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Inspection on 15/11/05 for Breckside Park Residential Home

Also see our care home review for Breckside Park Residential Home for more information

This inspection was carried out on 15th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has a comprehensive Statement of Purpose in place that covers all matters identified in National Minimum Standards. Pre-admission assessments were being undertaken and prospective residents were invited to visit the home prior to making a decision about placement. Good working relationships were in place with GP`s, district nurses, the pharmacist and other visiting health care professionals. Residents commented favourably about the care and support provided by staff. They were also complimentary about food served in the home.

What has improved since the last inspection?

Progress had been made in ensuring all of the residents` had an up to date care plan in place. The acting manager, together with visiting district nurses had resolved the issue about the ownership and responsibility for controlled drugs. Some progress had been made on the introduction of staff supervision.

What the care home could do better:

Staff need to develop the work they have begun to develop care plans for residents in the home. The appointment of an activities organiser would assist the social and occupational development of residents. A qualified and experienced manager must be appointed to run the home. Further improvements need to be made to the detail and quality of information around staff appointments. The overall record keeping in the home would benefit from continuous improvement.

CARE HOMES FOR OLDER PEOPLE Breckside Park Residential Home 10 Breckside Park Anfield Liverpool Merseyside L6 4DL Lead Inspector Les Hill Announced Inspection 15th November 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Breckside Park Residential Home Address 10 Breckside Park Anfield Liverpool Merseyside L6 4DL 0151 260 6491 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) Mr Keshav Khistria Mrs Kirti Khistria Care Home 26 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (3), Old age, of places not falling within any other category (21), Physical disability (2) Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate five named persons under the age of 65 years Date of last inspection 20th July 2005 Brief Description of the Service: Breckside Park is a registered care home providing personal care for up to 26 residents in the category of older people. The home has been granted variations to the registered status to permit the care and support of named people in the category, younger disabled. The home is situated in the Anfield area of Liverpool and is close to parks, shops and public transport routes. Communal space within the home consists of 2 lounges, a dining room and a large conservatory. The home has 26 single bedrooms five of which have an en-suite WC. The home benefits from a large enclosed rear garden and further garden areas to the side and front aspects of the home. Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection of Breckside Park was undertaken on Tuesday 15th November 2005 over a period of 4.5 hours. It involved the examination of records, a tour of the building and meeting separately with the homeowner, the acting manager and 8 residents. A pre-inspection questionnaire had been completed and returned by the homeowner prior to the inspection taking place. The inspection was part of the Commission’s responsibility to visit and report on each registered care home on two occasions each year. What the service does well: What has improved since the last inspection? Progress had been made in ensuring all of the residents’ had an up to date care plan in place. The acting manager, together with visiting district nurses had resolved the issue about the ownership and responsibility for controlled drugs. Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 Page 6 Some progress had been made on the introduction of staff supervision. 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. Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 and 6 Good information was in place to inform prospective residents about the home. Adequate pre-admission assessments were being undertaken. EVIDENCE: The home has a statement of purpose in place that is well presented and contains all the matters identified in Schedule 1 of the National Minimum Standards, Care Homes for Older People. A copy of the document is maintained in the entrance to the home. Although a service users guide was available the manager told the inspector that residents had said they did not wish to have their own copy. A contract/statement of terms and conditions of residency was in place on each care file examined in the home. The resident had signed the document wherever possible. The inspector sampled three resident’s care files during the inspection. Each of them contained an assessment of need. The detail varied between the files but the information was adequate and would enable staff to draw together a plan Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 Page 9 of care. Further details about social history, family make up, hobbies and interests would be of benefit. The home is registered to provide care and support to older people but variations to the conditions of registration have been approved to allow named individuals below the age of 65 years to be accommodated. Information from the files and from observations and discussions during a tour of the building confirmed that all current placements are appropriate. Admission procedures encourage prospective residents to visit the home prior to any placement being made. In practice however, many of the residents have moved in straight away. Emergency admissions have been made and policies and procedures for managing such situations are in place. The home will also provide respite care if there are vacancies. The home is not contracted to provide Intermediate Care. Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Care plans were in place that would benefit from further improvement. Medicines kept at the home were being managed safely. EVIDENCE: The new care plans introduced in February 2005 have been put together for all residents in the home. The information recorded provides basic guidance for staff in managing the care and support needs of residents but similarly to the assessments, they would benefit from more detailed construction. Daily records were being made to inform staff of progress and any changes to the original plans and there was some evidence that the plans were being reviewed. The Commission recommends that staff review care plans on a monthly basis in order to ensure that care is being delivered appropriately at al times. The acting manager told the inspector that residents receive good support from local GP’s and the district nursing service. Additionally the services of an optician, dentist and chiropodist are made available as required. Continence assessments are undertaken when necessary and appropriate products Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 Page 11 supplied. Records indicated that a number of admissions to hospital through A&E hade been made during the past twelve months. Health care professionals visiting the home had arranged all of the admissions. An examination of the medicines kept in the home confirmed that they were being managed in line with safe procedures. Good support is provided by the pharmacist who will visit the home to check on the supplies and procedures and will provide training for staff on the administration of medicines. None of the current residents has responsibility for their own medicines and homely remedies are not use. The inspector spoke with eight residents during the course of the inspection visit. All of them were complimentary about staff working at the home. During a tour of the building the acting manager knocked on each bedroom door and waited for a reply before entering. Policies and procedures are in place to support residents at the end of their life. The acting manager was working through the process of recording the wishes of residents to ensure appropriate procedures are followed at the time of their death. Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The engagement of an activities organiser would strengthen the opportunities for residents to satisfy recreational interests. Residents were able to exercise choice over their own lives. Food provided at the home was of a good quality. EVIDENCE: Some of the residents are able to go out from the home unaccompanied. Care staff organise parties, Bingo, sing-a-long, pool and other board games. It is expected that staff time will be spent each afternoon organising one or more activities. However, the demands for care in the home will sometimes mean that activities are put on hold. The engagement of an activities organiser to work at appropriate times during the week would ensure a regular commitment to supporting leisure time and would ensure more residents could engage in individual activity. Visitors to the home are welcome at any time but unfortunately only a few residents receive regular visits from family or friends. Staff will take residents out from the home in times of better weather and the inspector was told that some trips to Southport had been undertaken during the previous summer and residents had been taken out for pub lunches. The lack of visitors and the general availability of staff to support activities further support the introduction Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 Page 13 of a specialist worker. The inspector discussed with the homeowner, opportunities for advertising the role. Residents who spoke with the inspector said they were free to spend time in their own room or in one of the communal areas around the home as they wished. They could decide what time they get up and what time they retire to bed. A choice of food is also available at mealtimes. The acting manager told the inspector that staff encourage residents to join in activities but always respect their wishes if they indicate that they do not wish to participate. The home’s menus identified a full and balance diet. Residents can choose from a range of cereals, toast or cooked breakfasts, and have a choice of two main meals at lunchtimes. A sandwich or hot alternative lighter meal is served at teatime and staff will prepare light suppers later on in the evening. All but one of the residents who spoke with the inspector said that the food provided is of a good quality and is served in good quantities. They also confirmed that further alternative choices to the ones shown on the daily menu are provided on request. Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 Complaints procedures are in place and staff have received training in adult protection. EVIDENCE: The home has a complaints procedure in place that is displayed in the entrance hallway at Breckside Park. A complaints report form is provided to record the process of any investigation. The home claimed that two complaints had been made since the CSCI inspection in July 2005 however, on closer examination the inspector concluded that the matters were not about the functioning of the home or the treatment of residents and should not have been recorded as complaints. All of the residents are listed on the Electoral Register and have the opportunity to vote in national and local elections. The home has policies and procedures in place to deal with any incidents where abuse is suspected and to encourage staff to raise any concerns. The acting manager has attempted to obtain a copy of Liverpool’s adult protection procedures without success. There was evidence on staff files that training in adult protection had been provided. Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. The home was clean and well cared for. Some minor repairs were needed. EVIDENCE: Breckside Park is located in a quiet street in the Anfield district of Liverpool. The home is a former dwelling that has been adapted and extended to provide care and support to 26 people on three floors. A passenger lift and staircases give access to the upper floors. Some minor repairs were identified during a tour of the building. The extractor fan was not working and some re-sealing of the tray was needed in the shower room on the second floor. The toilet in room 3 needed new seat and a lid for the bin. The door to this room did not close properly. Plaster had come off the wall by the special bath in room 5. The vent cover at the laundry window needs to be replaced and the fly screen to the kitchen window is in need of repair or replacement. Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 Page 16 The homeowner has confirmed a quotation to provide air extraction in the smoking lounge. However the builder has indicated that because of current commitments, it will be after Christmas before he can carry out the work. Bed rails were being used in two of the bedrooms seen during the inspection and one of them was not fitted with the appropriate “bumper” covers. Where bed rails are recommended the home must undertake a risk assessment to ensure they can be used safely and the resident or their family must confirm their agreement to them being used by signing the assessment. Bed rails must not be used without the correct “bumper” covers. There have been no changes to the construction or layout of the home since the CSCI inspection in July 2005. On the day of this inspection the home was clean and free from any offensive odours. Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Practices around the appointment of staff need further refinement to ensure they are safe. Training opportunities were being developed. EVIDENCE: Staffing levels agreed with the former registering authority were being maintained. Since the CSCI inspection in July 2005 the acting manager has been allocated 6 hours each day to carry out management responsibilities in the home. The home has 16 care staff (excluding the manager) six of which have an award at NVQ level 2 or above, in care. A further 10 staff are to begin NVQ training in the New Year. The home will therefore not achieve the standard of 50 care staff with an award at NVQ level 2 by the end of 2005. The inspector sampled three staff files. Some improvements to the employment procedures were evidenced but there were still one or two matters that require further development. All of the staff have an up to date CRB clearance. There was also evidence of POVA clearance on the files of newer appointments. A reference for one member of staff was in the form of a testimonial and did not cover the matters needed when appointing someone to work directly with vulnerable adults. Another file did not contain sufficient evidence of identification. The homeowner should maintain a photocopy of the identification evidence used to gain CRB clearances on the staff files. Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 Page 18 There was certificated evidence on staff files to confirm their attendance at training events. Training had been provided in moving and handling, food hygiene, first aid and adult protection. There was still a need to provide regular 6 monthly training in fire awareness. The acting manager told the inspector that she was in regular contact with the training organisation and would continue to provide appropriate training opportunities for staff at the home. Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 37 and 38. The appointment of a manager is essential if the home is to build on and improve its ability to meet all of the National Minimum Standards. EVIDENCE: The acting manager has withdrawn her application to be registered as manager of Breckside Park. The homeowner must now take steps to recruit an appropriate person to manage the home. The atmosphere in Breckside Park at the time of this inspection was busy but calm. Residents who spoke with the inspector were complimentary about the staff and said that they worked hard. Staff were observed to get on with their work and to talk with residents in a friendly and respectful manner. The homeowner is an appointee with a building Society for one resident and staff assist others to manage their money on a day-by-day basis. Detailed Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 Page 20 records are being kept of deposits and expenditure and receipts are held to confirm purchases. The acting manager had begun the process of staff supervision and records of some supervised activities were held on staff files. However, the process should be developed to ensure supervision encompasses professional development and training needs. A suggested format for formal one-to-one supervision meetings was left with the acting manager. The home has a good set of policies and procedures in place that should form the basis for work at Breckside Park. Staff undertaking NVQ training will need to access the procedures and in doing so should become more aware of the underlying principles of care and the reasons why certain practices are in place. Confirmation that staff have read the procedures would give reassurance to the homeowner and to CSCI that the documents are a working tool. Some improvements to the record keeping have been identified earlier in this report. Information provided by the home identified that the fire alarms were checked weekly, and that fire fighting equipment in the home was tested on 12th October 2005. An approved contractor carried out gas safety checks on 09th June 2005. An electrical wiring certificate was issued in December 2000. The lifts are checked bi-monthly and hoists/bath lifts were checked in November 2004. The home has a contract for the collection of “sharps” and soiled waste. The homes Employers Liability Insurance is valid until April 2006. Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 3 3 2 2 3 Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7OP37 Regulation 15 Requirement The manager must ensure that comprehensive care plans are in place to support staff in providing appropriate levels of care. The homeowner must ensure that the premises are kept in a good state of repair internally and externally The homeowner must ensure that the records of staff specified in Schedule 4 of the National Minimum Standards are kept in the home. The homeowner must employ a qualified and competent person to manage the home. Timescale for action 31/12/05 2. OP19 23(2)(b) 31/12/05 3. OP29OP37 17(2)(3) 31/12/05 4 OP31 8 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations The homeowner should consider the appointment of an DS0000025331.V257146.R01.S.doc Version 5.0 Page 23 Breckside Park Residential Home 2. 3. 4. OP18 OP28 OP36 activities organiser to enhance the opportunities for social and occupational interaction amongst residents. The homes manager should obtain a copy of Liverpool City Councils policies and procedures on adult protection. The homes manager should ensure that at least 50 of care staff have an award at NVQ level 2 in care as soon as possible. The homes manager should develop the arrangements for staff supervision to ensure they include opportunities for personal and professional development. Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Breckside Park Residential Home DS0000025331.V257146.R01.S.doc Version 5.0 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. 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. 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