurately reflect the client’s current needs. Specialist nursing equipment to provide pressure relief for one resident was seen by the district nurse to be inadequate. The inspector left an immediate requirement for the manager to replace this piece of equipment and review all residents who were at risk of developing pressure sores. This was to ensure they were using the correct equipment for their needs. Although an outcome of Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 Page 13 the assessment was received no evidence of the assessment process was recorded. The manager stated he had done the assessments in consultation with the senior carer. But not using the recognised risk assessment process. The manager has been required to do full assessments of needs on all residents using recognised risk assessments tools. In line with current clinical guidelines. Several of the residents re assessments conducted by the mental health team identified an increased risk of falls. The manager has been advised to conduct a risk assessment of all residents with regards to the risk of falling and what systems are to be put in place to minimise any identified risk. At the last inspection the inspector observed a lack of respect from some staff and in maintaining a residents privacy and dignity. A requirement for further staff training was required in treating residents with respect and ensuring privacy and dignity is maintained. Staff training in maintaining continence was also required. Neither of these training needs have been met. The self-administration of medication had not been assessed in accordance with the homes self-administration policy. The medication administration records were generally up-to-date but discontinued medicines remained listed making it difficult to determine which medicines were current: There were some ‘blanks’ in the recording of administration. An immediate requirement notice was also issued to address this concern. The medication room was untidy with dressings and appliances stored on the floor and under the treatment couch. Poor stock control was evident and a quantity of dressings and appliances were out-of-date. Records indicated that medicines on occasion ‘ran out’. Good practice was seen during the morning medication round, medicines were administered one-by-one to each resident with records completed at the time of administration; squash or water was available. However, the timing of the rounds must be reviewed as the teatime and evening rounds are occasionally too close together. Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,14 and15 Resident’s social and recreational needs, preferences and capabilities were not met. Menus did not accurately reflect the choice available, however the quality of the food provided for lunch was good. EVIDENCE: There had not been any progress in ensuring residents social, and recreational needs were met. The care records did not consistently record residents preferred choices with regards to rising or retiring times or preferred interests. Residents should have the opportunity to exercise their choice with regards to all aspects of daily living and leisure and social activities. The manager stated he had employed part-time activities co-ordinator but there was no evidence of any progress made. Residents spoken to stated that staff where always very busy and there was never much going on. This was also recorded in the occupational therapist report, in which she states. “There was no evidence of regular activities for occupying and stimulating the residents”. Despite being registered for residents with dementia. No consideration has been given to developing the social and leisure activities for the residents with dementia. Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 Page 15 Requirements were made for programmes of activities to be developed suitable for residents needs. This had not been complied within the timescales set. At the time of inspection, lunch had just been served and staff were assisting residents away from the dinning tables. From discussions with residents in the ground floor dining room it was evident that the menu displayed did not always correspond with what they were served. Comments about the quality of food for lunch were generally good, however the inspector observed in the second floor dining room that soft diets were being served mixed together. The meat and vegetables were not in individual portions as had been previously recommended. Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 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 standard(s) 16 and 18 The systems in place with regards to the investigation of complaints and adult protection issues are incomplete. Staff had some understanding of the vulnerable adults procedure but had not yet received any formal training. The home has had a long spell without a manager and the level of complaints have risen. EVIDENCE: A complaints procedure was in place and displayed in the entrance area. In addition the procedure is available in the service users guide. The home had been without a manager for three months prior to the current proposed manager starting in late December 2004. Two complaints have been received by CSCI since April 2004 alleging poor care practice. Both of these complaints came after October 2004. One was not upheld and the second is ongoing. At the time of this inspection a complaint was made in writing to the home this was being investigated in line with the local ‘Protection of Vulnerable Adults’ procedure. There were also two other investigations ongoing which had prompted the Social Services Directorate to initiate a review of all residents to ensure safe practice. This review had involved District Nursing input for the residents with nursing needs, Community Psychiatric Nursing input for the residents with ongoing mental health needs and an Occupational Therapist’s input for all residents with moving and handling needs. Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 Page 17 During these investigations and reviews all agencies had been kept updated and notified of outcomes. The social worker leading and co-ordinating events and all agencies confirmed that the home had fully co-operated in the investigation process. The policies and procedures used by the home for the protection of vulnerable adults are the local authority guidelines. These were followed on receipt of the recent allegation. The inspector identified that the current staff training in the protection of vulnerable adults was inadequate. Some staff had not received any training and for other staff, their knowledge was outdated. The manager was accessing training but he must ensure all staff attends this. Feedback from the team involved in the reviews of all residents has revealed that some residents and relatives were not confident that the new manager listened and acted upon their concerns. He was reported to be ‘vague’ and gave unsatisfactory responses to enquiries from relatives. The manager must ensure that he is fully involved with residents and relatives particularly when issues of concern are raised and this must be documented. Communication with residents/relatives must improve and evidence of systems to address this must be produced. The inspector noted that there is a ‘signing in book’ for anyone visiting the home. However visitors are not encouraged or reminded to ensure they record their visit. Staff must be aware of who is on the premises for health and safety reasons. Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 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 standard(s) 19 and 26 There have been several environmental and safety issues identified that do not provide the people living in the home with safe, comfortable surroundings. EVIDENCE: Following the recent concerns raised by the Social Services Department a visit was made by an Occupational Therapist employed by Rochdale Adult Care Services. Her report contains an assessment of facilities, equipment and manual handling issues at Braeside. The report shows some satisfactory facilities and equipment being available but also highlights shortfalls in several areas. Particular reference is made to several emergency call bells being inaccessible form the toilet or bath. These must be repaired or replaced. Support/grab rails were not available in specific bathrooms/toilets. These must now be provided. Lounge chairs with pressure relief cushions were found to be unacceptably low which restricted residents from getting up, out of the chair, on their own. Several wheelchairs had broken footrests and cushions were not being used. Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 Page 19 Zimmer frames and walking frames were in good repair and suitable for specific residents needs. The report also highlights the poor manual handling techniques being used by staff. This puts staff and residents at risk of injury. A small passenger lift is provided. However, the occupational therapist stated it was not possible to transfer a resident to another floor in a wheelchair using the footrests. It was also not suitable for a self-propelling wheelchair user. There was also no emergency call bell system in the lift. The report also has concerns about the doorways stating it appears difficult to open and push a wheelchair through with one person and that a self-propelled wheelchair would be unable to move around independently. The ground floor was also identified as being uneven making it difficult for wheelchairs and potential increasing the risk of mobile residents falling. There were a lack of protective aprons and gloves being available in toilets and bathrooms. It is essential for the control of infection that these are readily available for staff use, as and when required. From observation by the inspector and from speaking to staff it was evident that the water pressure to the bath on the second floor was inadequate. This had resulted in residents having to go down to the first floor to have a shower or a bath. The residents on the second floor require a useable bathroom to facilitate personal hygiene needs. One member of staff stated that she also found it difficult accessing the toilets when transferring immobile residents. The registered person must have an occupational assessment of these bathing and toilet facilities to ensure they meet resident’s needs. The environment was not fully inspected on this visit. However an inspection was undertaken by an Occupational Therapist who did inspect the environment and the moving and handling equipment. A number of recommendations have been made to improve the quality and standards of care at Braeside. There must be further discussions with the Occupational Therapist so that her recommendations can be put into place. Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 Page 20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 & 30 On occasions the home was operating under the required staffing levels, which meant the residents needs were not being met. The recruitment and selection policies and procedures were not always being adhered to and staff were not receiving the appropriate training required for them to perform their role. This placed residents at risk. EVIDENCE: Although the home has a core element of dedicated staff who try to ensure continuity of care. There has, since the last inspection been a high turnover of staff and regular use of agency staff. Rotas on both the general and EMI units, identified understaffing on a regular basis. Residents, relatives and staff also confirmed that staff shortages occurred regularly. The manger must ensure that steps are taken to address the problems in order that adequate staffing levels are maintained at all times on each unit. The staff files of three staff members employed in the past year indicated that the home had not followed it’s own recruitment policies and procedures. Despite receiving an unsatisfactory reference and a corresponding conviction on a C.R.B. check a member of staff was employed. This staff member is no longer at the home. Inspection of staff training files identified there had not been any training provided for staff for almost a year. There was little evidence to show that staff had undertaken induction training. The manager must ensure that all staff Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 Page 21 undertake induction training, which meets National Training Organisation specification within 6 months of appointment. Staff had not received the mandatory moving and handling training for over 12 months and some new staff had never had moving and handling training. It is essential that staff have this training as a basic requirement before assisting with the transfer of residents. None of the staff had received any recent training in Fire, Health and Safety, Infection Control or the in the Protection of Vulnerable Adults. Staff are to receive as a minimum 3 days training over a 12 month period. The home cares for residents with Dementia. None of the present care staff have received dementia care training. The manager and at present only two part time qualified staff have mental health nursing qualifications. They are responsible for prescribing, evaluating and overseeing the mental health care of these residents. The hours on duty are determined by the residents needs. The dementia unit at present has residents with high dependency needs and their care must be regularly observed and evaluated by suitably qualified staff. The manager must be able to evidence that mental health needs, of these residents is being met. In the recent review of residents care plans. The community psychiatric nurse identified a lack of qualified mental health input necessary to meet the daily needs of the current residents. In his professional opinion there was a poor standard of care planning and record keeping. The majority of residents having care plans written over a year ago and now do not accurately reflect the residents current needs. If Braeside wishes to continue providing dementia care then qualified and care staff must have relevant and current training, including dementia care. There must also be relevant training provided to improve the standard of care planning and record keeping. Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 Page 22 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,35,36 and 37 There has been no clear leadership; guidance and direction to staff to ensure residents receive consistent quality care. This has resulted in some practices that do not promote and safeguard the health, safety and welfare of the residents using the service. EVIDENCE: There has been a period of around 3 months when the home was without a manager. In that time the standards of care and record keeping have deteriorated. A new manager commenced in late December and has had a difficult time addressing all the issues that developed during that 3 months. The manager is due to attend a ‘fit person’ interview with the CSCI and therefore is not as yet a registered manager. Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 Page 23 Communication between the management and residents/relatives has been poor. With some relatives stating that the manager is dismissive or vague with information about their relatives progress. He has as yet to demonstrate to staff, residents and relatives the clear sense of direction and leadership, which is needed to improve standards and the quality of care. The home had a satisfactory accounting system in place. All paper and computer systems were made available for inspection. The records examined were well maintained, with meticulous entries. Each resident for whom money is kept at Braeside has a pocket book. Receipts were retained for all financial transactions. There was evidence of regular audit. It was recommended that the Responsible Person, records conversations with residents regarding financial transactions and decisions. The service user may wish to sign such record. Residents may wish to transfer any larger amounts of money to interest bearing accounts. It is strongly recommended that advocacy services are involved for those residents who have no immediate relatives or present advocacy available. From inspection of specific staff files it was established that the employment policies and procedures are not followed by the home. The induction and training systems once in place had broken down. The structured supervision system initially set up for staff had also been neglected and now requires re structuring. Record keeping for individual care plans was inconsistent and now requires more development to ensure it address all residents needs. The manager must also ensure safe working practices by providing mandatory staff training. Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 Page 24 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 1 x 1 1 x x x 1 STAFFING Standard No Score 27 1 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 1 1 1 x x 3 1 1 1 Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 Page 25 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 1 Regulation 4(1)(a) Requirement The statement of purpose must be ammended to reflect the changes in management.(previous timescale of 31/03/05 not met) The pre admission assessment must include all relevent physical, psychological and social health needs. Staff must receive training appropriate to the assessed needs of the residents. This must include dementia training. Risk assessments which meet relevent clinical guidelines must be completed. Care plans must be developed to demonstarte precisely what health and personal care needs individual residents require assistance with. Care plans must acurate and regularly up dated to reflect residents changing needs and current objectives. Incidents of pressure sores, their treatment and outcome must be acurately recorded in residents care plan and reviewed on a regular basis. Residents oral health care must Timescale for action 30/07/05 2. 3 14 31/07/05 3. 4 & 30 18 31/07/05 4. 5. 7 7 13(4) 15 31/07/05 31/08/05 6. 7 17 31/08/05 7. 7 17(1)(a) Schedule 3 (3)(n) 15(2)(b) 12(1) 31/07/05 8. Braeside 8 30/06/05 Page 26 F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 9. 10. 8 8 & 26 11. 12. 8 8 13. 8 14. 15. 16. 9 9 9 17. 9 18. 9 19. 12 be improved and staff must maintain standards. 12 Accurate records must be completed to record residents intake and output when required 13(3) Adequate precautions must be taken to prevent the spread of infection. Disposable gloves and aprons must be appropriately placed and accessable for staff. 23(2)(n) Specialist nursing beds must be available to meet residents needs. 13(1)(b) Residents psychological and mental health is clearly asessed and regularly reviewed with treatments, care and outcomes recorded. 13(4)(b)(c All residents must be assessed ) with regards to the risk of falling. Systems must be put in place to minimise identified risk. 13(4) Ensure that all self administration of medication is assessed and reviewed. 13(2) Ensure that all medication records are complete, clear, accurate and up to date. 13(2) Ensure that the household remedies are only administered in accordance with policies and procedures describing their safe handling. 13(2) Review the management of medication rounds to ensur that an adequate doseage interval is maintained. 13(2) Ensure that the medication storage is orderly; unwanted medication must be promptly segregated for disposal, all prescribed medication must be available. (previous timescale of 31/01/05 not met.) 16 A planned programme of activities must be formulated in consultation with residents and F56 F06 S63307 Braeside V216089 250405 Stage4.doc 30/06/05 30/06/05 31/08/05 31/08/05 31/07/05 13/06/05 13/06/05 13/06/05 13/06/05 13/06/05 31/07/05 Braeside Version 1.30 Page 27 20. 12 16 21. 15 12(2)(3) 22. 23. 24. 16 18 19 22 13(4) 23(2)(b)( d) 25. 21 23(2)(j) 26. 21 23(2)(n) 27. 22 23(2)(n) 28. 22 23(2)(n) 29. Braeside 27 18 the programme implimented and recorded.( Previous timescale of 31/03/05 not met) Specific social and leisure activities for residents with dementia must be implimented. The activities must be in line with current guidelines. A menu offering an acurate choice of meals must be developed, displayed and regularly reviewed to offer a nutitionally well ballanced diet with seasonal foods. A clear record of all complaints must be kept with details of investigations and outcomes The provider must ensure that all visitors to the home record their visit on arrival. A programme of routine maintenance is to be produced to denote areas of the home maintained and areas scheduled for maintenance. The bath on the second floor must have an adequate hot water supply to allow residents to access this facility. The provider must have a detailed occupational assessment of the toilet and bathing facilities on the second floor. This is to ensure adequate access for residents with poor mobility. All recommendations made in the occupational therapist assessment report dated 11/5/05 must be complied with. This must be in consultation with the occupational therapsit. There must be access to an emergancy call bell system in all areas of the home accessed by residents, including the passenger lift. Adequate staffing levels must be maintained at all times, on both 31/08/05 31/07/05 31/07/05 30/06/05 31/07/05 31/07/05 31/07/05 31/08/05 31/07/05 31/05/05 Page 28 F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 units. 30. 29 19 The recruitment policies and procedures must be complied with to ensure protection of service users. The dementia care unit must have suitably qualified staff with mental health qualifications to ensure residents mental health needs are met. All staff must complete induction training which meets TOPSS specifications. All staff must receive a minimum of 3 days training per year. There must be a training and developing programme developed to identify all staff training needs. All staff must now have moving and handling, infection control, health and safety, fire and protection of vulnerable adults training. The provider must ensure that the registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. The manager must demonstrate a clear sence of direction and leadership. The manager must communicate effectivly with residents staff and other stakeholders to ensure residents needs are met. The provider must ensure there is an effective quality assurance and quality monitoring system based on seeking the views of service users in place.(previous timescale of 31/01/05 not met.) A structure supervision system must be re-established for all staff. The provider must ensure that a 31/05/05 31. 27 18(1)(a) 30/06/05 32. 33. 34. 30 30 30 18 18 12(1)(a)( b) 12(1)(a)( b) 31/07/05 30/06/05 31/07/05 35. 30 31/07/05 36. 31 9 (1-3) 30/06/05 37. 38. 32 32 10(1) 12(1) 30/06/05 30/06/05 39. 33 24(1)(2)( 3) 31/07/05 40. 41. Braeside 36 37 18 26 31/07/05 30/06/05 Page 29 F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 visit by the registered person or a suitable designated person must take place monthly. A written report must be produced and a copy sent monthly to the commissions and to the manager.(previous timescale of 31/01/05 not met). 42. 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 9 15 35 Good Practice Recommendations The refrigerator should be regularly defrosted and a record of the temperature should be maintained. Meals served in a semi soft consistency are to be served in specific food portions. Not all foods liquidised together. Advocay services should be accessed for residents where no other responsible person is available. Braeside F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 Page 30 Commission for Social Care Inspection 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 F56 F06 S63307 Braeside V216089 250405 Stage4.doc Version 1.30 Page 31 - 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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