Inspection on 28/06/05 for Breme

This inspection was carried out on 28th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Breme 16/12/09

Breme 28/11/06

Breme 25/01/06

Breme 01/02/05

Breme 22/06/04

Breme 26/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Maple Lodge

Polesworth Group 32 Station Road

Heathlands

Aston Court Nursing Home

Polesworth Group 70 Long Street

Ravenhurst

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

CARE HOMES FOR OLDER PEOPLE Breme House 46 Providence Road Bromsgrove Worcestershire B61 8EF Lead Inspector Annie OMara Unannounced 28 June 2005 07:00am 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 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 House E52 S41841 Breme V235369 280605.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Breme House Address 46 Providence Road Bromsgrove Worcestershire B61 8EF 01527 571320 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) breme@heartofengland.co.uk Heart of England Housing and Care Limited Mrs Karen Keen Care Home 60 Category(ies) of DE(E) Dementia (over 65) - 60 registration, with number LD(E) Learning Disability (over 65) - 2 of places OP Old Age - 60 PD(E) Physical Disability (over 65) - 60 Breme House E52 S41841 Breme V235369 280605.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: There are no condition of registration in addition to those recorded on the previous page. Date of last inspection 2 February 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 ensuite with toilets and showers. The upstairs rooms are accessed by passenger lift and there are hand rails throughout the building. Separate toilets and bathrooms are adapted for people with physical disabilities. Breme House E52 S41841 Breme V235369 280605.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place during the early morning until early afternoon. Night staff were spoken to and a brief tour of the premises was undertaken. Residents’ care plans were inspected and general observations made. Three residents, three staff members and four visitors were spoken to, and a selection of staff files were examined. What the service does well: What has improved since the last inspection? What they could do better: The written care records could improve to ensure that the residents’ needs are being consistently met. This includes the provision of nutritional and skin care risk assessments. The staffing arrangements in the dementia unit must be reviewed to ensure that the residents are not waiting for their breakfasts or medications. Rails around the garden could be provided to ensure the safety of residents when outside. Staffing levels at night must be maintained at the agreed level. Breme House E52 S41841 Breme V235369 280605.doc Version 1.40 Page 6 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 House E52 S41841 Breme V235369 280605.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Breme House E52 S41841 Breme V235369 280605.doc Version 1.40 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 standard(s) 1, Information is available for prospective residents and their families to help them to make an informed decision about moving into the home. EVIDENCE: The Statement of Purpose and Service Users’ Guides were readily available in the reception of the home. It was observed that there were still references to the NCSC in them. These will need to be replaced with ‘Commission for Social Care Inspection’ when the documents are next reviewed. Breme House E52 S41841 Breme V235369 280605.doc Version 1.40 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 standard(s) 7, 8, 9, 10. The recording systems in place for meeting residents’ needs are comprehensive, but they are not consistently filled in by staff. This could put residents’ health and welfare at risk. The systems for the administration of medication are good but some inconsistencies could put residents’ health at risk. The staff have a very good understanding of the residents’ needs and this is evident from the relationships between them and the comments made by the residents. Personal support is offered in a way, which promotes the privacy and dignity of the residents. EVIDENCE: Care plans were in place for all the residents, providing information as to their general welfare and healthcare needs. The care plans gave a good description of residents’ needs and how these were to be met by staff although there were some shortfalls in the recording and reviewing of parts of the plans. Observations made and discussions with staff indicated that while these aspects of care had not been recorded, the residents were receiving the care they needed. Examples of information missing were as follows; A general risk assessment had not been updated. Breme House E52 S41841 Breme V235369 280605.doc Version 1.40 Page 10 There were some gaps in the summary signing sheets. One plan did not show the changes in a resident’s health care needs. A moving and handling risk assessment did not reflect that a resident had had a fall. There were some dates missing from the summary signing sheets. A monthly weight chart recorded that a resident had lost 2 stone 3lbs in a month. There had been no information recorded to indicate this fact or follow up to it. It did transpire that the resident had not lost the weight but the mistake had not been noted. There were no nutritional or skin care risk assessments in place. It was difficult to ascertain where changed to the resident’s needs were recorded in their care plan. The complexity of the care plan lay out was discussed with the registered manager and the customer services manager. The monitoring forms, which are in place to provide a regular check of the plans, showed that for many months there were shortfalls in the records of personal care, which had been noted but had then not been improved. The concern was that the auditing was not having an impact on improving the plans and that a different approach may be needed. Reviews were written in good detail and carried out regularly. The medical notes from the G.P.’s were not always reflected in the care records. A resident who had an area of sore skin was seeing the district nurse frequently and specialist equipment had been provided. Staff confirmed that she was being turned every two hours and when visited she looked very comfortable. Records were kept of G.P. and district nurses visits and residents confirmed that their healthcare needs were responded to quickly by staff. Residents who were spoken to about the care they received said that they “were very well looked after” “care is very good” and “no fault to find”. The medication policy was available and sample signatures of all staff authorised to give out medication were kept. Medication was signed and checked when received into the home. One resident’s medication administration chart indicated that he had missed three doses of antibiotics. The care records did not give any information as to why this had happened. The customer services manager had already picked up this shortfall during her audit. It was noted that the morning medication was not given out until 10.00am. The member of staff on duty said it was usually given out earlier but there had been some disruption of routine on the day of the inspection. Observations made indicated that residents were treated with respect and their dignity maintained. Residents were not rushed when being given personal care. Relationships between residents and staff were seen to be warm and friendly. Residents spoken to said staff treated them well. Staff gave good examples of how they promoted the dignity and privacy of the residents including emotional support to enhance self-esteem and confidence. Breme House E52 S41841 Breme V235369 280605.doc Version 1.40 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 standard(s) 12, 13, 15 Routines in the home are flexible and allow for individual residents to live their lives as they wish. A strong emphasis is placed on the importance of activities allowing residents to have meaningful occupation. The choices for meals and standard of food meets the residents’ dietary needs. EVIDENCE: Residents’ interests were recorded in their care plans although the record of activities was not kept up to date for individuals. There was a varied program of activities in the home and trips out were organised regularly. The home had access to a minibus. Local community based activities were also taken advantage of by the home. Resident spoken to who were able, said they enjoyed the activities provided. Residents were observed out in the garden watering the plants. Residents were able to see their visitors in private and visitors confirmed that they were welcomed into the home at any time. All of the residents spoken to stated that the food was very good. Comments such as “marvellous” “suits me” “loads of choice” were made. Visitors also stated that the food always looked very good. Minutes of residents’ meetings confirmed that they were consulted about the provision of food. Breme House E52 S41841 Breme V235369 280605.doc Version 1.40 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 standard(s) 16,17,18, Staff receive advice, guidance and training to protect vulnerable adults. Service users have relevant information and are confident that if they raise concerns they will be addressed. EVIDENCE: It was observed that the complaints procedure was readily available in the Service Users’ Guide, displayed on a notice board and contained in the ‘Admissions Pack’. A member of staff confirmed that she was aware of the procedure and would take appropriate action if concerns were brought to her notice. When new people moved into the home the member of staff supporting the new person was responsible for ensuring that the contents of the ‘Admissions Pack’ were explained. Five complaints had been received by the home since the previous inspection. Two of these had concerned food, one care and the other administration. All had been appropriately dealt with and were well recorded. A resident was able to confirm that she had brought a concern to the attention of a senior member of staff and this had been dealt with. Information regarding advocacy was displayed through the home and the manager confirmed that support would be given wherever it was needed. The manager said that most service users were on the electoral roll. Some had postal votes and at the time of the general election exercised their right to use them. Others had visited the polling station. Breme House E52 S41841 Breme V235369 280605.doc Version 1.40 Page 13 Policies and procedures relating to the protection of service users were available in the reception. A member of staff confirmed that she knew their location and could consult them when she wished. She had received training in this area some time earlier and was looking to have this updated. Another member of staff confirmed that they had received abuse awareness training. Breme House E52 S41841 Breme V235369 280605.doc Version 1.40 Page 14 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 standard(s) 19, 20, 21, 22,26 The standard of the environment is very high and provides residents with a safe, comfortable home. The hygiene practices in place help protect the residents from infection. EVIDENCE: The building was well maintained and provided a safe comfortable environment for the residents. Communal space was provided in a variety of lounge and dining areas, which were furnished to a high standard. A visitor raised a concern about accessing the garden through the smoking lounge, and the registered manager stated that this was being dealt with in the near future. A member of staff also raised an issue regarding the lack of rails around the garden paths. Toilets and bathrooms were clean and well equipped for the residents’ safety. Safety equipment was provided to meet the residents’ needs and staff confirmed they had received training in its use. A member of staff raised concerns about safe storage of equipment. Breme House E52 S41841 Breme V235369 280605.doc Version 1.40 Page 15 Staff were observed wearing the correct protective equipment when working in different areas of the home and residents confirmed that staff wore gloves and aprons when providing personal care. Breme House E52 S41841 Breme V235369 280605.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Insufficient staff are on duty at times to attend to the service users needs. The recruitment process and training of staff protect service users and ensure acceptable care is provided. EVIDENCE: When the inspection commenced the night staff were on duty. It was said that the staffing level at night was for four care staff awake on duty. However due to sickness there were occasions when there were only three if cover could not be found. This put pressure on staff and the care process. None the less the manager said that the staff team were very good and provided extra cover whenever they could. Agency staff were difficult to obtain at short notice, as they were rarely needed. It was also noted that during the morning of the inspection the day staff were very busy and breakfast and medication rounds were delayed in consequence. The managers said that usually they would be lending a hand where necessary. It was recommended that the deployment of staff be reviewed to ascertain how this could be addressed. Breme House E52 S41841 Breme V235369 280605.doc Version 1.40 Page 17 Duty rosters were seen. It was noted that there was no identifiable shift leader at night. Currently the most experienced person on duty was designated to be the shift leader. This should be reflected on the rota. Training records indicated that fourteen care staff were trained to NVQ level 2 or above. The care team numbered forty-four persons. The manager said that one senior now took the lead in providing support, and mentoring new staff through the induction training. This had strengthened the training and support given. All staff received and maintained their own Induction Training Manual. A new member of staff confirmed this. The manager said that the organisation did not have a structured Foundation Training Programme in place therefore she ensured new recruits were immediately put forward to commence NVQ level 2 training. (These standards are currently being revised.) The training records appeared to indicate that all staff received three or more training days each year. However this was not being monitored. It was recommended that a system be developed to ensure everyone was meeting the standard. Staffing records indicated that an acceptable recruitment procedure was used. Breme House E52 S41841 Breme V235369 280605.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 to 36 The home is well managed for the benefit of the service users. Standards of care are monitored to ensure care is acceptably provided for the service users. Service users are safeguarded by the financial procedures in use. Supervision of staff provides opportunities to develop skills and strengths for the benefit of service users and staff career development. EVIDENCE: The manager was well qualified and competent to manage the home. She said that she was nearing the completion of her studies to attain the Registered Manager’s Award and in addition had undertaken training in other care subjects this year. Breme House E52 S41841 Breme V235369 280605.doc Version 1.40 Page 19 Other staff confirmed that she was approachable, willing to listen and responded when necessary. Ideas and discussions were always welcome and given due consideration. Residents spoke highly of the managers in the home. A Quality Assurance Programme and an Annual Development Plan were available for the home. Questionnaires were undertaken with a range of people involved in the varied services provided by the home and the analysis and actions taken were well recorded. The manager said that a programme to review the policies and procedures for the organisation and the home had commenced. References to the ‘NCSC’ would then be replaced with ‘Commission for Social Care Inspection’ (CSCI). Sound financial and accounting procedures were in use and records were maintained. Service users’ monies, held for them in safekeeping, were well managed and readily available to the service users concerned. All was well documented. A file of staff supervision dates was seen and the manager confirmed that each mentor and staff member concerned held records of their meetings. A staff member said that she was finding the sessions useful. The fire risk assessment was drawn up in April 2004 and the fire safety systems and equipment were last serviced on 05.01.05. Routine fire safety checks were being undertaken at the required frequency and the records indicated that appropriate action was taken when faults were identified. Staff training in fire safety was undertaken and detailed records were maintained to ensure no one was overlooked. Eighteen staff had participated in a training session given by an external trainer on the day before this inspection. They were very enthusiastic concerning the quality and appropriateness of the training. Breme House E52 S41841 Breme V235369 280605.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 3 x x Breme House E52 S41841 Breme V235369 280605.doc Version 1.40 Page 21 no Are there any outstanding requirements from the last inspection? 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 1 Regulation 4 Requirement The statement of purpose must be updated to include information about the Commission for Social Care Inspection. Care plans must be updated as residents needs change. Records of residents care needs must be kept accurately. Risk assessments must be reviewed and updated as residents needs change. Risk assessments must be put in place for nutrition and skin care. Prescribed medication must be administered as stated. Medication must be given out at the prescribed times. Night staffing levels must be maintained at the agreed levels. Staffing arrangements in the morning must be reviewed to ensure that staff are appropriately deployed in the home to meet the residents needs. Timescale for action 31st July 2005 2. 3. 4. 5. 6. 7. 8. 9. 7 7 8 8 9 9 27 27 15 15 13(4) 13(4) 13(2) 13(2) 18(1)(a) 18(1)(a) Breme House E52 S41841 Breme V235369 280605.doc Version 1.40 Page 22 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. Refer to Standard 7 12 20 22 27 30 Good Practice Recommendations It is advised that the care planning process in the home is reviewed in order to simplify the recording needed to be carried out by staff. Individual records of activities should be kept. The provision of rails in the garden should be considered. Arrangements for storage of aids and adaptations should be considered. The member of staff who is the designated person responsible for the home at night should be identified on the rota. A record should be kept of the amount of training staff receive. Breme House E52 S41841 Breme V235369 280605.doc Version 1.40 Page 23 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 House E52 S41841 Breme V235369 280605.doc Version 1.40 Page 24 - 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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