CARE HOMES FOR OLDER PEOPLE
Brambles Birchfield Road Redditch Worcestershire B97 4LX Lead Inspector
Y South Unannounced Inspection 20th October 2005 12:00 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 Brambles DS0000028579.V251210.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. Brambles DS0000028579.V251210.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Brambles Address Birchfield Road Redditch Worcestershire B97 4LX 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) 01527 555800 01527 548888 Heart of England Housing and Care Limited Care Home 60 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (60), of places Physical disability over 65 years of age (60) Brambles DS0000028579.V251210.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The Home may accommodate one person under 65 years of age who has a physical disability and a mental disorder The Home may also accommodate one person over 65 years of age with a learning disability. The home may accommodate one person under 65 years of age who has a physical disability. 4th May 2005 Date of last inspection Brief Description of the Service: Brambles is a purpose built home for older people who may have a physical disability and/or mental health needs associated with old age. Additionally the home has registration for one older person with a learning disability and registration for one person under 65 who has a physical disability and mental disorder. The home is set in a residential area of Redditch which is about half a mile from local amenities and convenient for public transport. The home is on three floors and there is a passenger lift to all levels. All bedrooms are single and have en-suite facilities. Communal adapted toilets and bathrooms are available on all floors. There is also a garden area, which can be accessed by residents. The home is owned by Heart of England Housing and Care Ltd, for whom the responsible individual is Mr John McCarthy. The post of home manager is currently vacant. The acting manager, Mrs Margaret Hook, is temporarily overseeing this and another of the proprietor’s homes. Brambles DS0000028579.V251210.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place over two and a half hours between 12 midday and 2.30pm. Assistance was given by Amy Troth the care services manager, and the inspector also spoke to seven staff and four residents. A tour of the home was undertaken and a range of records was inspected. The inspection focused on the requirements and recommendations that had been made following the previous inspection and the management of infection control. Prior to the inspection a service questionnaire was completed by the home and returned to the Commission for Social Care Inspection. The manager was also asked to distribute other questionnaires regarding the service to residents, relatives and health care professionals. The completion of these is voluntary but proves useful in assessing the various views that are held. Fourteen responses were received. What the service does well:
The receptionist gives a warm welcome to everyone who comes to the home and assistance is readily given. Positive comments received in the questionnaires that were returned included the following; Generally we are very satisfied. My mother seems very content. Staff are helpful and informative. Things seem very well organised and run. Suggestions are looked into and addressed. I’m happier with the home. The care was excellent. The staff were extremely friendly. Meals were excellent. A thoroughly calming atmosphere throughout the home. Staff are always very polite and caring. The top floor is very well organised and staff are very caring and use their judgement well. The care my mother receives is outstanding. The home is clean and safe. The food is excellent. The staff are totally dedicated, hardworking and caring. I have nothing but admiration for the staff. They are a credit to the profession. Staff can be observed relating well to the residents in a respectful and helpful manner. Brambles DS0000028579.V251210.R01.S.doc Version 5.0 Page 6 The attractive enclosed garden provide a pleasant amenity for people to use in the good weather and the activities organiser encourages and assists the resident who are interested in a little light gardening. A range of activities and entertainment is provided and the details are displayed through the home. The home is generally clean and tidy there are no obvious risks to health and safety. The staff receive training to enable them to provide the care that people require. What has improved since the last inspection? What they could do better: 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. Brambles DS0000028579.V251210.R01.S.doc Version 5.0 Page 7 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 Brambles DS0000028579.V251210.R01.S.doc Version 5.0 Page 8 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): EVIDENCE: These standards were not assessed during this inspection. Brambles DS0000028579.V251210.R01.S.doc Version 5.0 Page 9 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): EVIDENCE: These standards were not assessed during this inspection. However six requirements had been made following the previous inspection. Although the changes to the care recording systems had not yet been finalised and implemented the care services manager said that monthly monitoring of records ensured that they were maintained and up to date. This was done more frequently when necessary. Changes had been made to ensure that medication was given on time. There was not currently a need for a protocol to address specific behavioural needs but the staff were aware that these could be needed. Brambles DS0000028579.V251210.R01.S.doc Version 5.0 Page 10 The records indicated that there was still room for improvement in the maintenance of medication records. Not all hand written records had been double signed and not all medications received into the home were recorded as checked and signed. Brambles DS0000028579.V251210.R01.S.doc Version 5.0 Page 11 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): EVIDENCE: These standards were not assessed during this inspection. However it was observed that the recommendation to advertise the activities programme more clearly had been accepted and implemented. In addition the care services manager said that those residents who stayed in their rooms received their own copy of the programmes. Brambles DS0000028579.V251210.R01.S.doc Version 5.0 Page 12 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): EVIDENCE: These standards were not assessed during this inspection. However the complaint record from reception was seen to contain three complaints that had been made since the last inspection. These had all been valid and appropriate action had been taken. Complaint procedures were displayed around the home. Nonetheless two residents said in the questionnaires that they did not know whom they should talk to if they were unhappy with their care. Brambles DS0000028579.V251210.R01.S.doc Version 5.0 Page 13 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): 26 The home is clean and has no unpleasant odours. However not all areas are maintained to an acceptable standard. This is being addressed. The reorganisation and addition of domestic staff hours should impact favourably on the environment. Infection control measures were in place. EVIDENCE: One recommendation had been made following the previous report and this was that corridor walls that had been damaged should be repaired and redecorated. Brambles DS0000028579.V251210.R01.S.doc Version 5.0 Page 14 A maintenance man had been appointed and it was observed that work had commenced to repair the damaged walls. However priority was being given to the residents’ bedrooms. Three bedrooms had been redecorated since the last inspection, two carpets had been replaced and work was in progress to attend to more. One negative comment concerning the cleaning was received in the questionnaires that were returned. The home had no unpleasant odours and generally looked clean. However the appearance of the corridor carpets was poor. The inspector was told that a contract cleaning company had, that day, submitted a quote to clean the carpets in all the communal areas and ‘deep clean’ the main kitchen. The hotel services manager said that they had recently been able to increase the domestic hours by twenty. This had enabled a re-organisation of the housework to take place and a cleaning schedule had been drawn up to indicating who had been responsible for carrying out the work. The laundry and the main kitchen were clean and well managed. Personal protective equipment was readily available throughout the home and the staff confirmed that they had all the equipment that they needed. Liquid soap, disposable towels and clinical waste bins were suitably placed. Brambles DS0000028579.V251210.R01.S.doc Version 5.0 Page 15 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): EVIDENCE: These standards were not assessed during this inspection. All the residents who spoke to the inspector were most complimentary regarding the staff, the home and the care they received. However the inspector was made aware of concerns that were linked back, by the concerned individuals, to the staffing levels. One resident told the inspector that he thought there were insufficient staff employed to provide care for any more residents who had high dependency needs. He considered that the staff were already stretched to the limit. Some of the returned questionnaires also raised concerns. One health care professional said that because senior carers covered two floors she always had to wait for five minutes if she wished to talk to him/her. She considered that the top floor was better organised than the others and there was a need for staff to have a better understanding of the roles of nurses and GPs. Another comment made concerned the cleaning of rooms. It was suggested that this was influenced by a lack of staff time and ‘cleaners’. Brambles DS0000028579.V251210.R01.S.doc Version 5.0 Page 16 Two people made general statement that here were sometimes staff shortages. Weekends were specifically mentioned by one person. One person thought that a greater variety of activities could be provided if staff had more time. Access to the home had been very difficult for one person who said that he had had to wait for twenty minutes to gain access one evening. These negative comments need to be balanced against the higher number of positive comments. Some action was already in progress to address some issues. However the other issues that had been raised need to be discussed and appropriate action taken wherever possible. The staff that spoke with the inspector confirmed that they were happy in their work, felt well-supported and received appropriate training. They had the equipment that they needed. They were observed to work in a friendly respectful and helpful manner with the residents and the residents in turn were most complimentary regarding the care they received from the staff. Brambles DS0000028579.V251210.R01.S.doc Version 5.0 Page 17 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): EVIDENCE: These standards were not assessed during this inspection. A requirement and a recommendation had been made following the last inspection. The requirement relating to records had been met. However the care services manager did not know the current situation regarding the review of policies and procedure so was unable to say if the recommendation had been accepted. Brambles DS0000028579.V251210.R01.S.doc Version 5.0 Page 18 The acting manager was temporarily managing two homes. She was not at the home during this inspection but she spoke with the inspector on the phone and confirmed that she was able to manage both homes with the support of the senior team in each home and the provider’s senior management. The fire log indicated that the safety systems and equipment were being checked and faults were being addressed. Staff training was on going. Brambles DS0000028579.V251210.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X 2 X Brambles DS0000028579.V251210.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement All medications received into the home must be checked and recorded. Handwritten records must be double signed. Timescale for action 20/10/05 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. Refer to Standard OP19 OP37 Good Practice Recommendations The corridors around the home should be repaired and redecorated. Policies and procedures should be regularly reviewed. Brambles DS0000028579.V251210.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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