Inspection on 10/07/06 for Brenan House

This inspection was carried out on 10th July 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Brenan House 24/04/07

Brenan House 19/12/05

Brenan House 19/09/05

Brenan House 09/02/05

Brenan House 22/09/04

Brenan House 17/02/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Brenan House 21 Vale House Ramsgate Kent CT11 9DE Lead Inspector Clair Brown Key Unannounced Inspection 10:15 10th & 11th July 2006 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 Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brenan House Address 21 Vale House Ramsgate Kent CT11 9DE 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) 01843 582837 Mr David Barrie Spicer Sandra Caroline Spicer Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users DE(E) are restricted to one (1) whose DOB is 26/04/1909. Date of last inspection 8th September 2003 Brief Description of the Service: The Home is a large old building situated around an attractive tree lined square, close to the local shop and amenities. The home is laid out over several floors and has a shaft lift to all the floors providing accommodation to Service Users. Recently the Registered Providers have started to install ensuite facilities in some bedrooms. The top floor contains a private flat. There is a paved courtyard to the rear of the building. The home provides care for older persons and has started to develop a range of activities and entertainment. Fees are from: £303.25 - £395 per week Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection consisted of an unannounced visit to the home on 10th & 11th July by one inspector. The inspection takes account of information received from a variety of sources including written information from the registered providers, relatives, service users, care managers and general practitioners. The previously made requirements and recommendation from other inspections were inspected and all key standards. Comment cards were completed by 10 service users. The inspectors spent time talking to service users and the care staff to gain their views. A partial tour of the premises was conducted. Documents and records were seen and service users files were case tracked. What the service does well: What has improved since the last inspection? What they could do better: There has been a decline in the overall management of the home but this is being addressed. The number of staff provided have been affected by staff sickness and some leaving, the increase in the number of service users that Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 6 require 2 or more carers has also had an impact on the care hours that needs to be provided, therefore there has been insufficient care staff on duty at certain times of the day. The recruitment procedures used to employ new staff are unsafe and fails to ensure that they have been fully vetted before starting work. Immediate requirements were made relating to the staffing and recruitment issues. Service users care plans need to be improved so that they contain sufficient information about them to enable the staff to be able to meet all of their care needs. Staff need to complete special training course in subjects such as dementia and adult protection. The registered provider needs to develop a system to monitor the quality of service the home provides. 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. Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12346 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The statement of purpose does not provide up to date information to enable prospective service users to make an informed decision. The contract/terms and conditions does not specify the services provided. Prospective Service Users are assessed but some are admitted outside of the registration of the home compromising the ability to meet the Service Users needs. The home does not provide intermediate care; therefore standard 6 is not applicable. EVIDENCE: The statement of purpose does not contain all of the required information, although the registered provider has reviewed this document they have failed to include the appropriate information. The service users contract does not specify what services the home provides for the fees paid. Although the registered provider carries out detailed pre-admission assessments this has not prevented service users being admitted outside of the homes registration. The Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 9 information provided by the registered provider in the inspection paperwork confirmed this. Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. 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. The care planning system does not adequately provide staff with the information they need to satisfactorily meet service users needs. Service users are supported to ensure health care is accessed. Medicines practices have improved and are now being handled and managed safely. EVIDENCE: Two service users files were case-tracked and where possible the service user met and to talked to. The care plans were incomplete and basic, only one had been reviewed and changes identified in the review were not cross referenced to the care plan. Assessments of potential health needs including skin integrity and nutritional assessment were either partially completed or blank. Both service users had a recent history of falls, for one lady a recent fall at home; the service users told the inspector this was “the final straw” to choose living in residential care. However neither of the service users had falls monitoring systems in place and one had experienced falls since admission. The quality of daily records was poor and failed to provide evidence of care being provided and needs being met. There was documentation to that supported the home Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 11 works closely with healthcare professionals and does respond quickly if medical attention is needed. Service users spoke highly of the home and were content living there. A medication audit found only one error; this had already been acted upon by the registered provider and appropriate action taken for both the service user and the member of staff. Medication audits by the home had been carried out regularly until a few months ago and then stopped, good practice would be to continue these on a regular basis. Overall service users are treated with respect & dignity, practices are in place to ensure private items that may disclose specific needs such as continence are not on public display. However one carer was observed being abrupt with a service user for being in the way, this was discussed with the registered provider who was upset by this incident and made a commitment to deal with the issue. Nine of the ten service users surveys stated that they receive the care and support they need and stated they receive medical support when they need it. Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The programme of activities satisfies the wishes of most of the service users. A balanced diet is provided. Relatives are made welcome and are encouraged to visit. EVIDENCE: The home offers a variety of activities both within the home and activities outside the home. These include trips to the theatre, a trained complimentary therapist visiting on a regular basis and the usual range of activities that includes, gentle exercise, quizzes, sing-a-longs and activities in the gardens of the home. On the day of the inspection visit the complimentary therapist was working in the home. Seven of the service users surveys recorded that there is always suitable activities available, only one said that they never joined in and that this was due to visual impairment and their personal choice. Another service user told the inspector that they do not like to go in to the lounge as they have problems communicating due to being partially sighted and some deafness and that there are no special activities provided for them. The home does subsidise the complimentary therapies provided which include head massage, aromatherapy and much more. The garden is a large patio area this has been transformed with containers into a beautiful area. A small selection of fresh vegetables are now grown in the garden and then used by the home. Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 13 Service users are encouraged and supported to participate in interests and clubs outside of the home. Service users surveys recorded that they enjoy the food. A new cook has recently been employed; he produces a variety of meals, which includes hot choices. Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been an improvement in the recording and acting upon complaints received. Service users are aware of how to make a complaint. Staff have not been provided with a knowledge and understanding of adult protection. EVIDENCE: The registered provider now records all complaints received. Service users surveys showed that they understand how to make a complaint and who to talk to if they have any concerns. The records of complaints do not provide any information relating to any investigations conducted and any action taken. The staff files and training matrix showed that staff have not completed any form of adult protection training. However the registered person has previously raised issues with the adult protection co-ordinator when she believed a service user was at risk from an external source. Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 25 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The building is well maintained providing a homely environment for service users. EVIDENCE: A partial tour of the premises was conducted; the registered provider continues to strive to improve the standard of accommodation provided. One bathroom has been fitted with a low level assisted bath. There is an assisted shower suite and a hairdressing area. The hairdressing facilities are used several times a week by the visiting hairdresser. Screening has been fitted in all of the shared bedrooms. There are further plans to increase the number of en-suite facilities provided. There are two communal lounges and a dinning area in the conservatory. The home benefits from an attractive paved garden which service users enjoy throughout the summer. Infection control procedures are adhered to. The home was clean and free from offensive odours. Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 16 Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care staff are not always provided in sufficient numbers to meet the needs of the service users. Recruitment procedures do not protect the safety and welfare of the service users. Staff have not completed mandatory training courses and new staff are not enrolling on the induction programme. EVIDENCE: The staffing rotas show that between 2-3 care staff are on duty at a time, most recently only 2, at night there is 1 waking and 1 sleep-in carer. However four service users require a minimum of 2 carers to meet their care needs. One service user told the inspector that she does have to wait a long time to get assistance and that this is due to there not being enough staff and that the home is short staffed. She does not like to ask for help because the girls (carers) are so busy and have enough to do. The registered provider stated that the elderly volunteer gardener has covered the sleep-in shift when there has been no one available. The gardener has not had any training. Seven of the 10 service users surveys said that staff are always available when they need them, three said usually. During the inspection visit there was an incident where a service user had a fall, the registered provider was in the office and responded quickly, care staff were not readily available to respond quickly. Two staffs files were assessed these showed that recruitment Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 18 procedures are not being adhere to. Staff are employed without CRB and POVA first checks being completed before new staff start work, one person worked in the home for 3 months before these checks were completed. There were no interview records or evidence of investigating gaps in employment history. New staff have not been through the induction training although the registered provider has obtained the updated version of the induction training. Staff have not completed the mandatory training course. The home now provides care for at least one service user with dementia, however staff have not undertaken the dementia training. 50 of care staff have complete the NVQ in care course. Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 35 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The decline in the overall management of the home has resulted in the deteriorations of the service noted throughout the inspection visit. There are no quality monitoring systems. Systems are in place to ensure service users finances are protected. EVIDENCE: The registered provider has the registered managers award qualification. The registered provider admitted that due to a number of personal issues she had not been concentrating or able to cope with the day-to day management of the home. This is evident from the overall findings of the inspection visit and the content of an anonymous complaint. The registered provider stated that she had recognized the need to act upon the difficulties she was experiencing and has sought professional support and that she was already feeling the benefit of this. The registered provider has not had a holiday from the home in a Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 20 number of years. The welfare of the service users has been the priority of the registered provider however this needs to be taken further in the management of the home. Currently there is no form of auditing conducted to monitor the quality of practice and no annual quality monitoring system in place. The home operates an invoice system for the service users money so that they are not directly handling any of the service users money; these include detailed individual accounts (records) and receipts. The environmental health & safety certificates were in date but there were some gaps in fire checks and the fire risk assessment needed reviewing, last reviewed 2004. Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 1 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 X 3 X X 2 Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 5 Sch 1 Requirement To revise both the Statement of Purpose and Service User Guide to include all of the required information detailed in the Regulations. Previous timescale 30.06.05 and 31.12.05 & 28/02/06 The Registered Provider is required to amend the Service User Contract to ensure it clearly states details of the service provided. Previous timescale 30.06.05, 31.12.05 & 28/02/06 An application for a variation must be made for those Service Users outside the registration of the home. Service users must not be admitted outside of the homes current registration. The home is required to produce and implement accurate and detailed care plans with risk assessments that identify all the individual Service Users needs. Care plans and assessments must be accurately reviewed DS0000044013.V301126.R01.S.doc Timescale for action 30/11/06 2. OP2 5 30/11/06 3. OP4 12,14,18 30/11/06 4. OP7 12,13,15 30/11/06 Brenan House Version 5.2 Page 23 monthly or earlier if needed to ensure all changes in needs are recorded and actioned and met. Previous timescale 30.06.05, 31.01.06 & 28/02/06 5. OP8 12-17 Sch 3 All Service Users must have health assessments. To include skin integrity and nutritional assessments, these must be reviewed monthly. Previous timescale 31.12.05 & 28/02/06 The Registered Provider must record in detail evidence of investigations of complaints and action taken. All staff must complete Adult Protection training. Staff numbers must be reviewed, ensuring sufficient care staff are provided taking into account the needs of the service users including those that need 2-3 carers at a time. Volunteer staff must not must not be used to cover duties normally provided by employed staff. Recruitment procedures must be thorough, prospective staff must not start work without a POVA First and CRB check being completed. All staff working with only a POVA First but without a CRB must be constantly supervised. The Registered Provider must develop and implement an induction programme for new staff that complies with Skills for Care and is completed over a sufficient period of time to ensure staff have fully understood and learnt the contents of the programme. Previous timescale 30.06.05 and DS0000044013.V301126.R01.S.doc 30/11/06 6. OP16 17,22, Schedule 4 12 13 17 20 23 sch 3 17 18 Sch 4 30/11/06 7. 8. OP18 OP27 30/12/06 11/07/06 9. OP27 17 18 Sch 4 7 9 12 19 Sch 2 30/11/06 9. OP29 11/07/06 10. OP30 12,13,18 30/11/06 Brenan House Version 5.2 Page 24 31.01.06 11. OP30 12,13,18 Staff training, all staff must complete the mandatory training and other appropriate courses e.g. dementia. All new staff must complete the induction training. The home must be managed in a calm and peaceful manner, ensuring peoples confidentiality and the safe management of the home. Systems must be introduced to ensure the home is well managed and to enable the registered provider to have annual leave. The registered person must comply with all requirements made including those not previously met. The Registered Provider is required to develop and implement a quality assurance system and to produce a written report of the collated information gathered and any actions required. A copy must be sent to the CSCI. Previous timescale 30.06.05, 31.01.06 & 28/02/06 The registered person must ensure all of the safety fire checks are conducted and recorded at the appropriate time intervals. 30/12/06 12. OP32 5 10 12 18 21 24 30/11/06 13. OP32 5 10 12 18 21 24 10,12,15, 24 30/11/06 14. OP33 30/12/06 15. OP38 12,13,16, 23 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 25 No. 1. 2. 3. Refer to Standard OP7 OP9 OP12 Good Practice Recommendations To review care plans/service users files to make them more user friendly To conduct regular medication audits and to record this and any action taken if errors are found. Recommendation to provide activities/stimulation for those with visual impairment Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Brenan House DS0000044013.V301126.R01.S.doc Version 5.2 Page 27 - 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!