CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE
Breckside Park Residential Home 10 Breckside Park Anfield Liverpool Merseyside L6 4DL Lead Inspector
Debbie Corcoran Unannounced Inspection 10:00 3 and 6 November 2006
rd th X10029.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.V320743.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 and Care Homes for Adults 18 – 65*. 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.V320743.R01.S.doc Version 5.2 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.V320743.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To accommodate six (6) named persons under the age of 65 years in the overall number of twenty six (26). 22nd August 2006 Date of last inspection 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.V320743.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This site visit was unannounced and was carried out as part of a second key inspection. The visit was carried out over a period of 10 hours over 2 days. Throughout the visit 5 residents were spoken with on a one to one basis and the majority of residents were met at some point throughout the visit. The manager of the home, the home owner and four members of care staff were spoken with on a one to one basis. Records which were examined included resident’s assessments and care plans, staff files, health and safety records and checks, accident and incident reports, and records maintained for residents’ monies. Questionnaires were left for residents to complete and return to the Commission. A tour of the premises was carried out and this covered all areas of the home. What the service does well: What has improved since the last inspection?
Since the last inspection a new system for care planning has been developed and each of the residents now has a care plan. The new system for care planning is good and could be a very good tool if the information in the care plans is completed accurately and appropriately. Resident’s plans include risk
Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 6 assessments for general issues and for specific issues such as falls or nutrition. Moving and handling assessments and nutritional assessments are in place were appropriate to the needs of the resident. The home has been visited by a pharmacist inspector on 3 occasions since the last key inspection visit. Random inspection reports are available for these visits. These visits were carried out as a result of serious concerns as to the procedures and practices for receipt, storage and safe administration of medication. Following the issuing of requirements for the safe administration of medication the manager has introduced new practices and all staff who are responsible for the administration of medication have been provided with medication training. There has been some improvement in the level of indoor activities for residents since the last key inspection visit. However, feedback from the residents was that there is still room for improvement in the level of activities on offer. Resident’s meetings have been introduced and are taking place on a regular basis. The majority of the staff team have been provided with training in safeguarding adults from abuse. The training of staff in this area was made a requirement following the last inspection because at that time the practices in place for dealing with allegations of abuse were poor and failed to protect residents. Staff have been provided with training in first aid, fire safety, moving and handling and food hygiene, as required following the last inspection, as few staff had been provided with training in these skills. There have been some improvements in the home environment since the last inspection and all areas which were identified as in need of attention have been addressed. This has included; Redecoration of a number of resident’s rooms, redecoration of the conservatory and hall ceiling and carpets have been cleaned in a number of areas across the home. A new staffing structure has been introduced. The home now has a deputy manager and 3 senior carers. All residents now have a designated key worker. What they could do better:
The findings of the last inspection were that the home was failing to meet many of the National Minimum Standards and the Care Home Regulations 2001. There are areas in which the service has improved, however, there are still significant areas where the service needs to develop to meet The Care Home Regulations 2001 and the National Minimum Standards. The home has been visited on six occasions between the last key inspection visit and this visit. These visits have been made to check how the home is meeting the requirements and fulfilling their responsibilities required by law. The home should make sure that they operate within the regulations at all times.
Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 7 Three of these visits have been made by a pharmacy inspector. Whilst medication procedures and practices have improved there were examples whereby medication administration records were not being maintained appropriately or accurately. In addition to this there has been a recent incident involving medication which has identified an area of poor practice. The current practice has failed to ensure that medication is managed safely for all residents. The home has an appointed manager who took up the post approximately 10 months ago. The home does not have a registered manager and this is in breach of the Care Standards Act 2000 and The Care Home Regulations 2001. The referral and admissions procedures for new residents are poor. Two residents had been admitted to the home without an appropriate assessment of their needs having been carried out and one of these residents may have needs outside of the category of registration of the home. A comprehensive assessment of the residents needs should always be carried out by a suitably qualified or suitably trained person in order to ensure that the prospective residents needs can be met at the home. A copy of a statement of the terms and conditions of residency was available in resident’s files . However, these do not include the required information and there is no indication that they have been provided to the residents or signed by the residents. The registered person must develop these and ensure they are provided to each resident. The quality of care planning is mixed. Some care plans provide a good level of information as to how to meet the personal and health care needs of the residents and others give incorrect and misleading information and there were a number of examples seen whereby vital information was not recorded on the resident’s care plan. This could result in staff not being aware of the resident’s needs and the resident’s needs therefore not being met. Each of the residents has a key worker and this person is responsible for developing the resident’s care plan. The manager should ensure that staff have the appropriate experience and knowledge to complete care plans. There was no indication that residents or as appropriate their relatives have been included in their care planning. It is recommended that residents are involved in the development of their care plan and are requested to read and sign care plans as appropriate. The home has no system for quality assurance and therefore no means of measuring the quality of the service provided to residents. Since the last key inspection visit there has been one complaint made directly to the home. There was no recorded evidence of how the complaint had been investigated or of the action taken to resolve it. There have been a number of complaints/ concerns about the home raised directly to the Commission and to relevant Social Services departments since the last key inspection visit. Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 8 The presentation and cleanliness of some areas of the home is poor there are areas which are in need of attention including a number of the resident’s bedrooms. Areas to be addressed have been noted in the main body of the report. The registered provider should produce a maintenance plan for the home which identifies ongoing maintenance work, redecoration and refurbishment so as to ensure residents are provided with a homely, well maintained and safe environment. Infection control practices are poor and this may fail to safeguard the well being of residents and staff. The manager must ensure that staff are clear on their responsibilities for infection control and are provided with appropriate training. It is recommended that the home has designated staff to take care of laundry. The home employs 18 care staff and 6 of these (33 ) have attained a relevant National Vocational Qualification (N.V.Q). In order to meet the national minimum standards the registered person should aim for 50 of the staff team to attain an N.V.Q. Staff recruitment practices have improved since the last inspection visit, however the practices need to be improved further in order to aim to protect residents by ensuring that all pre employment checks for new employees are carried out thoroughly. 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. Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some residents are being admitted without an appropriate assessment of their needs and the home is accommodating a resident whose needs cannot be met appropriately. Residents are not provided with an appropriate form of contract for the provision of services and facilities. EVIDENCE: There have been eight new residents admitted to the home since the last inspection. In order to assess the admissions procedure the records for four of these new residents were checked and discussed with the manager. For two of
Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 11 these residents the manager had attained an assessment of their needs from the relevant Social Services department and additional information from a health professional. For one of the residents there was no assessment information at all and the resident had been living at the home for approximately four weeks. For another resident the manager had completed an assessment of their needs before they moved to the home. However, based on limited information provided by another care home, this person may have been admitted outside of the category of registration of the home. Where an assessment has been carried out by a representative from the home then this person must be a suitably qualified or suitably trained person. Assessment information should be signed and dated by the person who has carried out the assessment. At the last key inspection a number of residents had been identified as being inappropriately placed at the home. The manager was required to refer to the placing Authority for a reassessment of needs for those individuals and for a review of their placements. Those residents deemed to be inappropriately placed have now moved from the home to alternative services. However, there have been further incidents involving one of the residents which indicates that this person’s placement may no longer be appropriate and may be putting the health and safety of other residents at risk. The manager is required to attain an appropriate assessment of this person’s needs and to review this person’s placement with Social Services. The manager has forwarded applications for variation for all residents who have been living at the home and are outside of the home’s category of registration. However to date the manager has failed to provide the Commission with supporting evidence for a number of these applications. This is required in order to identify the residents assessed needs and to evidence that these can me met at the home. It was evident during this visit that another of the residents needs have changed significantly and this person’s needs can no longer be met. The home is not registered to provide the type of care required by this person and staff do not have the required training and experience. This had not been appropriately addressed and the registered person is therefore required to ensure a professional assessment is carried out to determine this resident’s needs and the residents placement must then be reviewed. This is not the first example whereby the home has continued to provide a service to a resident whose needs have changed significantly and for whom a referral should have been made to Social Services for a re assessment of the resident’s needs. A statement as to the terms and conditions of residency was evident in resident’s files. However, these do not include the required information and there is no indication that they have been provided to the residents or signed by the residents. The registered person must develop these and ensure they are provided to each resident. The home does not provide intermediate care and therefore this standard was not assessed.
Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents care plans require further development to ensure that they provide a accurate and appropriate information on the care and health needs of the residents. Residents are being supported with their health care but this isn’t always clearly planned or reflected in the resident’s records. Medication practices have failed to protect the health and well being of one of the residents and administration records are not always maintained accurately.
Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 13 EVIDENCE: Each of the residents has a care plan. The care plans for six of the residents were examined. The quality of care planning is mixed. Some care plans provide a good level of information as to how to meet the personal and health care needs of the residents and others provide incorrect or misleading information. The care plans are a pre printed core care plan and these are then amended to reflect the needs of the individual. The new system for care planning is good and could be a very good tool if completed accurately and appropriately. Residents’ plans include risk assessments for general issues and for specific issues such as falls or nutrition. Moving and handling assessments and nutritional assessments are in place were appropriate to the needs of the resident. The new care plans are computer generated and include some core information on meeting needs. There were a number of examples whereby the core information had not been amended and therefore the information in the care plan was incorrect and misleading. For example a care plan stipulated the use of bed rails for one of the residents when this was not the case. Information is added to core care plans to make them specific to the needs of the individual. However there were a number of examples seen whereby vital information was not recorded on the resident’s care plan. For example how to support the person with pressure area care. Each of the residents has a key worker and this person is responsible for developing the resident’s care plan. The manager should ensure that staff have the appropriate experience and knowledge to complete care plans. There was no indication that residents or as appropriate their relatives have been included in their care planning. It is recommended that residents are involved in the development of their care plan and are requested to read and sign care plans as appropriate. Resident’s care plans include information on their health and a record of health related visits or appointments. However, as above, the care plans do not include sufficient information when a resident has a pressure area and there were minimal entries in the resident’s records to show that a district nurse had been referred to or had been visiting the residents in question. The home has been visited by a pharmacist inspector on 3 occasions since the last key inspection visit. Random inspection reports are available for these visits. These visits were carried out as a result of serious concerns as to the procedures and practices for receipt, storage and safe administration of medication. Following the issuing of requirements for the safe administration of medication the manager has introduced new practices and all staff who are responsible for the administration of medication have been provided with medication training. Medication storage and administration procedures were
Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 14 checked and there has been an improvement in these since the last key inspection. However there were examples whereby medication administration records were not being maintained appropriately or accurately. A recent incident involving medication has identified an area of poor practice relating to when residents are storing and administering their own medication. When this is the case a risk assessment must be carried out to ensure that the person is not at risk of self harm or mismanagement of their medication. Resident’s daily choices are respected in that they are choosing when to get up, when to go to bed, they have a choice of meals, choice as to when they want support with their personal care. Many of the residents are easily able to express their choices and are doing so. Residents are making choices as to how to spend their day and this will include going outside of the home on their own if they have the skills to be able to do this independently. When asked about how they are supported with their personal care the residents confirmed that the staff respect their privacy. The manager should review the opportunities for residents to be supported to have a bath or shower. A bath ‘rota’ was on display in one of the communal bathrooms. This was removed at the inspectors request as this compromises the privacy and dignity of the residents. Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to use the local community when they have the skills to do this independently. Residents who are unable to do this have limited community access. There has been some improvement in the level of indoor activities for residents. Residents are provided with a choice of a well cooked meals and a varied diet. Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 16 EVIDENCE: Residents are encouraged to use the local community when they have the skills to do this independently. Residents who are unable to do this have limited community access. Residents did however point out that they had recently had a trip to Blackpool. There has been some improvement in the level of indoor activities for residents since the last key inspection visit. Feedback from the residents was that there is room for improvement in the level of activities on offer. An activities coordinator was employed at the home to put an activities programme in place but this person left the post and the post has not been recruited to again. Residents confirmed that they are making choices and they gave examples such as choosing when to get up, when to go to bed, their meals and their daily routine. Residents reported that staff respect these choices. Staff also gave examples of how residents are making choices. A number of the residents are well able to express their views and therefore contribute to decision making within the home. Resident’s meetings have been introduced as a forum for this as recommended following the last key inspection visit. To assess the meals and food provided many of the residents were asked their view on the food and the catering arrangements were checked. Residents were seen to be given a choice of the main meal of the day, which was served at lunchtime, and they are also given a choice of lighter meals for their evening meal. The kitchen was presented as clean and well organised but some refurbishment is recommended as the equipment and fittings are dating. The chef is aware of the needs and likes and dislikes of meals for the residents. Residents can have an alternative to the menu and this was noted to have been offered to a number of residents. Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure. Complaints are not dealt with appropriately which could lead to issues not being noted and addressed. The home has adult protection procedures and residents are supported by staff who have received training in adult protection. Some of the home’s procedures have failed to protect the residents. EVIDENCE: The home has a complaints procedure in place. An outline of this is available in the porch to inform residents and visitors of how to make a complaint. Since the last key inspection visit there has been one complaint made directly to the home. This complaint was not recorded appropriately as it was recorded in the daily report book. There was no recorded evidence of how the complaint had been investigated or of the action taken to resolve it, although the manager reported that action was taken to resolve the complaint. There have been six complaints/ concerns about the home raised directly to the Commission and or to relevant Social Services departments since the last key inspection visit.
Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 18 The home has an adult protection policy which identifies that an allegation of abuse should be referred to relevant agencies for example Social Services, the Police and the Commission. The majority of the staff team have been provided with abuse training since the last inspection when this had been made a requirement. Since the last inspection a number of residents who presented a potential risk to other service users and staff have moved on from the home. This was in response to a requirement for the registered person to arrange for the reassessment and review of a number of residents who may no longer be appropriately placed. This process did take longer than the timescale provided to the registered person and during this period the manager was failing to safeguard the well being of residents and staff. A record of accidents and incident are maintained. These records were examined in some detail. Incident reports indicate that there are some issues with the appropriateness of the placement of at least one other of the residents. Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 25, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The presentation and cleanliness of the home is poor in some areas. The home does not provide a safe, well maintained and hygienic environment for all of the residents. Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 20 EVIDENCE: The home provides care for up to 26 residents over 3 floors of accommodation. The home has 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 has a large well maintained and enclosed garden to the rear and further garden areas to the side and front. A new drive has been laid since the last inspection. A tour of the premises was carried out and this included all areas of the home. The communal lounges are reasonably maintained and welcoming. The home has some aids and adaptations for those residents with mobility needs. There is access to the front of the property via a ramp but there is then a step for access to the house. There is also ramped access at the rear of the home. All areas of the home, which were identified as in need of attention at the last inspection, have been addressed. This has included; redecoration of a number of resident’s rooms, redecoration of the conservatory and hall ceiling, and carpets have been cleaned in a number of areas across the home. The tour of the home during this visit identified the following areas which need to be attended to; Three of the resident’s bedrooms need the flooring / replacing or cleaned. • One of the resident’s bedrooms needs the wardrobe to be replaced or secured. • One of the resident’s bedrooms has a large area, which is showing signs of damp, and the room is also in need of redecoration. • Two of the resident’s bedrooms are malodorous and this needs to be addressed. • One of the communal toilets is in need of redecoration and requires repair to fittings. • There was no supply of hot water in the upper first floor bathroom. • Many of the bathrooms and communal toilets did not have hand soap or hand towels. • The laundry is dirty, unorganised and infection control practices are not being adhered to. • One toilet door (sited on the main ground floor corridor) did not have a lock. • Table clothes need to be thoroughly cleaned or replaced. There is no maintenance plan for the home. The registered provider should produce a maintenance plan which identifies ongoing maintenance work, redecoration and refurbishment. The manager reported that all hand basins across the home are going to be replaced. The registered person should consider the replacement of resident’s bedroom furniture as part of the maintenance programme.
Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 21 • Staffing
The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the 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 adequate. This judgement has been made using available evidence including a visit to this service. Care staff are at hand to support residents and spend time with the residents. Staff are trained in some health and safety skills. There is room for improvement in the number of staff who are qualified in care so as to ensure that residents are supported by a more qualified work force. Staff recruitment and selection practices are not thorough enough to protect the residents from potential abuse. EVIDENCE: The home is staffed by three members of care staff through the day and evening. Residents and staff reported that staff spend time with the residents and staff seem to be available to meet the needs of the residents in a timely
Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 22 way. A new staffing structure has been introduced since the last inspection. The home has a deputy manager and 3 senior carers. All residents have a designated key worker. The appointed person has carried out an analysis of staff training as recommended following the last inspection. A requirement was made following the last inspection for staff to be trained in core health and safety skills as appropriate to their role and for training in the protection of vulnerable adults. Staff have been provided with training in adult protection, fire safety, moving and handling, first aid and food hygiene since the last inspection. The care staff team consists of 18 staff and of these 6 have attained a National Vocational Qualification (N.V.Q) level 2 or 3 in care. In order to meet the national minimum standards the registered person should aim for 50 of the staff team to attain an N.V.Q. The manager reported that 3 of the senior staff have enrolled to undertake an N.V.Q level 3 in care and that 7 of the care staff have enrolled to undertake an N.V.Q level 2 in care. Two of the senior staff are currently undertaking a team leaders course. Staff recruitment practices and procedures were checked by examining the staff file for a recently recruited member of staff. The records showed that two written references had been attained prior to the person starting work at the home and a protection of vulnerable adults (pova) check and a Criminal Records Bureau disclosure (CRB) had been attained. It was evident in this case that the practice for attaining refernces is poor and the information provided in at least one reference gave no indication as to the relationship of the referee to the candidate, no date and no indication that the references had been verified. The staff recruitment procedures had also been assessed during a visit to the home following the last key inspection. At this time a member of staff had been employed without appropriate checks having been carried out. This fails to protect residents from potential abuse. Staff induction needs to be developed to ensure that all staff are provided with a structured induction which meets the National Training Organisation specifications. As recommended following the last inspection staff meetings have been introduced and are taking place on a regular basis. Feedback from staff is that these provide a good opportunity for open discussion and for resolving issues. Residents gave positive feedback about the staff including “staff are really kind” and “I have a laugh with staff”. A small number of relatives gave feedback on the home and this was positive. The home has been the subject of complaints by a number of relatives since the last inspection. The manager should include feedback from relatives as part of a quality assurance process. Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 23 It is strongly recommended that the home has designated staff to take care of laundry. Care staff are currently responsible for this and adequate care and attention is not being paid to the residents clothing. The laundry is not being kept clean and infection control practices are poor. Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 24 Management and Administration
The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) 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 poor. This judgement has been made using available evidence including a visit to this service. Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 25 The home does not have a registered manager. There are no systems for checking the quality of the service provided to residents. Health and safety practices are sporadic. Infection control practices are not sufficient to ensure that residents are protected from the spread of infection. The current system for managing resident’s monies is not sufficient to account for all of the residents monies appropriately. Staff are not being provided with appropriate supervision to guide them in their practice and support their development. EVIDENCE: A new manager was appointed to the home in January 2006. The home does not have a registered manager and this is in breach of the Care Standards Act 2000 and The Care Home Regulations 2001. The appointed manager has applied to the Commission for registration as manager. The home has does not have a system for quality assurance. The registered person is required to adopt or produce a quality assurance system and this should include surveying the residents and their representatives on the quality of the service. Feedback from this process should then be published and distributed. It is also recommended that an annual development plan is produced which reflects aims and outcomes for residents. The registered person is managing resident’s monies. Records for this were checked and found to be appropriate for some but not all of the resident’s. In some cases the registered person is failing to account for the resident’s monies appropriately. The registered person should ensure the residents sign for receipt of their money where this is appropriate. The storage of resident’s monies must be reviewed as a significant proportion of this is kept in one bank account, which offers no facility for identifying the individual resident’s money, and therefore any individual interest accrued. Staff records and discussions with staff show that staff are not being provided with one to one supervision on a regular basis. Since the last inspection most care staff have had the opportunity of one supervision meeting only. It is a requirement that staff receive regular and recorded supervision. Health and safety checks were examined. The home has recently been visited by a fire safety officer and a fire risk assessment is in place. Staff have been provided with fire safety training and have been included in a fire drill practice since the last inspection. Gas and electricity safety certificate were checked and were up to date. Portable hoists had been serviced recently. The manager reported that the registered person checks and records water temperatures on a regular basis but records to confirm this were not available for inspection. Infection control practices are poor. Most of the communal
Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 26 bathrooms have no soap or hand drying facilities and the laundry arrangements do not safeguard against the spread of infection. The manager must ensure that staff are clear on their responsibilities for infection control and are provided with appropriate training in this. Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 27 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 x 2 1 3 1 4 2 5 x 6 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 2 ENVIRONMENT Standard No Score 19 2 20 3 21 x 22 3 23 2 24 1 25 2 26 1 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 1 32 x 33 2 34 x 35 2 36 2 37 x 38 1 Breckside Park Residential Home DS0000025331.V320743.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5 (1) ( c) Requirement The registered person must ensure that residents have a standard form of contract with the home for the provision of services and facilities. The registered person must ensure that residents are only admitted to the home following an assessment of their needs by a suitably qualified and experienced person. Previous Requirement The registered person must ensure that the home meets the conditions of registration. The registered person must ensure that the home only admits residents whose needs can be met and within category of registration. Previous Requirement The registered person must take appropriate action when a resident’s needs change and the person’s needs can no longer be met at the home.
DS0000025331.V320743.R01.S.doc Timescale for action 06/02/07 2. OP3 12 14 06/12/06 3. OP4 12 (1) 06/12/06 4. OP4 14 (2) (b) 06/12/06 Breckside Park Residential Home Version 5.2 Page 29 5. OP7 OP8 1513 (4) (c) 6. OP7 15 (1) 12 (2) (3) 17 Schedule 3 13 (2) 7. OP8 8. OP9 9. OP16 12 (4) (a) 10. OP19 23 11. OP29 19 (1) (b) 12. OP36 18 (2) 13. OP33 24 The registered person must ensure that each resident has a comprehensive care plan which describes their care needs for all aspects of their personal and health care. Previous requirement The registered person must ensure that residents are consulted with when their care plan is developed. The registered person must ensure that all health related information and appointments for residents are recorded. Previous Requirement The registered person must ensure that medication is managed safely and medication administration records are accurately and appropriately maintained. Previous Requirement The registered person must ensure that complaints and the outcome of these are recorded appropriately. The registered person must prepare a maintenance plan to ensure that the home is in a good state of repair and decoration throughout. Previous Requirement The registered person must ensure that staff do not commence employment prior to receipt of all relevant pre employment checks. The registered person must ensure that staff are provided with regular and recorded supervision. Previous Requirement The registered person must establish and maintain a system for reviewing and improving the quality of care provided at the
DS0000025331.V320743.R01.S.doc 06/12/06 06/12/06 06/12/06 06/12/06 06/12/06 06/02/07 06/12/06 06/01/07 06/01/07 Breckside Park Residential Home Version 5.2 Page 30 14. OP34 16 (2) (l) 15. 16. OP38 OP38 13 13 (3) 17. OP38 13 (4) (b) home. Previous Requirement The registered person must make arrangements for service users to acknowledge receipt of their personal monies in writing. The registered person must review the risk assessment for safe working practices. The registered person must ensure that infection control practices are carried out and staff are aware of their responsibilities in this. The registered person must ensure that water temperatures are checked and recorded on a regular basis. 13/12/06 06/01/07 06/12/06 06/12/06 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. 2. 3. 4. 5. 6. 7. 8. Refer to Standard OP3 OP9 OP10 OP12 OP30 OP30 OP38 OP33 Good Practice Recommendations Social Services assessments should always be requested were the person is referred by Social Services. The recording of staff supervision and assessment of competence should be improved to show that staff are capable of handling medicines correctly. The registered person should review the arrangements for residents being supported with bathing / showering. Residents should be offered opportunities to be involved in a greater range of activities and community access. The registered person should review the systems in place for staff induction. The registered person should aim for 50 of staff to have attained hold a National Vocational Qualification in care. The registered person should consider having designated staff for laundry duties. The registered person should develop an annual development plan for the service linked to outcomes for residents.
DS0000025331.V320743.R01.S.doc Version 5.2 Page 31 Breckside Park Residential Home Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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
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