Inspection on 19/09/05 for Brenan House

This inspection was carried out on 19th September 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 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 10/07/06

Brenan House 19/12/05

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 Announced 19,20/09/2005 at 10:00hrs 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. Brenan House H56-H05 S44013 Brenan House V243466 190905 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Brenan House Address 21 Vale House, Ramsgate, Kent. CT11 9DE 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) 01843 582837 Mr David Barrie Spicer Registered Care Home 16 Category(ies) of Older Persons registration, with number of places Brenan House H56-H05 S44013 Brenan House V243466 190905 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 09.02.05 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. Brenan House H56-H05 S44013 Brenan House V243466 190905 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the home’s announced inspection. The inspection was conducted by one inspector and the duration of the inspection was 10 hours over two days. The Home representative was the registered provider. Additional time was spent in planning the inspection and report writing. The inspectors spent time talking to 4 service users and 3 staff to gain their views. Twelve service users and four relatives completed inspection comment cards. A full tour of the premises was conducted, documents, medication and records were examined and service users files were case tracked. What the service does well: What has improved since the last inspection? What they could do better: Care plans need to be produced to detail all aspects of the service users needs and be regularly reviewed. The staff must use the knowledge gained through training to improve their practices, especially for the administration of medication. All medicines need to be handled and recorded accurately. The registered provider needs to be more objective when handling complaints and to try and not take it personally. The procedures for the recruitment of staff Brenan House H56-H05 S44013 Brenan House V243466 190905 stage 4.doc Version 1.40 Page 6 need to be improved to ensure that all of the checks are conducted prior to the start of employment. 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 H56-H05 S44013 Brenan House V243466 190905 stage 4.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 Brenan House H56-H05 S44013 Brenan House V243466 190905 stage 4.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) 1,2,3,4,5 The statement of purpose does not provide up to date information to enable prospective service users to make an informed decision. The contract 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. EVIDENCE: The statement of purpose has not been amended since the last inspection. The Commission has been provided with current copies of both the Statement of Purpose and Service User Guide. Both of these documents were well presented and easy to read. The Inspector notes that the registered person has not included all of the required information listed in the Regulation 4,5 & schedule 1, but has referred to the policies held within the Home. The policy or a synopsis of it must be included in both of these documents. The terms and conditions between the registered provider and service user does not include details of the services provided for the fee. Pre–admission assessments are conducted and details recorded. However, the pre-inspection Brenan House H56-H05 S44013 Brenan House V243466 190905 stage 4.doc Version 1.40 Page 9 questionnaire confirmed that a number of service user have dementia and the home is not registered to for this category. Brenan House H56-H05 S44013 Brenan House V243466 190905 stage 4.doc Version 1.40 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 standard(s) 7,8,9,10 The care planning system does not adequately provide staff with the information they need to satisfactorily meet service users needs. Medicines are not being handled or managed effectively and that this could potentially place service users at risk. EVIDENCE: Two service users file were assessed. This found that files were difficult to follow and caused confusion were information needed to be recorded. Care plans did not identify all aspect of care needed, such as specific needs relating to communication, dementia and difficulties with eating. Every document was labelled “care plan” including the pre-admission assessment, this caused some confusion and there was also a degree of repetition in the records. However, there has been an improvement in the care plans since the last inspection. None of the service users files had skin integrity and nutritional assessments. An audit of medication was conducted this found multiple errors, with gaps in the records of administration, evidence of sharing of medicines between service users, medicines left out on a desk and concerns that some medicine is not being administered. However, records of receipt and returns are now kept which assists in the auditing process. A service users disabilities relating to communicating was not always managed in a dignified by one member of staff. Brenan House H56-H05 S44013 Brenan House V243466 190905 stage 4.doc Version 1.40 Page 11 Overall staff were observed interacting with service users respectfully. Three of the five relatives comment cards completed added comments stating they were very happy with the care provided and one said the staff are extremely kind and caring. Brenan House H56-H05 S44013 Brenan House V243466 190905 stage 4.doc Version 1.40 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 standard(s) 12,13,14,15 The programme of activities satisfies the wishes 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. One service user is supported to enjoy their interest in gardening and although 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. The meals provided include hot choices. The cook bakes on a daily basis. Brenan House H56-H05 S44013 Brenan House V243466 190905 stage 4.doc Version 1.40 Page 13 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 There is a failure to formally acknowledge verbal complaints and to handle complaints objectively. EVIDENCE: The registered providers investigated a recent complaint, although it was investigated in detail the registered providers found it difficult to remove their personal emotions from the investigation and this was reflected in their findings of their investigation. This was the first formal complaint the home has received and they have learnt from the experience. Verbal complaints are dealt with directly but are not recorded or acknowledged formally. Brenan House H56-H05 S44013 Brenan House V243466 190905 stage 4.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) 19,20,21,22,23,24,25,26 The building is well maintained providing a homely environment for service users. EVIDENCE: A full tour of the premises was conducted, the registered provider continues to strive to improve the standard of accommodation provided. One bathroom has been refurbished and has been fitted with a low level assisted bath. The registered provider stated that since this has been fitted, there has been an increase in requests for baths. The unused shower room has been refurbished to included an assisted shower suite and a hairdressing area. The hairdressing facilities is 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. Infection control procedures are adhered to. The home was clean and free from offensive odours. Brenan House H56-H05 S44013 Brenan House V243466 190905 stage 4.doc Version 1.40 Page 15 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 Care staff are provided in sufficient numbers to meet the needs of the service users, but this is currently compromised by the care staff covering the ancillary duties. Recruitment procedures are not thorough and do not ensure the safety and welfare of the service users. Staff are attending training courses but they are not implementing the knowledge gained through training. EVIDENCE: The Home currently employs 13 care staff on days, with an average of three on duty at a time, plus the registered provider. There is one awake carer and one sleep-in carer on duty at night. The Home has a cook and the registered provider covers her days off. There was ancillary staff for cleaning and general maintenance. However the cleaner has recently left and the care staff are currently covering these domestic duties. Five care staff have completed the NVQ level 2 in care with a further 6 staff enrolled on the course. Other training includes food hygiene and safe handling of medicines. Evidence detailed in this report demonstrates that staff are not imparting their acquired knowledge and skills into their working practices, especially medication practices. Staff files provided evidence that staff are employed without CRB and POVA checks being conducted. Not all staff had two references and one member of staff was reemployed following a break in service without any formal checks being conducted and now works independently taking charge of the home. Brenan House H56-H05 S44013 Brenan House V243466 190905 stage 4.doc Version 1.40 Page 16 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) 31,32,33,36,37,38 The registered provider has the knowledge and skills to manage the home. The registered provider has a vision for the home but needs to develop their management style. There is no quality monitoring systems. EVIDENCE: The registered provider has recently completed the registered managers award. 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 or for an annual quality monitoring system. The registered provider does not monitor staff procedures and practices such as medication practices. Brenan House H56-H05 S44013 Brenan House V243466 190905 stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x 3 2 1 x x 1 2 2 Brenan House H56-H05 S44013 Brenan House V243466 190905 stage 4.doc Version 1.40 Page 18 yes 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 OP2 Regulation 5 Requirement Timescale for action 31.12.05 2. OP7 3. OP8 4. OP9 5. OP9, 33 The Registered Person is required to amend the Service User contract to ensure it clearly states details of the service provided. previous timescale 30.06.05 12, 13, 15 The Home is required to produce and implement accurate and detailed care plans with risk assessments that identifies all the individual Service Users needs. Care Plans and assessments must be accurately reviewed monthly or earlier if needed to ensure all changes in needs are recorded and actioned and met. previous timescale 30.06.05 12, 13, All service users must have 14, 15, health assessments that include 16, 17 skin integrity and nutritional schedule assessments, these must be 3 reviewed monthly. 12,13,14, All medication must handled 16,17,23 and administered adhereing to schedule safe procedures / practices. Medication must be given at the 3 correct times, as prescibed. 10,12,13, The reistered person is required 14,15,16, to conduct regular medication 17,23,24, audits as part of the quality H56-H05 S44013 Brenan House V243466 190905 stage 4.doc 31.01.06 31.12.05 01.11.05 31.12.05 Brenan House Version 1.40 Page 19 6. OP16 schedule 3 17,22 schedule 4 assurance process. 31.12.05 7. OP29 8. OP30 9. OP33 10. 11. OP38 OP04 12. OP1 The registered persons must record and acknowledge all concerns/complaints made including verbal complaints. Responses to complaints should be appropriate and objective. 18, 19, A thorough recruitment schedule procedure must be used and new 2 staff must not start work until all checks (POVA first & CRB) have been completed. 12, 13, 18 The Registered person must develop and implement an induction programme for new staff that complies with TOPSS 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 10, 12, The Registered Person is 15, 24 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 12, 13, Visual inspections of fire fighting 16, 23 equipment must be conducted at the specified time intervals. 12,14,18 An application for a variation must be made for those service users outside the registration of the home. 4,5 To revise both the Statement of schedule Purpose and Service Users Guide 1 to include all of the required information detailed in the Regulations. previous timescale: 30.06.05 01.11.05 31.01.06 31.01.06 31.12.05 01.11.05 31.12.05 Brenan House H56-H05 S44013 Brenan House V243466 190905 stage 4.doc Version 1.40 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations To review care plans/service users files to make them more user friendly. Brenan House H56-H05 S44013 Brenan House V243466 190905 stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent. TN23 1HU 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 H56-H05 S44013 Brenan House V243466 190905 stage 4.doc Version 1.40 Page 22 - 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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