Inspection on 30/11/06 for Breadstone House Care Centre

This inspection was carried out on 30th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Breadstone House Care Centre 28/01/09

Breadstone House Care Centre 29/09/08

Breadstone House Care Centre 25/06/08

Breadstone House Care Centre 22/10/07

Breadstone House Care Centre 16/03/06

Breadstone House Care Centre 22/09/05

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

CARE HOMES FOR OLDER PEOPLE Breadstone House Care Centre Breadstone Nr Berkeley Glos GL13 9HG Lead Inspector Mr Adam Parker Key Unannounced Inspection 30th November 2006 09:20 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Breadstone House Care Centre Address Breadstone Nr Berkeley Glos GL13 9HG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 08453 455782 Blanchworth Care Homes Ltd Mrs Denise Rose MacKereth Care Home 40 Category(ies) of Dementia - over 65 years of age (40) registration, with number of places Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th March 2006 Brief Description of the Service: Breadstone House Care Centre is a registered Care Home with Nursing. It is registered to accommodate older people with dementia. The home is situated off the A38 Gloucester to Bristol road and is approximately 20 miles from Gloucester. It is a detached house situated in attractive grounds. The communal areas are situated on the ground floor and include 3 lounges and a dining room. There are 25 single bedrooms (7 with ensuite) and 9 double bedrooms. Current fees are £434.00 to £654.00. Hairdressing, chiropody, escort and personal toiletries are charged extra. The home makes information about the service, including CSCI reports available to service users through a service user guide and statement of purpose available in the home. Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was carried out by one inspector on one day in November 2006. The registered manager of the home was not present for the inspection visit but was spoken with on the telephone at a later date. The clinical manager was present for the inspection visit which consisted of a tour of the premises and examination of service users care files. In addition staff recruitment and training was looked at as well as documents relating to the management and safe running of the home. A sample of service users were selected for inspection against a number of outcome areas as a ‘case tracking’ exercise. Three service users were spoken to during the inspection visit. Two comment cards were received from General Practitioners (GPs). The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. As part of this unannounced inspection the quality of information given to people about the care home was looked at, although due to the nature of the service users in the home this was not checked directly with them. The information included the service user’s guide, statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. What the service does well: The home has a good care planning system in place and works with health care professionals to ensure that service users’ health needs are met. Care is delivered in such a way as to uphold service users privacy and dignity. In addition service users benefit from a varied activities programme suitable for their abilities. The home was generally well maintained and clean providing service users with a safe and comfortable environment. Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 6 The home has robust recruitment procedures and has a programme for providing induction and ongoing training to staff. More than half of the care staff employed in the home have achieved an NVQ. The home has been generally well managed to provide good outcomes for service users. 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. The summary of this inspection report can be made available in other formats on request. Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 & 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information about the home is made available to the representatives of prospective service users. Service users have written contracts or statements of terms and conditions relating to their stay in the home. The home’s admission procedure ensures that all service users are admitted to the home on the basis of a full assessment of their needs, so that they can receive the care that they require. EVIDENCE: The provider confirmed that copies of the service user guide are sent out to the representatives of any service user who make enquiries about the home. In Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 9 addition a copy of the guide is kept in the home. The home also has a fee list available for any enquirers. The provider also confirmed that each service user has a copy of their contract of statement of terms and conditions which in the case of the service users in Breadstone House is usually sent to the representative of the service user. Generally this is due to the nature of service user’s in the home and their ability to comprehend the information. Copies of these documents are scanned and can be viewed on line on the home’s computer. The assessment documentation for three service users recently admitted to the home was looked at. These had been completed following an assessment of the service user’s needs by the registered manager prior to admission to the home. In one case for example the assessment had been completed by the registered manager while the service user was still in hospital. In addition copies of needs assessments and care plans carried out by the funding authority had been obtained. The home does not provide intermediate care and so Standard 6 does not apply. Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good individualised care planning system in place which provides staff with the information to meet service users’ needs. The home works well to meet service users’ health needs through liaison between the nursing staff and health care professionals. Medication administration practices in the home ensure that service users are protected although storage temperatures should be monitored. Care is given in such a way as to promote the privacy and dignity of service users. EVIDENCE: Care plans were of good quality, they were detailed, specific and individualised, they had been reviewed on a monthly basis and some had Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 11 extra written evaluation. The home has a system for displaying the review dates of care plans on a notice board in the office as a reminder to the staff concerned with this. One care plan for example detailed the number of staff required to meet a service user’s personal care needs. As well as physical health and personal care, care plans had also been compiled to address service users psychological health needs and one service user had recently been referred to the local mental health team. The home involves representatives of service users with care plans where this is appropriate and an example was seen of a relative of a service user signing a care plan to indicate their agreement. Risk assessments had been completed for pressure areas, moving and handling and falling out of bed, these were linked to care plans where appropriate. One service user had a risk assessment about wandering behaviour and although this identified the need for the service user to be cared for in a particular area of the home for their safety it also recognised the need for access to areas outside of the home under supervision and for the service users to be included in trips out of the home. The home uses hip protectors to protect service users who may be at risk of injury from falls, the use of these is linked to risk assessments and involves consultation with service users representatives. Service users care files contained records of visits from GPs,community nurses and chiropodists. One service user had been referred for specialist input for a skin condition. On the day of the inspection visit several service users were receiving influenza vaccinations from community nurses visiting the home. Medication administration and storage arrangements were looked at. Medication is stored in two locations within the home. Temperatures in the refrigerator in the upstairs storage had been monitored and recorded and had been maintained at appropriate levels. The temperatures of the general storage of medication had not been monitored in both storage areas. The medication administration recording sheets were examined and found to be generally in good order with hand written entries signed and dated. Liquid medication had been dated when opened. A good example of a care plan was seen for medication prescribed on an ‘as required’ basis for one service user. Staff were observed treating service users with respect and shared rooms had curtains in place to maintain privacy. One service user spoken to said that the staff were “patient”. Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a range of appropriate activities inside and outside of the home and maintain some links with the local community. Service users are helped to exercise some choice and control over their lives dependent on their individual abilities. Service users’ dietary needs are well catered for taking into account choice and nutrition. EVIDENCE: The home has an activities coordinator and offers a range of activities for service users. During the inspection visit the home was celebrating St Andrew’s day the patron saint of Scotland. During the afternoon the activities coordinator was giving a demonstration of how shortbread was made. During this she engaged with service users in a meaningful way regarding both the present and in relation to their past life experiences. Service users responded positively to the session and although some had lapses of concentration this was appropriately managed by the coordinator and supporting care staff. In Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 13 the inspector’s view this was an excellent example of the activities on offer in the home. In the hall a notice board displays information about activities past and present including some photographs. Examination of care plan files showed that the home collects information on service users life histories and hobbies. This knowledge was used by the activities coordinator during her session. Other activities on offer in the home include ‘Pat a Dog’ where a dog is brought in to the home to visit service users on a regular basis, visits by a singing group, bingo and a beer tasting session. Service users spiritual needs were met through regular visits and communion by a local clergyman and a Christian service held by a lay preacher. A carol service provided by local school children was being planned nearer Christmas and service users had also been involved in harvest festival celebrations. The programme of activities in the home also allows time to be spent with service users who may be more isolated and who do not generally join in with group activities. No restrictions are placed on visiting times and service users are able to receive visitors in their rooms or in communal areas. A notice was displayed in the entrance hall giving information to visitors that meals can be taken with service users if they wish. Due to the abilities of service users in the home, none are able to control their own finances relying on relatives and representatives for this. The home could benefit however from the availability of information on how to contact advocates for service users, this was not evident during the inspection visit. There was plenty of evidence of service users bringing their own possessions including furniture into the home. Lunch was observed which was served to the service users in various locations in the home including their own rooms and in dining rooms. Meals served to rooms were appropriately covered. Staff were interacting with service users appropriately during the meal and were wearing protective aprons. Drinks were served with the meal although it was noted that condiments were not placed on the tables and it is recommended that consideration be given to doing this where this would benefit service users. One service user spoken to confirmed that she was offered “plenty of drinks” and that the food was “very good”. A menu for the day was displayed on the notice board with an alternative offered to the main dish. Some service users identified as being nutritionally at risk have their food and fluid intake monitored and recorded. Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a clear complaints procedure and information about this is available to service users and their representatives should they wish to make a complaint. The homes has policies and procedures which linked with staff training should ensure that service users are protected from abuse. EVIDENCE: The home keeps a log for recording complaints and the response to these. although none had been received by the home since 2003. The complaints procedure is displayed on a notice board in the home and is also included in the service user guide. The home has robust procedures for responding to suspicion or evidence of abuse. In addition staff receive training on abuse and challenging behaviour on a biannual mandatory basis. It was noted that the protection from abuse policy was displayed on the wall in the office with a note that staff should read it. Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have the benefit of living in a well maintained and generally clean, environment. Service users have not all had the benefit of beds made up with clean pillows and bed clothing. EVIDENCE: A tour of the premises was conducted, this revealed that the home was well maintained and generally clean. The condition of pillows, pillowcases and bed clothing was looked at in a number of rooms particularly on the first floor in the ‘Phase 2’ part of the home. There were six beds that had been made up with pillows that were in need of replacement and pillowcases and in two cases bed covers that were in need of laundering. Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 16 A small number of cleaning issues were pointed out to the clinical manager and were dealt with during the inspection visit. In addition bar soap was in use in two areas which is not good practice for infection control, again this was pointed out to the clinical manager and removed during the inspection visit. The laundry which is detached from the home and not accessible to service users was generally in good order. There were some items stored on the overhead beams and this was relayed to the clinical manager for review. Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good, adequate. This judgement has been made using available evidence including a visit to this service. The numbers of care staff ensure that service users needs are met. The level of NVQ training should ensure that service users are in safe hands. Service users are protected through robust recruitment procedures. Induction and foundation training should ensure that staff are trained and competent to meet service users’ needs. EVIDENCE: On the day of the inspection visit the home was staffed by the clinical manager, two registered nurses and four care staff during the morning, providing seven staff which reduces to six for the afternoon. A cook and a kitchen assistant as well as a cleaner and a laundry worker support the care and nursing staff. At night there is one registered nurse and 2 care assistants. The home has a system for working out the numbers of staff needed in the home based on service users numbers and their needs. There were four occasions when the Commission were notified of the home working short of staff in the twelve moths prior to the inspection visit. Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 18 The level of care staff who have achieved NVQ training at the time of the inspection was reported at 67 . The records for the two most recently recruited members of staff were examined. All the required information and documentation had been obtained with all required checks made with any risk assessments completed where necessary. Staff are provided with induction and foundation training in line with national specifications. Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally well managed in the interests of service users. Quality assurance systems are in operation to ensure that the home is run in the interests of service users. The home has arrangements for ensuring that service users’ financial interests are safeguarded. An improvement needs to be made with the amount of supervision that staff receive to ensure they are working in service users interests. Safe working practices ensure service users’ safety although some improvements are needed with the storage of cleaning materials. Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 20 EVIDENCE: The registered manager was not present during the inspection visit although she was spoken to on the telephone on the day following the visit. She is a registered general nurse and has obtained the registered managers award. In addition the registered manager has undertaken recent training in time management and wound care. The registered manager is supported by the clinical manager who is a registered mental nurse. The home conducts an annual quality assurance survey and this had been completed at the time of the inspection visit. Comments from the survey are collated and any requiring action are followed up by the registered manager or the director of care. The storage and recording of service users money and valuables held by the home was looked at. A secure facility was available for storage and associated records were accurate and in good order and included the recording of money won by service users as a prize in games of bingo. Staff supervision records were looked at and discussed with the clinical manager. This had been identified as an area that needed improvement by the management of the home and while supervision sessions were taking place they had not yet met the recommended number of six sessions per year for care staff. The storage of cleaning materials on the cleaner’s trolley was looked at and some bottles contained cleaning substances that had been decanted into bottles that did not have sufficient labelling. This was not in line with the Control of Substances Hazardous to Health (COSHH) Regulations and was discussed with the clinical manager. The home has ensured the servicing and maintenance of electrical and heating systems and appliances as well as hoists and the lift. Regular checks are made on hot water temperatures and recorded along with a number of other safety checks. Work was carried out in 2005 regarding the risk of Legionella in the home. The home keeps a record of accidents and incidents and monitors these with an audit. Staff have received health and safety awareness training, infection control training and moving and handling training. Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP24 Regulation 16 (2) (c) & (e) Requirement The registered person must ensure that the cleanliness and condition of all pillows, pillowcases and bedclothes in use in the home is reviewed and any remedial action taken. The registered person must ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated (This refers to cleaning materials that must be stored in adequately labelled containers in line with the Control of Substances Hazardous to Health Regulations (COSHH) 1988). Timescale for action 02/03/07 2. OP38 13 (4) (c) 02/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The temperature of the medication storage in the DS0000063838.V322110.R01.S.doc Version 5.2 Page 23 Breadstone House Care Centre 2. 3. 4. OP14 OP15 OP36 treatment room and the office should be monitored and recorded. The home should obtain information on how to access advocacy services for service users. Consider placing condiments on the meal tables where this would benefit service users. Care staff should receive six formal supervision sessions per year. Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Breadstone House Care Centre DS0000063838.V322110.R01.S.doc Version 5.2 Page 25 - 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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