CARE HOMES FOR OLDER PEOPLE
Breme 46 Providence Road Bromsgrove Worcestershire B61 8EF Lead Inspector
Mrs Yvonne South Unannounced Inspection 25th January 2006 14:00p 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 Breme DS0000041841.V272676.R01.S.doc Version 5.1 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. Breme DS0000041841.V272676.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Breme Address 46 Providence Road Bromsgrove Worcestershire B61 8EF 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) 01527 571320 01527 882218 Heart of England Housing and Care Limited Mrs Karen Keen Care Home 60 Category(ies) of Dementia - over 65 years of age (60), Learning registration, with number disability over 65 years of age (2), Old age, not of places falling within any other category (60), Physical disability over 65 years of age (60) Breme DS0000041841.V272676.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: There are no additional conditions of registration. Date of last inspection 28th June 2005 Brief Description of the Service: Breme House is a purpose built 60 bedded home in a residential area of Bromsgrove, which is close to the town centre and is on a bus route. The home offers a service for 60 older people who may have a physical disability and mental health needs associated with older age. Additionally the home is registered for 2 people over the age of 65 who have a learning disability. The home also has a separate 8-bedded unit for people who have dementia. The home is on three floors and all the bedrooms are single and en-suite with toilets and showers. The upstairs rooms can be accessed by passenger lift and there are handrails throughout the building. Separate toilets and bathrooms are adapted for people with physical disabilities. Communal lounge, dining facilities and kitchenettes are provided on all floors and there is an attractive garden. The registered providers for the home are the owners Heart of England Housing and Care Ltd for whom Mr John McCarthy is the responsible individual. Mrs Karen Keen is the home’s registered manager. Breme DS0000041841.V272676.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place over three and a half hours from 2pm until 5.30pm. The focus was on the requirements and recommendations that had arisen out of the previous inspection and key standards that had not previously been assessed this year. Ms Keen the registered manager and Mrs Pinnegar the care services manager assisted the inspector. A tour of the home was undertaken and the inspector spoke to residents and staff. A range of records was assessed. A service questionnaire was sent to the manager prior to this inspection, which was completed and returned to the Commission for Social Care Inspection. The manager was also asked to distribute other questionnaires regarding the service to residents, relatives and health care professionals. The completion of these is voluntary but proves useful in assessing the various views that are held. Eight responses had been received prior to this inspection. What the service does well:
The service provides a warm welcome to all visitors and has a cheerful relaxed atmosphere in all communal rooms. Staff interaction with Residents is respectful and caring. Staff training is well organised and updated to ensure the staff team is qualified and skilled to provide the service needed. The house is clean, comfortable, well decorated and furnished. Seven of the questionnaires that were returned contained positive feedback. One relative said that all the staff at Breme House were very approachable and attended to her relative’s welfare and best interests The manager said that the comments in the eighth response were already being addressed. Breme DS0000041841.V272676.R01.S.doc Version 5.1 Page 6 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. Breme DS0000041841.V272676.R01.S.doc Version 5.1 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 Breme DS0000041841.V272676.R01.S.doc Version 5.1 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, 3 Pre admission assessments ensure the service is able to meet the needs of the people who move into the home. EVIDENCE: Standard 3 was assessed as met. Community Care assessments had been provided for people who were funded and these were supported by assessments carried out by members of senior staff from the home. The assessments were acceptable and more detail was being added as information became available from the prospective resident, family members and health care professionals. Further staff support and guidance was suggested in one instance. The requirement made, following the last inspection, to amend the statement of purpose had been met Breme DS0000041841.V272676.R01.S.doc Version 5.1 Page 9 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, Documentation provides information for staff that enables them to provide the individual care required by the residents. Medication systems ensure residents receive their medication as prescribed. EVIDENCE: These standards were not assessed in full but a considerable amount of time was spent assessing care documents, as there were six related requirements and one recommendation made in the previous report. The new record system was being piloted with residents in one unit and with residents who come for respite care. Various views were expressed as to the merit of different recording methods. The views of staff using the new system will be fed back during the registered provider’s managers’ meeting to amend and improve the documentation further in the light of information, suggestions and discussions.
Breme DS0000041841.V272676.R01.S.doc Version 5.1 Page 10 First impressions were that the system was easy to follow and locate information. The old system of recording was still in use elsewhere in the home. The records that were assessed had some weaknesses but regular monitoring by senior staff took place to ensure these were identified and addressed. Risk assessments were in place and being reviewed. Brief risk assessments for nutrition and skin care were undertaken during preadmission assessment and if a concern was identified an in-depth assessment was then carried out. It is important that such assessments clearly lead to care plans that advise and guide the staff in the action they should be taken. Staff routines had been reorganised to ensure medication was administered on time and as prescribed. Breme DS0000041841.V272676.R01.S.doc Version 5.1 Page 11 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, EVIDENCE: These standards were not assessed during this inspection. A recommendation that individual records should be maintained of activities had been implemented. Breme DS0000041841.V272676.R01.S.doc Version 5.1 Page 12 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): EVIDENCE: These standards were not assessed during this inspection. Breme DS0000041841.V272676.R01.S.doc Version 5.1 Page 13 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): 20, 22, EVIDENCE: These standards were not assessed during this inspection. A short tour of the home confirmed that it was clean, well maintained, decorated and furnished. Equipment was appropriately stored. The provision of rails in the garden had been discussed with the residents and they had decided that they did not want them fitted at this time, as they could see no great benefit. Breme DS0000041841.V272676.R01.S.doc Version 5.1 Page 14 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, 30 EVIDENCE: These standards were not assessed in full during this inspection. However compliance was checked regarding the two requirements and four recommendations that had been made. All had been met. There was a full staff compliment and the team was appropriately deployed. The duty roster indicated who was in charge of the home at all times. A staff training matrix was displayed that clearly showed the training each person had undertaken each year. The care staff team numbered 52 persons. Twelve of these had NVQ qualifications and seventeen were currently on courses. The manager had renewed her training as an NVQ assessor and another colleague was now undertaking the course. Dementia care work shops were taking place with the staff directly concerned with this care and it was planned to extend the training to staff in other areas as there was such a heavy demand on the home for dementia care places. Breme DS0000041841.V272676.R01.S.doc Version 5.1 Page 15 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): 38 The home is managed with due regard for the health and safety of the people in it. EVIDENCE: Staff were receiving training on all health and safety subjects and the maintenance records demonstrated that close regular monitoring was carried out on equipment and systems. A recent outbreak of infection had been well managed by the home. They had sought and received guidance from the Community Infection Control Advisers and the manager said that the home had been congratulated on their good management and practice.
Breme DS0000041841.V272676.R01.S.doc Version 5.1 Page 16 The fire log was well maintained with records of regular checks and responses to concerns. Fire safety training was undertaken as a standing agenda at all staff meetings. An attendance log was seen for fire drills and events. It was suggested that a similar tool was used to monitor participation in the quarterly training requirement. Breme DS0000041841.V272676.R01.S.doc Version 5.1 Page 17 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X 3 X 3 X X X X STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Breme DS0000041841.V272676.R01.S.doc Version 5.1 Page 18 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Breme DS0000041841.V272676.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Breme DS0000041841.V272676.R01.S.doc Version 5.1 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
