Inspection on 27/09/05 for Branthwaite Care Home

This inspection was carried out on 27th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Branthwaite Care Home 28/01/09

Branthwaite Care Home 14/12/06

Branthwaite Care Home 13/06/05

Branthwaite Care Home 17/03/05

Branthwaite Care Home 16/06/04

Branthwaite Care Home 25/02/04

Similar services:

Trevayler Residential Care Home

Thornham Grove

Thistle Hill Hall

Conifer Lodge

Westwood Lodge

Egerton Lodge Care Home

Alfred Minto House Care Home

St Matthews Unit

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

CARE HOMES FOR OLDER PEOPLE Branthwaite Care Home 34 Welham Road Retford Nottinghamshire DN22 6TN Lead Inspector Jayne Hilton Unannounced 27 September 2005 at 10:00 am th 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. Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Branthwaite Care Home Address 34 Welham Road Retford Nottinghamshire DN22 6TN 01777 706720 01777 701758 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) FBC Care Homes Limited Mrs Leelah Manee Sooriah Care Home (CRH) 21 (Twenty One) Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (MD) - 9 (Nine) of places Mental Disorder, excluding learning disability or dementia - over 65 - 12 (Twelve) Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 The 9 people within the registration category MD shall be resident in the house 2 the 12 people within the category MD/E shall be resident in the lower extension. Date of last inspection 13/6/05 Brief Description of the Service: Branthwaite is an older style adapted and extended home offering accommodation for 21. there are 17 single bedrooms and 2 shared bedrooms. Access is via stairs and a vertical lift. Many of the bedrooms have direct access to the gardens via French doors. There are a variety of day spaces well furnished in a homely style and lounges include designated smoking areas. There are attractive well-maintained gardens, which offer security and privacy for service users. The home is situated in a quiet residential area close to the town facilities of Retford. The home is sited on a main bus route. Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on 27th September 2005 by Regulation Inspector Jayne Hilton for a duration of five hours. The Registered Manager was on holiday and therefore some of the requirements and recommendations set at the last inspection could not be fully assessed and have been, carried forward, to be assessed at the next inspection. There are some issues identified in the main body of report that have not been addressed, but were encompassed within the overall general requirements. The inspector will set these as individual requirements in this report to ensure that these are complied with by the next inspection. The methodology used at this inspection included the examination of four care plans and associated records. Speaking with two service users, two staff members and a representative for the Registered Provider. A partial tour of the building took place and the previous requirements and recommendations assessed for compliance. The provider/manager informed the inspector that they have plans to build a new purpose built home in the grounds of Branthwaite and demolish the current property. There are a number of repairs and issues in relation to the existing building which the manager acknowledged and stated that this has contributed to the decision to build a purpose built home to meet with new environmental standards. The service users in the home are of a mixed age group and have different needs. The report addresses the National Minimum Standards specific for each service user category. The scoring section addresses older persons standards and includes an overall assessment, which includes the linking standards from the Younger adults standards. Any specific requirements and recommendations relating to Younger adults only will be addressed following those identified in general for all service users. What the service does well: Service users spoken with praised the care provision at the home. The environment is homely and service users benefit from personalised and comfortable bedrooms, lounges and dining rooms. There is a good knowledge of the complaints procedure demonstrated by service users. Service users are happy with the support for personal care and were clean and well clothed. Service users were happy with the food, and a menu with choice options is provided. There were numerous thank you cards and letters from relatives about the care provided. Service users rooms were personalised and a service user said that she felt her business was kept confidential by staff. Many of the bedrooms have direct access to the gardens via French doors. There are a variety of day spaces well furnished in a homely style and lounges Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 Page 6 include designated smoking areas. The home is furnished in a homely and comfortable manner. Service users spoken to are happy with their rooms that they can choose to spend time in. The home has several communal rooms that service users can choose to use throughout the day. 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. Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 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 standard(s) OP1, 2, 3, 4 [standard 6 OP is not applicable] and YA, 1, 2, 3, 5 The newly devised Statement of Purpose does not quite meet the regulation and requires amendment. Completed contracts were now evident but there was no evidence that service users had received confirmation that the home could meet their needs. The assessment documentation has been reviewed but needs to address both service user categories to ensure all individual needs are met. The registered person has admitted service users outside of the registration category, which is a breach of legislation. EVIDENCE: A new statement of purpose has been produced, however after a thorough assessment of the document it still does not provide accurate and sufficient detail of the service provided. The registered provider’s representative explained that a new brochure was in process and this with the finalised statement of purpose would be given to each service user. The current statement of purpose does not meet regulation in relation to: Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 Page 9 The statement of purpose must be specific to Branthwaite and identify its category of registration, who the service is registered to care for. The home provides care for younger adults also but only states older persons needs cared for in the information The number and size of rooms. The name of the provider and the qualifications of the provider. The section for admissions requires expanding to include emergency admission and the assessment process. The information for social activities, hobbies and interests needs expanding. A sample of the terms and conditions document was seen The terms and conditions meet the NMS for older people but were not applicable for younger adults. The registered person needs to address this. There was no evidence that the registered person had confirmed in writing to the service users that having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in respect of his/her health and welfare. Regulation 14[1][d] There was an assessment in place, which was the same for both younger and older service users catered for. The registered manager is in the process of revising the documentation to revise the document to include all of the topics listed in Standard 3.3 of older people NMS and 2.3 of the NMS for younger adults. Any reference to nursing observations has been removed. The registered manager demonstrated that all new service users are only admitted once a full assessment has been carried out. Three service users who had been admitted since the previous inspection had clearly been admitted outside of the registration category for the he home. The home is NOT registered to care for people with a primary need of Dementia, which all three assessments clearly identified. An immediate requirement has been set that the home must not admit further service users with a primary need of dementia and those that have been admitted since the previous inspection, who fit this criteria must be placed within a home that is registered accordingly. One of the service users was a younger adult who was at risk from wandering out of the building and the staffing levels provided on the middle floor were clearly not sufficient to appropriately supervise this service user. Staff had resorted to locking the front door, which was a fire exit and this is not acceptable practice. St 27, 38 The service users spoken with were happy with the service provided. Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 Page 10 A detailed social history and assessment should be included and a care plan devised to instruct staff how these needs are to be met. The section for religion of service users should be expanded to include spiritual and cultural needs. Where service users are referred through Care Management this should be indicated and the necessary Care Programme Approach [CPA] for people with mental health problems in place. There was evidence that one service user had their own bedroom door key and key for lockable facilities which the service user had requested to have. There was no evidence on the care plans or during the inspection that other service users had been offered keys or/either risk assessed as not able to manage a key. The issue should be addressed on admission and reviewed periodically. Community Care assessments were observed in care plan files where appropriate. On one of the files examined there was an indication of a history of falls, however this was not followed up in the form of review or evaluation of incidents of falls that may have occurred in the home [see standard 8] Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 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) OP7, 8, 9, 10,11 and YA 6, 16,17, 18, 19, 20,21 Care plans are in place for service users, however these are to be reviewed and structured to the relevant service user category. The healthcare needs of service users, their wishes and preferences needs to be more detailed within the care plan system. Medicines management is overall satisfactory but some areas need further work. Service users are happy with the support for personal care and were clean and well clothed. EVIDENCE: Care plans were in place and were assessed as generally in line with the identified needs of service users, [will need to be improved with an improved assessment document which will identify all needs of service users] however the registered person is in the process of revising the style of the care plan format and ensure that the components of standard 6 of the younger adults standards are followed. One service user spoken with praised the support provided by the home. This is an example of the service is meeting the changing needs and aspirations of service users and service users personal goals. A key worker should be allocated for service users who are younger and the care plan reviewed and evaluated with the service user, significant professionals, family, friends and advocates at the request of the service user or at least every six months. Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 Page 12 Care plans for older service users were reviewed monthly since the last inspection. These would be further improved if they demonstrated a clear process of evaluation from daily notes, hospital/GP visits etc. Of the four care plans examined these were generally disorganised and would be improved by a standard system of organisation and dividers for different sections. The daily log of service users’ progress was factual and personalised to the individual and was written in an holistic way. Some care plans were signed as agreed by the individual or their representative although risk assessments that were in place were signed. Health care topics were not fully structured into the assessment and care plans, such as the arrangements for foot care, medication [no reference to self medication and either risk assessments], optical and dental care, no running record of falls [cross referencing from accident reports] and the evaluation and monitoring of falls, There was now care plans in place for monitoring service users psychological health and regarding specific nutritional needs and risk assessments for nutrition and tissue viability One care plan referenced a hospital visit but this was not documented in the GP/hospital running records and it was clear why the service user had needed to attend for an x-ray. The provider representative agreed an out patient record form would improve the care plan structure. A head injury was noted to be recorded in the accident records, but no advice had been sought from a medical professional. Service users confirmed that they were assisted well with personal hygiene and all service users were observed to be clean and wearing clean clothing, which was appropriate to their age and the season. A record of GP visits was seen and was, noted to be called in promptly. Younger adults should be encouraged to have an annual well person check and other checks such as regular smear tests, breast screening and hearing checks and this should be evidenced within the care plan structure. Their wishes for the end of life should be obtained and recorded. Where younger adults have increasing frailty and are ageing this should be addressed within the care plan topics. At the previous inspection it was observed that authorisation for use of bedrails is usual practice, however one service user case tracked had no evidence on her care plan that this had been sought. It was explained that circumstances had prevented this and advice was given to ensure that there was adequate Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 Page 13 documentation held regarding this and that the district nurse or GP should be involved, where relatives cannot be. The term “cot sides” is not an age appropriate term and should be changed to bedrails. [This is to be assessed at the next inspection] Service users financial records were examined at this inspection. [See standard 35] Medicines management was not fully assessed at this inspection due to time constraints and will be further inspected at the next visit. The British National Formulary was date 2001 and is clearly out of date. Medicine trolleys were secured to the wall when not in use. There is no evidence of medication profiles, \medication reviews or evidence for opportunities to self medicate and appropriate risk assessments for this purpose. Service users felt that their privacy was respected and a staff member spoken with relayed how she maintained service users privacy and dignity. Service users confirmed they had easy access to a telephone and could use it in the privacy of their rooms if so wished. There was now evidence of recorded preferred term of address recorded in the care plans that were examined The wishes of service users for the end of their life are now documented in their care plan. Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 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) YA 7,8,12,13,14,17 OP12, 14, 15 Service users are provided with activities, however this facility could be further improved. Service users were happy with the food, and a menu with choice options is provided. EVIDENCE: There is no structured programme of activities but staff organise something every day and this is and who participated is documented in the activities file. During the inspection music was played in the ground floor lounge. Other recorded activities were hair and beauty, darts, DVD, and Holy Communion. There was no evidence of any specific activities for the younger service users. The Inspector advised that a structured programme of activities, be set up so that service users know what is arranged and that it is based on the assessed social needs of service users and written into care plans. It is an expectation of standard 14.4 that the home provided a seven- day annual holiday for service users who are younger adults. There were numerous thank you cards and letters from relatives about the care provided. Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 Page 15 Service users rooms were personalised and a service user said that she felt her business was kept confidential by staff. Service users should be offered a key to their own bedroom and where able a key to the front door. One service user did not have a lockable facility in her room and this must be rectified. A four - week menu was displayed on the notice board in the dining room; there was a second option on the menu and service users said that if they did not like the meal that was presented the staff would get them an alternative. The main food is cooked at the neighbouring care home Cherry Holt and is transported to Branthwaite on a heated trolley. The vegetables are prepared, by, night staff and a good selection of fresh vegetables was seen in the fridge store. There are no service users on soft diets but special diets for diabetics. A bowl of fresh fruit was also seen in the kitchen. Evidence should be provided that service users have a choice of meals, which should be in the form of a daily record of what each service user has chosen from the menu offered. A page a day diary would be useful for this purpose and which fridge and freezer temperatures and food probe temperatures can be recorded at the same time. Food probe temperatures and fridge and freezer temperatures were now being taken daily. Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 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) OP 16,18 and YA 22, 23 Service users and relatives spoken with were aware of how to make a complaint. There are systems in place to protect service users from abuse and staff training on adult protection would further support this. EVIDENCE: Service users spoken with were aware of how to make a complaint should they wish to and were confident that this would be dealt with appropriately. The complaints procedure displayed was lengthy and not easily accessible. A shortened version should be updated and placed in a prominent position. The complaints procedure format meets with the standard and a new formal system is in process but not yet completed, it is recommended that a formal system of paperwork is devised which can be used for complaints and which copies of letters and investigation reports can be kept together. One recent complaint was documented and investigated as a vulnerable adults referral. The outcome of the investigation is not upheld. Staff have not received training in adult protection, but were clear about reporting any concerns about bad practice. Policies are in place for adult protection and whistle blowing. Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 Page 17 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) OP19, 20, 21, 22, 23, 24, 25, 26 and YA 24,25, 26,27, 28, 29,30 Generally service users have a comfortable and homely environment to live in with adequate toilet and bathroom facilities. The specialist equipment provided has not been assessed by a professional occupational therapist and due to lack of space may not be suitable to meet all service users needs. Service users rooms are well personalised and those spoken with, were happy with them. A number of repairs and refurbishment is needed throughout the home. Overall the home was clean, hygienic and free from malodour. EVIDENCE: Branthwaite is an older style adapted and extended home offering accommodation for 21. There are 17 single bedrooms and 2 shared bedrooms. Access is via stairs and a vertical lift. The lift is only large enough to carry two people and staff reported difficulty when using the lift with wheelchairs and stated that they have to fold the handles down. Many of the bedrooms have direct access to the gardens via French doors. There are a variety of day spaces well furnished in a homely style and lounges include designated Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 Page 18 smoking areas. The home is furnished in a homely and comfortable manner. Service users spoken to are happy with their rooms that they can choose to spend time in. The home has several communal rooms that service users can choose to use throughout the day. The provider/manager have reported that they are aware of the limitations the home is now presented with in terms of physical environment and there are plans being drawn up to replace the existing home with a purpose built home on the site. Toilet and bathroom facilities on the ground floor were adequate. On the first and second floor there are adequate bathroom and toilet facilities. One toilet was out of use at the last inspection but was not assessed at this inspection. As there are a number of vacancies this is sufficient, however if further beds are filled, the toilet must be in use. A plastic garden chair was observed once again, in the bathroom and the inspector enquired as to its use, as it was not deemed to be safe practice to use this as a bath chair staff stated that it was not in use and it was quickly removed. Assisted bathing was provided, however as there has been no occupational assessment regarding whether the specialist equipment is appropriate to meet the needs of the individuals the inspectors were concerned that this was required. A number of grab rails were provided in bathrooms and toilets and these too should be assessed as suitable by a qualified occupational or physiotherapist. Call alarms were observed to be in place and in reach for service users. A bathroom on the second floor housed a hoist, which had damaged the tiles and skirting whilst being used, as there was clearly limited space to manoeuvre this. Wheelchairs were stored under the staircase. The flooring on the hallway, which leads to the lift on the second floor which was uneven and was a trip hazard and staff reported that it also made it difficult to push wheelchairs over the raised area has now been made level. Service users bedrooms were well furnished and personalised. One room on the front of the house was noted to have wallpaper lifting at the side of the window, possibly as a result from a water leak or possibly damp. This needs to be investigated, appropriately made good and the room re-decorated. A kitchenette on the middle floor has been re-decorated, and old appliances removed. Overall the home was generally clean. At the previous inspection the laundry room was examined two washers and two driers were provided which meet the standards for disinfecting. There was, conflicting reports from staff about how soiled linen is transported and sluiced. There was no procedure for this practice. Staff, are due to undertake infection control training shortly and it is recommended that a policy for Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 Page 19 prevention of cross infection in relation to laundry procedures is developed in conjunction with the Environmental Health Officer. Standard YA 30.5 At the previous inspection the water outlet temperatures had not been checked and the water in service users rooms and bathrooms was extremely hot and posed a risk of scalding. The manager reported that there was a system of regulation valves in the loft and demonstrated a commitment to rectify the issue. An immediate requirement was made for the water outlet temperatures to be regulated to 43 degrees. Records should be kept of monthly checks, which detail the temperature reading and any action taken to rectify temperatures and a retest. The environmental health officer had made a visit on 12th July 2005 and made a requirement that sufficient risk assessments for hazards which may affect the health and safety of people on the property and that at the time of his visit there were no risk assessments available for the hazards of legionella and scolding from hot water and radiators and a requirement was made that sufficient risk assessments be put in place and adequate control measures. At this inspection no follow up documentation was seen from the EHO regarding this requirement and this must be provided to the inspector. Records of water outlet temperatures were seen, however three were above 43 degrees and there was no action taken or recorded or a retest documented. There are no staff room facilities and these should be provided. [Standard YA 28.3] A downstairs bathroom was found to be generally untidy with continence pads stored on the floor at the side of the bath. Staff uniforms and clothing were seen. It is recommended that the room be tidied and its use #defined. The lighting in the ground floor hallways was very dim. Standard OP25.6 requires that a lux level of 150 should be provided. The provider needs to ensure that that the lighting is of a safe level for service user safety and in consideration of possible sensory impairment of service users. On the exterior of the building several windows are in need of re-varnishing and the exterior bricks to the old building were showing signs of weathering and were breaking down. Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 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) OP27, 28, 29, 30 and YA 32, 33, 34, 35, 36 Service users are supported by, a committed staff team who are keen to undertake training to improve their skills, however rotas must be an accurate record of staff working each day and staffing levels adjusted to meet the needs of current service users. Other training provision needs to be kept up to date. Recruitment policies are being improved. EVIDENCE: Staffing rotas were examined and staff confirmed that 3 care staff, are provided to support the older service users on the ground floor and 1 staff member for the younger adults on the first floor throughout the daytime. The third staff member on the ground floor is counted as a floating person to be available on both floors as needed, however the front door had been locked as a newly admitted service user had wandered out and clearly one staff member on this floor is clearly insufficient at this time. On night shifts 1 staff member covers each floor, As the main meals are cooked at the neighbouring care home there are no kitchen staff employed, although night staff prepare vegetables and care staff prepare snacks, sandwiches and alternatives. There are no laundry staff employed and care staff, are expected to undertake laundry duties also. The manager had said at the last inspection she was always around so in effect would be four on duty, however the registered managers hours should be super-numery. The manager also reported that she is on call if needed at night as lives in an adjacent property. Staff rotas need to demonstrate, that they meet with the previously agreed staffing levels and the dependency levels of the two different service user groups in the home. Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 Page 21 The rotas also need to demonstrate that for 21 service users, 42 hours are provided for domestic and laundry and 42 hours for catering in addition to 341.5 care hours for day staffing hours. The staffing hours must be evidenced in this way. Two handymen are employed and are shared by the neighbouring home. The rota was found to be inaccurate as a member of staff and the manager who were both absent were documented as on shift. Evidence of induction for new staff could not be seen, as these were not available for inspection. The manager explained at the previous inspection that the home is now registered with the local college for Skills for work induction, to perform in line with National workforce standards for training. It is recommended that induction topics are signed and dated by the new staff member and the assessor, at the time, when each has been completed. A training programme is displayed on the manager’s wall and this indicates the majority of training is now ready for updating. The mandatory training subjects should be provided annually as refreshers. One member of staff spoken with reported that she has not undertaken any food hygiene training yet has been employed at the home for five years. She also reported that she had no training in first aid, and that it was some time since she had training in manual handling. All food handlers including carers who serve food must undertake training in food hygiene. Health and safety training is currently underway. Further training is booked for more in depth training on dementia care. Fire safety training appeared to be up to date but the provider must provide evidence of this. Staff member’s personal files were seen, an immediate requirement was made at the last inspection for all staff personal files to be completed as required by regulation and as listed in Schedule 2. POVA first Checks [Protection of Vulnerable Adults list] had been carried out. The registered person has been working to comply with the legislation and these are almost now complete. The registered provider has stated that he will not employ any new staff without obtaining the relevant documentation prior to allowing them to start work. Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 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) OP33,35, 37 38 and YA 7 =[op35], YA 38, 39,41, 42 The quality monitoring systems in place could be further improved to ensure the home is run in the best interests of service users. Service users best interests are generally protected by record keeping in the home. However some were found to be inaccurate or not available. Some identified issues in the report compromise Service users’ health, safety and welfare. EVIDENCE: At the previous inspection there was a supply of, service user survey questionnaires available and these were seen in the home, however the position of these and the suggestion box, for posting these are not in an ideal place and may be overlooked by visitors. Only two old questionnaires were seen as evidence that the process is working satisfactorily, both were not dated. The manager was advised to promote the survey and look at sending out to service users, relatives and supporters each quarter or every six months Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 Page 23 and cover one topic in detail at each time, this would reduce the risk of repetitive questions being asked and would give the provider more to work with than the current system allows, if services needed improving. Feedback is to be provided after each survey to those taking part. This issue could not be followed up at this inspection and therefore carried forward to the next inspection to be assessed. The manager had also completed a quality audit tool, which appeared to be a good system, however this had been used once and a signature added for subsequent reviews. As there were issues identified in the building that should have been identified from regular monitoring, it is recommended that the system be reviewed to ensure that the manager or provider or their representative are aware of the standard of repair and services provided in the home. This issue could not be followed up at this inspection and therefore carried forward to the next inspection to be assessed. Samples of service user’s personal monies records were examined and although appeared to be up to date and carried two signatures the receipts were not evident. The representative reported that there were no service users belongings kept in the safe and was not aware of a receipt book being available should this facility be needed. The contract details insurance cover for service users personal possessions. The level of training for staff to ensure safe working practices for staff needs some improvement to ensure that all staff undertake the mandatory training requirements. There was no evidence of risk assessments being carried out for surface temperatures of radiators. Covers had not been provided. There is now a colour coding system for use of mops and buckets. The gas safety certificate was seen but the electric certificate was not yet available and this must be sent to CSCI once received. Fire risk assessments are now in place. Fire testing records were examined and these were satisfactory. There was no evidence of were generic risk assessments. Accidents were well documented but they did not comply with Data Protection Act 1998, however a new book is on order to rectify this. The food trolley transported from the neighbouring home is connected back to the electric on immediate arrival at Branthwaite; there are now records of safety probe checks of the temperature of the food. Cleaning products were noted to be left unattended in the home, a carrying box full of these was left in a corridor and was a potential trip hazard as well as contravening COSHH regulations [Control of Substances Hazardous to Health] The dustbins were observed to be placed under the fire escape and several cardboard boxes had been discarded under the fire escape also, which was not acceptable or safe practice. These were removed during the inspection. Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 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 2 2 1 1 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 2 15 3 COMPLAINTS AND PROTECTION 2 3 2 2 3 2 2 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 2 x 2 x 2 2 Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 Page 25 yes OP2 and OP38 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. 2. Standard 0P/YA1 OP3YA2 Regulation 4 14[1][d] Timescale for action Amend the Statement of Purpose 27th to ensure it meets the regulation November fully 2005 The registered person must 27th confirm in writing to the service November user that the home can meet the 2005 assessed needs of individuals The registered provider must not IMMEDIAT admit service user outside of the E 27TH September registration category. Those service users admitted since the 2005 last inspection with a primary need of Dementia must be found appropriate accommodation in conjunction with the individuals social worker Provide two staff members on 27th the Youger adults floor at all September times, whilst the service user 2005 who wanders remains at the home Ensure the staff personal records 27th Nov of staff are completed. 2005 Provide update training for all 27th staff and ensure all staff November undertake training in food 2005 hygiene, first aid, infection control, manual handling and provide evidence that all staff are up to date with fire safety training. Version 1.40 Page 26 Requirement 3. OP4YA2 CSA 2000 4. OP27 YA31 18 5. 6. OP29, YA34 19 OP30 12, 1318 Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc 7. 8. OP37 OP38YA42 9. OP38 10. OP38 11. 12. 13. OP38 OP38 OP38 Ensure all records are accurate up to date and available for inspection. 12, 13, 16 Ensure that service users health and safety is protected by safe storage of cleaning materials and toiletries. This is second time breach in this area. 12, 13, 16 Provide evidence of risk assessments for surface temperatures of radiators and cover radiators risk assessed as priority 12,1 3,16, The front door must not be kept 23 locked during the daytime and measures must be put into place to ensure staff have access to the keys at night to enable safe evacuation in the event of a fire 12, 13, Ensure that dustbins and 16, 23 combustables are not stored under the fire exit. 12, 13, Provide evidence of the five 16, 17 yearly electrical safety certificate 12, 13, 16, 23 17 27th November 2005 Immediate 27th September 2005 27th November 2005 27th September 2005 27th September 2005 27TH November 2005 Ensure water outlet 27th temperatures are regulated to 43 November degrees. 2005 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 OP2 OP3YA5 OP3YA5 Good Practice Recommendations Ensure the terms and conditions and contracts are appropriate for the age and category of srevice user and a copy is held on the individuals care plan. Ensure the assessment documentation meets with Standard 3.3 for older people and Standard 2.5 for younger adults Include the preference of service users for door keys and keys for lockable facilities is included in the assessment documentation. C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 Page 27 Branthwaite Care Home 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. Ensure the care plan files are organised and divided for easy reference and follow up and is in the relevent format for the service user category. OP7YA6 Further develop the care plans risk assessments and OP8YA19 charts for monitoring healthcare needs OP3OP7OP Where service users are referred through Care 8YA5YA6YA Management this should be indicated and the necessary 19 Care Programme Approach [CPA] for people with mental health problems in place. OP7OP8YA Include a detailed social assessment and care plan for 12, YA14 individuals to meet those identified needs. YA13, Provide evidence of suitable activities provision for the YA14 younger adult service users. OP8 Provide a running record of incidents of falls in care plans and monitor and evaluate the imncidenec of falls OP8 Provide evidence that the information in care plans have been fully evaluated from daily notes, weight records and appointments attended etc. YA 18 Provide keyworkers for younger adult service users OP8 Where service users sustain a head injury as a result of a fall, appropriate medical advice must be sought OP8 Authorisation for bedrails should be sought from relatives and professional involved in the service users care. OP18 Ensure youger adults have an annual well person checks and appropraite screening OP9YA20 Ensure service users files indicate assessment for self medication and outcome OP9YA20 Use medication profiles in care plans which can be updated when medication reviews have been undertaken OP9YA20 Obtain an up to date British National Formulary YA12, 13, Provide appropriate activities for younger adults 14 YA14 Provide a seven day holiday for younger adults YA14 Ensure all service users have lockable facilities OP15YA17 Provide evidence of individual food choices of each service user in the form of a daily record. OP16YA22 Further develop the format for recording complaints, response dates etc OP18YA23 All staff should have training in adult protection OP21 Provide facuilities for staff OP22 Cease the practice of using garden chairs in bathrooms/showers OP22 Obtain a professional Occupational Therapy assessment regarding the aids and adaptations provided in the home OP22 Tidy and define the use of the bathroom on the ground floor. C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 Page 28 OP7YA6 Branthwaite Care Home 28. 29. 30. 31. 32. YA26 OP26 OP30 OP35,YA 7 OP38 YA42 Repair the wall in the identified service users room, make good and redecorate Ensure that procedures are in place for safe handling of laundry and infection control procedures are in place Provide evidence of staff induction. Ensure receipts are kept with service users financial records Provide evidence of risk assessments for all safe working practices Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 Page 29 Commission for Social Care Inspection Edgeley House Tottle Road Riverside Business Park Nottingham, NG2 1RT 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 Branthwaite Care Home C53 C03 S8638 Branthwaite V248117 270905 Stage 4.doc Version 1.40 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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