CARE HOMES FOR OLDER PEOPLE
Brandon 29 Douglas Avenue Exmouth Devon EX8 2HE Lead Inspector
Anita Sutcliffe Unannounced Inspection 11:45 16 . December 2005
th 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 Brandon DS0000021891.V256969.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. Brandon DS0000021891.V256969.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Brandon Address 29 Douglas Avenue Exmouth Devon EX8 2HE 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) 01395 267581 01395 270806 brandonhouse29@aol.com Mrs Wendy Pamela Marsh Mr John Howard Marsh Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35), Physical disability (35) of places Brandon DS0000021891.V256969.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26/07/05 Brief Description of the Service: Brandon is registered to provide personal care for up to 35 older people who may or may not have a physical disability. The detached property is situated in a residential area of Exmouth with large gardens and patio areas. There is a dining room and three lounges. Bedrooms are large and all have en suite facilities. Brandon DS0000021891.V256969.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection began at 11:45 and took place over 3 ¾ hours. Standards looked at on this occasion were the key standards not included at the July inspection. The care of three residents (service users) was examined. This involved meeting them, looking at care records and visiting their room. Many other residents were met and an exercise session and lunch was observed. Staff provided information and a visiting health care professional gave her opinion of the home. Most of the home was visited, including the laundry. Medication was examined. CSCI information and contact details were left at the home. What the service does well: What has improved since the last inspection? What they could do better:
No errors in medication were identified, but not all safeguards to prevent mistakes occurring were in place. Medication records should always be signed, dated, have the dose, strength and frequency recorded, with hand transcribed Brandon DS0000021891.V256969.R01.S.doc Version 5.0 Page 6 information checked and signed by two staff members to further safeguard against mistakes. 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. Brandon DS0000021891.V256969.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 Brandon DS0000021891.V256969.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): Not inspected on this occasion. EVIDENCE: Brandon DS0000021891.V256969.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): 9 & 11 The system used for the recording and storage of medicine to be administered to the residents had the potential to place the residents at risk. End of life care is sensitively and professionally managed. EVIDENCE: Residents are supported to maintain control over their medication if they wish. This is done taking into account, and managing, risk which this might involve. All staff that administer medication have undertaken training and one of the ‘line managers’ has the responsibility for managing medication at the home. Medication was stored securely. Medication records were, for the most part satisfactory, but some hand written entries did not state the strength, dose or frequency that the medication should be given; some had not been signed and dated. Where there was a hand-transcribed entry this had not been checked by a second person, which would further ensure safety. Brandon DS0000021891.V256969.R01.S.doc Version 5.0 Page 10 A visiting Hospice nurse praised the home for its management of the very frail and dying. She said that staff are able to adapt well to a resident’s deteriorating condition, they are very attentive, work closely with her, that care provided is very good, and that staff always manage even in difficult circumstances. Brandon DS0000021891.V256969.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): 12, 13, 14 & 15 Residents are able to maintain control over their daily lives, with support as requested by them. Their experiences at the home match their expectations and wishes. Residents receive a nutritious varied diet, which meets individual choice and health care requirements. EVIDENCE: Residents are given every opportunity to meet physical, mental, creative and artistic needs. A seated exercise session was observed during the inspection; there had been flower arranging the day before. Family are invited to some social events, entertainers come in and residents organise and lead some activities themselves. Residents’ rooms are very personalised, containing their own furniture and fittings. Some had taken the opportunity to garden in tubs on the patio. The home is designed so that residents with physical disability are not restricted, with adaptations such as the vertical lift to aid mobility. Communion is available monthly. Residents said that the food was good. Dietary needs were well assessed on admission and specialist dietary needs are met. Weight is monitored so as to
Brandon DS0000021891.V256969.R01.S.doc Version 5.0 Page 12 identify any cause for concern. The dining room is very attractive and was beautifully laid for the lunch. Fresh fruit and vegetables are used and food home baked. Residents said that they have more than enough food provided. Brandon DS0000021891.V256969.R01.S.doc Version 5.0 Page 13 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): Not inspected on this occasion. EVIDENCE: Brandon DS0000021891.V256969.R01.S.doc Version 5.0 Page 14 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 very clean, fresh and hygiene is well maintained. EVIDENCE: The laundry room contains modern commercial equipment so that laundry can be managed effectively, meeting good practice guidelines on hygiene and infection control. The laundry worker said that protective clothing is provided and she spoke of health and safety training and how she achieves separation of soiled from routine laundry. The home is spotlessly clean and fresh. A visiting Hospice nurse described the standard of hygiene at the home as “fantastic”. Brandon DS0000021891.V256969.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): 28 Residents benefit from staff that are qualified and competent in providing personal care. EVIDENCE: Residents were very satisfied with the care provided and said staff were very competent in what they did. Staff felt that residents were very well looked after and a visiting Hospice nurse confirmed that standards of care at the home are very high. Care homes are expected to achieve 50 of care staff qualified to NVQ level 2 or equivalent by 2005. Brandon is congratulated for achieving 95 , which also includes staff with NVQ levels 3 and 4. Brandon DS0000021891.V256969.R01.S.doc Version 5.0 Page 16 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 The home is well managed and run in the bet interest of residents. EVIDENCE: The registered manager sets high standards at the home, which are achieved through clear leadership and good organisation. She has achieved the Registered Managers Award, is an NVQ assessor, a moving and handling trainer and has experience working in environmental health and the nursing profession. Her competence is further achieved through regular up-date training. Providing a quality service is a high priority at the home. The manager said: “we want people to be proud to live here”. To obtain feedback resident and family surveys are used, staff and residents’ meetings held and there is a comment book available. Brandon DS0000021891.V256969.R01.S.doc Version 5.0 Page 17 The home chooses not to have direct involvement in residents’ finances. Many look after their own financial affairs; some have family or an advocate working on their behalf. The manager said that lockable storage is available for rooms as required. Brandon DS0000021891.V256969.R01.S.doc Version 5.0 Page 18 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 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X 4 STAFFING Standard No Score 27 X 28 4 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X X Brandon DS0000021891.V256969.R01.S.doc Version 5.0 Page 19 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. Standard Regulation Requirement Timescale for action 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 1 Refer to Standard OP9 OP9 OP9 Good Practice Recommendations The strength, dose and frequency on each entry of medication should be recorded. Each entry of medication to be administered should be signed and dated. Hand transcribed information on medication should be checked by two members of staff (and signed by both). Brandon DS0000021891.V256969.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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 Brandon DS0000021891.V256969.R01.S.doc Version 5.0 Page 21 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
