Key inspection report
Care homes for older people
Name: Address: Braunstone Firlands Care Centre Gooding Avenue Braunstone Leicester LE3 1JS The quality rating for this care home is:
one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Fiona Stephenson
Date: 2 5 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People
Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home
Name of care home: Address: Braunstone Firlands Care Centre Gooding Avenue Braunstone Leicester LE3 1JS 01162558809 01162558809 firlands@prime-life.co.uk info@prime-life.co.ukwww.prime-life.co.uk Prime Life Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: No person under 55 years of age falling within the categories MD or DE may be admitted into the home except for the named person identified in the registration report of 22 December 2006 Date of last inspection Brief description of the care home Braunstone Firlands Care Centre is a care home providing nursing and personal care for up to twenty-four residents with mental health conditions including dementia. Braunstone Firlands has twenty two rooms, two of which are large enough to be shared should this be a positive choice. The home has a rear courtyard garden, which is accessible to residents. Braunstone Firlands is part of the Prime Life Group and is situated in Braunstone, Leicester. The entrance to the home is opposite Braunstone Park. There is public transport to the City Centre. Accommodation is provided over two Care Homes for Older People
Page 4 of 31 Over 65 24 24 14 14 3 0 0 1 2 0 0 9 Brief description of the care home floors with access between the floors being via stairs or a passenger lift. Communal areas are provided on both floors of the home. The fees range from £270 to £543 and may vary in accordance with the assessment of care needs carried out. People who live at the home are responsible for any additional charges such as hairdressing, personal toiletries, and private chiropody. Care Homes for Older People Page 5 of 31 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection included a visit to the service. This is the first key inspection of the service since January 2009. We (the CQC) visited the home on the 24th November 2009. The manager and the staff in the home helped us during the visit. Our visit started at 8.00am and finished at 5.30pm. We then visited again on the 25th November between 1.25pm and 3.15pm. The main method of inspection we used was case tracking. This means looking at the care given to people in different ways. We do this by, - talking to the people who live in the home and their relatives (if they are visiting), - talking to the staff and management, -watching how people are given support, Care Homes for Older People
Page 6 of 31 -looking at records. Because many people who live at Braunstone Firlands have dementia, as part of this key inspection we spent two hours undertaking a Short Observational Framework for Inspection (SOFI). During this time we sat in one of the communal lounges for two hours and watched how the three people who were sitting in the lounge were being cared and supported. We looked at the Annual Quality Assurance Assessment (AQAA). This is a document the provider (the person who owns the service) sends to us at the CQC, and it tells us what the provider thinks about the service they deliver to people who live at Braunstone Firlands. We looked the surveys called Have Your Say About which are sent out to people who live and work at Braunstone Firlands, relatives, and professionals who visit the home to support residents with personal and medical care. We did not receive any back from people living at Braunstone Firlands, but we received five back from relatives of those living in the home. The relatives, on the whole felt the service provided the care and support they expected, although one person felt they only sometimes provided the expected care and support. Relatives told us they knew how to make a complaint, and said that the service has responded appropriately if they have raised concerns. When asked what the service does well, relatives responded by saying: keeping XX clean and tidy, making sure XX uses the toilet when needing to go. Activities Although xx communication skills are are not good...the carers always tell him clearly what they are going to do - so he is not alarmed. They always ask his opinion, and await a reply they get to know the person very well, understand her likes and dislikes...always encourage her to do things for herself. Being kind and thoughtful to her and making her feel special friendly manner, patience.. when visits from GPs or other professionals required, this is swiftly provided. They also told us the service could improve by: making it more possible for clients to visit their homes there are disruptive and awkward residents who are aggressive to the other residents leaving hot drinks with patients, and not being supervised due to lack of carers in ratio to patients it would be great if there was more time to spend with individuals games/physio etc but I understand the limitations of time and cost sometimes I think the TV in the lounge is on very loud, and not always an appropriate channel i.e. some sort of pop channel with constantly changing screen and Care Homes for Older People
Page 7 of 31 flashes...something more gentle/old fashioned might suit residents more there could be more done if there were more carers on shift We received one response from a social and health care professional. They felt that the service usually responded to the needs of people who live at Braunstone Firlands. As part of the key inspection process, we also look at information sent to us since the last key inspection. We have therefore looked at the Regulation 37 notifications, complaints, and safeguarding referrals made to social services. We have also asked to see the monthly visit reports, written by the Director of Elderly services for Prime Life. Care Homes for Older People Page 8 of 31 What the care home does well: What has improved since the last inspection? The service was working hard to implement the changes required from our last key inspection. But in the last few months the service has seen a number of staff leave, and has had to use its own internal system of bank staff and bring in new staff. The Registered Manager also left the service, and another manager replaced her. This manager also left the service, and Ruth Hack, the Director of Elderly services for Prime Life is now temporarily in charge. Ms Hack has worked hard over the last six weeks to improve the service being provided to people who live in the home. These improvements are recent but include: Better care planning, and review of care to ensure that staff are aware of the current needs of people using the service. Improved systems to ensure the home is clean, and equipment used by people is kept clean. A new key worker system is being introduced so care staff take more responsibility for the care needs of the individuals they are key worker to. Staff are beginning to understand how they can provide activities based on the needs of the individual. There is now better communication between staff to ensure that staff know if a Care Homes for Older People
Page 9 of 31 persons needs have changed. Improvements made since the last inspection that were maintained include: Ensuring that new staff who have not received their enhanced Criminal Record Bureau clearance, are rotad as working under supervision at all times until their CRB record is checked by the Prime Life company. The statement of Purpose had been revised, however will need to be revised again once a new manager has been appointed. All residents now have access to a dentist, and the opportunity to have check ups each year should they wish them. Key pads have been fitted to the doors leading to the stairs. This has improved the safety of people living in the home, as they are not now at risk of falling down the stairs, or of using the stairs to get to the kitchen and laundry room in the basement. Staff have received training to help them work with people who have challenging behaviour. What they could do better: The service should ensure that the recent changes which have improved the care practice in the home, continue. The service should ensure that a new manager is appointed who has a good understanding of the needs of people who require nursing care, and who have dementia. The manager should have good experience of managing a care home and be able to demonstrate effective leadership skills. The service should continue to monitor staffing levels. There are residents at Braunstone Firlands who have high dependency needs, and residents who have challenging behaviour. There are concerns from relatives, and other health care professionals that there are not always sufficient staff to keep other residents safe. The person we saw being given one to one support in the SOFI inspection only receives this for four hours a day, and there are concerns about how their behaviour is managed at times when the one to one support is not available. We have been informed that the service is seeking additional funding to provide one to one support to people living at Braunstone Firlands with higher dependency needs. The service should ensure that when assessing if a person is suitable for Braunstone Firlands, they assess whether they have sufficient staffing to meet their needs (particularly if the person has challenging behaviour). The service should ensure that they do not mislead people by displaying judgements made about the service by the CQC which are not accurate and up to date. The information in the lobby of Braunstone Firlands was still showing the rating as good when it has been adequate since January 2009. We were told that this information was removed from the lobby immediately following the inspection. Care Homes for Older People Page 10 of 31 The majority of the staff at Braunstone Firlands are still relatively new and inexperienced in working in care. They continue to need additional support to help them understand the needs of people they work with. Although all staff have received training in Safeguarding Adults not all staff we spoke with, understood what their responsibilities were if they had concerns that a resident was being abused. The service must ensure that all staff are clear about the action they must take. We were told during our visit that some people are not happy with their main meal, provided by the Prime Life central kitchen. The staff group did not see that there was an issue in terms of privacy and dignity in having the hair dresser use the double bedroom of people living in the home, to do the hair of all those who live in the home. Experienced staff in particular should have known that this was not acceptable. The AQAA, written by the service Provider, did not accurately reflect the issues facing Braunstone Firlands. The AQAA was written more to show the CQC what the aspirations of the company were in terms of its services generally, as opposed clearly demonstrating what the issues, both positive and negative were for Braunstone Firlands in particular. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 11 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 12 of 31 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People moving into Braunstone Firlands are having their needs properly assessed. Evidence: The service provides individuals considering moving into Braunstone Firlands an information pack which includes a service user guide. Since the last key inspection, the Statement of Purpose had been updated, however this information is now out of date as the person who had been recruited to fill the position of manager, has left. We saw in the entrance of Braunstone Firlands a large framed poster which informed people visiting the home of what inspectors had said about the service, and of the two star rating the service had been given. This was dated 2006, and was misleading as since then, the service was inspected in January 2009 where it was rated as adequate. We saw that the maintenance department have been asked to take this down. We were informed by management that this had been taken off the wall, immediately following the inspection.
Care Homes for Older People Page 13 of 31 Evidence: Since the last inspection we have been made aware that one person who was new to the service, did not have their assessed needs met. We are also aware, that since we were alerted to this, changes have taken place within the service. We looked at the most recent admission to Braunstone Firlands Care Centre, and saw that a full assessment of the persons needs had been carried out, and that staff were working to ensure their assessed needs were being met. Care Homes for Older People Page 14 of 31 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal care support is improving. Evidence: Since the last inspection we have recently been made aware that the service has not always delivered effective health care and support to people who live at Braunstone Firlands, and that care plans have not always clearly identified the needs of people, and how staff should support the identified needs. Senior management at Prime Life, having been alerted to the issues, have put a comprehensive action plan into place. We saw that the action plan is being followed, and the care planning process for people living at Braunstone Firlands is improving. We were told by care staff that they are going to have a greater input into the care planning process, and have recently been told who they will be key workers to. We looked at the care records, and saw that these had improved. The care plans, on the whole give good information about the social, physical and mental care needs of people living at the home, and of the assessed risks they might have. We saw that the
Care Homes for Older People Page 15 of 31 Evidence: care plans were being reviewed, and were now being up dated when required. We checked the administration, storage and disposal of medication. We saw that in all areas the service was complying with the good practice recommendations of the Royal Pharmaceutical Society. We observed how staff treated people living at Braunstone Firlands, and saw staff were kind, and treated individuals with respect. But, during our visit we noticed that the hairdresser used a bedroom belonging to two people who lived at the home. She told us that she always used the room, and she used it to do the hair of everyone who lived there. We spoke with the Prime Life Director about this, who was unaware of this practice and stopped it immediately. The hairdresser was asked to go to each persons own bedroom to do their hair. We also noticed that although staff were kind to residents, they did not always think through their actions. We saw breakfast being served by relatively new staff. Breakfasts had been served to residents before coverings had been put on their clothes. We saw residents spill their cereals down clothes they had only just put on. We also saw, that people using wheelchairs were not always wheeled close to the table, and so when eating breakfast they again were spilling cereal. We saw one person who had to be monitored closely when eating, put porridge in her tea. Staff did not see this because they were busy serving other residents. We saw another resident who appeared to need adapted utensils for eating, as most of her breakfast ended up on the table. We informed the Prime Life Director of these issues. She spoke with the staff, and we saw that the lunch time experience was much more dignified. We were also told that the Director would bring forward staff supervision relating to supporting residents with eating and drinking. Care Homes for Older People Page 16 of 31 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Daily life at Firlands is improving, but there are still areas that need attention. Evidence: We arrived at Braunstone Firlands at 8.00am. We saw that only a few residents were out of bed and dressed, with the remainder still sleeping. We saw people gradually waking up and getting up for breakfast. We saw a number of visitors during the day, and they told us they were made to feel welcome, and were able to visit at any reasonable time. In the afternoon we saw that some of the residents went on a bus trip. We saw staff asking residents whether they would like to go on the trip. The trip was to be a drive to Bradgate Park. Staff did not effectively communicate what people might see, and how they might enjoy being at the Park, or remind people what Bradgate Park is. As many people at Braunstone Firlands have dementia, this would have helped them to understand more about the trip and might have prompted more people to join in. We saw, that in the last month, staff have began to provide more activities to people
Care Homes for Older People Page 17 of 31 Evidence: as part of their daily life at Firlands. We saw evidence that staff have been putting on music and dance afternoons, and chair activities for less mobile residents. There has also been an Al Johnson tribute act playing to residents, and the service has started to book someone who comes in once a month to help residents do chair aerobics. We did not see any reminiscing activities for people with dementia. Ruth Hack agreed that this was an area that needed to be improved, and had already started this process. One of the visitors we spoke with(whose relative has dementia) said that they hadnt seen their relative enjoy many activities and that they wished they did more than watching the television. During the SOFI inspection, we observed that for the 2 hours we were in one of the lounges the television was on all the time. We saw for a large part of the time people were not interested in the TV, and for a small part of the time one resident seemed to get distressed with the noise coming from it. One person enjoyed the TV briefly, and asked for the sound to be turned up. It was, but when they became disinterested and left the lounge, the sound remained loud, adding to the discomfort of one of the residents left in there. We saw later on in the day, that music was being played in another lounge. At meal times we saw that residents had choices of meals. A resident told us that she enjoyed the breakfasts and teas at Firands but not the lunches as they come from Central Kitchens and can become a bit coddled. Some staff also told us that the quality of food from Central Kitchens is not alway good. We looked at the meal being served on the day we visited. The choice was pork, potatoes, and vegetables (cauliflower); or macaroni cheese and vegetables. We saw that the pork, gravy and potatoes looked appetizing, but the macaroni cheese looked congealed, and the cauliflower looked watery. We were told that during the week, Firlands is the last care home that the Prime Life Central Kitchen deliver the food to, and the quality always seems worse than at the week-end when it is one of the first homes the dinners are delivered to. We have been informed by management that other residents they have spoken with, suggest they are happy with the food provided. We saw that those needing a pureed diet, had a pureed dinner from Central Kitchen. We saw that the food groups had been pureed individually so that the taste and colours could be be distinguished. The pureed meals come in molded plastic plates. We saw that these plates were put in front of residents who needed the pureed food. The cling film style wrapping was removed and residents then ate from the plastic plate. Care Homes for Older People Page 18 of 31 Evidence: We saw that the dining room had been nicely set out for breakfast and for lunch time, and we saw that those requiring support to eat, did get individual staff support so they could eat in a dignified way. We saw that the new kitchen assistant had improved the teas given to people living in the home, who now have more hot food as their evening tea. We also saw that she has introduced more of a range of snacks at coffee times. We saw that as well as biscuits, people were offered fruit, and crackers and cheese. We saw residents enjoying the variety on offer. Care Homes for Older People Page 19 of 31 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has not been able to safeguard all of the people who live at Braunstone Firlands, however this is improving. Evidence: We monitor the regulation 37 incidents that the service has to send to us. For most, we were satisfied that the appropriate action had been taken, however one of the notifications was a safeguarding incident where one resident had hit another. The acting manager was contacted and was not aware that this incident should have been dealt with as a safeguarding situation. We contacted senior management and they quickly put into place supervision so that the manager would be aware of this in the future. The service has had two formal complaints since our last key inspection. The last complaint was serious and led to a safeguarding investigation. Since this complaint, Senior Management at Prime Life have worked very closely with the home, with Ruth Hack, the Director of Elderly Services for Prime Life taking management control. At the time of our visit, she had been working at the service for one month, and was working hard with staff to ensure that the well being and safety of residents could be assured. We spoke with staff at Braunstone Firlands and asked them what they would do if they were concerned that a resident was being abused or if they witnessed abuse. Most
Care Homes for Older People Page 20 of 31 Evidence: knew to inform their manager, but one person thought it was acceptable to reprimand the person themselves in the first instance, and only take it to management if the behaviour was repeated. We looked at the AQAA. This gave us information about the number of safeguarding referrals and the number of complaints made to the service, but it didnt inform us of what specific action the company had taken with staff at Braunstone Firlands to protect people who live at the home. The information was more linked to the overall response the company has to complaints and protection. The three visitors we spoke with during our visit said that they would feel able to talk to management or staff if they were not satisfied about care being provided. One told us that they had concerns about a resident who could be aggressive, and was concerned about them being aggressive to their relative when staff are not around. During our SOFI inspection we saw that one of the residents could very quickly become aggressive. We saw that staff dealt with this well, and he had one to one support. But we were told that this support was only for four hours a day. We were told that the service is trying to get further funding to give this service user more one to one support. Care Homes for Older People Page 21 of 31 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Braunstone Firlands experience a clean and pleasant environment. Evidence: During our visit we saw that all areas of the home we looked at, and these included the communal lounge, dining rooms, bathrooms, kitchen and some bedroom, were clean and tidy. We did not smell any unpleasant smells in any area. We saw that since our last key inspection, key pad locks have been fitted to door leading onto the stairs. These have improved the safety of the home as there is now no risk of people living in the home using the stairs and going down to the basement where the kitchen is. The dining room tables are nicely laid out with fresh table cloths for each sitting. The service has recently had a property audit by Prime Life, and we saw that the dining room is going to be redecorated in the near future. The home was warm throughout our visit. We saw that one of the ground floor lounges has new furniture, however the shabby state of two of the larger curtain chairs reduced the positive impact this had. One of the chairs belonged to a resident, the other, was thought to belong to a resident, but
Care Homes for Older People Page 22 of 31 Evidence: Ruth Hack found out during our visit that it did not. We saw a bathroom which looked bare and institutional but we saw that this was on the property audit as one which was to be redecorated. We saw that the service has good infection control systems. Care Homes for Older People Page 23 of 31 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has gone through a period of instability with staff, but this is improving. Evidence: On the day of our visit, there were 17 people living at Braunstone Firlands, 15 of whom needed nursing care. We saw the rota and were told by staff that the service has three care workers and one nursing member of staff on duty between 08:00 and 20:00; plus an additional care worker for continuing care support. We saw that from 20:00 to 08:00 there is one nurse and one care worker on duty. The service also employs a kitchen assistant, and a laundry worker. We saw that since the last inspection there has been a big change in staff. Since our last visit in January 2009, there are only six of the sixteen permanent staff remaining in the home. The service has had to use its own internal system of bank staff to support it whilst recruiting new staff. The staff group were observed to be considerate and helpful to residents. Through records, and talking to staff we saw that all staff have had induction training, and have received training to ensure their work practice keeps people safe. The majority of staff are still going through a learning process. Due to the changes in staff, only five staff currently have a National Vocational Qualification in Care to level 2 or above. Care Homes for Older People Page 24 of 31 Evidence: We checked the recruitment of new staff and saw that the company had undertaken all the required employment checks to support the safety of people living at Firlands. As part of our SOFI inspection we looked at how staff engaged with people who use the service, and how much time they spent in the communal areas. We sat in one of the downstairs lounges for two hours. We saw that one of the residents we observed received one to one support from staff during the whole period. This clearly contributed to the residents sense of well being. We were aware that this person could be challenging, and saw staff dealing with their challenging behaviour effectively and quickly. We were told that this person only receives funding for one to one support for four hours a day. Having one to one support for one resident, also improved the levels of staff engagement for another resident. The third resident we monitored did not have much engagement with staff, as they were asleep for the majority of the SOFI inspection. Care Homes for Older People Page 25 of 31 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Weaknesses in management have resulted in a poorer service for people who live in the home, but this is now improving. Evidence: The previous registered manager left her post in July 2009. Prime Life recruited a new manager who was a registered nurse, with a view to her becoming the registered manager. She started in July 2009 and left her post in October 2009. For the last four weeks, the Director of Elderly Services, for Prime Life has been managing the service whilst recruitment takes place for a new manager. Information received by the CQC since the last inspection has shown that standards of care have fluctuated, and prior to Ruth Hack taking over the management of the service, we were made aware that one service user had received poor standards of care. In the short period of time that Ruth Hack has been managing the home, better care
Care Homes for Older People Page 26 of 31 Evidence: planning processes have been introduced, and a key worker system is being introduced. Staff have also received supervision on different aspects of care, and team meetings to ensure that they are clear about their roles and responsibilities. The AQAA was not reflective of the specific issues relating to Braunstone Firlands. It gave an overview of what the company aspires to do, and over its processes and procedures, but did not clearly inform of how the individual needs of those at Firlands are being met, neither was there any clear references to the challenges the service has faced over the last few months, what action it has taken, and any learning it has done as a consequence. The AQAA was sent to us on the 3rd November 2009. There have been concerns about safe working practice at Braunstone Firlands. During our visit we were satisfied that that staff were moving and handling residents properly; that they were taking good precautions to prevent the spread of infection (e.g. using gloves and aprons when undertaking personal care); and that good practice was being followed for food hygiene. We checked the accident and incident book. Ruth Hack told us that she has recently implemented a falls log. This will track the incidence of falls to see if there are any patterns, and help the service to take action. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 18 18 The provider must ensure that all staff know the adult safeguarding policy and procedures the service has to work within. To ensure that people who live at Braunstone Firlands are safe. 11/01/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 1 The provider should up date the Statement of Purpose once a new manager is in post to inform people of the management structure of the home. If the new manager is not a nurse, the statement of purpose must clearly outline who will have clinical responsibility for nursing staff. Staff should be made aware that a service users bedroom is their own private space, and should not be used for activities involving other residents eg. hair dressing. The provider should continue to work with staff in upholding a persons dignity when supporting them in eating and drinking. 2 10 3 10 Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 4 12 The service should continue to support staff in providing individualised activities for people living at Braunstone Firlands, and develop reminisence activities for those with dementia. The provider should seek the views of residents and staff about the quality of food being delivered by Central Kitchens and seek to improve the service. The manager should ensure that those having a pureed diet, have their meals served on plates more conducive to homely living. The provider should continue to pursue avenues to increase funding for residents who have more challenging behaviour and require additional support. The provider should consider replacing the curtain chairs which look shabby and worn. The service should continue to monitor and ensure there are sufficient numbers of staff on duty to support residents with more complex and challenging behaviours, and to support those who live with them in feeling safe from their challenging behaviours. The AQAA should be more reflective of how the individual service is operating. It should identify what Braunstone Firlands does well in terms of its specific client group, as well as what challenges the service has encountered, how it has dealt with them and how it will improve. 5 15 6 15 7 18 8 9 19 27 10 33 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!
