CARE HOMES FOR OLDER PEOPLE
Brandon Lodge Care Home Commercial Street Brandon Durham DH7 8PH Lead Inspector
Mrs Sue Lowther Unannounced Inspection 14th September 2006 09:30 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 Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brandon Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Brandon Lodge Care Home Address Commercial Street Brandon Durham DH7 8PH 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) 0191 3781634 0191 3781636 brandon.lodge@fshc.co.uk www.fshc.co.uk Tamaris Healthcare (England) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Anna Marie Clark Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places Brandon Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd November 2005 Brief Description of the Service: Brandon Lodge was custom built as a care home. There are 38 bedrooms, located over two floors. All bedrooms are single rooms, 37 have en-suite facilities. Brandon Lodge caters for service users who require general nursing and residential care. The home is located in a semi-rural setting and is surrounded by small, well-maintained gardens. There are a variety of sitting rooms located throughout the home and a dining room is available on the ground floor. There is a varied social and recreational programme available for those who wish to participate. He fees charged at the time of this inspection were between £365 and £412 per week. The fees do not include hairdressing, toiletries and newspapers. Brandon Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection of Brandon Lodge Care Home took place on the 14th September 2006. Records were examined and a tour of the building took place. Time was spent talking to service users, staff and relatives. The manager supplied some information on a pre-inspection questionnaire. One service user and two relatives returned surveys to the Commission for Social Care Inspection (CSCI). Information about these is reflected in the report. The inspection focussed on key standard outcomes for service users What the service does well: What has improved since the last inspection?
Staff have received training with regard to care planning and as a result these have been evaluated regularly to ensure that all of the needs of the service users are met. Food records are now kept in sufficient detail to confirm that the diet is satisfactory.
Brandon Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 Page 6 The recording of complaints is now kept in enough detail to show that appropriate action has been taken. Some additional commodes have been provided. The manager told the inspector that more have been ordered. The home has recruited several new members of staff and there is now a consistent team to provide good care for service users. The manager has completed an appropriate management course to ensure that the staff are appropriately supervised and that the home is run in the best interests of service users. 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. Brandon Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 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 Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 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): 1, 2 & 3. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Whilst admissions to the home are well managed some service users have not received a contract to tell them what is included in their fees. The home does not provide intermediate care. Therefore assessment of Standard 6 is not required. EVIDENCE: Copies of the statement of purpose and service user guide were on display within the home. These documents contained all of the information required to enable people to make an informed choice about whether they would like to live at Brandon Lodge Care Home. The manager showed the inspector some contracts that had been signed and retuned. However these were not available for all of the service users who live in the home.
Brandon Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 Page 9 Four care plans examined showed that a full pre-admission assessment had been carried out. On the day of inspection the manager visited a prospective service user before admission to the home. The service user and their relatives were involved in this process. This is to ensure that the home can meet the needs of the prospective service user. One family said that they had looked around the home before their relative went to live there. She said, “When I came to look around the staff were friendly and helpful. They gave me enough information for me to decide that my mother would like to live here”. Brandon Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 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 & 10 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Good systems are in place to ensure that health care needs of service users are met. Service users can be confident that their privacy and dignity is protected and that they are treated with respect. EVIDENCE: The manager said that all of the service users have care plans. Four were looked at during the inspection. These were comprehensive and well written. Records examined showed that service users receive visits from other healthcare professionals. These include district nurses, doctors, and care managers. Although some people said that they were aware of their plan of care, there was no written evidence to confirm this. Brandon Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 Page 11 Medication systems were looked at during this inspection. The home uses a monitored dosage system. All of the medication was signed for on the medication administration records. The manager said that she carries out an audit on a regular basis to ensure that any problems are quickly identified and action taken where necessary. She also said that staff are now more aware of any potential problems and bring them to her for immediate attention. Service users and relatives said that the staff are polite, friendly and treat people with respect. One service user said, “The staff here are pretty good and always polite”. Another said, “The staff are very nice. They are polite and helpful”. All of the people spoken to confirmed that their privacy is maintained. Brandon Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 Page 12 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 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The activities are varied and provide recreation for some of the people living in the home. Family and friends can visit the home at any time and are made to feel welcome. The meals are of a good standard. Menus are varied and service users are given a choice. EVIDENCE: The home employs an activities co-ordinator. Activities take place both inside and outside of the home. The indoor activities include bingo, board games, dominoes, skittles and carpet bowls. Outside entertainers visit the home from time to time. The activities organiser said that she tries to spend time with people on an individual basis so that she can find out which activities they like. She keeps written records to identify what each person likes to do. One service user said, “I get involved in all of the activities and really enjoy them”. Another told the inspector that she likes to read and when her eyesight deteriorated the home arranged for have to have access to the talking book library. Brandon Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 Page 13 Most of the people said that they liked the food and that a choice is always available. The daily choices were displayed in the dining room. One service user said, “The food is quite all right and I get a choice”. Another said, “ The food is good, there is plenty of it.” The lunchtime meal was observed. The atmosphere was relaxed and unhurried. Staff who were helping service users with their food did this in a courteous and discreet manner. Nutritional assessments are undertaken and special diets are prepared when required to ensure that all service users receive adequate nutrition. The manager carries out a regular kitchen audit which covers staff training and competencies, environmental and health and safety issues. Any areas of concern which she identifies are brought to the immediate attention of the company for action. Brandon Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 Page 14 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 & 18 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users can be confident that their concerns and complaints are dealt with appropriately and that safeguards are in place to protect them from abuse. EVIDENCE: Information is available for service users and visitors to the home on how to make a complaint. Service users and families views are obtained through regular contact and an ‘open door policy’. Residents meetings are held to discuss any concerns or potential difficulties. Service users and relatives said that they feel confident in discussing any issues with the manager The policies and procedures regarding protection of service users are regularly reviewed and updated. These provide information and guidance to staff. There has been one referral to the local authority for investigation under the safeguarding adult procedures that was not proven. Training in adult protection has been provided for almost all of the staff. Brandon Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 Page 15 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, 21, 22 & 26 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Although improvements have been made since the last inspection, there are still areas which require attention to provide a safe and homely environment for all service users. EVIDENCE: The inspector looked around the home and found it to be light and airy. However the requirement in the last inspection report that the home must have a sufficient number of bathrooms and shower rooms to meet the needs and choice of service users had not been met. Following the day of inspection a letter was sent to the company to tell them that all of the bathrooms must be in full use within one month.
Brandon Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 Page 16 Service users said that they could take their own possessions into the home to make their rooms more pleasant and homely. The communal areas of the home were clean and service users confirmed that their bedrooms are always cleaned to a good standard. The last inspection report recommended that additional commodes must be provided. The manager told the inspector that four had been purchased and some more had been ordered. There were no unpleasant smells apparent on the day of inspection. All of the people who returned questionnaires said that the home is always clean and fresh. Brandon Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 Page 17 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 & 30 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Staff are appropriately recruited, trained and in sufficient numbers to meet the needs of the people who live in the home. EVIDENCE: The home had staff files in place, which provided evidence that the appointment of new members of staff is made through proper recruitment processes. This includes the vetting of staff through the use of Criminal Record Bureau (CRB) checks, Protection of Vulnerable Adult checks (POVA) and written references. Two members of staff who had been recruited since the last inspection were spoken to. They told the inspector that they had been given sufficient information and training to enable them to do their job. Copies of induction records were available in the staff files. The staffing rotas were examined during the inspection. Staff felt that the levels are sufficient to meet the needs of the service users. One service user said, “Staff come quite quickly when I want them but leave me alone when I want to be. I like that”. Brandon Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 Page 18 Training has recently taken place in fire safety, moving and handling, drug administration, health and safety and infection control. Certificates to confirm this were seen in staff files. At the time of the inspection 40 of care staff had completed the National Vocational Qualification (NVQ) in care to level two or above. Six further people have been enrolled on the course. When these are completed, the home will achieve the standard of 50 . Brandon Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 Page 19 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, & 38 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users can be assured that the home is well managed and they are given the opportunity to comment on how the home is run. Policies and procedures are in place to safeguard their health, safety and wellbeing. EVIDENCE: The manager is well qualified, with several years experience in working with older people. She is a qualified nurse and has completed an appropriate management qualification since the last inspection. One member of staff said, “The manager is good, she is approachable and supportive. The staff can rely on her”.
Brandon Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 Page 20 Meetings are held every month. Service users and families are welcome to attend. This gives people an opportunity to make their views about the home known. The area manager carries out a quality assurance and monitoring visit on a monthly basis. This covers all aspects of care delivery and environmental issues. Copies of these were available in the home. The administrator is responsible for the record keeping with regard to service user finances. The company audits these on a monthly basis to ensure that residents are protected. The manager confirmed that the home carries out regular health & safety checks. The inspector checked some of the records. Those viewed were up to date. Brandon Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 Page 21 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 3 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 1 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Brandon Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 Page 22 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 OP2 Regulation 5(1)(b) Requirement Each service user must be supplied with the statement of terms and conditions (a contract) so that they understand the service that they are entitled to receive. There must be sufficient and suitable bathing facilities available to meet the needs and choice of service users. The bathrooms must be restored to full working order. (This is outstanding from the previous report. Previous timescale of 01/02/06 not met). Timescale for action 31/10/06 2. OP21 23(2)(j) 16/10/06 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. Refer to Standard OP7 Good Practice Recommendations Wherever possible care plans should contain written
DS0000000702.V303235.R02.S.doc Version 5.2 Page 23 Brandon Lodge Care Home 2. OP30 evidence that service users have been consulted with regard to their care. A minimum ratio of 50 of staff (excluding the registered manager) should be trained to NVQ Level 2 or equivalent. This will ensure that staff are trained and competent to do their job. Brandon Lodge Care Home DS0000000702.V303235.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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